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Archive for the ‘Healthcare’ Category

I am always surprised how easy it is for people to make decisions for their pets when they are too ill and need to be euthanized.

When it comes to health decisions for family members there are so many barriers including emotional ones. I find that even healthcare professionals cannot agree on the use of morphine for end stages of cancer. The main reason for addiction and to work around the reasoning does not make sense especially when the patient is termiinally ill and experiencing pain.

Somehow, there appears to be difficulty in making that responsible decision, yes the patient will die but given the morphine he/she will have an easier transition. This includes the family who are caught in the middle having to support their loved one and witnessing the suffering, feeling helpless and being forced to be put in advocacy situation.

It has been twenty years since my father passed away from cancer who in his last days was in severe pain and every dose of morphine had to be begged from the treating physician who was concerned about addiction for my father who only had days to live.

In a recent article on BBC World News the reader is informed patients in the USA and the UK are given morphine if needed but in Third countries availability is a problem. We are introduced to Joyce dying in a Uganda hospital in agony due to pain and a lack of available morphine.

The poignant part of Joyce and other patients who are dying in needless pain is that this issue needs to be addressed as a priority regardless of where one lives that patients have the right to die in dignity and painfree. Unfortunately, those who can be spokespersons pass on and the family members traumatized by the events rarely have the energy to address this. So, it is up to responsible individuals who need to address this issue now in the hopes there will be guidelines in place if they should ever require  such humane care.

Hospices are a vital link to dying at home or home setting with all the available resources at hand. Many are associated with local hospitals and are able to provide services and special attention to services than on an ordinary ward. They have specialists and may assist getting through the red tape for pain management. Hospice is a vital option to those who require support both in services and to the family.

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The OHIP Appeal Board is the news more frequently as a result of cases involving prior approval for out of country medical services denied by the ministry. The main issue as Canadians we are brought up to believe that we have universal healthcare and that we will be taken care of by our government.

Unfortunately, with an aging population, decreased medical resources and long waiting lists some Canadians have looked elsewhere for healthcare including India for cardiac care and Thailand for hip replacements. We are not talking about third world care but first world care and medical care with affordable prices and no wait times making this an attractive proposition.

What is in the news today are the most tragic of stories of individuals being caught in having to leave the country for care due to a lack of experts in Canada necessity a leave such as my March 24, 2012, “Ordinary People Do Get Cancer “:
“Lisa, 34 years of age is one such person living in the Ottawa area who was living a full life when she was diagnosed with neurofibromatosis. During a routine check up in her late teens she was informed was told she had neurofibromatosis but that it was benign and if they grew she would have them removed.

Fast forward to about two years ago when Lisa was experiencing difficulty eating as the tumours had grown so large, she was unable to swallow. After seeing specialists in Canada and the USA, she was informed there was nothing that could be done. In 2009 there was clinical trials at the Mayo Clinic and she was accepted with OHIP coverage, as there was no other treatment available in Canada. Then she was informed by OHIP they would not accept it as it was termed “experimental”. The cost was $50,000 and as an average citizen there was no extra cash. Lisa is a public servant working at the Canada Border Services Agency. Family, friends and community have supported Lisa with donations on her website and it is at the $33,455.81 mark. “

Recently, Erika Crawford’s family have spent over $90,000 to have surgery for Ehlers-Danlos syndrome to stabilize her neck and if not done any fall or sudden movement could have taken or life or made her a quadriplegic. 17 years old with her whole life ahead of her and to be faced with waiting to die or as in this case her family and her community supporting her to recovery. The specialist was in Maryland, USA and this is classified as out-of-country care. The final bill from Maryland is over $90,000 and was denied by OHIP. The appeal hearing is booked for January 2013 but maybe pushed to February 2013.
There are other individuals in the news such as Brooklyn Mills, Oakville and Charlie Smith, Kingston who have been denied. With the surgery Erika has a new lease on life.
Read Susan Gamble’s article in The Brantford Expositor.
What Canadians should ask is why the OHIP Appeal Board exists as it appears it serves no purpose other than to pay representatives that they are giving a “fair hearing to Canadians”. While in actuality the members are bound by strict rules and legislative law. The board is not even allowed to make recommendations back to the government, so when you think if you do not get monetary compensation, that this will allow justice for other Canadians, it does not. This hearing is one sided. This appeal process should be overhauled or abolished as it costs taxpayers money and brings false hope to those who are seeking a fair hearing and loss of valuable time to their lives of two years at least. The sad part it is not the money in the end, but that as Canadians we are given a voice in a democratic society.

What happens to other Canadians who do not have family or a community -give them a voice in the next election. Shout loud and hard.
STOP OHIP APPEAL HEARINGS & SAVE TAX DOLLARS & LIVES

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Field Of Deams

The Field Of Dreams- making what is the impossible possible.

The Gonda Building is a medical facility owned by the Mayo Clinic completed in 2001 and designed by Ellerbe Beckett. It is part of the medical practices called The Mayo Clinic.

I meet with Terri in Rochester over dinner and she shared the story of when the ground breaking took place for the Gonda building that the previous night someone had outlined a baseball field with a sign “build it and they will come”. This was referring to the Field Of Dreams movie with Kevin Costner of building a baseball field in a corn field and trusting one’s beliefs. Come they do as in 2011 they saw 500,000 patients at the clinic.

It is a belief in that the “patient comes first” as established by the two founders, Drs William and Charlie Mayo. Mayo physicians are paid a salary that is not linked to patient volume or income from fee for service. This way it ensures as an incentive to spend more time with patients.

Dr William Mayo stated, “No one is big enough to be independent of other”, and this is one of many mainstay missions that has transformed healthcare experience at the Mayo Clinic.

Today, Dr John H. Noseworthy, M. D. President & CEO stated the Mayo Clinic is translating idealism into action. Sharing that almost a century ago, Dr Charles Mayo articulated Mayo’s greatest strength.

Dr Charles wrote, “ If we excel in anything, it is in our capacity for translating idealism into action.”

In today’s challenging world Dr Charles Mayo words still remain fresh in that, ”we don’t react to changes in healthcare , we lead the change to what healthcare should be”.

Leaders in healthcare research resources:
Ongoing clinical trials
http://clinicatrials.mayo.edu
http://clinicaltrials.gov

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I was asked by my 20 year old daughter to help out her friend from
high school whose mother was admitted to hospital last week and told
she had terminal cancer. My daughter was crying because this news
was only given to the family a week ago. They were told that the
mother’s cancer was Stage 4, and that the cancer had metastasized and
spread to other parts of the body from the primary site. The family
was in shock. The main issue was a complete lack of communication
between the doctor and the family. The daughter described the medical
team running back and forth with the doctor after having a short interaction
with her mother stating there was nothing to be done. That was the extent
of any dialogue. The hospital where these events occurred is Toronto East General Hospital
which is a community hospital fraught with a lot of good and bad press over the
years.

I arranged to meet the daughter in the lobby and discussed with
her the positive aspects of meeting with the representative of Patient
Services, Wayne, as a connection point between the family and doctor.
Wayne was an under utilized person who proved to be an asset at the hospital.
The daughter communicated her concerns regarding the lack of communication
and given her mother’s condition and the lack of treatment, they were considering
a second opinion at the Mayo Clinic in the US.

Everyone wants hope that a treatment can buy some time, not a full lifetime.
The family wanted to review other options, as they felt if they stayed trapped
in the slow moving Canadian system their mother’s time would run out.
Wayne was able to communicate to patient records to have them faxed to the Mayo
immediately instead of 3-4 week delay that patient records said was the norm. A
$300 fee that was waived, and Wayne arranged to have a family meeting with the
medical team to discuss treatment options. Even if palliative care was the only route,
the family still needed to be prepared for this and not medical decisions made unilaterally
just by the medical team. Preparation had to include legal arrangements,funerals
and wills made so that the family’s cultural norms were respected.

By no stretch of the imagination was the family wealthy or had endless
resources. They were hard working middle class Canadians who immigrated
from China as professionals. But they would use up their savings to
save the one they loved. The family realized that if they politely
waited without asking questions, their mother would be getting no
information about her diagnosis or treatment plan. Even if there is
only palliative care, this  remains as a final decision with the
family and the patient. Worst of all it was difficult for the family to speak up as
they feared the physician would drop their mother as a patient and their
options would remain in no man’s land.

It appears patients do not know their rights in Canada. Also, the erroneous
idea that healthcare is free, when it is actually paid for by our taxes,
makes people unwilling to ask questions or express any dissatisfaction. All
patients should feel totally comfortable about questioning their own care.
As a student nurse I questioned when patient treatment plans would
have in pencil “no code” meaning that the medical decision was to not
revive the patient. I wonder how much of that decision was made by the
patient?

In my view, Doctor Day, a day to appreciate doctors across Canada. should
be replaced with Patient’s Day, a day  when doctors would take special note
of the respect and kindness due to patients.


Communication is the key to better healthcare.

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It seems that cancer is a less frightening word even from 10 years ago as we are bombarded by photographs of survivors and massive fundraising initiatives.

Yet, when we hear of another person we know receiving a diagnosis of cancer, we feel a step closer to mortality. The face of those being diagnosed appear to be younger and younger and not an elderly person’s disease.

Lisa, 34 years of age is one such person living in the Ottawa area who was living a full life when she was diagnosed with neurofibromatosis. During a routine check up in her late teens she was informed was told she had neurofibromatosis but that it was benign and if they grew she would have them removed.

Fast forward to about two years ago when Lisa was experiencing difficulty eating as the tumours had grown so large, she was unable to swallow. After seeing specialists in Canada and the USA, she was informed there was nothing that could be done. In 2009 there was clinical trials at the Mayo Clinic and she was accepted with OHIP coverage, as there was no other treatment available in Canada. Then she was informed by OHIP they would not accept it as it was termed “experimental”. The cost was $50,000 and as an average citizen there was no extra cash. Lisa is a public servant working at the Canada Border Services Agency. Family, friends and community have supported Lisa with donations on her website and it is at the $33,455.81 mark.

There have various news articles, interviews all in hopes of supporting Lisa, but more importantly to make Canadians aware that this could be them. That our healthcare system is imperfect and has flaws.

As Canadians we feel we are lucky to have universal healthcare. But how accessible is it when as a productive member of society wants to get proper treatment to maintain independence and not be a drain on the system.

Lisa has appealed to OHIP and has spent precious time and money trying to get her point across. The sad fact is that the elected politicians do not get back to her, the ones we the taxpayers elect to be our voices. The MPP who represents her riding is Dalton McGuinty the Ontario Premier and he has not done anything. To make matters worse, the federal government decided to audit her to confirm she is using her money in the USA for treatment.

I have never meet Lisa but I am in contact with her family regarding her OHIP appeal. This is an exceptional Canadian family who have strong values and proud to be Canadians despite the government treatment. On June 22,2011 on Lisa’s blog she shares her struggles of experimenting with a new form of radiation, which caused extreme fatigue and she states she hopes to return to work. Lisa adds OHIP has denied her appeal after a year with no costs to be covered.
Although, Lisa got her hearing to be heard the process remains flawed especially when it drags the claimant through years of wasted time and money if they obtain legal advice. In the end, the taxpayers pay for this lengthy process and the claimant wastes precious time left in their lives.

The lesson here is that we as Canadian citizens need to be vocal regarding our healthcare, the accountability by our elected politicians and to rid of OHIP hearings because it wastes time, money and energy when you are lead down the garden path of an unfair judicial process.

Tell and Email Dalton McGuinty , Premier that patients have rights and should be heard not through OHIP hearings that drag on for years.

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Every day as I meet more people, and they either share their personal story or of someone they know who have difficulties in the healthcare system with a late diagnosis or a lack of timely access. I am truly amazed how this is becoming more common place. It seems Canadians are getting more sicker, while waiting on their healthcare.

Annie who is a smart business woman shared with me how she is a private patient of the Cleveland Clinic, Canada. The clinic made an early diagnosis of cancer during a routine physical and thus she was able to get treatment at Stage 1. The Cleveland Clinic prides itself as part of their mission statement as being focused on preventing disease and enhancing overall health. Prevention being the key and patient empowerment.

The Executive Health Program with 5 hr assessment , use of urgent care for 12 months
Prescription for health, be proactive and responsible for your own health when well. Making you feel you have someone on your side much like an advocate on wellness.

21st century- visit. virtual tour at the Cleveland Clinic

Unfortunately, Annie’s friend who was diagnosed late with breast cancer received delayed diagnosis and thus treatment. She is presently dealing with a double mastectomy and Stage 4 cancer with metastasis.

In the old days, they use to say time is money, but it takes a new meaning when time saves your life. That is the dilemma for Canadians like myself brought up on universal healthcare expecting the government to provide coverage. The budget includes old age pension being threatened, so healthcare slashing is here to stay.

Our healthcare problems just did not start recently, another associate who is in his 80’s a businessman shared the story of how his mother when he was in his 50’s was very ill and the physicians thought it was in her head. Finally the family took her to the Mayo Clinic where they diagnosed cancer, but it was too late. The reason we never hear criticisms of the system is because those it failed are dead and they are no longer here to speak out.

What can Canadians do to protect themselves? Canadians should look at benefits their employers are offering, as well as looking into secondary healthcare providers. If you are sick, no matter what your financial status you need to have a back up whether critical illness insurance that pays a lump sum and the best part getting your principal back if you do not collect at age 70.

Ontario Health Minister Deb Matthews

Canadians need to speak up at the polls and to the government. We can no longer wait until a crisis hits or a loved ones is stuck in the push-and pull of getting timely treatment and having to pay for their life. Politicians need to be accountable.
Ontario’s Health Minister Deb Matthews announced that acute care hospitals should just be that and that there will be a shift towards stand-alone clinics, care at home and after-hours doctor visits. This is not rocket science but it will not solve our woes completely as one needs a trained personnel and with declining nurses who fills those roles. Will physicians work for profit in setting up for profit clinics and is this okay? When we speak about after hours doctors visits is this realistic given the number of people who do not have a primary physician.

It seems again, we have our finger in the dyke and the healthcare dam will again burst.

Let your opinion count contact Ontario Health Minister Deb Matthews and like the healthcare there is no direct route and need to go through her parliamentary assistants.

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Poison or not Poison, as individuals who are taking Tamoxifen need to understand all the risks including factors that impact on its effectiveness. Note there are no warnings or contraindications on the packaging.

Research has shown up to 50% of breast cancer survivors are depressed. Can you imagine taking medication that is suppose to prevent recurrence of breast cancer being ineffective because of antidepressant medication? So by taking your antidepressant this may in fact increase your risk for recurrence. Tamoxifen is the standard treatment for anti-estrogen pharmacological treatment for hormone receptor positive breast cancer in pre-menopausal women. Some breast cancer cells require estrogen to grow and Tamoxifen binds to the estrogen receptor preventing it from activating and breast cancer growth is blocked.

Some women may develop a mood disorder such as Major Depression and require pharmacological treatment. Also, Tamoxifen has a  potential side-effect of causing depression in 30 per cent of women. The treatment with Tamoxifen with certain psychiatric medications are contraindicated in that they decrease the effectiveness of the Tamoxifen. This makes the Tamoxifen less effective and give rise to increasing the recurrence of cancer. These medications listed are Pimozide (Orap), Fluoxetine (Prozac), Paroxetine (Paxil), Perphenazine (Trilafon), Thioridazine (Mellaril), Chlorpromazine, Citralopram, Clomipramine, Doxepin, Escitalopram, Haloperidol, and Sertraline.

In 1992 the Lancet published a review of a number of studies reported that pre-menopausal women who are ER-negative had absolutely no benefit from taking Tamoxifen, the majority of women who take Tamoxifen live no longer than women who do not take it,Tamoxifen reached its maximum protective effect on breast tissue with women who took it for five years and noted some breast cancers learned how to use tamoxifen to stimulate their growth.

A study presented at the American Society of Clinical Oncology’s annual meeting in 2009 found that after two years, 7.5 percent of women who took only Tamoxifen had a recurrence, compared with 16 percent who took either Paroxetine, Fluoxetine or Sertraline. The British Medical Journal, February 2010 found women who took Paroxetine and Tamoxifen notes that Paroxetin interferes with the way Tamoxifen works.

In numbers this means patients treated with both Paroxetine and Tamoxifen have a 67% increased risk of death from breast cancer. Quite scary for women who are on antidepressants and breast cancer treatment caught between treating breast cancer or a mood disorder probably precipitated by a cancer diagnosis. Knowing this information first hand, and picking the appropriate treatment with your physician can decrease your stress levels.

There is another controversy on whether one should have blood work to check on one’s metabolization that affects the overall effectiveness of Tamoxifen. As, Tamoxifen needs to be metabolized before it can be fully effective to treat breast cancer.  An enzyme in your body called CYP2D6 is important to convert the Tamoxifen to Endoxifen, which then can block estrogen. There are four levels of metabolizers: ultra rapid metabolizer, normal metabolizer, intermediate metabolizer and poor metabolizer. The poor metabolizer notes that your body is unlikely to convert Tamoxifen to the useable form and that a different cancer treatment should be reviewed with your physician.

The CYP2D6 blood test
is one factor in determining treatment. Even if test is normal there maybe other unknown factors impacting on the result. There are other drugs that can interfere such as using over the counter medication like Diphenhydramine, which is in Claritin. Checking with your pharmacist is one of the key steps in being your own advocate.
This information is often not well known among family physicians, oncologists and even pharmacists.
Bloggers are online discussing pros and cons and where to get testing .

Obtaining the CYP2D6 blood test is not available in Canada despite the fact that Tamoxifen is the most prescribed form of treatment for pre-menopausal breast cancer. At the Mayo Clinic Clinic, USA this blood test costs approximately $60. In certain circumstances patients in Canada maybe able to be tested, but at a cost of approximately $500 with blood work sent over the border. This would have to be arranged by your oncologist. While Tamoxifen is the most widely prescribed cancer medication in the world generating revenues of US $265 million in 1992 and in 1995, worldwide sales reached $400 million there is no information or access to a blood test that is essential for its effectiveness. It is unclear why this blood test is not standard procedure for women prescribed Tamoxifen or even mentioned on their literature. This could be a question for the Canadian Health Minister The Honourable Leona Aglukkaq, P.C., M.P. and should be addressed in writing so further action can be taken on behalf of women being treated with Tamoxifen.

Knowledge is emPOWERment as it provides options in treatment and control of outcomes.

So, women can discuss with her physician if her mood disorder can be treated with another medication or another treatment modality such as cognitive behaviour therapy, daily exercise regime or mindfulness. Therefore not compromising her risk of recurrence of cancer, while on Tamoxifen or not.

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