Canton Repository, Dec. 25, 2007
BY DIANA ROSSETTI, REPOSITORY LIVING SECTION WRITER
Repository Scott Heckel
PULLING TOGETHER When one member of a family is managing multiple diseases, the entire clan is affected, said Karen Long, shown here with her husband, Kenneth (third from left), and children Ryan, 21; his fianc�e, Khristie Wagner; Chelsea, 18; and their dog Toby. Karen, 45, suffers from a number of diseases, including diabetes, coronary artery disease, migraines and fibromyalgia. |
MASSILLON -- If Karen Long had to deal only with the diabetes that has held her captive 40 of her 45 years, it would be challenging enough. But Long is one of the growing numbers of those facing multiple chronic diseases.
Married and the mother of two, Long also suffers from coronary artery disease, fibromyalgia, peripheral vascular and arterial diseases, degenerative disc disease, small vessel disease and arthritis in her spine.
One patient plus several diseases equals more frequent hospitalizations, possible treatment conflicts and escalating costs of care.
Dr. Charles E. Smith, the endocrinologist who treats Long, said his practice is representative of many in which physicians help patients manage multiple diseases.
"Endocrinologists get involved in a lot of that because the great majority of adult diabetics have high blood pressure, cholesterol problems and heart disease," explained Smith, a Canton native who practices at Aultman Hospital and Mercy Medical Center. "Add to that the usual complications of nerve damage, foot ulcers and eye and kidney problems. And they are starting at a younger age than you would think."
Debilitating pain and fatigue are Long's constant companions. She takes 11 prescription medications daily. Diabetic seizures that had been controlled for years, recently reappeared. She has had surgery to open arteries in her legs. Two stents to keep blood vessels open have been placed in her heart, another two put in her abdomen. She was hospitalized two weeks ago for bleeding ulcers in her esophagus.
"I told my mom suffering makes you wise," she said with a rueful chuckle. "My attitude is I'm never in trouble until they tell me my condition can't be fixed."
KEEP LOOKING
There are support systems in place for Long and others like her, said Patty Sedello, a registered nurse and case management director for Aultman Hospital. Her department is staffed by registered nurses and social workers who act as liaisons between patients and insurance providers, many of which now have their own disease management programs. They also suggest community resources for specific patient needs.
"We make referrals to United Way, to home-care agencies, Trillium, the American Cancer Society, a wide variety of agencies," Sedello said. "We kind of consider ourselves air-traffic controllers. We have that global view. We help steer families and maybe prompt them with what questions they may want to ask their physician to get the best care."
Other area hospitals provide similar services.
Patients with multiple diseases are a challenge for health-care insurers, Dr. Smith added.
"Sometimes getting coverage for things you know would help prevent complications for disease down the road is tough. But the extra expense now could help save money later," he explained. "But with people changing insurance all the time, there was no incentive to do that. But more and more companies are realizing that, though people change jobs, they may have them as patients later on as well."
Establishing a partnership with a pharmacist is a key move for these patients. Multiple regimens of treatment call for a panorama of prescription medications, some of which could cause troubling interactions, observed Mark Giangardella, a pharmacist at The Medicine Shoppe on Tuscarawas Street W in Canton.
"A lot of studies have shown that by managing these diseases, we are increasing life expectancy," Giangardella, a 26-year veteran, explained. "But it is important to watch them closely, because you could have a patient on a cholesterol medication and also a medication to reduce high blood pressure. But when the drugs are broken down in the body, sometimes they are competing with each other. The blood-pressure medicine could cause an increased level of the cholesterol medication in the blood. That is why these patients usually are getting blood work done on a regular basis, monitoring liver and kidney functions."
When multiple prescription drugs are taken, patients often consult pharmacists for advice on which over-the-counter medications are best and safest for colds, headaches or joint pain.
"It does matter what you take over the counter in these situations," Giangardella advised. "I question them on what kind of pain or inflammation they are having. Acetaminophen, like Tylenol, is a pain or fever reducer. And it has minimal anti-inflammatory properties. Ibuprofen, like Advil or Motrin, basically is anti-inflammatory and a fever reducer. But it does help with pain because it reduces inflammation. Aspirin is an anti-inflammatory and fever reducer. And naproxen, like Aleve, is along the same lines as ibuprofen."
Many insurance companies are assisting pharmacists, he continued, in electronically tracking patients' medications when they fill prescriptions at different pharmacies.
"One thing we see as people move through is that it is such a cumbersome system," Sedello commented. "Families need to really stay attuned to what's going on and ask questions and be involved as much as they can. And listen to the answers. We might see what somebody might need or benefit from but people have the right to make bad decisions. We try to guide them as best we can."
Reach Diana Rossetti at (330) 580-8322 or e-mail:
diana.rossetti@cantonrep.com
FORMULATE A BATTLE PLAN
A recent Consumer Reports health feature listed key strategies for dealing with multiple diseases.
- Identify: Pinpoint specific difficulties you face, such as drug side effects or financial worries.
- Prioritize: Arrange those problems in order from most to least vexing.
- Communicate: Ask your doctor to focus on your most important problems.
- Collaborate: View your doctor as a partner and seek others such as pharmacists, nurses, patient advocates, financial counselors and fellow patients who can help resolve your problems.
- Educate yourself: Learn about your diseases from classes or reliable books, articles or Web sites.
For information, log onto
ConsumerReportsHealth.org.
