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Living with Myeloma

Why Flying Will Give You Covid, Probably

I wasn’t going to write this article, but my brain won’t stop writing it in my head whenever I stop moving for a second. So. I’m going to write it, so my brain can do something cooler.

Why The Airport Can Give You Covid

Alright, let’s start with the basics. There are a lot of airports out there. And, some of those airports do a better job with trying to reduce the spread of Covid than others. The smaller and less used an airport is, the better. That being said, they all have very similar problems that make it likely you are going to get Covid if someone there has Covid.

All of the following is doubly true if you fly during a higher demand time like holidays, weekends, and Monday mornings and Friday afternoon/evenings.

More People = More Covid

Math is never wrong. More is more.

You don’t have to be an expert in epidemiology, or understand statistics, to know that the more people there are, the more likely at least one of them has Covid.

Here in Colorado our restaurants are operating at 50% capacity with six-feet between parties. That is actually pretty safe, especially if people are wearing masks when they are up walking around. Six feet turns into zero feet if someone has to walk by your table on the way to the bathroom.

But, it isn’t just the six feet that makes restaurants safer during Covid. Lower capacity means less people. Our local Mexican food joint holds maybe 30 people at 50% capacity. If there is only 30 people, then the odds that one of them has Covid is pretty low, especially when compared to something like 300 people.

If there is no one with Covid, you can’t get Covid, no matter how close people stand to you.

Airports Have Lots of People

Airports have way more than 30 people in them. Sure there is more space, but the odds are still much greater that someone in there has Covid. The only way you can get Covid is if someone has Covid, and it is almost a mathematical certainty that in any airport, there is at least one person somewhere with Covid. – Do you feel lucky? Well do ya?

Does your local airport have just 30 people?

Nope. There are more. Lots more. Even at the smallest airports there are more than 30 people before you even count the passengers.

And that six feet thing?

Airports Are More Crowded

It’s cute that they blocked off some of the seats. Although one airport seat isn’t really six feet across in most cases. It takes three or four airport seats for me to lay across. I’m a couple inches over six feet tall. You do the math.

But it doesn’t matter.

Because, when you go through security you’re going to get close. Really close.

Even if people somehow remember to stay six feet away from you in the security line (they don’t), they won’t think twice about getting right up next to you as you load your carryon bags onto the scanning conveyor belt. And, they’ll stand right behind you as you wait your turn to go into the X-ray, lest someone cut the line.

Oh, and remember one of the X-ray machines is a semi-enclosed tube, that you will walk into seconds after someone else stood in there exhaling. (Probably exhaling more than usual, because people get stressed going through airport security. Oh, and you are probably breathing harder than usual for the same reason, which means inhaling more than usual. You get the point.)

Remember these?

It gets worse. Spacing on escalators and people movers? Nope. People have to wait to get onto those things. When people have to wait, they take their turn as soon as possible. And when they take their turn, they get on right behind others, lest someone else cut them off. Even if you space, the guy behind you won’t.

How about lines for the restaurants? Coming out of the relatively quiet San Diego airport, the line for Einstein Bagels was chest-to-back and 20 people deep. Don’t even look at the small area customers have to stand in to wait for their food. To get everyone six feet apart, you would be too far away to hear your name called when your food was ready.

Boarding Lines Are Never Six Feet Spacing

And when people line up to finally get on the plane, they’ve been waiting for a long time. Expect that line to be front to back, with people trying to cut in as well.

Ever see the lines used to board for a Southwest plane?

six feet spacing boarding line covid
All five of you stay six feet apart, in 10 feet of space…

They have these pillars where you line up by number. Numbers 11-15 between two poles that are maybe 10 feet apart. That’s 5 people in 10 feet, or two-feet of space per person.

Oh, but it’s worse than that. There are also five people lining up on the other side of those poles as well. That’s another five people in less than 10 feet of space, going sideways. That’s 20 people in a 10×10 area. Good luck getting six-feet each.

It’s not just Southwest. The other airlines don’t officially mark it, but their boarding lines are just as close together once they call everyone seated in Group 2, or whatever. Often it’s worse because it is first come first serve, and you have to stay close together so no one cuts in.

Then, there is the jetway. Spacing? Nope. That would require another employee to stand in the jetway ensuring passenger spacing, and that costs too much money, and takes too many people.

DIA Is Covid Spreading Dream

Some airports are even worse than others.

Does your airport have a train?

A closed-in train?

A train with standard, not-that-great, ventilation? (Know how you can tell? If you can smell someone’s body odor, you can inhale their breath too.)

At Denver’s airport, DIA, you MUST get on that train to get to the concourse. There is no way to walk and avoid the train.

There is a comical sign in the train waiting lobby (which is often filled with people) that says to space out by moving to the middle of the platform, which works great during very limited “off-hours”. Otherwise, there are likely enough people to fill the beginning, middle, and end of the hall by the time a train arrives.

And, that train you are waiting for is going to have a bunch of other people on it with you, because there is no reasonable way to wait for an empty train.

Sure, you could try and wait, and then, after all of the passengers in the waiting area with you get on the train you will be by yourself — for a moment or two. But, over the next three to five minutes that it takes for the next train to arrive, more passengers will arrive too.

You could wait there for hours and never have a chance to get on a train car with less than 10 or 20 people in it, unless you’re lucky enough to be flying very late at night, or maybe very early in the morning (but there are a lot of flights that go out starting at 6 am). Plus, it is the same train for all three concourses. So even if you get on an empty train out on Concourse C, it’s likely a dozen or more people will pour in at Concourse B (and then Concourse A…)

Masks? Oh sure. If they aren’t eating, drinking, talking on the phone… or just don’t feel like it because they’re tired (or jerks).

Your only saving grace is that the train ride only takes five minutes or less.

The Airplane Will Give You Covid Too

Airplanes love to cite that one study that says you should be safe from Covid on an airplane based on a model that assumes EVERYONE WEARS A MASK THROUGHOUT THE FLIGHT.

But, do you know what happens on every flight?

On all flights but the very shortest ones, at some point during the flight, the flight attendants will come down the aisle and ask if you want a drink and hand you a bag of in-flight snacks. And do you know what happens next?

THE ENTIRE AIRPLANE TAKES OFF ALL THEIR MASKS AT THE SAME TIME AND LEAVES THEM OFF FOR SEVERAL MINUTES SO THEY CAN DRINK AND EAT THEIR SNACK.

Remember, it is ok to remove your mask while you are eating or drinking. Some people nurse that Coke for 20 minutes, not wearing the mask the whole time. That would be fine if it was only that person, but it is almost everyone at the same time, including the guy in the middle seat right next to you. You better snarf down that snack and get your mask back up and hope for the best. Better yet, sit there with your mask on for 20 minutes until most of the planE has put their masks back on.

Southwest doesn’t keep middle seats free anymore like they used to. United, Delta, and the others never did. They just said screw it, we need the money, and they put someone in a seat less than one foot away from you.

Prove It

I’ve been in four airports since the whole Covid thing started. These are my observations, and my opinions. I’m not a scientist, or a doctor. However, all you have to do is look around your airports and you’ll see the same things I saw. Don’t have a ticket? Just go into the airport and start looking around. Head for security. You don’t have to go through it to verify quite a bit of what I said.

Restaraunts?

Escalators?

People Movers?

Security Line?

Baggage Claim?

Security While Preparing to scan carry on luggage?

How Do I Know?

How do I know all of this? Well… *deep inhale, blurt it all out in one breath*

Last year, Colorado’s Governor shut down the state. It worked. Covid numbers (we were still calling it coronavirus then) dropped like a rock. Hospital ICUs had plenty of space, the graph looked great. I heard stories from friends of mostly empty airports and planes that were less than a third full. I had been locked down longer than most people because I started my lockdown in January because of my stem cell transplant. I was dying to get out. To do SOMETHING. To go SOMEWHERE. Especially before I had to start maintenance mode chemo. I figured this might be my last chance to do something while still mostly healthy. So, I booked a trip to the Outer Banks. Then, just before we left, the numbers started getting worse. The day we got back, they started saying, “third wave.” When I got to the airport I got a pit in my stomach. The airport wasn’t mostly empty after all, and United sent me a text saying that my flight was going to be full too, but you can change it if you want. To when? All the other flights were also fairly full.

covid-airline-text

“Fairly full,” by the way meant all but a few middle seats were full.

I put my head down and hoped for the best.

It worked.

Until we flew home.

Shortly thereafter we tested positive for Covid. We almost certainly got it when we flew home based on incubation period. We were by ourselves (beach house, empty beaches) before, during, and after, when we relocked down. That day we flew home was the only time we were out of our bubble that corresponded to symptoms. I can’t prove that is how we got it, but anyone can go to an airport and prove that the safety of spacing is nonexistent. If you can on a plane you can verify the rest of what I said is true as well.

The rest of the family, ironically, tested positive for Covid antibodies a few weeks later even though none of us got very sick. So, when we flew again this Spring, we did so with an ace behind each of our facemasks, antibodies. This time, I saw all the same Covid issues, but it was even more crowded. The trains were fuller, the sit-down restaurants were spaced, but all the carry away places had un-spaced lines, and those passengers took their food to the gate area where they took off their masks and ate it.

Vaccines for the Win

So what?

So nothing.

Do what you want, just know what the reality is.

The truth is that it’s over. The vaccines are here and millions already have them. Every vaccinated person is a person who “doesn’t count” when it comes to spacing or wearing a mask. That doesn’t mean you shouldn’t wear one, just that if you take it down to drink your Diet Coke, no one will get Covid from you.

But, in another way, that makes the risk so much worse. How much would it suck to get Covid now that you are less than a few weeks away from a vaccine? How much worse is it for someone to die of Covid now when the numbers will be plummeting by summer?

Unless you’re vaccinated, or have antibodies, I’d stay away from air travel for another month or two. After that, you don’t have to worry about being one of those bummer stories about catching Covid right at the end.

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Living with Myeloma

Covid Vaccine Multiple Myeloma

If you’ve been reading the news, you know that the Covid vaccine rollout has had its share of problems. You also probably have seen that virtually all states have come up with a tier system that tries to get the Covid vaccine to the most vulnerable people the fastest.

Cancer patients count as vulnerable in most of those systems.

I tried to get a Covid vaccine stock photo, but didn’t want to spend all day on it, so I took this one from the Pfizer oncology press kit. – I figure we count for that, eh?

What Tier is Multiple Myeloma for Covid Vaccine?

While the tiers are not the same across all of the states, most states have set Tier 1 as health care professionals that work directly with Covid patients, as well as various first responders that potentially come into contact with Covid victims. Obviously, this tier would not include multiple myeloma patients.

However, the second tier, or Tier 2, in most Covid vaccine rollouts include patients who are immunocompromised. Multiple myeloma patients should fall into this tier. Myeloma is a disease of an important component of the immune system, after all. That being said, there can be a lot of interpretation between who is immunocompromised, and who is more immunocompromised than those suffering from other aliments or diseases.

Vaccine Availability

It is also important to understand that the availability of the vaccine plays a role in when I will receive the Covid vaccine as a multiple myeloma patient.

In my individual case, my oncologist has informed me that I will get a message directly from the hospital system that I got my SCT from. The bone marrow transplant unit there has a database of immunocompromised patients. As one of the largest hospital systems in the state, much of the vaccine supply comes in through their doors, especially the Pfizer vaccine due to its difficult refrigeration requirements. And, finally, as one of the largest facilities in that hospital system… well, you get the idea.

My oncologist thinks that I will likely get vaccinated in February, but to keep an eye on my health care portal messages starting now.

The trick to a quick vaccine rollout is that you have to keep moving forward instead of getting caught in bottlenecks like finding and contacting immune compromised patients. As a result, while the state is figuring out how to find and contact multiple myeloma patients in more rural areas, my BMT group will be reaching out and vaccinating us. I suppose this is another reason that all things being equal, you want to be near the research if you have cancer — a university-affiliate hospital is probably the best unless you live near one of the major cancer centers like Anderson, or Mayo.

Multiple Myeloma and Covid Vaccine

All three of the Covid vaccines approved for emergency use by the FDA are non-live vaccines. That is, the material in the vaccine is not weakened virus like the MMR vaccine is, so it cannot give you coronavirus, no matter how weak your immune system is. (If your immune system is too weak, however, it won’t mount a response which means the vaccine will be wasted. They might not give it to you right after ASCT, or even some chemo if your immune system is knocked too far down.) If the Covid was a live vaccine, they probably would not give it to myeloma patients at all, or at least not until they had studied it in the strongest of us.

These mRNA vaccines are actually a great advancement, and might prove useful for other future vaccines as well, which would be great for us myeloma patients.

Vaccine Covid Antibodies and Multiple Myeloma

One of the most interesting facets of getting the Covid vaccine with multiple myeloma for me is that I have already tested positive for antibodies to coronavirus despite never having actually developed any Covid symptoms. (Lucky, right?)

The oncology team still wants me, and all of the multiple myeloma patients who had Covid, vaccinated anyway. And, for bonus fun, they’ll be monitoring our blood draws to see if, how, and when people with multiple myeloma mount a response to the Covid vaccine.

So, while cancer patients like us won’t be skipping the Covid vaccine line, we won’t be at the end either, which is a nice change from last year, when we were put at the bottom of people to treat if there was ever a need to triage Covid care.

Covid Vaccine Reactions Multiple Myeloma

If you get the Covid vaccine and you have multiple myeloma, let us know how it goes. So far, the people I know that did get it report fevers, sweats, and pains, ironically, kind of like getting the flu. But, it only lasts for one or two days. The fevers are so common, that my doc even said if I got a fever after taking the Covid vaccine to just take Tylenol and get some rest, not call in like I’m usually supposed to if my temperature ever goes over 100.4 degrees.

Welcome to the post-Covid age, my myeloma friends.

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Living with Myeloma

Pregabalin for Neuropathy

When I got blasted with melphalan last year as part of my autologous stem cell transplant (SCT), it chewed up the nerves in my feet leaving me with some pretty substantial neuropathy.

What Is Neuropathy?

You can find the official medical definition of peripheral neuropathy here. For, those of us with multiple myeloma, neuropathy is a pain and numbness, usually in the fingers and feet. It is caused by the chemotherapy drugs.

Velcade side-effects caused neuropathy in my fingers until my hands hurt so bad I told them to take me off it, and figure something else out. (This is why I switched doctors. You shouldn’t have to beg for your own quality of life.) It left me my feet mostly alone.

My fingers are largely better now. There is no pain, but there is a numbness or missing nerve sensation that makes things like separating two book pages, or counting out cards, or money difficult. I have to really focus, and rely on my sight as well.

pregabalin neuropathy pain

Neuropathy in Feet with Myeloma

These days, nearly a year after my SCT, my real difficulty is the neuropathy in my feet. I started, like so many patients with gabapentin. It seemed to work for a while, but the dose went up and up, until it wasn’t really working.

My current doc considers quality of life actually suggested medical marijuana and/or CBD. I need to look into that. In the meantime, I wanted the ease of a prescription.

He set me up with pregabalin. I haven’t had any pregabalin side-effects, which is very nice.

Pregabalin for Neuropathy Pain

Here we go with the sucky US healthcare system again. It’s a shame that Republicans can’t fight over how to make healthcare better, instead of just tearing down anything Democrats made. You don’t like Obamacare? Fine. Make something else, but quit pretending the nonsensical system we have in place doesn’t need any fixing.

You see pregabalin costs a lot of money of money because there is no generic version yet. It is sold under the brand name of Lyrica.

Fortunately, for me, I have pretty great insurance. It will cover Lyrica with some sort of deductible, and some sort of co-pay. As a cancer patient, those numbers are meaningless to me. I blew past my out-of-pocket-maximum in just days. All that matters to me are coverage limits.

In this case, my insurance will only cover 300 mg per day. I really need 400 mg per day to make my feet manageable. (Don’t get me wrong. This doesn’t bring my feet anywhere near to normal, but I can ignore the nerve issues… unless I step on something.)

Doctor versus Insurance Company

One of the reasons you want to have a good doctor who really considers patient care the most important thing they do, is because in situations like this, the only hope I have is for my doctor to do some sort of battle of words with my insurance company to get them to cover the 400 mg.

If he loses, I’ll make do with 300 mg and maybe see if I can get a double prescription for nortriptyline, which I have a prescription for, but it’s for bedtime. Supposedly, a side-effect of nortriptyline is that it makes people very drowsy. It doesn’t necessarily have that effect on me, so rolling out of bed with that, and then, doing the 300 mg pregabalin might just do.

That, plus always wearing shoes…

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Living with Myeloma

Multiple Myeloma and Mental Health

Cancer is a tough beat. That being said, for the most part, I tend to keep my spirits up. Unfortunately, a large part of that relies on the optimistic belief that I’ll “get my life back,” somewhere in the future.

Cancer and Optimism

The truth is that I’ve spend most of the year-plus since my diagnosis weaker, and sicker than I have ever been in the past. The pain from the neuropathy in my feet doesn’t really seem to be going away. And, the cracks in that optimism start to appear.

Even before cancer, I found that it is all too easy to look up. The house that you want that is a little bit bigger, has a library, and pool in the backyard. The job that offers more money, more respect, and paid trips to the coolest conferences. And so on.

While looking ahead to these things is meaningfully motivating, it is also important to acknowledge what you’ve already achieved.

mental health myeloma cancer

The house on the quiet street with a nice-sized bedroom for each kid. The job that allows you to work from home while you have to juggle doctor’s appointments and bouts of sickness. The solid life insurance and paycheck that covers all of your bills and a little bit of fun.

The fact that your back no longer hurts so badly you can barely stand.

The fact that you can throw the ball to your son while he still wants you to.

The fact that you can be clever and interesting to your teenage daughter… at least in short bursts.

A loving spouse that may be one of the best caregivers of all time.

No Going Back

And, so while it is entirely possible that I won’t ever get my old life back, the reality is that the one I have is pretty wonderful in so many ways. I’m glad to be here, and I’m glad to keep soldiering on.

And, if it turns out I get “back” to whatever I had before, I’ll be sure to be grateful instead of automatically looking ahead. After all, there are always mountains that I could have climbed, 5Ks that I could have ran, and exotic places left to visit.

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Living with Myeloma

Outer Banks Beach Trip

I have multiple myeloma. It is a blood cancer that weakens the immune system. So, why am I flying across the country to spend a week on a beach on the Outer Banks of North Carolina? Because time marches on.

Beach Trip with Covid out there.

My kids are getting older. One of them will be leaving the house soon. I DO have cancer, which means that none of my days are promised to me, even more so than they are not promised to you.

Covid sucks, but with proper precautions, the spread appears to be slowing. My oncologist says to get an N95 mask if I can (it looks tricky) and to wear gloves on the airplane (will do).

Hey, check out my Acorns reviews.

Longer Lockdown

Besides, I’ve been on lockdown longer than most anyone. I had my stem cell transplant in January and they told me not to leave the house for three months back then. — Plus I was throwing up all the time so I wasn’t really up for it anyway.

Long story, made short, I’ve been on mostly lockdown since January while most of you didn’t start until March.

Does that make me special?

Nope.

Does that mean that Covid will leave me alone?

Nope.

What it does mean is that I’m willing to risk certain death against taking all the proper precautions. Hopefully, all goes well and my quarantine will, for at least a week, be a sweet day at the beach.

Go here to learn the difference between an IRA rollover and a transfer.

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Living with Myeloma

Alpha-Lipoic Acid and Neuropathy

Alpha-lipoic acid helps with neuropathy according to studies.

Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent side effect in cancer patients. For multiple myeloma, Velcade is a primary cause of neuropathy for patients receiving the traditional triplet cocktail of Revlimid, Velcade, and dexamethasone. Neuropathy from stem cell transplants is also common in multiple myeloma patients. In this case, stemming from the powerful dose of melphalan, or other chemo used to kill off the immune system as part of ASCT.

Peripheral neuropathy manifests in many different ways. For me, the Velcade caused increasing pain in my fingertips, and then hands, before I basically insisted they stop giving it to me. The melphalan, on the other hand, has given me neuropathic pain in my feet since my transplant.

You may wish to talk with your doctor. There are prescriptions for neuropathy that are available from your oncologist.

Alpha-lipoic acid and neuropathy

A 1999 study suggested that alpha lipoic acid (ALA), which is a natural antioxidant, helped patients with diabetic neuropathy.

Diabetic neuropathy is different in some ways that CIPN. But, a different 1998 study suggested that did work for CIPN that was not from patients treated with Taxane. (Melphalan is not Taxane)

On the other hand, this 2020 study review says that there isn’t a lot of evidence for ALA being effective for CIPN. What it does say is that glutamine and omega-3 fatty acids were potentially effective treatments.

So, why am I trying ALA anyway?

Check out my SoFi review.

A lot of people in the multiple myeloma community swear by it, and not all CIPN is equal. Studies show that the neurotoxicity caused by oxaliplatin and cisplatin are not responsive to ALA. But, I never used any of those. Those are both for treating non-myeloma cancers.

Ideally, I would like to see more recent studies with more positive results, but they just aren’t out there. Fortunately, ALA is easy to find and not expensive. If it doesn’t work for me. I will just stop taking it. But, if it does, then maybe I won’t have to try so hard to get the right dose of pregabalin for myself.

I’ll keep you posted.

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Living with Myeloma

Neuropathy Treatments for Myeloma

Multiple Myeloma Neuropathy Treatments

A lot of multiple myeloma patients will experience neuropathy. Peripheral neuropathy (peripheral just means at the extremities like your hands and feet) is caused by chemotherapy for myeloma patients.

Velcade is one of the main neuropathy culprits for myeloma patients. Another is the melphalan used for stem cell transplants in treading multiple myeloma.

If you are in pain, or the numbness has gotten out of hand, do not stay silent. There are neuropathy prescriptions your doctor can give you.

The catch is that not everyone has the same neuropathy, and not everyone responds the same to each medicine. That means that you might have to try a few different neuropathy medicines and doses before you find the right combination for you.

neuropathy prescriptions

Unfortunately, there is no cure for neuropathy, and the treatments can be iffy. That doesn’t mean that there is nothing that can be done.

Gabapentin

Originally, I was prescribed Gabapentin. Keep your doctor up to date on how you are feeling. As it turns out, you can go up to pretty high doses of gabapentin, so long as your body will tolerate it. So, if you are still in pain, tell your doctor. If they don’t offer, specifically ask about increasing your dosage.

Your oncologist’s job is to keep you alive. You are responsible for the quality of that life.

Over time, I seem to have gotten all of the relief I could from gabapentin. It felt like the gabapentin stopped working for me, although I’m sure the reality is that I would have been much worse off without any. Either way, I wanted to get more improvement.

Pregabalin

Pregabalin is the generic name for Lyrica. Unfortunately, Lyrica is still under patent. That means it is expensive. For this reason, your doctor will likely look to this as a treatment last, even though it may work better for many myeloma patients.

Your oncologist will have you step up your dosage over time for two reasons. One, is to ensure that you tolerate the medication. You don’t want pills making you worse. Myeloma already gives you plenty to worry about.

The second reason is to get an idea of what the minimum dose is that works for you. For me, the best dosage seems to be 400 mg per day.

Neuropathy Medication Costs

Gabapentin is generic, so your insurance should cover it. If not, it shouldn’t be too crazy.

Pregabalin is another story. Lyrica is still under patent. That means it is pricey. I have pretty good insurance and most of my medications are actually free because I hit my annual out-of-pocket-maximum already. That does not mean I get to go around the insurance policy limits though.

My insurance plan only covers 300 mg per day of pregabalin. My doc tried to get them to allow me to have 400 mg per day because that is what works form. This is successful more often than you might think, but in this case, apparently that is not what is says on the medication’s “label” and it also is not in some book, or prescribing manual, so they will only pay for 300 mg per day.

Unfortunately, that leaves me short 30, 100mg pills per month. At my usual CVS pharmacy that costs an extra $111. I’m not looking to get into another $1200 per year of medical expenses.

I have a plan to try and get around it. We’ll have to see how it works out.

GoodRx Myeloma and Cancer

I have seen ads for GoodRx and my research makes it seem as though GoodRx is legit. According to the website, I could get the extra pregabalin I need at another pharmacy with a GoodRx coupon for a very reasonable cost. So, theoretically, all I need a prescription with no insurance information and the GoodRx app coupon, and I could get it for like $20.

I am having my doc’s office crank out the extra prescription and I will keep you posted about how it works out.