Hypomagnesiumia, I am a ticking time bomb!!

Home Health Columnist / Guide · Feb 16, 2005

did some google sleauthing to back up my overloaded memory re magnesium:

green lettuce negligible source:

dietary sources magnesium

http://ods.od.nih.gov/factsheets/magnesium.asp

the analyst - internet health report: treatment: magnesium

http://www.digitalnaturopath.com/treat/t29193.html

has an endocrinologist seen you since also diabetic?

high levels of aldosterone, antidiuretic hormone, or thyroid hormones can cause hypomagnesemia by increasing the excretion of magnesium by the kidneys

http://www.merck.com/mmhe/sec12/ch155/ch155g.html

[color=#333333]it is a good idea to take a b vitamin complex, or a multivitamin containing b vitamins, because the level of vitamin b6 in the body determines how much magnesium will be absorbed into the cells.

http://www.umm.edu/altmed/conssupplements/magnesiumcs.html

other sites w/ helpful info:

http://www.ctds.info/5_13_magnesium.html

http://www.mgwater.com/inmgdef.shtml

Home Health Columnist / Guide · Feb 16, 2005

Gave pregnant women home IV therapy with Magnesium so don't see why your case couldn't be run past a home infusion company unless insurance flat out refusing to pay. We teach 80yo wives to administer TPN to spouses so sure could teach a nursing student to administer once port accessed.

Access port on Monday RN teaches and observes patient setup and administration, return demonstration...see again thurday with patient handling treatment with RN observation. Have even had patients deacess port after on service for a while.

Magnesium is cheap med so probably no profit margin, but would think cheaper for home infusion vs inpatient unit.

Never hurts to do some sleuthing with local infusion companies...

curleysue · Feb 19, 2005

Gave pregnant women home IV therapy with Magnesium so don't see why your case couldn't be run past a home infusion company unless insurance flat out refusing to pay. We teach 80yo wives to administer TPN to spouses so sure could teach a nursing student to administer once port accessed.
Access port on Monday RN teaches and observes patient setup and administration, return demonstration...see again thurday with patient handling treatment with RN observation. Have even had patients deacess port after on service for a while.
Magnesium is cheap med so probably no profit margin, but would think cheaper for home infusion vs inpatient unit.
Never hurts to do some sleuthing with local infusion companies...

I know what your saying. Believe me I have searched, and asked. My insurance companies is saying "ABsolutely NOT!" for the home infusions. So I am stuck. This week my PCP wrote the order for infusions for once a week and I have tried that but I cannot do it. As I write this its Saturday and my infusion isn't until Monday. I am in so much pain, my muscles are cramping, twitching and everything. I don't know whether or not to go to the ER, I hate all the doctors there. My mom is the admitting manager and says she doesn't think the insurance company would cover the visit to the ER for an infusion. And she thinks for sure the doctors would say you need to go through your PCP. But its a weekend, what am I supposed to do? I am bedridden right now, my parents are taking care of me. I am in a wheelchair when things get this bad.

And its so easy to reverse this. Instantly after my infusion its like day and night. Every symptoms is gone, GONE! For about 3 days I feel awsome!!

I am so so frustrated with my nephrologist cause he says he doesn't know what to do. He knows its my kidneys doing this. Well if its my kidneys and your a kidney doctor why can't you FIX IT?!!! Its so FRUSTRATING. I cannot stop crying cause I hurt so bad. And I feel like nobody cares except my parents. My PCP is so bombarded with patients. He has so many patients that its so hard to get in and see him. In fact I called the office thursday and the nurse said he wouldn't change the order to twice a week unless I see him. Well I cannot see him until MARCH 14!! They don't understand. I cannot do this anymore. I am so depressed.

Well, anyways sorry I am just venting. I need to go to the MAYO clinic so bad but I have no money to do that. I just don't know what to do. I am trying everything possible to get my mag levels up. All I eat is mag rich foods and I am trying to take the supplements but I have diarrhea and vomiting with them.

Oh well. Again I am sorry I am venting. thanks for listening. Curleysue

NurseFirst · Feb 19, 2005

Sorry you are having such a tough time!

From what I've heard about applying to disability is:

1) SS automatically denies the person the first time around (unless, I guess, they are in hospice or something like that)

2) You need a disabiliity lawyer to help you get your claim approved. It's terrible, I know, but that seems to be the way it is. The good thing is that you will likely get your claim backdated and so receive money from previous months--usually in a nice lump sum.

Good luck,

NurseFirst

I know what your saying. Believe me I have searched, and asked. My insurance companies is saying "ABsolutely NOT!" for the home infusions. So I am stuck. This week my PCP wrote the order for infusions for once a week and I have tried that but I cannot do it. As I write this its Saturday and my infusion isn't until Monday. I am in so much pain, my muscles are cramping, twitching and everything. I don't know whether or not to go to the ER, I hate all the doctors there. My mom is the admitting manager and says she doesn't think the insurance company would cover the visit to the ER for an infusion. And she thinks for sure the doctors would say you need to go through your PCP. But its a weekend, what am I supposed to do? I am bedridden right now, my parents are taking care of me. I am in a wheelchair when things get this bad.
And its so easy to reverse this. Instantly after my infusion its like day and night. Every symptoms is gone, GONE! For about 3 days I feel awsome!!
I am so so frustrated with my nephrologist cause he says he doesn't know what to do. He knows its my kidneys doing this. Well if its my kidneys and your a kidney doctor why can't you FIX IT?!!! Its so FRUSTRATING. I cannot stop crying cause I hurt so bad. And I feel like nobody cares except my parents. My PCP is so bombarded with patients. He has so many patients that its so hard to get in and see him. In fact I called the office thursday and the nurse said he wouldn't change the order to twice a week unless I see him. Well I cannot see him until MARCH 14!! They don't understand. I cannot do this anymore. I am so depressed.
Well, anyways sorry I am just venting. I need to go to the MAYO clinic so bad but I have no money to do that. I just don't know what to do. I am trying everything possible to get my mag levels up. All I eat is mag rich foods and I am trying to take the supplements but I have diarrhea and vomiting with them.
Oh well. Again I am sorry I am venting. thanks for listening. Curleysue

weetziebat · Feb 19, 2005

sorry you are having such a tough time!
from what i've heard about applying to disability is:
1) ss automatically denies the person the first time around (unless, i guess, they are in hospice or something like that)
2) you need a disabiliity lawyer to help you get your claim approved. it's terrible, i know, but that seems to be the way it is. the good thing is that you will likely get your claim backdated and so receive money from previous months--usually in a nice lump sum.
good luck,
nursefirst

curleysue, feel so bad for you. in this country with the very best of medical care for you to still be suffering so seems ludicrous. i think nursefirst gave you some excellent advice. so did everyone else, but maybe its time to get yourself a disability lawyer and have someone fighting for you with the medical establishment. good luck! :icon_hug:

NurseFirst · Feb 19, 2005

curleysue, feel so bad for you. in this country with the very best of medical care for you to still be suffering so seems ludicrous. i think nursefirst gave you some excellent advice. so did everyone else, but maybe its time to get yourself a disability lawyer and have someone fighting for you with the medical establishment. good luck! :icon_hug:

that the disability lawyer gets "paid" by getting a cut of that lump sum you receive...probably the usual 30% or so...i've forgotten--but it is worth it. see if you can find a free legal clinic; i don't know much about finding them (if there's a nearby law school you could try contacting them...)--but there are probably folks on the board who know more about it...

nursefirst

webblarsk · Feb 20, 2005

Sorry you are having such a tough time!
From what I've heard about applying to disability is:
1) SS automatically denies the person the first time around (unless, I guess, they are in hospice or something like that)
2) You need a disabiliity lawyer to help you get your claim approved. It's terrible, I know, but that seems to be the way it is. The good thing is that you will likely get your claim backdated and so receive money from previous months--usually in a nice lump sum.
Good luck,
NurseFirst

Excellent advice. I was going to suggest finding a lawyer.

webblarsk · Feb 20, 2005

CurlySue, I am so sorry that you are having such a hard time. Don't give up, keep trying the disability route! I will be thinking and praying for you!

CritterLover, BSN, RN · Feb 20, 2005

curleysue,

i am feeling very frustrated for you. insurance companies can be a major pain in the tail to deal with.

however, i was actually referring to giving the mag to yourself at home, without having a home health nurse, and without involving the insurance company. someone could be taught to access the port for you (and i know you could direct/supervise it, since you know what to do), and then you could give yourself the mag infusion. i don't know for sure, but i think that even if you paid for everyting out of pocket, it would be less than the co-pay you are being stuck with when going to the infusion center. mag is cheap. if you understand drip counts and don't keep getting up and down, you could even forget about the pump. that would leave you with the tubing (reusable for at least 96 hours if you keep it sterile), and the port access (good for a week), and the flushes. since you doctor is willing to write the rx for the home infusion, it is worth looking into. i know we charge insurance companies $18 for the iv tubing. a 100 cc bag of d5 is somewhere around $9. a saline flush is $2, heplock flush $3 (and we are talking pre-filled syringes, here, not the multi-dose vial good for 30 days). that leaves the port access and the cost of the mag. when you go to the infusion center, the bulk of what you are charged for is the nure to administer it and the physician to "supervise" it. call a home infusion company or a home infusion pharmacy and ask them what the cost would be. it may be considerably cheaper than you are thinking. certainly cheaper then $200 a pop.

at the risk of beating a dead horse, are you sure you have spoken with a nurse case manager at your insurance, and not just the claims person that answers the phone? i have frequently been surprised with what a case manager can get approved if you can get to one. at least a good case manager. the insurance company's best interests are served by you staying as healthy as possible, and out of the hospital. running such a low mag level puts you at very high risk for many cardic problems, including vtach, which is not a cheap hospital visit. while i understand why they won't provide you a home health nurse for the infusions, refusing to cover the cost of the above materials for use at home is insane. it is going to save them money in the long run. it is even going to be cheaper for them for you to do this yourself at home rather than the infusion center.

if i remember right, you recently obtained private insurance, right? did you have any choice in what insurance company you use? the job i have right now, we are able to pick between 2 plans with the same provider. but other places i have worked, we were able to pick between providers. not all insurance companies follow the home-bound rule. being homebound is a medicare requirement for home health care. like everything else, many private insurance compaines follow this medicare rule. but they don't have to. i have taken care of some private insurance patients that were not homebound, yet their insurnace company was willing to approve some home health visits. if changing insurnace companies is a possibility, you might want to check into this the next time open-enrollment comes around where you work. i want to say that blue cross is one that will sometimes approve home visits for a non-homebound paitent, but my memory could be faulty.

as far a disablity goes, unfortunatly i don't think a lawyer is going to be able to help you at this point. it is very difficult to qualify for disability, and if you are able to go to nursing school i can't see how you will ever qualify. (though i really can't see how you are able to go to school, as sick as you are).

is your doctor part of a large teaching practice? do you live anywhere near a major university-affiliated medical school? you've mentioned the mayo clinic. would your md be willing to referr you there? as nrskarenrn pointed out, you really need to find out the eitiology of this whole problem.

webblarsk · Feb 20, 2005

curleysue,
as far a disablity goes, unfortunatly i don't think a lawyer is going to be able to help you at this point. it is very difficult to qualify for disability, and if you are able to go to nursing school i can't see how you will ever qualify. (though i really can't see how you are able to go to school, as sick as you are).

i have to disagree.........i personally know a girl that is certainly not in the shape you are in and got approved for disability on her first attempt with a lawyer.

curleysue · Feb 21, 2005

Wow you guys are great. Thanks for all the good information.

About last night... I did end up going into the ER. I was in so much pain from my muscles cramping and spasming. Plus my heart was in the 150's (mostly sinus tach but occational SVT). The ER was full, we only have a 10 bed ER but because of my heart history and because my pulse was high I was seen immediately.

The ER doctor was actually really cool. He had my port accessed and my mag was low, but not the lowest its ever been it was 1.6. Heart doc wants it above 2.0 and I usually run 1.5-1.8 never had it any higher. Anyways I got my usual 4g IV mag sulphate. At first the nurse ran it way too fast and I got extreme hot flashes. I can only handle about 1g/hour. Plus they always pre-medicate me with benadryl and phenergan which helps so so much. And this nice ER doc also added a little diluadid which helped so much for the muscle pain. I was in heaven got my mag on board and my pain cured in a matter of seconds.

But this ER visit doesn't come without a huge cost. About $500 out of my pocket. I needed it really bad, I just hope my PCP doc can accompidate me the next time and just order it outpatient therapy. He is such a busy doc in our small town and he said he cannot change my IV order to twice a week unless he sees me in his office. Well unfortunetely I cannot see him until March 14! I cannot beleive he cannot just change the order without seeing me. What am I supposed to do? AHHH its such a mess.

About the disability stuff. I am about fed up with SSI. I have applied twice and got denied. THey said I am able to hold a job so I felt hopeless. Plus its such a long long process. Getting all my 12 specialist to write in a letter plus having to wait at least 6 months for SSI to reply back only after recieving all the records they need. And I have tons of records! I have no doubt that with an attorney I would be able to get it but in a way I want to be able to work also. Maybe not full time but the work I do now as a caregiver isn't that hard. But it doesn't pay the bills thats why I am still with my parents.

At 25 I am still at home, its so depressing. I wish I could find me a boyfriend or husband but living in such a small town its so hard to find someone. Specially someone who can put up with all my medical problems. That is why my last 2 year relationship didn't work. We tried the long distance thing for a while but during that time is when I was having severe SVT before my ablation. I had about 12 hospitalizations including 3 ICU admissions all for my heart. So there where so many times I would call him and say, "Guess where I am?" That just got too much for him. I need a man who will be there for me. Is that so much to ask?

Anyways, I would love to do everything at home with the infusions and stuff. And I am more than capable of accessing my own port and flushing it. But I still think it would be really hard to get my PCP to help me order everything. He is kinda a new PCP for me and doesn't know everything about me, well I hope he knows enough, but I have only been to see him about 3 times since NOV. He is so hard to get into! I would love a new PCP but our small town, no docs are accepting new patient. AHHH! I wish I could move.

Critter lover: Thanks for your long post. Shows you really care. Anyone who reads this cares for me and I appreciate that so much. Sometimes I feel so alone. But anyways, yes I do have private insurance and the only option they gave me is ODS or Keiser. But we don't have Keiser in our area or within 250 miles so that would be too hard. THis insurance is through the state so I don't have that many choices. I tell everyone its a "BETTER THAN NOTHING PLAN".

I will look into speaking with a nurse case manager with my insurance and see what kinda of info I can get from her concerning home infusions. That is a good idea. Also our nearest university hospital is 250 miles away and I have a couple specialist there, its not the best hospital. The MAYO clinic is where I really need to go. I don't know how much longer I should be doing these infusions. Its been a little over a year now and nobody can give me a real solution. I need to really look into going there, plus save a bunch of money.

I have really tried to look up low magnesium or hypomagnesiumia on the internet and haven't found hardly any good sites. There is one site that has information on like a lot of hypomagnesiumia disorders including Barrters disorder which the kidney doc says I might have but I don't fit the description exactely. Whatever.

I am going through such a rough time with this stupid magnesium. My diet consists of mag rich food, I try to take mag supplements but when I do that I have constant watery diarrhea and vomiting with bad bad nausea. Its like I am addicted to magnesium sulphate infusions! Is that possible?

Really guys, I mean it, thanks so much for listening and every reply means so much to me. Take care. Curleysue :rolleyes:

moonbunnie · Feb 21, 2005

i would also recommend appealing the insurance denials. i used to work for blue cross, and i saw that sometimes if you write in appeal a decision, and have a dr also write your letter of medical necessity, they will overturn their decision. You can also call and talk to customer service, but a written appeal is the first step. You do have to be persistent and possibly jump through some hoops, but often times they will approve it. It seems like you really have no other option than the twice a week infusions, as you have tried many other options already, and this is something the insurance company would take into consideration. i also know that you, the patient, have to be the one to file the appeal, your dr cannot do it for you, although he can submit supporting documentation. that is what i would suggest you do, although that wont cure you, at least it would help your financial situation if insurance would cover your treatment.