Monday, July 6, 2020

WHAT I CANNOT DO AND WHAT I CAN DO

Before my back broke -- thanks to the medical mismanagement of Prolia, I could do the following things easily, and without pain.

1. Take care of my daily needs, including shopping for food, managing other activities of daily life with ease.

2. Spend enjoyable retirement time with friends and family, visit their homes, attend important family events (weddings, funerals, etc.), enjoy my grandchildren,  go out for dinner with friends, entertain from time to time.

3. Travel - one of the things I most enjoyed in retirement.  Visiting new places on my own or with friends, enjoying a few winter weeks in warmer climates and summers at a family place in the Indiana Dunes.

4. Getting about the city on foot, by public transit, and driving my car.

5. Actively engaging in community activities, political campaigns, and good causes of various kinds.

None of these things are possible for me now, at least not without so much pain as to cancel much or all of the enjoyment they might offer.

So what can I do?  I can do everything I can to warn others about how Prolia and its mismanagement can destroy active living, and turn an enjoyable middle and old age into a kind of hell on earth.  I am stuck in this painful trap of a broken body forever, but if I can keep even one other person from falling into the same trap I'll have done my job.
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Wednesday, April 29, 2020

PUBLIC CITIZEN HEALTH RESEARCH GROUP PETITIONS THE FDA FOR BETTER WARNINGS ABOUT PROLIA

Public Citizen Health Research Group recently petitioned the Food and Drug Administration (FDA) for better warnings about the osteoporosis drug Prolia.

While most of the suggestions in that Petition were ignored, the FDA agreed to some modest changes.  

You can read the entire petition and the FDA response here:

https://www.citizen.org/article/petition-to-the-fda-to-require-a-black-box-warning-for-the-osteoporosis-drug-prolia/

Readers in a hurry can get the gist of the Petition from the press release: 

https://www.citizen.org/news/patients-doctors-must-be-warned-about-risk-of-spinal-fractures-soon-after-stopping-osteoporosis-medication/


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Wednesday, April 15, 2020

CAN AMGEN EVEN KEEP ITS OWN STORY STRAIGHT?



I keep in touch with Amgen, manufacturer of Prolia in a few different ways.  

Sometimes I call them at their phone number for this purpose: 1.800.772.6436.  There I generally speak with either a nurse or some other medical professional.  There is nothing they can do for me but listen, and that they do very kindly.  They never offer any useful information.  (That, they tell me, is only for my doctor to do!)

Sometimes I write to the President of Amgen, Mr. Robert Bradway.  I'm sure he never reads these letters, but I generally get an answer signed by someone named Gunjan Thiagarajah, who appears -- as far as I can figure out from www.Amgen.com to serve in some sort of marketing function. 

The following is not really about my Prolia-related broken back, but a incident that really leaves me wondering more than ever about Amgen!

On March 25, 2020 I telephoned called Amgen however, to express concern that supplies for patients on Prolia might be interrupted during the current COVID-19 situation.   I spoke with a very nice nurse who identified herself as "Lucy."  

I explained to Lucy that since (as described elsewhere in this blog) a brief delay in my Prolia shot left me with fractures that had pretty much ended my active life, I did not want to risk still more damage if Prolia were not available for my next shot which was to be on April 14. 

 On Sunday April 5 I received a UPS Express envelope containing a letter from Amgen: a single sheet dated April 3, 2020 addressing this issue. It cited Amgen's information source for COVID-19 issues: www.amgen.com/covid-19 and also offered a resource for doctors to find alternative sites of care for Prolia injections www.proliafinder.com. It was signed by the above Gunjan Thiagarajah.  Not the most reassuring letter about my specific concerns but at least it was something.   

But on Monday April 6, 2020, around 5:30 p.m. I actually received a telephone call from a woman who said she was from Amgen.  And it also seemed to come in response to the telephone call I made on March 25th (in which I spoke to Lucy).       

I had a hard time understanding this caller but she spelled out her name and I think it was Sama Hassan.    I could not find this name anywhere on the Amgen.com website.

I may have gotten a return call before in response to a phone call I'd made, but generally I get no response to these calls that I make about once a month.  And certainly not TWO responses! 

As noted, she said she was responding to my call of March 25, 2020, in which I brought Amgen up-to-date on how I was getting along since my Prolia disaster.  

She said she had "material for my doctor" if I would give her my doctor's name.  I said there had been three doctors in two different institutions  involved with my care -- the one who put me on Prolia in 2012, then, after he retired in 2016, the one who came in after my bones had broken because I had been unable to get my regular Prolia shot on time during this change, and finally the doctor I am seeing now.  

But I continued, saying that while I would be glad to give her these names, I first wanted a copy of whatever she was going to send them.    

She said she could not authorize that and would have to check with the the proper people to see if she could do that!  So watch this space!  We might learn what exciting information Amgen imparts to doctors but not to patients!   

I did get my Prolia shot at Northwestern on time on Tuesday, April 14, 2020, but I have yet to figure out what all these calls were about.  And I have yet to get the "doctors only" material from Amgen. Are Amgen's internal processes just as screwed up as they were at the University of Chicago?    I'll never know!

MEDICAL AND DENTAL CARE IN THE TIME OF CORONA VIRUS

(Note, this is also printed at my blog https://joanscovid19blog.blogspot.com/2020/04/medical-and-dental-care-in-time-of.html )

(With apologies to Colombian Nobelist Gabriel Garcia Márquez, author of Love in the time of Cholera.)

As readers of these pages know, I have been dealing with the fallout from painful multiple vertebral fractures occurring following the medical mismanagement of the osteoporosis drug, Prolia. Now, two years and a lot of physical therapy later, I can now walk a little and remain upright (standing or sitting) without too much pain for an hour or two.    I've given up my car; driving was just too distractingly painful, and I avoid theatre or concerts or anything requiring me to remain quietly seated for an hour or more with no opportunity to depart quietly and gracefully when the pain becomes too intense.

But now comes another issue which is causing me great consternation and one more example of the negotiations I must carry out when various health professionals present me with conflicting sets of requirements, and where the consequences to me of a slip-up could be more painful, debilitating, independence-threatening fractures!


Early in 2020 I had a toothache.  A bad one!  Dental x-rays revealed a broken root, but I had to wait almost six months until the tooth could be extracted because I was on Prolia.  This is because apparently Prolia leaves your jaw vulnerable to fracture.   At first I was told I had to be OFF Prolia completely before this tooth could be extracted -- which could have left me quite vulnerable to more fractures!    I discuss this on these pages at:
http://www.joansbackbonedisaster.com/2019/12/a-cruel-prolia-related-choice-must-i.html

So in view of the dire consequences of even a short delay in getting a Prolia shot (caused by medical mismanagement of this drug as discussed elsewhere in this blog) I wanted to make sure there would be no delay here in getting my Prolia shot April 14 (the mandated six months and 5 days for spacing Prolia injections.)


I knew this would take a lot of juggling because despite the fact that the two doctors involved are across the street from each other in Northwestern Medical Center buildings, and both have telephones,  they do not  communicate with each other, leaving me to fly back and forth like a Carrier Pigeon with messages.   But I finally was able to establish two dates:
April 8 for Oral Surgeon follow-ip exam.
April 14 for Prolia shot.

I had already cancelled many other medical checkups with other doctors who agreed that I did not need to come to their offices as scheduled given the Corona Virus danger.   (In fact some of them were no longer even coming to their offices!)

So inasmuch as the Oral Surgeon did not seem to think I needed to come in for  a "follow up" I cancelled that.  We agreed that additional exposure to COVID-19 was unnecessary.


Corona Virus - COVID-19 -- Complicates Matters!   To recap, the broken tooth having been extracted as scheduled on March 10, in the normal course of events, the Oral Surgeon would examine me ten days later and then I would get the Prolia shot as scheduled on April 14.

But by early March, the "normal course of events" was history.  Corona Virus -- COVID-19 -- was on a rampage around the world, with no effective prevention methods in sight.  Our political leaders and medical experts were adamant in the importance of personal protection by quarantine and self-isolation, and knowing that at age 83 I was in an especially vulnerable age cohort, I was carefully observing that, staying in my home, having no visitors, and sending out for my groceries.

But as the time for my Prolia shot came due, I knew I would have to leave my carefully maintained  COVID-19 free quarters and venture to Northwestern University medical buildings two more times: First, to have my "follow up" appointment with the Oral Surgeon, and then several days later for the Prolia shot.


So to minimize this exposure, I called the Oral Surgeon's office and reported that the extraction site felt fine; no pain, no swelling, and it was agreed that I could defer the follow-up visit to minimize COVID-19 exposure risk.

But this did not work for the Prolia doc's office where I was told that following the March 10 extraction, I MUST see the Oral Surgeon to be "cleared" for the Prolia shot.   So I dutifully called back and reestablished the Oral Surgeon follow-up exam for April 8 and then the Prolia shot on April 14.

It appeared then that I would have to go out out TWICE, with TWO exposures to COVID-19 in order to get the Prolia shot on time so that I wouldn't have MORE fractures!   Talk about a rock and a hard place!

So I was really delighted when the Oral Surgeon said that since I reported (honestly) to him that following the extraction I had no pain or swelling and that the site was well healed,  that I could cancel the "post extraction" exam and get the Prolia shot at the scheduled time. 
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Tuesday, March 31, 2020

FOOD SHOPPING IN THE TIME OF COVID-19*

Or: What I Learned from Two Years of Prolia-driven disability!

Note: This information is also posted at:
 https://joanscovid19blog.blogspot.com/2020/05/food-shopping-in-age-of-covid-19.html.

Further updates on this and other things pertaining to COVID-19 are posted at https://joanscovid19blog.blogspot.com  as well.  


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These food sources -- mostly with Chicago area people in mind --  may be convenient for those sheltering in place!

-- Amazon (www.Amazon.com
-- Imperfect Foods (www.ImperfectFoods.com)
-- Daily Harvest (www.Daily-Harvest.com)
-- Fresh Picks (www.FreshPicks.com)
-- Freshly (www.Freshly.com)
-- Sprinly (www.Sprinly.com)
-- Veestro (www.Veestro.com)
-- Splendid Spoon (https://splendidspoon.com)


These are all sources I have used and I appreciate them a lot -- especially now!  Check to see if they serve your location.

1. In general I prefer using PayPal for online shopping.  Where CC is required I keep all online purchases on one "dedicated" card so it's less hassle if it gets frauded.

2. Be flexible.  Stores may be out of what you want but may have other choices to deliver to you.

3. Write dates on cans & boxes with marking pens so you can consume the oldest items first.

4. Leave realistic delivery instructions.  Check your building's requirements.  

5. Websites I've used.  The four websites listed here have worked best for me since my Prolia disaster made shopping quite painful.  


6. I've used Instacart but I've found the stores here work better for me.  But check what Instacart offers in your area! 


7. Keep a list of what you got where so you can easily find your faves again!

Here is more detail about each of the sources I've used: 

A. Amazon. www.Amazon.com


1. I know we all love to hate Amazon, but for now, Amazon can be helpful.   

2. Sign up for Amazon Prime.  The price you pay for this feature will likely be offset by free deliveries of many things plus speed, convenience, and selection.

3. Explore the many Amazon food shopping services - Amazon Fresh, Amazon Whole Foods, Pantry Lists, etc.  Most offer free delivery for orders over a certain price, and/or for Prime customers.   

4. Consider buying staples by the case. 

5. Get an idea of what's available by entering the name of food you want and seeing where Amazon takes you!

6. Keep a list of where you got things you especially like so you can find them again.

7. Keep lists of orders "in progress" and pay when you reach free delivery levels.  And keep an eye out for online specials.

I mostly shop Amazon's Whole Foods list, but right now (April 9, 2020) they are not even giving delivery slots. Check back for delivery windows.


I was happy to see that (at least. according to Forbes), Amazon is not "COVID-teering" (the word I just coined for companies making unfair profit from this crisis).
https://www.forbes.com/sites/moorinsights/2020/05/04/amazon-neither-winning-or-profiting-from-covid-19/#2f58aa706793

B. Imperfect Foods.  www.imperfectfoods.com  
See if they this company delivers to your area. They offer organic and conventional foods, raw and prepared, vegan and animal-sourced, all considered "imperfect" because of being close to expiry dates (but not beyond), or from broken lots, or too oddly sized or shaped for supermarket display.   

You can sign up for weekly or bi-weekly delivery on a "Book of the Month Club" model, so you need to let them know in advance when you don't want a box. You can also make some choices and list foods you never want.   More details at their website. 

C. Daily Harvest https://www.daily-harvest.com/app/home
Daily Harvest delivers prepped produce, mainly vegetables and fruits, in measured containers, for healthful smoothie to which you only need to add liquid and blend. (They also deliver salads, soups and some other items in frozen containers).   

I have a plan were I get four or five smoothies and one or two soups every week.  Since standing for a long time doing food prep is hard for me, this is truly a healthful luxury!  

This is a "Book of the Month Club" type of service.  You can always skip a box or change the contents, but if you do not do so by their deadline you'll get what they send you!  But check it out - some offerings -- soups, harvest bowls etc. -- are higher in sodium than I'd like, so these are just occasional treats!  


D. Fresh Picks.  www.FreshPicks.com
This is a Chicago area company.
If you are in the Chicago area you may know Irv and Shelley's Fresh Picks from the summer produce markets.   Besides local organic produce. they sell some prepared foods and some animal based products, many from small local companies.  It's a nice selection and worth a look.


They offer weekly deliveries of either their pre-assembled boxes (best prices) or your selections.  
You'll get an e-mail about what is offered each week but you can set it up so they only deliver when you place an order.  

Your produce may arrive in a large insulated bin which is good if you won't be home.  (I ask for delivery in a big plastic bag so I don't have to worry about leaving the bin out for them to pick up.  Ask them for details on this).

E. Freshly (www.Freshly.com)

Freshly offers complete meals in containers ready to microwave and enjoy.  The are gluten free. For other sensitivities you can read the ingredient list on each selection.  Delivery is weekly, and these meals are intended to be kept in the refrigerator, not the freezer.  You can select a 4, 6, 9 or 12 weekly plan, with prices lower per dish for the larger plans.  

Deliveries come in large boxes with freezer packs, which likely accounts for the high price of this service. 

You can keep the same selection week after week, switch selections, or opt for no delivery that particular week.  (If you don't opt out, however, you'll get a delivery automatically.) 

I find that one serving serves me well for two meals especially if I add a salad.   These are on the pricey side but well done.   

F. Sprinly (www.Sprinly.com)

Sprinly offers ready to heat and eat meals that are vegan and gluten free.  While there is some choice of number of meals and frequency of delivery there are just six choices of meals each week.   They are good, and half a meal serves me well. 

G. Veestro (www.veestro.com)

Gluten free and Vegan -- they offer several plans.  Heat and Eat meals with enough for a week delivered at one time.  They arrive frozen and are to be kept frozen until ready to use. 

H. Splendid Spoon (www.SplendidSpoon.com)  
Gluten Free Vegan.  Wonderful smoothies!  The best yet, and very good soups and stews to just heat and eat.  Easy to skip or unskip a week. 
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*Much of this information is also at www.JoansBackboneDisaster.com as I compiled much of it originally because it was physically difficult for me to shop in person. 


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Friday, March 20, 2020

PROGRESS NOTE UPDATED TO JANUARY 2020

Progress Note -- Updated to January, 2020.

Nearly two years since my Prolia disaster the bones are healed (albeit not like before) and I have gotten some of my life back.  But unless I am flat on my back (or lying on my side or floating in water) the pain remains.  Standing or sitting for more than an hour without adequate support is painful and after another hour becomes nearly unbearable.   

The resulting inactivity left me much weaker than before, although I try hard to stay as active as I can, despite the pain.  I exercise regularly under the supervision of a physical therapist. 

I remain quite limited in what I can do or even want to do.  Do I join family and friends for an evening out?  Can I handle the pain this invariably brings?  Do I travel (as I did regularly prior to this disaster)?  Do I have the strength? Is it worth the pain?    

Here's a quick recap of the past few years: 

Here I am in the winter of 2018, just weeks before my Prolia disaster. OK, I'll say it: for an 81 year old I thought I was doing pretty well!

That didn't just happen  -- it was in part the product of attention to a healthful diet and the right kind of exercise -- as well as decent genes. 


I was enjoying two weeks in the Cayman Islands, climbing up and down the pier ladders, (quite a climb at low tide), and, with my fins, mask and snorkel, spending hours observing fascinating marine life, and handling flights and luggage with ease.   

I didn't know that just weeks later, this part of my life would be over.  There I was "81 going on 60."  Now I'm "83 going on 160," much too disabled for this kind of travel and in pain a good deal of the time.  

The picture below is how I looked just a few weeks later, not long after three vertebrae fractured because of the brief Prolia delay resulting from what I would call a "medical clerical error."  

You can clearly see the spinal curvature and swollen midsection, and the pain and weakness made many activities of daily life painful and/or extremely difficult. 


Here is how I looked in September, 2019, after well over a year and a half of pain and disability, and many months of physical therapy as well as exercise at home. 



There is still some curvature, but it is less severe.  And now I can be upright -- sitting or standing -- for an hour or two without too much pain.  However, after about two hours the pain is generally quite severe. 

My body shape is still quite different, in part because of the major loss of height in my midsection, and in part the likely result of inactivity and inflammation.  So while I am better than a year and a half before, before, I still have a long way to go.

Now in the just before the New Year of 2020,  I drive my car once a week (mostly to keep the engine going, from indoor garage to indoor garage or easy nearby parking).  I'm seriously thinking of letting go of the car this spring, but that's a hard decision -- having spent well over 60 years behind the wheel.    But taxis and Uber may make more sense at this point, although I would very much miss the flexibility of driving.

I still cannot handle air travel.  The kind of travel I loved two years ago would be like taking a trip to the Moon today!  

Even going downtown to the physical therapist, with whom I'm working so hard, must be in a cab for a distance I used to walk or take the bus.   

I've cut my hair quite short -- it was getting matted from so much time lying down -- and wearing "normal" clothes is still impossible. Thank goodness for soft-waisted yoga pants which don't add to the pain of my inflamed mid-section!

I do as much as I can online -- including routine grocery shopping -- as handling bags of groceries is difficult now. I am just grateful that I now can stand long enough without too much pain to prepare my own meals and am no longer confined to delivered food or "TV dinners!" 

But, as noted in another post, I need to have a broken tooth extracted which, thanks to Prolia, I may not be able to do without fracturing my back or my jaw.  Read more at the post "A Cruel Prolia Related Choice; Must I choose a Toothache or a Backache!"


And all of this because of a corporate and professional failure to warn that even a short DELAY in receiving a Prolia shot could result in painful fractures wiping out years of effort to promote and preserve health. 

That is why I write this blog:

1. To warn others that once on Prolia, it may be impossible to get off it safely!  

2. To warn that once on Prolia, even a short DELAY (a word I could not find in the Prolia labeling for doctors and not until quite recently -- in 2019 -- in any information for patients) could leave you with the kind of fractures that brought my healthy, active life to a screeching halt! 

3.  To urge anyone considering Prolia to carefully research this drug before making a decision. 

It's too late for me, but if you have not started this drug it is not too late for you, so consider your options carefully!

Saturday, March 14, 2020

KINDRED SPIRITS ON FACEBOOK

A truly helpful friend told me about Facebook groups actually devoted to Prolia debacles!  Who knew?  I certainly didn't!

There is no way to establish the veracity of these posts, but when I looked at some of these pages I thought "Wow!  I could have written these posts!"
They so precisely described my own terrible experiences with this drug.   

So I posted too - just a fraction of what I'm dealing with because of fallout from the Prolia bombings I have endured.   I am not editing here, but simply cutting and pasting what is already online.

Here are some of those Facebook Pages.   
If you know of more please let me know!

1. Prolia side effects and complaints, effects secondaries et plaints.  2.3 k members.
https://www.facebook.com/groups/988541067970186/    

"WELCOME! If you are looking for details of the many frightening side effects caused by Prolia - which many of you will have had your doctor deny - look at the latest Monograph published by the drug's manuacturer itself. This alarming document details most - but not ALL - of the drug's side effects, as well as warning users that the manufacturer does NOT know all the side effects and are still discovering them. That document is all the warning you will ever get from Amgen, so be sure to read it - and make sure your doctor reads it too! (Monograph is in the Files section and also here"

[Note: Here the author of this post gives a link to the Amgen Monograph for Prolia]


"Familiarize yourself too with the crucial information in the Files about rebound fractures and the damage Prolia does to bone remodelling/bone turnover. These files are from scientific medical sources and investigators...not unreliable websites and dodgy sources. These are medical researchers around the world, sounding the Prolia alarm!
Then! Join in the conversation - make friends - share your experiences - ask questions and give answers! There is a wealth of information here."
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2. Prolia (osteoporosis treatment) discussion group.  1.7 k members. 

"This group is for the expressed purpose of discussing the osteoporosis treatment Prolia and your personal experiences with Prolia. Unless you are a physician, no member has the right to suggest whether another member should or should not take Prolia. This group is only for folks taking Prolia or considering taking Prolia. (NOT for ex Prolia Users)"
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3.  Multiple Vertebral Fractures after Stopping  Prolia   471 members 
Group created May 13, 2018

"Group created to discuss on the international level the possible multiple fractures and rebound effect after stopping 
Denosumab/Prolia." 

"Scientific information:

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Tuesday, March 10, 2020

PROBABLY BEST LEFT UNPUBLISHED BUT I'M PUBLISHING IT ANWAY!

This is probably best left unpublished but I want to put down on paper.  Some of this is repetitive of matters discussed elsewhere in this blog.  Sorry about that!  But it goes more into my personal experience with this body-breaking debacle, and especially my experiences with University of Chicago specialists I will call Dr. A. and Dr. B.!


I had been receiving Prolia shots twice a year from Dr. A. at the University of Chicago since 2012.    I was always on time for these and even built any out of town trips I might take at those times around these shots so I would get them on time.

But when my January, 2017 appointment to see Dr. A. and get a Prolia shot at the University of Chicago was cancelled because of Dr. A's retirement, the schedulers would not make an appointment for me to at least get my next Prolia shot when it was due, because they could not give me an appointment beforehand with the new doctor, Dr. B., who was already heavily scheduled.     

The only appointment they could make with the new doctor, Dr. B. was months ahead, and the fact that I had been receiving Prolia shots there every six months for the last four years seemed to make no difference to them.   

I thought they knew what they were doing. They didn't.

My fractures occurred a few weeks after that cancelled January appointment.  

I was finally able to get a Prolia shot on March 16. 

When I finally got to see Dr. B. around that time I was still in terrible pain but I was able to get there. 

When I told her what happened her response was:  

"You missed your Prolia shot!"  

She said this in a way that seemed to imply that missing the shot was my fault.  I couldn't believe what I was hearing.  Not a word about the role of her clinic at the University of Chicago in allowing this to happen!

In a subsequent appointment with Dr. B., several months later,  I asked her if she could help me find resources to help me deal with the fallout from these painful fractures, and perhaps refer me to physical therapy.  Her response was that she thought there was a physical therapy place, "maybe on 53rd Street" but could offer nothing more, and certainly did not offer to try to help me find more information.    

It was clear that as far as the University of Chicago was concerned, rehabilitation following the my injuries sustained because of their failure to make it possible for me to get Prolia shots on time was of absolutely NO concern!

At last, with the assistance of my chiropractor, I was able to locate a Physical Therapist who has given me a lot of help in recovering some mobility and ability.  Because of the COVID-19 situation however I'm not going downtown, but continue exercises on my own.   

Also, after some research and telephone calls (and NO help whatsoever from University of Chicago Endocrinology), I was able to self-refer to the U. of C. Pain Specialist who was helpful in reviewing all the things I do on my own, and lets me me know what is, in his view, safe and effective.   

(During all this time, and to the present day, however, I have not enjoyed one pain free day!    Fortunately I can get some relief lying flat on my back, but this is not how I want to spend the rest of my life.  However, with time and physical therapy and exercise I can be upright -- sitting or standing -- for about an hour with out too much pain.) 

But I have yet to hear a word of apology or guidance from University of Chicago Endocrinology about their role in letting this debacle occur in the first place, or in being unable or unwilling to help me find rehabilitative resources.

So this explains my ire when, the next time I saw Dr. B, looked at me with some surprise and said:  "Most people don't look so good after this happens!" 

And finally, when Dr. B. showed me a card she was going to give PATIENTS warning them to get their Prolia shots on time, without a WORD about how front desk was being trained to facilitate making sure her patients who required timely treatment, were being properly managed, that's when I left the University of Chicago Endocrinology service. 

The University of Chicago Endocrinology Service had every opportunity to help me and also to make sure that no one else had to go through this.  The former certainly never happened and I have reason to suspect that neither has the latter. 
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