Tuesday, September 29, 2009

Behavior Change and Healthcare Cost

My sister says that I talk too much about my health.  I try not to, but I can't watch the whole health care reform debacle without putting my own two cents in.

If we are going to cover health care for everyone, and I think it is a moral and practical imperative, we should also look at simple behavior changes that can reap big savings.  Why are the main proponents of taking personal responsibility for our own health conservatives opposed to universal health care?  I am a universal health care proponent who believes in personal responsibility.

I got an unlucky genetic draw when it comes to immune systems.  Yet, the first referral my internist gave me after examining my lab results and  speaking to my immunologist was to a behavior psychologist who works with medical patients.  I told her that I didn't need a psychologist--the tests prove that I was not crazy and the symptoms were real.  She told me that I could see the psychologist or find a new primary care physician.  I went.

I learned an amazing amount in those sessions, and they reaped $$,$$$ of health care savings.  He joked that he was used to counseling OCD people that they didn't need to be so fearful of germs.  But he needed to teach me (and his patients undergoing chemotherapy) to become OCD about germs.

I was already scrupulous about hand washing, but we had to extend that to others around me.  Everyone who enters my office has to use the vat of alcohol-based hand sanitizer on my desk.  Everyone who enters my house is directed to the powder room to wash their hands.  I still don't know what to do when people proffer a hand shake.  If I can't get out of it, I use the hand sanitizer I carry in my purse.  I also wear a surgical mask when I fly or go into crowded places.

And then there was the matter of staying up late to perform the second shift.  It's been proven that immune response plummets with insufficient sleep.  I just had to understand that I am not responsible for other people's messes.  I shut my bedroom door and go to bed.  My child can decide when she goes to sleep, because mommy has already passed out.

I was told that I had the 'asthma triad' of asthma, allergies and aspirin sensitivity.  No one was sure why those three went together, but they often did.  (The correlation was clear, but the causality was not.)  I really wasn't so sure that I had asthma.  Oddly, my asthma episodes coincided with infections and joint swelling.

One time, I went to an ENT (ear, nose and throat doctor) for an infection.  I was miserable.  I had coughed so hard, I couldn't keep food down and I was short of breath.  He put a scope down my throat and said that I was coughing up stomach acid and then  inhaling it.  But it wasn't just this recent infection.  Judging by the scar tissue, it had been going on for a long time.  Didn't I often take aspirin and NSAIDs for arthritis?  Did I experience asthma flare ups with arthritis flare ups?

So I stopped popping NSAIDs like ibuprofen and Vioxx.  When my joints hurt, I rest, do gentle range of motion exercises (Pilates/Yoga/Feldenkreis moves), and alternate hot and cold compresses.  I eat smaller, more frequent meals.  I am a big fan of hobbit-like second breakfasts.  ;-)  That takes care of the acid reflux and asthma.  That saved my health insurance company (and the taxpayers who ultimately fund my medical care):
  • $600 monthly Xolair infusions
  • $200 Advair inhaler
  • $80 Flonase nasal spray
And that's not all.  If you read the fine print on everything I took, they all say that more frequent infections may result from taking that drug.  Well, my antibody count was so low, they were discussing whether I should start lifelong IgG infusion therapy.  Read the link.  It is as expensive as it sounds.
* And don't forget, I already explained why I decided to forgo Enbrel or Humira, for another $1000/mo savings.

I stopped taking NSAIDs and my asthma went away.  I stopped taking asthma meds and I came down with fewer infections.  I figure, behavior change shaved $2,000-$3,000 per month off my health care tab.

My immunologist says that my immune function isn't too bad now, perhaps one in 1000 people are in the same boat.  (My goal is to claw my way to one in 300 and eventually to one in 100.)  That means I am at very high risk when I encounter someone infectious.

There are pockets of antibiotic-resistant tuberculosis, particularly in downtown and east LA immigrant communities.  I come into contact with someone with it, and I am dead.  Do I care about the immigration status of infectious disease carriers?  Will you care if the big one hits, disrupting LA's water supply, and a cholera pandemic breaks out?  Hell, no.  It is in our self interest to make health care available to all sick people, regardless of their immigration status and ability to pay.

Tb, MRSA, avian or swine flu--pathogens don't care about borders and immigration status.  Universal health care access is a moral imperative and in our collective self interest.  Now we all just have to change our behaviors so we can afford it.

Links:
I'm safe on board. Pull up the life rope from Roger Ebert's journal
Health Care- Personal and Universal from Wandering Scientist
Identity and morality from Hopeless but not serious

3 comments:

  1. It sounds like you've done a great job managing your chronic conditions. One of the reasons I want universal health care is that I want everyone to have the chance to do even half as well as you have. This requires trips to the doctor when you aren't in crisis, which is not something someone scraping by is going to pay for.

    I'm surprised the earlier doctors didn't tell you about the asthma-NSAID link and the reflux link. It is pretty well known. I checked into that when I was diagnosed with asthma. I eventually got mine under control and have been able to wean off the meds- I keep them around for fires and any time I have to go near a cat, but no longer have to take them everyday.

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  2. That's precisely it. Integrative medicine is a long-term process, not a quick hit intervention.

    It may not be cheap in the short term, but it can lead to huge payoffs in lowered costs and increased quality of life.

    No one makes money off of my getting more sleep and taking fewer meds. Well, my cleaning lady would earn more, but she refuses to add days to her regular schedule. She only works enough to pay her car and school expenses.

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  3. Fascinating discussion; personal experience, personal responsibility, and the health care debate.

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