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Comment by throwawaycloud | Hacker News Reader

Throwaway for privacy.

I've been concealing cancer symptoms for years, mostly because I can't afford to get a colonoscopy. Even the cheapest clinics run well over $1k, which is totally out of reach.

The secondary reason is an unhealthy fear of needles and a desire to live without a colostomy bag.

I know I need to see a psychiatrist or a therapist to help me get over these irrational fears, but you guessed it: I can't afford to. I make just enough not to be covered by any of the ACA's tiers, which means it'd be $400/mo for health insurance. It's like.. $400/mo? Do you have any idea what I could buy with $400/mo? I'd be able to afford to eat as much meat as I want to, let alone health insurance.

So yeah, just barely treading water down here in the good ol' USA. Cheers from down south.

(I'm not jealous, to be clear. Hopefully we'll get our stuff sorted out someday.)

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> The secondary reason is an unhealthy fear of needles

I realise this isn't the only problem, but with a fear of needles you will be more likely to make bad decisions for your health than you would otherwise make.

I know because I resisted life changing medication for several years because it required regular blood tests.

About 18 months ago I decided I didn't want to do that anymore and sought help for my phobia. I was at the stage that one of my biggest fears was having an accident and waking up attached to IVs. I would likely have hit someone who would come at me with a needle. I would leave the room if someone had a fake needle pen (trigger warning: https://cdn.thisiswhyimbroke.com/images/syringe-pens1-640x53...). I would cover the backs of my hands involuntarily just having a conversation about needles.

I saw a therapist (on the NHS, free) for 8 sessions over the course of about 3 months, who guided me through a course of Cognitive Behavioural Therapy (CBT), in my last session I held a needle (with it's cap on). Afterwards I was able to continue applying the techniques I learnt in therapy, and got better to the point where I started having blood tests in July. I've since had 7 blood tests and have been noticeably more able to cope with each one.

This is a fixable problem. This isn't part of you, it's just a bug in your brain, and CBT is a technique that you can learn to train your brain to work around the bug. There's a ton of evidence behind it, we know it works, it really is just this "one weird trick".

I highly recommend trying it, and while I was taught it by a trained professional, I suspect you'd be able to get significant value out of reading online. Find someone who can learn with you and have them keep you on track.

I say all this as someone who is skeptical of "therapy" and as someone who has seen very clear progress from CBT. It works, it's supported in research. Don't let a phobia be the reason you don't get medical help. If there are other reasons then tackle them, but a phobia will give you a reason not to even try so fix it.

Feel free to email me if you want to chat.

Consider a fecal occult blood test -- much cheaper than colonoscopy, has the same impact on mortality on a population level, non-invasive. If you get a "positive" on it you might be able to access care somehow.

Man, that's awful to hear, I'm sorry you're in that position.

If you haven't gone to see any doctor at all (and presuming one visit won't bankrupt you), you really should. They don't have to perform any procedure or examination you don't want them to and they're very understanding of people's phobias.

If you have gone and you know for sure you need a colonoscopy then yeah, I'm not sure what to say. It's an awful situation to be in choosing between debt and healthcare. I hope things work out for you and you can get some help.

Are you sure they are cancer symptoms? Seems you be dead by now if you and them untreated for so long.

Nope, I have no idea what the blood is from. I can't afford to see a doctor. :) TMI below, so stop reading.

Before I switched diets a month ago, I had blood about 80% of the time. It's ... Mixed in, and dark, as opposed to bright red and on the surface. Meaning whatever it is, it's deep inside my intestinal tract.

Since a month ago I've seen it only once. I'm holding out hope it's just a stomach ulcer or some weird thing involving sugar. Cutting that crap completely seemed to help.

But that's homeopathy, not medicine. I need to get scoped out to figure out what's up.

Those needles though...

https://scottgriddle.com/blog/dealing-with-my-needle-make-th...

https://medium.com/@sgriddle/im-35-and-i-may-suddenly-have-l...

I read that and think "I'd rather die of cancer," but then I read about what it's like and realize it's just a mental hangup. Pretty powerful one though. I think the author probably delayed getting checked for similar reasons.

Hi, Doctor here.

Go to a doctor immediately. There is no way that old blood mixed with stool is from a stomach ulcer. In fact, that’s not how it works anyway (upper gastrointestinal bleeds are modified by stomach acid and enzymes and have a characteristic effect on stool that we call Malena). You may have one of many different things, the most serious of which is, as you fear, a cancer, but the differentials run through benign polyps and vascular malformations.

I understand that you live in a country where you have to make practical choices about your engagement with healthcare VS putting food on the table but if you play your game slightly further out (ie add in the future value of the rest of your life VS the opportunity cost of a colonoscopy soon) it doesn’t make sense. You have a pressing and urgent need to attend to a doctor for referral for colonoscopy

You have no idea how much I want to, but $1k for a colonoscopy is wildly optimistic. It's probably going to be $3k or $4k minimum. I make $750 bimonthly, which barely pays the rent. My roommate pays the rest of our living expenses. There's $1,800 in the bank.

What do I do? Show up and say "There's no way I can ever pay for this, but see me anyway"? I literally have no idea, and I'd feel like a complete scumbag for doing that.

I know it's pressing and urgent, there's just... It's societal pressure. Am I really going to stare at the receptionist and say "No, I won't give you my debit card info; yes, I want you to see me anyway"? They'll tell me to GTFO.

Would it be ok if I send you an email?

More than happy to receive an email from you and take a consult. The large strokes of your history you’ve already given and whilst there is a lot of other information that would be useful for general picture (age, sex, family history particularly as it relates to bowel/GI issues, specifics of timing and actual dietary changes etc) it doesn’t overly change the story which is that further investigation is highly warranted and necessary for a definitive diagnosis to occur (even if underlying pathology is benign). Sorry I can’t help further, the unfairness of the US health system is beyond my comprehension

If your income is $18k/year like you said, it is low enough that you should qualify for a healthcare subsidy. I just checked.

If you won't get insurance, apply for financial aid in the healthcare system you use. They'll cover most or all of the cost based on hardship if your situation is that bad. Once you're received financial aid, it will probably apply for most of your medical expenses for several months to a year. Call various healthcare systems in your area to see what charity/financial aid programs they offer.

If you don't want to do that, at least call for quotes. $3-4k is possible to pay, but too high. It's worth driving a bit to save a few thousand dollars. Yes, you can get a quote for a colonoscopy; it's a standard procedure. Here is an example of a nationwide program that will do it for around $1,100 and that has several options in CA. It is not the only one. https://www.colonoscopyassist.com/After_Colonoscopy.html

For the sake of your health, please don't assume you have fully researched your options yet.

> If your income is $18k/year like you said, it is low enough that you should qualify for a healthcare subsidy. I just checked.

You checked? For a single adult? Most states don't even cove Medicaid for a single adult with no kids, regardless of income. And for those that do, I'd be surprised if $18,000 qualifies him in most of them.

> If you won't get insurance, apply for financial aid in the healthcare system you use

Healthcare system he uses? You realize he's in the US, right? What healthcare system are you referring to?

I'd recommend that the poster go to the ER and tell them his symptoms. I'd say they'll almost certainly do tests on you. Ask to talk with a social worker if needed, and ask them about payment plans, and then if you can't pay, don't worry about it. With you income, it's highly likely they'll be willing to write most of the cost off. It's our fucked up system that's left necessary medical care unaffordable to you. If you were in a reasonable country, either:

a) there would be universal health care or single-payer insurance and you'd not have to worry about paying, or

b) care would be much, much more affordable and you could afford it. In Mexico, a colonoscopy would be a few hundred dollars, and a fecal occult blood test maybe 20-30 dollars.

Because of the corruption of our political officials, and the greed of our insurance companies, pharma companies, hospitals, and doctors, you're left without the recourse that 90% of the world has. So go to the ER and get it taken care of. Even if you have cancer (and it doesn't necessarily mean you do), you won't always end up with a colostomy bag. But the longer you wait, the more likely that becomes.

Yes, $18k national average for a single adult should be low enough for a plan subsidy. I assume he is in a higher income state due to the rent cost.

Healthcare system meaning “St Jude” or “OSF” or “Kaiser.” These Are medium-to-large organizations in the US that many doctors and hospitals fit into to provide service. These orgs are large enough to provide charity if you do a little paperwork.

Why would you assume he had any association with a healthcare system like that? He's said he had no insurance.

That said, I agree that it would be good to check with any nearby large hospital to ask about their charity programs. Better yet, just show up at the ER of a large hospital and tell them the symptoms he's got. Given the urgency of the situation, I think they'd be obligated to treat, regardless of ability to pay. Then, once you're in the system, check on their charity programs.

I assumed that because most people interact with these systems if they have a doctor or go to the ER. That's not precluded by avoiding elective/preventative care.

If you are in the US you should call an organization that does healthcare enrollment. If you have no dependents you probably aren’t Medicaid eligible, but probably are subsidy eligible.

If you cannot find someone, Talk to a social worker at your local hospital.

> and I'd feel like a complete scumbag for doing that.

DON'T. Other people with less urgent medical matters are "cutting in line" before you because they don't have as much of a problem with it.

It might be our life on the scales, and maybe that's worth nudging your principles a little.

I sincerely hope you will get out of this better and more healthy.

Not an expert, and my apologies if you already know the following.

On costs: have you investigated going to an emergency room to be seen for blood in stool? Under Federal law, you have the right to screening, emergency care, and transfer to appropriate followup facilities regardless of ability to pay. It's possible you could at least get a diagnosis at an ER, and perhaps a full colonoscopy as part of that.

On needles: I don't have fear of needles, so I have no 'been there, done that' recommendations. However, there are effective oral anxiolytics that would probably reduce your anxiety enough to get past needle insertion. These might be combined with oral sedatives as well.

On the actual colonoscopy: I've had three. They've all been completely routine and painless. The first time, my doc asked me if I wanted to stay awake and follow the colono-tour on a video monitor, which I did. It was fascinating. For the others, I decided I'd seen it before and chose to not be a tourist, so I was sedated (Versed, I think).

My brother had intestinal cancer. He had a short bowel resection over 40 years ago and he's been fine since. No colostomy bag, no hassles, just 4 more decades of good life. Good outcomes do happen.

I hope you can get care very soon. Best of luck.

>I've been concealing cancer symptoms for years

You want to die? Because this is how you die. Even if you can be saved, the longer you wait, the more expensive the fix. You know, ounce of prevention, pound of cure.

I don't want to die, no, but see https://news.ycombinator.com/item?id=15889950 for my situation.

If you have ideas, I'm all ears, believe me.

A lot of places have community clinics that offer income based prices for medical services. The three places I've lived (mind you, it's not a very geographically diverse three places) have had clinics of this sort, so there may be one where you live as well. They may or may not be able to perform it, but if they can't, there is a good chance they can point you in the right direction to get it done with your income level.

If you haven't already, I highly suggest you look into these clinics.

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