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Cancer care journey-hospital March 28, 2010

Posted by medvision in Cancer Care.
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During my year long experience caring for my mother hospital stays became necessary. Looking back, some of these visits were necessary and unfortunately, some were the result of our lack of cancer understanding. A patient’s immune system becomes compromised when battling the disease, especially from chemotherapy and the accompanying anti-medic preparations. Prior, on several occasions, I’d been advised by nurses that it is necessary for someone to stay patients when hospitalized. This is a truth etched into stone.

The community hospital we utilized was a 150 bed facility located in East Tennessee. Though extremely understaffed from nursing perspective, the nurses on duty were very dedicated and hard-working. My mom’s floor/section was full with 23 patients, three of which were in critical care rooms. This section is was served by one nursing team consisting of an RN, LPN, aide and occasionally a support person from another area. I’m still amazed at the dedication of these clinical professionals, however they had an impossible task. Literally, running from patient to patient.

 During one hospital stay we were advised that she have a permanent port catheter inserted in her chest for ease of medication administration. It appeared to be a rather routine surgical procedure and didn’t question the skill of her surgeon. Right after the procedure my brother Andy and I were informed that a potentially serious complication had occurred. It seems the surgeon damaged the artery and she needed to be stabilized before a second procedure to repair. This time we spoke extensively to the new surgeon and became concerned when he mentioned they were searching for adequate stockpiles of her blood type for the surgery. After our discussion I could tell he wasn’t a fan of the first surgeon. While in the surgery waiting room, the surgeon appeared, gave us assurances the surgery was successful and, with a smile, stated he was happy to fix the problem caused by his associate.

Two other hospital stays resulted from something which turned out to be a common occurrence with this type of cancer. She was registering a very high 103+ degree fever in a matter of minutes. Both times I called the oncologist nurse service but ended up calling an ambulance. Finally I called a friend who worked for a fantastic cancer management company located in Raleigh North Carolina, Biologics. I wish I had done this earlier as he arranged for a quick conversation with one of their Oncology Certified Nurses. She immediately instructed the fevers were most probably, tumor fevers, very common which come and go.

(Learning Experience) It is absolutely true someone needs to pay very close attention/stay when a loved one is hospitalized. Concerning the surgeon, we did not question his qualifications/skills. Looking back, I believe we could have avoided this by simply questioning the nurses.

Understanding what is and what is not common to the cancer type/stage is a very critical issue. If the oncologist provides the information typically is not comprehended. Caregivers need to understand the complexity and identify sources for information.

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Cancer–Navigations of a caregiver March 23, 2010

Posted by medvision in Cancer Care, Chronic Disease.
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Three of the most devastating words in the world, “you have cancer.”  Most of us know of someone close facing cancer, many will become the caregiver for a cancer patient and some will face this disease personally. Years prior, my Mom had been diagnosed and treated for breast cancer. My family had always considered her a breast cancer survivor. So, 3 years ago, I was rattled to stark reality when my brother called saying, “the doc thinks Mom may have bone cancer.”

To back up, I’d been living in Florida for 20 years, and Mom lived, alone, in Tennessee. I’d been working providing health risk/quality management consulting services for mid to large employers,sponsoring self-funded medical benefit plans. I remember thinking, we’ll take things one day at a time, and I should have a “leg up” helping her manage her disease/process. I traveled to Tennessee and moved into my Mom’s house. (I already thought I was at a huge advantage as I could live with my Mom, work via WebEx and call on my brother’s assistance if I had any business travel)

By the time I arrived and unpacked, my Mom had already decided to go with a therapy the oncologist recommended, Gemzar. She remembered this will be relatively mild as it leaves hair intact.  Gemzar (Gemcitabine HCL) is a chemotherapy treatment which attempts to disable/slow/destroy cancerous tumors by a poisoning with a chemical compound. Maybe this was the mildest stuff available. After 3 weeks on therapy, we jointly decided to withdraw as her health was suffering to the extent I was worried she couldn’t survive. It took 3 additional weeks for her to recover to a state of what I considered normal. 

(Vital learning experience)–Other than providing emotional support and transportation, I’d flunked my introduction to caregiving. I failed to study, inquire about the side effects of Gemzar, or even question the physician’s treatment why he’d prescribed the drug. As important as the question of why, I’d missed the next question: “What happens if she decides not to take Gemzar”? Cancer is like no other disease. By its very definition, it tends to defy logic and reacts poorly to concepts we think of as evidence based treatment. By Mom’s next visit, I was armed (I thought) with insightful questions and suggestions. Prior to walking into his office, I picked up a cancer glossary similar to the one here. http://www.cancerindex.org/glossary.htm I had not scratched the surface!

Cancer-A scary subject-taken head on March 11, 2010

Posted by medvision in Cancer Care.
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I read an article from BusinessWeek this morning titled Lessons of a $616,616 Death . It’s a story of courage, determination, suffering and prolonged life. In future posts I will relay my own cancer story, a 13 month experience as a 24/7 caregiver for my beloved mother facing advanced breast cancer. As the story above, my experience was an ever-changing mental and physical roller coaster. In my opinion the above case represents situations in which the high dollars should be spent. Many of us are trained to rely on evidence-based medicine. Cancer throws this concept for a loop. More to come.
View the Article:
http://www.businessweek.com/magazine/content/10_11/b4170032321836.htm

Who’s buried in Grant’s tomb? March 1, 2010

Posted by medvision in Chronic Disease.
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Ulysses Grant? An old mind puzzle.

I feel the same reaction each time I see another article written in the national press asking, “why are healthcare costs rising so rapidly?” The answers given are amazing. Some experts point to technology… or it’s too easy to see the doctor…or we don’t understand the components of healthcare costs.

Our Centers for Disease Control and Prevention state 75% of our national healthcare expenditures are utilized to treat chronic disease. This does make sense as healthy people don’t seem to utilize intensive hospital-based care systems or utilize expensive drugs. So, yes, the answer is our healthcare inflation is due to increasing rates of population-based chronic disease.

Chronic disease is the cause of inflation in public plans, Medicare/Medicaid and employer-provided clients, whether self-funded or fully insured. This subject needs to be the focus of every discussion concerning healthcare. Yes, we do need to become better consumers of healthcare, and I agree, certain individuals do over utilize services.

Here’s a truism which encompasses my entire client base. When physician provided screenings increase, and employers focus on member-driven wellness strategies, the cost per member per month decreases. Physician directed/reinforced diet, exercise and pharmacologic therapy prevents catastrophic medical events.

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