Medical decisions

 

A while back I wrote a post Back to the beginning, We all bring something to the table.  Lately I have trying to apply some of these tactics to a series of medical decisions that I have had to make.  These decisions address a series of chronic conditions that I deal with.  Some of these conditions I have been dealing with for decades and some are more recent.  The basic issue that has come to light is due to the following circumstances:

• Multitude of doctor visits
• Different unrelated conditions
• Unknown relations between conditions
• Overload of information or information no layman can easily understand
• Multiple medications prescribed by different physicians

All of this has lead to a very unsettling situation.  Most unsettling is what to do next to improve my health.  What decisions and outcomes do I focus on to improve my health situation.  Before this evolves into a personal pity party I am not much different than anybody in their early 60's.  Many friends have had hip and or knee replacements.  Like most Americans I have a few extra pounds I should shed.  I do have two chronic conditions that many do not have to deal with.  One is a seizure disorder that appeared in my late 20's.  I have been on medication to keep this under control.  The medications have had a few minor side effects but have mostly kept the seizures under control and have allowed me to retain a drivers license.  The second is a heart condition described as a "leaky valve".  This has a heart murmur associated with it.  It is also accompanied by atrial fibrillation (afib).

Heart conditions are not anything surprising in older populations.  Most of us know people that have had sudden heart attacks.  A heart attack is an acute condition.  Acute conditions push all other health concerns to the back burner and the condition is immediately addressed.  When I experience a seizure that condition is immediate and vigorously addressed by the medical personnel.  A chronic medical condition is one that exist but does not require immediate and vigorous intervention.  Arthritis is mostly a chronic condition for most of us.  It generally causes discomfort and pain.  Many intermediate measures may be undertaken to manage the pain.  Only when the pain becomes severe, vigorous intervention is required.  These vigorous measures may be procedures such as joint replacement.  Once my seizure is controlled it becomes a chronic condition that is addressed through medication and non medical habits (mostly proper sleep).

So my dilemma is how do I address a multitude of chronic conditions, with multiple doctors, and a multitude of courses of action.  All trying to improve my health.  This sounds similar to the issue in the post I referred to above.  The underling theme of the previous post is that we have a lot of tools to deal with topics in which we have no formal training.  However none of this has relieved my current frustrations over my health decisions.  A different approach is needed.  A tactical approach is dictated.

Step 1 Assess each individual care provider:  Two criteria for this. One, is this provider necessary?  Sometimes this takes care of itself.  I saw a dermatologist because my wife noticed spots on my back.  the dermatologist looked at them and decided that they were not an issue and I do not need to see him again.  In order to maintain my drivers license I have to be under the care of a neurologist, so I continue my yearly visits and I follow his health plan.  The second criteria is the level of care.  Am I getting a level of care that is furthering my health goals?  Am I comfortable with the level of care.  Contrasting 2 of my providers;  my cardiologist (very happy with) and my sleep doctor (not happy with).  My heart condition was discovered by my GP and I was referred to the cardiologist.  My cardiologist confirmed the diagnosis by listening to my heart with a stethoscope and in the ensuing months ran a series of tests and prescribed a series of "fixes".  After the fixes tests were rerun to see of they any affect.  Eventually my cardiologist suggested that sleep apnea may be a factor.  The sleep doctor did a sleep test to confirm the apnea and prescribed a CPAP machine.  Like most I struggled with the CPAP machine but I did eventually become somewhat comfortable with it.  My frustration with the sleep doctor is in the follow up.  Sleep apnea can be caused by many things.  I asked the sleep doctor if they were going to investigate this further to better define the cause of my sleep apnea.  The answer was no.  The CPAP machine "fixed" my problem.  When I pressed the issue I was told that I could go see an ENT (ear/nose/throat) doctor,  then return and they would rerun the sleep test.  They had no interest in investigating and diagnosing my issue.  I came to the conclusion that I was not their patient I was a revenue stream.  I think I will look for a new sleep doctor.

Step 2.  Look for consistent messages.  Ask any medical professional how to improve your health and they will return with good diet, exercise and sleep.  They may even be more specific; limit alcohol, decrease fried foods and limit red meat.  An obvious example is exercise.  My cardiologist may suggest taking up running as a way to improve cardiovascular health.  However my Orthopedic doctor would probably not suggest it.  However I was  surprised at how many of my doctors suggest bicycle riding.  My Orthopedic Doctor is all for it since it is easy on my knees.  My cardiologist is all for it as a way to improve my cardio.  There was a poster in my urologists office promoting cycling as a way to improve urinary track health, this was a bit of a surprise to me.  Making the correct dietary choices can be a bit more difficult.  Rather than a list of what to eat a more tactical approach is needed.  I can across this site from Kaiser Permanente that suggest a process for addressing dietary needs when dealing with multiple health concerns.

Step 3. Take Notes and share them with your doctors.  I am not sure how well this would go over with some doctors.  I am not sure if they would like me taking notes in their office.  Also Doctors do have other patients and cannot take spend too much time waiting for me to write things down.  However most doctors do have waiting rooms and I can't think of any reason why they would stop you from sitting there and jotting down a few notes.  Many physicians will actually give you a printed summary of their findings and test results.  These really should be summarized in a journal so that it can be referred to when shared with another doctor.  Sleep habits can affect seizures.  On my most recent visit to my neurologist I happened to mention the the sleep apnea and my use of the CPAP machine.  I do not believe that I had mentioned the sleep apnea before.  When I did he explained that there is a relationship between sleep apnea and seizures.  The relationship is not well understood.  However my neurologist felt it was important for him to know about it.  I can barely remember what happened in the last month so I feel that a written history of medical visits can be quite beneficial.

The goal of all this is not to become a multidiscipline physician.  I am not trying to gain all the knowledge to second guess any medical professional.  Also I am well aware of the basics when it comes to a healthy life style.  It is important to eat right and exercise.  The goal is to manage all the information we receive from a series of doctors and make sound decisions to improve our health.