Patients Are Powerful

My patients are powerful and I listen to them. Though I like to think of myself as the Ultimate Chiropractor or the Preeminent Bone Man because I palpate, examine, and adjust bones all day long as part of my chiropractic treatment protocol, I have to say that my patients teach me every day that there isn’t a “one size fits all” approach to the human body. Sadly, medical doctors often feel compelled to approach there patients as if there were. Though there are many, many case studies that prove my point, being a Bone Man, I was especially interested a new study that suggests that many women who get screened for osteoporosis (a bone-thinning disease in which bones become fragile and vulnerable to breaks) may not actually need such testing.

“Expert” guidelines suggest that women age 65 or older should get a bone scan, and many women feel that it is better to be safe than sorry. But in this case it’s not the case. There is a “downside” to unnecessarily exposing the body to X-ray. And, in addition, treatment is often given in “borderline” low bone density cases. In these cases medical doctors often feel “compelled” to treat these women, often unnecessarily, with risky bisphosphonate medications, hormones, and other drugs that carry extremely negative side effects such as increased odds of stroke, breast cancer, and heart disease, and in rare cases thigh bone fractures and even bone death of the jaw.

Researchers found that of 615 women who underwent osteoporosis screening at Connecticut clinics, 41 percent did not meet those criteria. Forty-one percent!! As an advanced chiropractor, I am dismayed at that percentage rate!  My suggestion? If you are in a high risk group of women, like those who smoke, ask for a bone scan. But, if you are a women who sees her chiropractor regularly to keep her musculoskeletal system in good shape, and you eat nutritiously with a well-balanced diet rich in calcium and vitamin D, and you get regular exercise, you may be wise to just say “no!” to bone scan that you most likely don’t need.

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Back pain caused by pressure on the sciatic nerve can be excruciating and debilitating. Sciatic pain can interfere with the simplest pleasures in life. Even sitting through a movie at the theater seems to come at a price, i.e., pain that radiates down one or both sides of the buttocks, into the thigh area, and even into the knees. And, though there are support belts that may help, and chiropractic adjustments that may help even more, the best way to get rid of sciatic pain and keep it away is through sciatica stretches. Nothing is more empowering to a patient than to be able to take a significant role in their own recovery. Whenever back pain arises, a patient can offer himself or herself an instantaneous treatment by stretching the muscles in the low back. There are a number of good, extremely effective stretches that can be found online with a simple “google” search.

So, feel your power all of you sciatica sufferers. You are your own “best friend” when it comes to pain relief!

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Patient advocates who assist nursing home residents beware: Alarmed by the cost of providing health insurance to their employees, many nursing homes and home care agencies not only do not provide health insurance to their workers, or pay wages so low that employees cannot afford the coverage that is offered, but many are lobbying for exemption from the new health care law. As one who writes health articles regarding senior health care issues, I feel obliged to consider how uninsured nursing home workers might affect the health of nursing home residents.

It is a well-known fact that uninsured individuals are less likely to seek treatment for illnesses. Hands-on nursing home attendants who are not insured may work while they are contagious, infectious, and communicable, which can be a death sentence to elderly patients whose immune systems are already comprised by age and illness. In addition, even if an nursing home worker is not contagious, his or her untreated untreated condition might still impair mental and physical dexterity when needed.

Starting in 2014, the new health care law will require employers with 50 or more full-time employees to offer affordable coverage or risk paying a penalty. For a midsize nursing home, that penalty could easily exceed $200,000 a year. Nursing home executives are urging Congress and the Obama administration to spare them from the penalties.

Patient advocates should join nursing home workers against this grievous treatment of employees that endangers everyone associated with patient care, including the patients themselves. Someone in the Nursing Home and Home Care agencies is making plenty of money on the backs of nursing home and home care employees! It is scandalous for these agencies to be lobbying for special treatment and it would be more-than-scandalous for Congress or the administration to relieve nursing homes of the obligation to provide coverage to employees!

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A “healthy” organ donor is, of course, ideal when it comes to organ transplants. A body damaged by accident and injury, but unaffected by, i.e., not infected by, disease has the potential to give full-life expectancy to those in need of an organ transplant. But, what about those patients who are not expected to have a “full life” even with a much-needed transplant? I am talking about people living with H.I.V. As a chiropractor, I have a number of patients who come to me for regular chiropractic care who are living with H.I.V., and some of them suffer from kidney damage, either from the virus, itself, or from the medications that extend their lives. These days, the organ-donor waiting list is long…very long. And, with the continued rise in poor health among U.S. residents, the list does not appear to be shortening in the near future. Time is a critical issue for H.I.V. positive individuals who, literally, have no time to wait!

If there is good news at all, it is this: There is a potential source of kidneys and livers that, up until now, has been off limits — organs from donors who test positive for H.I.V.. It is at present to transplant these organs even to others who already have the virus. But health experts, and even federal health officials, are calling for repeal of the provision that bans such transplants, a 23-year-old amendment to the National Organ Transplant Act. And, according to research at Johns Hopkins, approximately 500-600 H.I.V.-infected kidneys and livers could become available each year!

Time is a precious thing for all of us, but for those who are H.I.V.-positive, time is truly of the essence. A wait on a long organ-donor waiting list that shows no sign of shortening is not time these patients have to spend, especially when there are, to put it bluntly, organs that are “customized” for their individual needs and would be excluded from the needs of others. According to the director of the Office of Blood, Organ and Other Tissue Safety at the C.D.C., there is no reason why H.I.V.-positive recipients shouldn’t get transplants and that H.I.V.-positive donors can’t be used.

One day soon, a cure for AIDS and the virus that causes it may be found. If the lives of those living with H.I.V. can be extended with the gift of an organ from those power patients who understood more than anyone else what it means to live each day with the clock ticking, then it is time to take the “stigma” out of this organ transplant issue and let us give “life extension” equally to all.

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Patients are powerful, especially when they have resources available to them. As a chiropractor who has a “live chat” feature on my website, I was impressed to learn that the Patient Advocate Foundation (PAF) also has such a feature. There is a plethora of information and a complete section on patient education on the website. Plus, it offers a number of patient services such as assistance with arbitration, mediation and negotiation to settle issues with access to care, medical debt, and job retention related to patient illness. But, the best thing that this particular website offers is a “live chat” function. I have found that many seniors find talking to a “real” person not only more helping than trying to negotiate website directions, but also comforting. And, isn’t that what we, health care providers and patient advocates, want for our patients? A one-on-one conversation can ease frustration and clear confusion in all patients who need help, but in my opinion, it is our senior population who desires this feature most.

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How many patient advocates does it take to fill the Cow Palace in San Francisco? A lot! But, those who were there over the weekend for the two-day International Cannabis and Hemp Expo, were too busy to count! I am a healthcare provider who believes strongly in the legalization of marijuana for medical purposes.  It seems to me, and thousands of others, that patients should have the right to choose or reject marijuana as a treatment alternative for the ease of their pain and suffering. Let’s face it, there are far too many “legal” pharmaceuticals that are not only addictive, but also have extremely risky side effects.

Patients are powerful when they come together in such large numbers to uphold patients rights, to stand for freedom of choice when it comes to their health and treatment of their pain and disease. To make the case for “actions speak louder than words,” under a white-canopied courtyard young adults in baggy jeans and baseball caps smoked alongside aging hippies. (Bob Katzman, chief operations officer for the expo, said he obtained permission for the medicating area last year from the Cow Palace, which is controlled by the state, after years of negotiations, and he credited the recent push to legalize marijuana in part for the approval.)

Even though California voters approved a measure in 1996 that allowed sick people to use marijuana if they have doctor referrals and an identification card, marijuana advocates want to take their advocacy a step further. In November, California voters will be able to consider a ballot measure on whether to legalize and tax pot in California, making marijuana truly a profitable “home-grown” industry!

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Talking to a doctor (when you’re a patient in an exam room) isn’t easy. I’m not talking about those fleeting moments when you suspect the doctor of having “God-complex” issues that make you feel as if you won’t be heard unless you genuflect or get down on both knees. No, what I’m referring to is when you’re standing barefoot or sitting bare-bottomed wearing a paper gown, with florescent lights beaming down on you making you look even less healthy than you already feel. Under these awkward and embarrassing circumstances, with the doctor fully dressed and sporting the all-wise, highly-achieved white coat, while you’re lacking even the basic outer accouterments that might give a modicum of self-confidence, it’s pretty hard for you to get your thoughts in order and feel your patient power. Instead, when it comes to your asking questions about your health, medical condition, and treatment, you feel uncomfortable, anxious, and ineffective. The “power gap” is almost palpable!

It is uplifting to take note that, in the last decade, some medical schools have started trying to bridge this gap by teaching their med students “clinical communication skills.” Third-year and fourth-year students are actually being required to role play, i.e., face-to-face encounters with actors playing patients of varying ages with a variety of dispositions and diseases. The students are then tested to see how well they interview “patients,” conduct physical examinations, and convey exam findings to the patients. Obviously, their ability to be empathetic is a big plus.

The good news is that this type of training doesn’t stop after graduation. In fact, in March 2005, the Communication Skills Laboratory at Memorial Sloan-Kettering Cancer Center began offering a series of three-hour interactive workshops intended to give hospital oncology residents practice in “Breaking Bad News,” “Discussing Prognosis” and “Responding to Patient Anger,” among other touchy health-related topics.

Still, with all the emphasis on a doctor’s communication with patients, the patient advocacy side of the problem has largely been neglected. For instance, where are the guidelines for patients, such as “how to” or “when to” raise important questions that will help to calm the psyche without alienating the very person who may end up standing over them with a scalpel in his or her hand?

Unfortunately, the number of appointments (confrontations?) that require a negotiation between the doctor and the patient seemed to be on the rise, while the amount of time spent with a patient during a medical visit seems to be on the decline. How does a patient get the answers they need from their doctor, or how do they respectfully disagree?

A patient advocate is invaluable when it comes to helping patients prioritize the questions that are most pressing. Studies have shown that often the most important symptom or worry that a patient may have, such as a suspicious mole or lump, or even the feeling that life isn’t worth living, is often not on the top of a patient’s list, and such questions are frequently blurted out at the very end of an appointment because the patient was either afraid to ask the question or didn’t know how to prioritize it in the framework of a typical medical exam. In these instances, patients who have a patient advocate by their side can feel more confidant and be more assertive when requesting a follow-up meeting.

So, in this current healthcare climate, even when doctors are taught to listen attentively to patients, they are also well-aware that with low insurance reimbursements such attention comes time-constraints attached. The more a prepared a patient can be prior to a scheduled appointment with their doctor, with a list of prioritized questions in hand, the more patient power they will have.

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As a Chicago chiropractor, I wait anxiously along with my patients and the rest of the country for the passing of a new comprehensive and compassionate Health Care Bill. And, along with the questions of cost and inclusiveness that everyone is asking, I believe that we should also be asking if an overhaul of the U.S. heathcare system will include simplification? Let’s face it, our current system is not only horribly expensive and amazingly ineffective, it is inherently complicated. When a person is ill, and may be in need of surgery or recovering from it, the last thing that they should have to worry about are complex insurance issues, sorting through mountains of bills, making certain that the proper medications are given, and that appropriate arrangements for follow-up treatment are made. Thanks to the dedicated patient advocate, these questions often do get answered.

However, if the new Health Bill falls short of simplification, as most Congressional Bills tend to do, through patient advocacy, patients will still have the “extra strength” they’ll need in order to stay informed when talking to the doctors, in getting to see a desired specialist, in ensuring that the pills that they are given are the ones meant for them, and, if necessary, in negotiating for any additional help that they may require and the fees charged for the services.

This is just part of the great service that patient advocates provide today. And, I suspect that no matter what happens to the healthcare system in the future, with the scores of aging baby boomers demanding, as they should, to receive the proper and affordable health care they require, the patient advocate will still be a vital part of any health environment.

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Chiropractors, like me, often find that one of their patients is a caregiver to a family member who is suffering from a progressive disease. And, frequently, that disease is cancer. Family caregivers are truly the dearest of all patient advocates, and sometimes they feel helpless in easing the pain of their loved one. So I was very interested in a study, sponsored by the National Cancer Institute that found that family caregivers can significantly reduce the suffering of a family member who has cancer, through the use of simple touch and massage techniques.

Ninety-seven multi-ethnic cancer patients were chosen and they represented 21 types of cancer (nearly half with breast cancer) and all stages of disease. The caregivers included spouses, adult children, parents, siblings and friends. Researchers evaluated the outcomes of a 78 minute DVD instructional program and illustrated manual shown to the patients and their caregivers.

Caregivers in the experimental group were asked to apply the instruction for at least 20 minutes, three or more times per week for a month. Caregivers in the control group were assigned to read to the patient for the same amounts of time. Patients completed report cards before and after sessions rating their levels of pain, fatigue, stress/anxiety, nausea, depression, and other symptoms.

Companionship alone had a positive effect as the results showed significant reductions for all symptoms after both activities. But, even though symptoms were reduced from 12-28 percent after reading, massage from a caregiver led to reductions of 29-44 percent. The greatest impact was on stress/anxiety with a 44 reduction. This was followed by a 34% decrease in pain, a 32 percent decrease in fatigue, a 31 percent reduction in depression, and a 29 percent reduction in nausea. In addition, caregivers in the massage group showed gains in confidence and comfort with using touch and massage as forms of caregiving.

“Touch and massage are among the most effective forms of supportive care in cancer, but most patients cannot access professional practitioners of these methods on a regular basis,” said principal investigator, William Collinge, PhD, president of Collinge and Associates. “It appears that family members who receive simple instruction in safety and techniques can achieve some of the same results as professional practitioners. This has important implications not just for patient well-being, but for caregivers as well. Caregivers are at risk of distress themselves. They can feel helpless and frustrated when seeing a loved one suffer. This gives a way to make a difference for the patient, and at the same time increase their own satisfaction and effectiveness as a caregiver. It also appears to strengthen the relationship bond, which is important to both.”

The DVD program is now released to the public, titled “Touch, Caring and Cancer: Simple Instruction for Family and Friends,” in English, Spanish and Chinese. More information and video trailers are available at http://www.partnersinhealing.net.

Technorati Tags: cancer, family caregiver, research, touch and massage

As a chiropractor and a passionate healthy lifestyle advocate, high on the “health do to list” that I give to my chiropractic patients, young or old, is to stop smoking! And, though I know from experience that patients are powerful when supported and encouraged, I also know that different people respond to different stimulus, especially when they are trying to give up an insidious habit like smoking cigarettes. So, I was particularly happy to read on Discovery News (link below) about a virtual reality video “game” that, according to a new study published by the journal Cyberpsychology and Behavior will help people to stop smoking. I’d never really considered a video game to work so impressively as a patient advocate.

Researchers from Canada’s GRAP Occupational Psychology Clinic and the University of Quebec in Gatineau divided 91 smokers into two groups and enrolled them in a 12-week anti-smoking support program. In addition, each group played a specially designed video game four times a week. After entering a computer-generated virtual environment, one group of participants chased down floating cigarettes and crushed them while the other group crushed floating balls.

The study’s findings showed significant reduction in nicotine cravings among smokers in the cigarette-crushing group. At week 12, 15 percent of the cigarette crushers had abstained from smoking, compared to just 2 percent among the control group. During a six-month follow-up, while 20 percent of  ball crushers reported not smoking during the previous week, that rate reached 39 percent among the cigarette-crushing group.

The researchers were unsure as to why the cigarette crushers’ had a higher success rate, but they speculated that the virtual exercise may have further motivated their meeting attendance, as well as boosted motivation to quit smoking and increased confidence in the ability to kick the habit. The game also may have provided participants with positive associations to fight off urges, i.e., crushing cigarettes in the virtual reality environment may have conditioned smokers to resist their urge to light up.

For more on the study and a link to the GRAP’s study, visit Discovery News

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