“They are both legitimate options,” the soft spoken cardiologist from a top US medical center told me. “He should consider them carefully.”
I wasn’t hearing this opinion in the area my client “Jim” lives.
Jim (not his real name) had some blockages in the arteries in his heart. He was resolutely opposed to open heart surgery–a so-called CABG or coronary artery bypass graft. Other members of his family had not done well with the procedure, and he had other medical issues that he knew needed treatment soon. He worried that the long recovery from surgery would interfere with that.
Jim hoped to receive a cardiac stent–a device that cardiologists place in the blocked vessel of the heart that reopens the passageway and revitalizes the heart in that area. But the anatomy of Jim’s heart made stenting a difficult procedure. Not many cardiologists would be willing to attempt it.
He thought it would be a snap to figure out the best cardiologist to do that: google it.
But it wasn’t as clear-cut as he thought. So he reached out to me for guidance. His hope was to find the top interventional cardiologists in the U.S. who might take on such a challenging case.
After multiple emails and phone calls to cardiologist and surgical colleagues, I narrowed down the choice to two cardiologists and surgeons in Jim’s area. I was concerned that Jim wasn’t really stable enough to travel far. And I felt it was important to find an outstanding cardiac surgeon also–so that Jim could weigh both options equally.
Fortunately for Jim, I found two physicians who were both in-network for him. When Jim and his doctors met, the respect was mutual.
I drew up a summary for Jim–pulling together the pros and cons of each approach that the doctors laid out for him, so he could consider both options.
In the end, after conferring with both the surgeon and cardiologist, Jim opted for the stent. He did really well with the procedure, although it was more challenging than his cardiologist predicted.
“When I woke up afterwards, I had a smile on my face,” Jim said “because the pain was gone, and I knew it had worked.”
Jim said, “it was one of those situations where the facts and options seemed to blend into nothing but uncertainty.”
Conferring with a health advocate was an “eye-opener,” he said. “It gave me a logistical edge.”
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Another patient I advocated for is “Bjorn,” a Norwegian who does not hesitate to question authority. At age 72, Bjorn was diagnosed with vitamin B-12 deficiency. He was told he had to receive monthly B-12 injections for the rest of his life.
“Why can’t I just take a vitamin B-12 pill?” he asked when he reached out to me. His gastroenterologist gave him the reason we all learned in medical school: it isn’t adequately absorbed in cases like his–so-called “pernicious anemia.” It had to be given as a monthly injection into the muscle.
He asked me to investigate the subject further. That afternoon, I looked into it, starting with an older article in the Lancet— a British publication for physicians, on a par with our own New England Journal of Medicine. One of the lead articles featured a study of oral supplements versus injections for B-12 deficiency–and showed that it can be successfully treated with the pills. In fact, some studies showed that oral supplements were a more effective treatment than injections.
According to one author, the oral form of vitamin B-12 has been known to work since the 1960s. Yet in some places it remains ”one of the best kept secrets in medicine.”
I called Bjorn to tell him the good news. “You will be so glad,” I said. He shared the article with his gastroenterologist and they decided that oral B-12 was an option for him.
On the daily oral supplements, Bjorn was able o maintain normal B-12 levels. Bjorn’s signs and symptoms of deficiency, including gastrointestinal symptoms, dizziness and anemia (low blood count), subsided.
Bjorn and Jim both had valid questions. Bjorn’s had to do with effectiveness of oral medication for a potentially very serious vitamin deficiency: could he achieve therapeutic levels when taking the vitamin supplement by pill? Or did he have to settle for the inconvenience of traveling to his doctor’s clinic every month for an injection?
Jim had an equally challenging medical decision: should he get open heart surgery or a cardiac stent? How could he make that decision in a thoughtful fashion? And where could he find a doctor who would objectively weigh the pros and cons with him–and support him in his decision?
That is where health advocates can play a key role–in doing the legwork and researching medical decisions large and small and helping find specialists who will help you weigh the choices–and let you know that there are legitimate choices to be made.
**Disclaimer: All patient names and identifying details have been changed to protect client confidentiality. The suggestions given here are not intended as a substitute for the medical advice of your physician.
