Mike Neal gets up early. Between 3 and 3:30 a.m. He tires later in the day so it is good not to waste hours when his energy levels are up. He eats oatmeal or Rice Chex. In days past he would easily drink a half gallon of milk with a meal, but those days are gone.
While it is still dark he climbs into his 1990 Chevy van with 252,000 miles on it and begins a drive he makes every Monday, Tuesday, Wednesday and Friday. He drives through the deserted streets of his home town of Lostine, heading for an imperative 6 a.m. rendezvous in La Grande 57 miles away.
A self-proclaimed workaholic since leaving high school at age 16, Neal is no longer going to work. First a bad heart, and now a dormant kidney, have sapped his energies over the years, and a big, robust man who previously drove logging truck has to rely on a dialysis machine to stay alive.
His kidneys can no longer produce urine and the dialysis machine is the only way to clean his blood. He is on the machine 4 1/2 hours at a stretch, four days each week. When he is first hooked up he is short of breath, but begins feeling much better as the treatment progresses.
Some people from Wallowa County have to drive to Walla Walla, Wash., for dialysis treatments, so the 400 plus miles he puts on his van each week could be much worse. "I thank God it hasn't broken down yet," he says.
Neal, who used to weigh 364 lbs., can drink only one quart of liquid each day. He often tones down his thirst by sucking on ice. He has lost 110 lbs. and hopes to lose more.
But his health is only one of the worries that face Mike Neal on a given day. Since Measure 28 was voted down Jan. 28 he lost his insurance through the Oregon Health Plan. Though Medicare picks up a substantial portion of the tab, Neal's only monthly income is $1,200 in disability payments to pay the rest of the bills. He has already had to swallow his pride and sell out 14 years worth of equity in the doublewide modular home he lives in. At age 51, his mother now carries the contract.
Medicines, previously covered in part by the Oregon Health Plan, are expensive. To date, since the OHP dropped his coverage, he has been paying for needed medicines by credit card. "I owe more on my credit card than most people do on their house," he says.
The most expensive medicine at $533 for a one month supply, says Neal, goes by the brand name of Renagel. Since phosphorus is a byproduct of many foods, including dairy products, and is normally filtered through the kidneys, Neal takes Renagel to enable his body to eliminate phosphorus through his stool. The alternative is to have the phosphorus come out through the skin, causing an itch "that drives me nuts."
Efforts are underway to relieve the financial crunch prompted by the Jan. 28 election. Caseworkers in Portland, where his kidney problems were first diagnosed one year ago, and from Enterprise are working on the problems. An effort is being made to coordinate a drug assist plan with the drug company that makes Renagel. Efforts are underway to provide Neal coverage under Blue Cross/Blue Shield, if he can come up with the capital to make the monthly payments.
Neal thinks that the cost of dialysis ranges from $2,500 to $3,000 each week. Though Medicare picks up the biggest share of the tab and bills keep being resubmitted to Medicare for payment, Mike Neal expects to be hit with "an astronomical accumulated bill" at some undisclosed date in the future.
The Oregon Health Plan used to pay partially for the dialysis, medicines and $25 mileage for each trip to La Grande for treatment. All that is gone with the exception of the mileage tab which is generously being provided by Neal's first wife, Cathy Johnson.
A weak heart forced a man who says "my kids and my grand kids are my life" to retire in 1998. He since has spent considerable time "puttering" around in his yard and in his shop. He walks with a cane and says that walking tires him out faster than anything else.
Fourteen-year-old Kian Shahin comes around regularly to see if he can be of help. He often lends a hand in the greenhouses where Neal grows tomatoes, cucumbers, squash and green beans; key ingredients toward a nearly meat free diet he has adopted in a push for better health.
"I can't get sick and go into the hospital," he says. "One day in the hospital would probably cost more than all of my medicines. Without the Oregon Health Plan I try not to create any more bills than I have to."