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Demystifying Medicine One Week at a Time

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End of Life Rallies

Let’s say your loved one is at the end of life. She’s 84, with advanced cancer that is no longer treatable.

A decision has been made to put her in hospice–which is a level of care more than an actual location. [Most hospice actually occurs at home.]

The patient waxes in and out of consciousness, sometimes lucid, but mostly not.

While no one is ready for her to die, this end-of-life process brings some solace–it’s what your loved one has indicated she wants, and the time at home without aggressive, often fruitless, medical treatment, allows other friends and family members to make visits and share stories.

One afternoon, she perks up and asks for a sandwich. This is surprising, because she’s barely eaten anything in the last ten days. But we get her that sandwich!

She nibbles at it, happy, but doesn’t eat much of it.

That afternoon, she’s talkative and engaged with others in a way that she hasn’t heretofore seemed able to muster.

Is she making a comeback? Healing from her illness?

More likely, this is what is called “rallying,” and while there’s ample anecdote of its occurrence in situations like this, we have very little understanding of it.

How does it happen? As a recent NYTimes article stated:

Physiologically, experts believe that the mind becomes more responsive when a hospice patient is taken off the extensive fluids and medications such as chemotherapy that have toxic effects. Stopping the overload restores the body to more of its natural balance, and the dying briefly become more like their old selves.

It’s deceiving because we think our loved one is getting better. And while she’s more like her old self, unfortunately, it’s not bound to last. Which is why it can be upsetting for some.

Spiritually, some suggest that the dying loved one is simply readying for transition–making sure that earthly concerns will be attended to in her absence and that final goodbyes may be uttered.

I’ve seen it–and especially in elders afflicted with dementia, it can be heartening to see them rally and seem to know what’s going on–accepting their impending death, and engaging with their loved ones before drifting off.

Can your city become a Blue Zone?

 

Tulsa is on a roll. With recent announcements about the openings of Gathering Place and a new Amazon fulfillment center, good news abounds. This week we have another opportunity to keep it rolling.

On Tuesday and Wednesday, our city will host visitors from Blue Zones, who will be here to help determine whether our community has what it takes to become a Blue Zone city.

What are Blue Zones?

Explorer Dan Buettner traveled the world to find the places where people live the longest and healthiest. In these places, which he named Blue Zones, people routinely live to 100 years of age, while still active and engaged.

Buettner formed a company to share the knowledge and practices of Blue Zones, and these initiatives have spread across more than 40 U.S. cities in nine states.

Blue Zones projects are designed to unite our community behind a common goal: transforming environments so there are more ways to make healthy choices easier.

More places to walk and bike outdoors. More healthy foods. And more purpose. All of which leads to more years to enjoy it all.

The Blue Zones matrix is not a turnkey solution. Their experts work in a diverse array of communities and bring scaffolding upon which we can build our own programming. We Tulsans must lead the way on implementation and operation.

Buettner will provide the event’s keynote address in a public presentation 6 p.m. Tuesday at OU-Tulsa’s Perkins Auditorium at the Learning Center on the Schusterman Campus.

Wednesday there’s an event called “Wine @Five,” which celebrates the social health aspects of Blue Zone communities. In addition, you’ll have the opportunity to meet Blue Zones personnel and many of our community stakeholders, ask questions, and share ideas. That event will take place at 5 p.m. at TCC’s Center for Creativity.

RSVPs are encouraged but not required.

Both events are free and open to the public — you can learn more about them and RSVP at this website: go.bluezonesproject.com/tulsa.

We hear all the time about how dismal our health outcomes are in Oklahoma. More people smoke, are overweight, and suffer from diabetes, mental illness and cardiovascular diseases than national averages.

We are near the bottom in terms of life expectancy, health promoting behaviors and access to health care. Nationally, our model of health care has emphasized the dousing of fires (“rescue care”) rather than fire prevention.

When I talk to patients, I boil down prevention to a few simple precepts that are easy to say but harder to do. Regular practice turns them into healthy behaviors. They are:

  • Get enough sleep.
  • Move your body throughout the day.
  • Eat well — a healthy assortment of foods. Mostly plants, and not too much.
  • Interact socially. Isolation is not good for the body, soul or mind.
  • Take some time to reflect on what you are grateful for.

These behaviors are practiced in Blue Zones across the world. They are not unique to those areas, and they can be more easily achieved here in Tulsa.

If finding a way to make life healthier as a core value speaks to you, then come learn about Blue Zones.

In addition to the two public events I mentioned earlier, there will be several theme-based focus groups taking place throughout the region on June 27. You can learn more about these at go.bluezonesproject.com/tulsa.

This week’s Blue Zones visit to Tulsa did not happen by chance. Many partners have been involved in bringing the site visit to life — including Mayor G.T. Bynum’s Office, the Tulsa Regional Chamber and the Tulsa Health Department. Local businesses, nonprofits, foundations and educational institutions have contributed time, talent and money to bring Blue Zones to Tulsa.

Here’s hoping that Tulsans can live healthier and longer and keep our city on a roll.

Dr. John Henning Schumann is president of the University of Oklahoma — Tulsa.

 

Costs of Care Redux: Extremis Edition

It’s not new to GlassHospital readers, but coverage of outrageous health care bills in the United States is having a bit of a moment.

At least two major news sources, NPR and Vox, are running series in which people who have received bills for health care that seem outrageous can share them with investigative journalists and get help.

Based on the success of her book An American Sickness, doctor/journalist/editor Elisabeth Rosenthal and Kaiser Health News are working with NPR to produce one of these stories for web and radio every month.

Story #1 told of a urine test (screening for drugs) that was billed at $17,850. This is not a joke.

Story #2 compared the difference in price between the same CT scan performed at a hospital vs. a freestanding radiology center. [Hint: hospitals are MUCH more expensive places to get tests done.] The same CT scan of a man’s abdomen performed at a local hospital was billed at thirty-three times the price of the outpatient center.

The most recent story featured a disabled Oklahoma librarian, who had surgery on her arthritic foot. When she had sticker shock at the charge of more than $115,000 for her surgery and three day hospital stay, she did a smart thing and asked for an itemized bill. The most outrageous finding? A charge of $15,076 for four tiny screws implanted in her foot.

The moral of these stories is a) hospitals and laboratories can egregiously mark up their prices, without warning, clarity, or fairness; b) if you are faced with such a bill, you simply MUST ask for an itemized list of charges if you want any hope of contesting them.

If you think charges for actual care can be outrageous, how about being charged for NOT getting care?

Vox tells one woman’s story of fainting, going to a nearby Emergency Department, then declining to be treated. Why did she decline? Fear of an exorbitant bill.

So what happened?

After being given an ice pack and a bandage, she declined treatment, went home, and subsequently received a bill for $5,751.

J.P. Berkazon

It was a big story: It held the news cycle for more than 24 hours, until something about some memo sucked up all our oxygen.

It was about business. And health care.

BIG businesses doing something to TRANSFORM health care.

The announcement caused the stock prices of other big companies in the ‘health care space’ to drop.

We’re still fuzzy on the WHAT.

As to the WHO: Amazon, Berkshire Hathaway, and JP Morgan Chase. The three behemoths plan to come together to form a non-profit entity to ‘disrupt’ health care.

The WHY: health care for their > 1 million combined employees (and all over the U.S.) costs too damn much.

The headlines were breathless, e.g. Forbes: “Amazon, Berkshire Hathaway, and JP Morgan Could Disrupt U.S. Health Care and Capitalism as we Know It.”

Capitalism as we know it.

It’s a great story. It has compelling figures. I, like many, want to believe that it’s possible to disrupt our piecemeal, overwrought, and insanely expensive health care non-system.

Many others have tried. And failed.

Here’s a contrarian view on the big announcement from a seasoned observer. Is his skepticism warranted or can Amazon and friends do for health care what they’ve done in retail and web services?

What do you think? Can J.P. Berkazon crack the U.S.  health care nut?

@GlassHospital

“The Future, Mr. Gittes. The Future!”*

The announcement of the proposed takeover of Aetna (a health insurer) by CVS (a drugstore chain calling itself a “pharmacy innovation company”) has become a big news story. What does it mean for U.S. health care? More importantly, how will it impact us as individual patients (what some like to call “customers”)?

I don’t know.

I’m not sure anyone has clarity on this yet. We’ll have to wait and see if the deal goes through, and then how the behemoth merged company brings efficiency or monopolistic pricing to the market.

Or both.

But if you want some other visions of the health care future, think about a hospital without patients as is detailed in this article from Politico.

Mercy Virtual, which opened in 2015, calls itself “the world’s first and only facility of its kind.” The 125,000 sq. foot building houses health professionals who remotely monitor and consult for dozens of hospitals and ICUs. It’s all done telephonically, er, remotely, errr, virtually.

[Another article in that same Politico issue makes the case against hospital beds, on the basis of bed rest being counterproductive for nearly every medical condition we treat. I used to get frustrated watching people ‘decondition’ while laying around in bed. It’s a serious problem, especially in the elderly.]

Which leads directly to another future question: is the age of the virtualist upon us? Yes, as predicted in a recent JAMA column by Dr. Michael Nochomovitz, who makes the case for a medical specialty devoted to care of patients through technology.

It may be the way of the future, but it sure makes performing physical exams harder.

These times. They are a changin’.


*Chinatown. Noah Cross (played by John Huston) to private investigator J.J. Gittes (Jack Nicholson). 

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