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Posts made in May 2019

Choices three paths

Choosing the Right Protocols for Treatments, Screenings, Medications

One of the most confusing aspects of dealing with any health issue is determining what your options are for treatment and which options to choose.  This becomes particularly confusing and difficult when you are already stressed about the mere fact that you have been diagnosed with a medical condition.

For example, among the choices for care and treatment of early stage prostate cancer are the following:

  • Active surveillance – Wait and see what develops with close monitoring by your physician, including frequent blood tests and biopsies
  • Surgery – Usually recommended for individuals younger than 70 who are in good health. The strategy is to remove the prostate, realizing that there may be side effects and radiation may follow.
  • Radiation Therapy – Recommended for men of any age with early stage prostate cancer, particularly for individuals who have health concerns, and therefore who are not good candidates for surgery, and for individuals who have had surgery and need further treatment.

What do you choose?

Another example are  patients diagnosed with multiple coronary artery blockages.  Is the right answer to have stents put in; to go for the more extensive coronary bypass surgery; or to avoid all invasive surgery and medicate to see if that resolves the problem?  Unfortunately, in spite of many years, of experience, and many studies, there is not enough evidence that shows better survival benefit from coronary bypass over stents. Additionally, many patients with coronary artery disease do just as well with medication.

For patients who require a  hip replacement there are also options:

Total hip replacement; where both the thigh bone (femur) and the socket are replaced with synthetic implant materials

Partial resurfacing, the most bone-conserving approach to hip surgery, where only the femoral head (where the leg joins the hip) is reshaped and resurfaced and the hip socket (acetabulum) is left completely intact. The benefit with resurfacing is that the patient keeps most of his or her own bone, which allows for easier revisions in the future (if one becomes necessary). These differences could mean improved outcome, smaller incisions that heal faster, less blood loss and shorter hospital stays.

For patients who are dealing with diseases such as diabetes and hypertension, there issues about whether to embark on extensive medication treatment, or change your diet and lifestyle, or do both.  Generally, it is only with trial and error that you can determine what will have the best result for your individual situation.

Here are some tips and guidelines to help you determine the best options for you, no matter what your medical specific issue:

  1. Proactively do your research including: reading articles, talking with friends and family, checking with reputable online networks and communities for specific experiences of other individuals who have a similar condition.
  2. Engage in an interactive discussion with members of online social networks to help you learn about available options.
  3. Seek a second, even a third opinion from qualified specialists.
  4. Create a chart listing all of the risks, benefits, side effects, and contingencies.
  5. See what your family feels is best for you. Some options work better with your lifestyle than others and it is wise to solicit the thoughts of those closest to you.
  6. If you still have questions, consult your primary care doctor who knows you best and can assist with the final decision
  7. Be sure you have a trusting partnership with the specialist who is treating you so together you can make the best decision.

 Dealing with the Medication Option: Benefits and Problems

More than three out of five American takes at least one medication daily.  This increases to several medications, often several times a day, with aging.  The unique characteristics of different medication therapies include the frequency and timing of doses; the number of medications required; and associated side effects, all of which can be challenging. Additionally, various medications specify different requirements e.g., “Take with food,” “Take on an empty stomach,” all of which leads to extensive confusion and ultimately medication non-adherence.

According to the World Health Organization, medication adherence can have a more direct impact on patient outcomes than the specific treatment itself. Medication adherence can affect quality and length of life, health outcomes, and overall healthcare costs. Non-adherence can account for up to 50% of treatment failures, (around 125,000 deaths), and up to 25% of hospitalizations each year in the United States. Typically, for each individual case, adherence rates of 80% or more are needed for optimal therapeutic efficacy. Adherence rates often go down over time, after the initial prescription is written, or as barriers emerge or multiply. .People are prescribed medication and for a variety of reasons including the high unaffordable cost, the highly complex knowledge required to understand why the medication will help, the difficulty administering the medication to yourself, and unpleasant side effects that often come when you begin a medication and last for a longer period of time than you would like to tolerate, adherence drops.

We know that medication non-adherence has significant health implications ranging from decreased quality of life and poorly managed symptoms, to death. There is also a cost factor to the health system the burden of which we all assume. Upwards of $300 billion of avoidable adherence annually in the U.S., comprises up to 10% of total health care costs.  Thank of what that much money could do to solve some of our healthcare crises

Questions to consider about treatment with medication include:

  • Do you understand the reasons why it has been recommended that you take a specific medication?
  • Do you understand how to take the medication?
  • Do you know how often and in what dose to take the medication?
  • Will the prescribed medication interact in a negative way with other medications you are taking?
  • Are you allergic or sensitive to any of the ingredients?
  • Will the prescribed medication impact other health conditions you have (e.g. blood sugar, heart rate, joint pain, etc.)?
  • Are the side effects of this medication temporary or long-lasting, and can you tolerate them?
  • Will you be able to administer the medication by yourself?  at home?
  • Is the medication cost affordable so that you do not end up rationing it and causing more extreme long-lasting problems?

Medicine and disease in the 21st century are complex and our system lacks the needed support that patients require in order to choose the right options for treatments, screenings and medication.  Compounding that is the enormous issue of how patients are able to pay for the healthcare that they need to stay healthy and alive.   There are no easy answers, but better collaboration and communication between patients and their providers would be a start toward making the situation tenable in these times of turmoil.