Myriad of Maladies

As we age, it is not uncommon to take on challenge of several chronic conditions

By Barbara Pierce

Patel
Patel

Harold Peterson’s cardiologist prescribes medications for his heart disease. His primary physician prescribes medications for his high blood pressure and referred him to an orthopedist who recommended surgery for hip pain.

Peterson, in his 80s, lives with several chronic conditions, and he’s far from alone, according to nextavenue.org.

Three out of four people over 65 have more than one chronic medical condition. These are conditions that last at least a year and require ongoing medical attention.

The most common are diabetes, high blood pressure, arthritis, heart disease, osteoporosis, kidney failure, and on and on.

Here’s the problem: With chronic conditions, a specialist treats a patient for each condition.

Treating one disease can worsen another. Medications interact in unpredictable ways. The older we get, the more side effects we get. Side effects can make us miserable, even if our lab results look better.

Each specialist is focused on their specialty, running tests, lab work, prescribing medications, diets and homework. One becomes overwhelmed by the long list of appointments and care routines.

It becomes too much to deal with. We don’t know what’s important, we can’t deal with the side effects, and we can’t manage all these treatment regimes at the same time. We’re as burdened by the care of each condition as we are by the conditions.

What’s the answer?

“Your primary care physician is able to track all of the specialist visits and review their recommendations in a timely manner,” said Janki Patel, assistant medical director at the Mohawk Valley Health System Rehabilitation and Nursing Center, Utica.

“If you’re feeling exhausted and overwhelmed by all of the aspects of self-care and dealing with multiple specialists, your PCP can help you prioritize which steps you should take first and which can wait a little longer,” she added.

“You can get support for all your issues through frequent visits with your PCP. It may seem like one more appointment you have to make, but frequent appointments with your PCP will provide the needed support,” Patel said.

A primary care physician, whether it be an internist, family practice doctor, nurse practitioner or geriatrician — is invaluable, and every patient should have one.

Bouncing between specialists without the glue of primary care means there’s little sense of continuity and more cracks to fall through. And that means you might not get all that you need to be as well as possible.

“As a geriatrician in Seattle, I have the ability to focus on the ‘whole person’ and the way that their diseases (and treatments) interact. This is absolutely central to providing good care,” says Carroll Haymon online. “Unfortunately, I spend a lot of time undoing the work of well-meaning specialists focused only on a single organ.”

Listen to your PCP

Tips for working with your PCP when you have several health conditions:

— What are your priorities? What’s really important to you? Make sure your PCP provider understands your priorities, so you can get what you really need. How do you want to live your life? What really matters to you in your present-day life?

For example, you may want to remain as independent as you can as long as possible. Therefore, you may prefer a treatment with fewer side effects, even if this treatment may not prolong your life as long as other treatments. Maybe being able to walk without dizziness is more important to you than living a bit longer. Maybe less frequent blood testing is worth greater freedom, freeing you from constant clinic visits, even if that means less stringent monitoring.

Specialists may know more about your illness. But only you know who you really are and how you want to live until you die.

Take for example Harold Peterson. He didn’t want surgery for his hip, despite the pain and difficulty walking. More troubling to him was the dizziness and fatigue because of his heart and blood pressure pills. That prevented him from playing poker with his friends — something he loves to do.

His PCP and cardiologist reduced his medication so he wasn’t dizzy and was able to enjoy poker. Though he might not live as long as he would if he had kept taking the medication, he’s enjoying life — and that’s what matters to him.

— Get as much information about treatment options as possible. Take the lead, understand all your options for care and take an active role in deciding what kind of care you would like.

Ask your PCP what this treatment is meant to do. Is it going to cure me? Make me live longer? Make me feel better?

What side effects can I expect? How long will they last? Can I stop once I’ve started? How long until I can tell if it’s working?

What are the benefits; what are the risks? Most have both. How will different treatment options affect the aspects of your life that are most important to you, such as your level of independence, stamina or pain?

Understanding all the pros and cons of each treatment will help you decide which option is best for you.

— Ask questions: Your PCP needs to know if he or she is not making sense to you, so ask questions. You should be able to discuss almost anything with your PCP. Speak up if your treatment plan is too complicated.

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