PEN Blog Archives

My Self-Advocacy Journey With Ultra High-Risk Multiple Myeloma

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My Self Advocacy Journey with Ultra High-Risk Multiple Myeloma from Patient Empowerment Network on Vimeo.

Multiple myeloma patient Lori shares her journey to diagnosis and treatment. Watch as she explains the varied symptoms that she experienced, the benefits of a second opinion and clinical trials, and her  advice to other patients.

Related Resources:

How to Thrive and Set Myeloma Treatment Goals

 Expert Advice for Newly Diagnosed Myeloma Patients

 Multiple Myeloma Danielle’s Clinical Trial Profile

Transcript:

Lori:

My name is Lori, I’m from Portland, Oregon. I was diagnosed at age 60 in June 2019 with ultra high-risk multiple myeloma. The road to my diagnosis was long and regrettably all too common.

I have always been very healthy and active. I believe my healthy history clouded my doctor’s ability to connect my symptoms to anything serious.

My journey started with chronic fatigue and needing extra sleep. Then came horrible headaches followed by shoulder and back pain, frequent infections that didn’t clear with antibiotics, and severe nose bleeds. 

In May 2019, I had my annual exam that included a blood draw. I later learned I was tested for diabetes and cholesterol but none of the basic blood panels that flag abnormal values. I went into my exam with my laundry list of issues, but was given a clean bill of health.

Four weeks after this exam I was traveling in Kenya on a safari.  I felt very sick during the trip, but I assumed I had picked up something on the long flight.  When I returned  home I could barely get out of bed. I collapsed in the middle of a dinner with some doctor friends who insisted I go to the ER where they held me overnight to perform additional testing. They discovered severe anemia and that my basic blood panels hadn’t been ordered for a number of years. I continued to think it was some odd African bug until the doctors arrived the next day to share the suspected diagnosis of multiple myeloma. I was in shock and very afraid.

I sought a second opinion and I was extremely fortunate to begin my treatment at Seattle Cancer Care Alliance. In July 2019, I was started on KRD induction therapy. Our journey was further rocked when our insurance declined coverage for carfilzomib, which was nearly $20,000 for two infusions each week. The insurer insisted I fail on the standard treatment before I could be approved.  I knew from reading how essential the first line of therapy is.  With Seattle Cancer Care Alliance’s help, I was finally approved due to my high-risk status. However, it took months to finally receive approval, and I had to take care of stressful, expensive bills while also completing my treatment.

Treatment was exhausting and required me to drive 3 hours each way each week from Portland to Seattle.  We needed to spend at least one night each week in a hotel. By October 2019, a bone marrow biopsy analysis showed no myeloma cells. I was reminded of the spotty nature of myeloma and the limits of biopsy testing, but I was extremely encouraged. 

At diagnosis, I was given a 20 percent chance of a 5-year survival. I am now 3 years post-diagnosis, and I am in remission.

Some of the things I have learned during my multiple myeloma journey are:

  • Ask your primary care doctor what tests have been ordered and request a comprehensive blood panel if you suspect something is wrong and not being adequately addressed.
  • Seek a second opinion at a cancer center that combines patient treatment and research. 
  • Clinical trials and new treatment combinations can be effective even for high-risk disease. 
  • Work with your doctors to get insurance approval for the protocols they recommend.
  • Empower yourself by learning about treatment options and new therapies.  
  • Be encouraged that there are so many positive advancements happening in multiple myeloma.

These actions are key to staying on your path to empowerment.

My Polycythemia Vera Journey to Empowerment

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My Polycythemia Vera Journey to Empowerment from Patient Empowerment Network on Vimeo.

Myeloproliferative neoplasm patient Mark shares his journey to patient empowerment. Watch as he discusses symptoms that eventually pieced together his polycythemia vera diagnosis, helpful support resources, activities that have aided him  during treatment, and his advice to help other patients.

See More from Best MPN Care No Matter Where You Live

Related Resources:

How Can MPN Patients Become More Proactive in Their Care?

 What Are the Unmet Needs in Access to MPN Care?

 MPN Caregivers: How to Provide Support During Appointments

Transcript:

Mark:

My name is Mark, and I live in the UK. I was diagnosed with polycythemia vera (PV) in April 2021 after a long path to diagnosis that was complicated by COVID-19 restrictions.

In December 2020, I had a routine blood test that flagged elevated hematocrit. My doctor told me the laboratory would re-do the test after Christmas and not to worry. Meanwhile, I researched various causes of elevated hematocrit and began drinking (approximately) 4 liters of water per day just to rule out any dehydration.

I had the repeat blood test in January 2021, which showed elevated hematocrit again. Next, I was sent for a JAK2 test and referred to a hematologist. I was also switching roles at work and moving at the same time. The moving and medical care changes were worsened by UK-wide COVID-19 restrictions. 

I got moved and awaited the results. A month passed with no news, and I could only connect with my medical team by Internet or phone. The test results could take up to 8 weeks. Then I started experiencing some strange eye issue with blurry zig-zag shapes and itching around my ankles and general skin discomfort after showering. I also had a gray-out in one eye that was like a shutter closing over my eye for about 30 seconds. I read about elevated hematocrit and microcirculatory issues before and decided to ignore it until my appointment. 

I was still awaiting my test results in March with a consultant appointment booked for April, and my doctor decided to repeat the JAK2 test. The results came in, and I was finally diagnosed with polycythemia vera. I was simply told that I would receive phlebotomies and was given a pamphlet. I went for my initial phlebotomy, and my journey began. Around that time, I told my doctor about the vision issues. They immediately referred me to the TIA clinic to investigate mini strokes and started me on aspirin. I  had no signs of a TIA, but the symptoms could not rule out the possibility. Fortunately, the vision issues stopped after my second phlebotomy.

I found the MPNVoice website and began learning about MPNs, which proved invaluable and helped me grasp my situation. It was so helpful to find others who lived with MPNs well beyond the Google-searched life expectancy, and reading their stories gave me comfort. Physically, I noticed that I had slowed down and was feeling sorry for myself, which isolation from COVID-19 restrictions didn’t help. I decided to start volunteering, re-started some yoga, and started exercising. I experienced immediate benefits and find keeping active is now a must.  

Initially, my hematocrit level didn’t lower, and I received advice for my hematologist to be more aggressive with my blood draws. With sometimes weekly draws, my levels started dropping. It took 6 months to level out to my target hematocrit maximum. 

Upon reflection, some things that I’ve learned during my PV journey include:

  • Try not to panic about what you don’t know and can’t control – this allows you to focus on the important stuff.
  • During the testing and diagnosis stage, try not to search too much on Google – it’s not helpful!
  • Finding others who are in the same situation can make a rare illness less rare and far less scary.
  • Keep active and don’t overthink everything. If you start feeling sorry for yourself, do something about it.

These actions are key for staying on your path to empowerment.

Myeloma Patient Profile: Jeff Boero

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When Jeff Boero shares his multiple myeloma patient journey, it’s clear that self-education has been a vital part of his experience. He was first diagnosed through his primary care physician who referred him to a general oncology group in the San Francisco area. They confirmed it was multiple myeloma. It soon became clear to Jeff and his wife that he perhaps needed a second opinion, and he was connected with the University of California San Francisco (UCSF) to their multiple myeloma specialist. 

The second opinion changed the approach to Jeff’s care rather dramatically. He was quickly scheduled for a stem cell transplant and subsequent maintenance after that. As Jeff recalls, “Through UCSF, I became eligible for a CAR T-cell immunotherapy trial in 2017. That was very successful and kept me disease-free and medication-free for about 2-1/2 years. And then I relapsed and went on another maintenance program. I became eligible for another clinical trial for a bi-specific T-cell engager (BiTE) that I’m on now and am having good results.”

Jeff was almost in complete denial about his diagnosis for the first 6 months. The diagnosis threw him into a world of terminology and treatment that was completely foreign to him. That sense of his diagnosis feeling foreign also started to lead into a certain level of depression — just not knowing what it is, how is it going to be treated, what it meant to his long-term survival. Jeff remembers, “So, with the encouragement of my wife as caregiver, I became more educated as I engaged in various conversations with specialists and participated in some of the PEN webinars. It  became clearer to me about what some of the options are and what they can be. Being engaged with UCSF really opened up the treatment options. With me becoming more educated and able to speak the language of myeloma, I was starting to understand the diagnosis as it was presented by UCSF. And it led to a much richer engagement in conversation with the oncologist and with the nurse practitioners.” 

As a cancer patient, Jeff views self-education as the key to empowering patients toward better care. It was through self-education that he learned about other options. Before becoming more educated, Jeff was mostly just listening and trying to absorb as much as he could and seemed to remember mostly bad news. According to Jeff, “There’s so much good news around myeloma treatment and available therapies. It was through self-educating and those conversations that my outlook brightened too.”

By patients educating themselves, they can start to ask questions about the clinical trial like: “What is it, and why is it going to show better results than my maintenance therapy?” And in conversation, patients can start to better understand the purpose of the clinical trial. “I think it’s important for patients to understand what they’re trying to accomplish through the clinical trial that wasn’t through their maintenance therapy. What is it about this trial that’s different that we haven’t addressed previously?” But patients can’t ask those questions unless they have at least a basic understanding of their cancer and how the various therapies approach the cancer cell. “But if you listen to webinars and things like that, you’re better able to have those conversations. As a matter of education as these opportunities arise, you’re able to have a much richer conversation with your oncologist and your care team about the benefits that could potentially be derived from the clinical trial.” 

Clinical trials have benefitted Jeff, and he recommends seeking an opinion that is dedicated to research of your specific cancer. Learning institutions have more access to emerging research and treatments that likely won’t be FDA-approved until 2 or 3 years later. “So if you as a patient can be at the forefront of some of these trials, that can be tremendous. I’m on therapies now that didn’t even exist when I was diagnosed. Research is moving quickly.”

Jeff senses some hesitancy among patients about clinical trials. “There’s this misconception that if you join a clinical trial, one group is getting the real stuff, and one group is getting the placebo. And the trials that I’ve been in, everybody gets the real thing, and everybody’s progress is tracked on their response to the real thing.” He knows trials can seem intimidating. Jeff went through his initial clinical trial, because he was almost out of options for conventional maintenance therapy. His cancer burden continued to increase, and he’d been through a number of different treatments. “The CAR T-cell program came up and seemed to be a perfect fit for me. So I did the clinical trial partially out of necessity, but I also had extreme confidence in my oncologist that he was promoting something that he thought would be most beneficial for me. I think it’s a matter of putting trust in your oncologist. Maybe I’ve been lucky, but I’ve had good results and good response to both clinical trials.” He also feels that the sponsoring institution will give an honest appraisal of where the program stands and what the progress and success has been up to that point. 

Reflecting on the value of Patient Empowerment Network (PEN) and other resources, Jeff says, “I’ve gotten so much out of the PEN webinars that are provided and some other organizations. I’m a slow learner in this area but am absorbing as much as I can. I need to hear the same thing a few times before I start to absorb it and fully understand it. So I rewatch the PEN webinars, and it works for me.” He also suggests learning as much as one can but was advised early on to stay away from Google. “There’s so much out-of-date information. Whereas websites like Patient Empowerment Network’s and others have updated information that’s far more relevant. And I also find the navigation on the PEN website very easy to use.”

After meeting patients who don’t have the same level of health insurance benefits, Jeff feels a sense of gratitude. “I had tremendous support from my employer who in essence said take the time you need to get yourself well again. So I have a lot of gratitude for that support, my wife as caregiver, family, social support, my faith community, and for my proximity to UCSF that makes treatment very practical and very possible.” It’s opened his eyes in that regard. There are so many benefits that he has that others don’t have. “I’ve joined various support groups initially to gain support. Now things have come full circle, and I find that I’m at the other end of the conversation to give people comfort in what they could possibly be doing to improve their situation.”

Support Resources

Financial Assistance Programs

Financial Resources for Patients and Families

Health & Disability Insurance

Federal & State Benefit Plans

Is It Too Late for a Myeloma Second Opinion?

Naïve T-cell Depletion in Donor Blood Stem Cell Transplant Patients 

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Introduction 

T-cell depletion is a strategy to remove T-cells from bone marrow or peripheral stem cells taken from a donor before they are given to a patient. T-cell depletion (TCD) has been around for quite some time, at least since the early 1980s. TCD decreases the risk of graft-versus-host disease (GVHD) and, in particular, deaths from GVHD. The goal is to also have similar survival to non-T-cell depleted transplants (sometimes referred to T-cell replete or T replete). This would be a significant advance. Removing only the naïve T-cells from the graft looks like a promising approach to achieve these goals. The recent article Naive T-Cell Depletion to Prevent Chronic Graft-Versus-Host Disease reports on a trial looking at the use of naïve T-cell depletion and comparing the results to historical controls.  

What are Naïve T-cells? 

I had not heard of naïve T-Cells before. According to an article from the National Cancer Institute (NCI) Can Chronic Graft-Versus-Host Disease Be Prevented? 

T cells are among the many types of immune cells that can attack cancer cells. But there are several subsets of T cells. Naive T cells have never encountered an antigen—a protein or other molecule that can provoke an immune response. For reasons that are not yet fully understood, they are more likely to react to healthy cells in the transplant recipient. 

I don’t know how naïve T-cells can be distinguished from other T-cells, but apparently this is possible. 

Problems with T-Cell Depletion 

TCD does significantly reduce the risk of GVHD and deaths from GVHD, however it is not without drawbacks.    There have been many attempts at T-cell depletion over the years, first removing all T-cells and more recently selectively removing some of the T-cells. However, most of the problems listed below have persisted to some degree: 

  1. Graft failure is generally higher in TCD transplants than in non TCD transplants  
  2. Epstein-Barr virus–associated lymphoproliferative disorders (LPD). This is a rare side effect of T-replete transplants, but is much more common in TCD transplants (as well as solid organ transplants) Generally, the decrease in deaths acute GVHD are about equivalent in the increase in deaths LPD  
  3. There is a much higher rate of disease recurrence after TCD transplants. It is well established that patients who experience GVHD have a lower rate of relapse (this was known at the time of my transplant, almost 30 years ago). This is because of what is known as a graft-versus-leukemia (GVL) effect (or more generally as a graft-versus-tumor, GVT effect). The T-cells are causing GVHD by attacking the host cells in the patients.  Since any residual cancer cells are also recognized as foreign by the T-cells, they are destroyed as well.

Current Study 

For the most part the current study did not show the problems listed above. There were 138 patients with acute leukemia treated in this trial. There were 2 patients who experienced graft failure (< 2%). The incidence of Epstein-Barr virus (EBV) reactivation was rare, only 3 patients (2.3%) experiences this.  Only 1 required treatment with rituximab (Rituxan, which is one of the more effective therapies for EBV related LPD).  The overall incidence of relapse was 23%, which is in line with the expected relapse rate from T-replete transplants. The incidence of acute GVHD was low and most patients who experienced acute GVHD were treated successfully with steroids.  Only 7% of patients developed chronic GVHD (much lower than T-replete transplants), which also largely responded to steroids. 

Future Reading 

  1. Naive T-Cell Depletion to Prevent Chronic Graft-Versus-Host Disease, the full article from the Journal of Clinical Oncology, from April 2022 (registration may be required). 
  2. A blog article from the National Cancer Institute (NCI) Can Chronic Graft-Versus-Host Disease Be Prevented? This is quite interesting and not nearly as technical as the journal articles. 
  3. An older abstract (2020) from the same author, Marie Bleakley: Naive T-cell depletion in stem cell transplantation  
  4. Naive T Cell Depletion for Preventing Chronic Graft-versus-Host Disease in Children and Young Adults with Blood Cancers Undergoing Donor Stem Cell Transplant, the clinical trial description from the National Cancer Institute 
  5. The history and future of T-cell depletion as graft-versus-host disease prophylaxis for allogeneic hematopoietic stem cell transplantation  from the journal Blood.  A technical and older (2001) article but may be interesting to some. 
  6. Does GVHD Ever Resolve in Acute Myeloid Leukemia Patients?

References

Naive T-Cell Depletion to Prevent Chronic Graft-Versus-Host Disease Marie Bleakley, Alison Sehgal, Stuart Seropian, Melinda A. Biernacki, Elizabeth F. Krakow, Ann Dahlberg, Heather Persinger, Barbara Hilzinger, Paul J. Martin, Paul A. Carpenter, Mary E. Flowers, Jenna Voutsinas, Theodore A. Gooley, Keith Loeb, Brent L. Wood, Shelly Heimfeld, Stanley R. Riddell, and Warren D. ShlomchikJournal of Clinical Oncology 2022 40:11, 1174-1185

Importance of Music for an MPN Patient and Care Partner

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Importance of Music for MPN Patient and Care Partner from Patient Empowerment Network on Vimeo.

 MPN Empowerment Leads Jeff and Summer discuss the role music has played in both of their lives and how it has specifically helped amid Summer’s myelofibrosis diagnosis. Watch now to hear how music has influenced their lives.

Transcript

Jeff:

Hi, I’m Jeff.

Summer:

I’m Summer and this is Zelda.

Jeff:

And we’re your Patient Empowerment Network Leads for the myelofibrosis portion of the Patient Empowerment Network. Here to talk to you today about music. How music affects you when you have cancer. Is it good, bad, or what? And what do you think, Summer?

Summer:

I think it has a very positive effect because, for example, I just finished doing an hour of Zumba dancing and I love Zumba music, and I now have 5,00o steps on my Apple Watch. I think it can really raise your endorphins and be very good for the immune system.

Jeff:

Well, research proves Summer absolutely right. There’s been a lot of research into how music affects the body. Music is a tremendous de-stresser, it helps people relax, and all of those things affect your physical body. Summer has talked at length about how the mind and body connection works.

For me as a caregiver, it’s a little bit different. I’m a musician. I play the piano. I play in a band and I love to listen to music. It takes me to other places and it relaxes me. And it takes my away from, similarly, it takes me away from the stresses that caregiving can sometimes provide. Now we don’t have too many, but it does. So really that’s how we would feel about music. We have two different approaches to it. Music is definitely a positive in dealing with your myelofibrosis.

Until next time, I’m Jeff.

Summer:

Summer. I’m Zelda.

Jeff:

We’ll see you later.

RMC Patient Profile: Lamar Valentina Part 2

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Read the first part of Lamar’s RMC journey here…

Part of Lamar’s cancer treatment occurred during the COVID-19 pandemic. He had to quarantine to keep himself safe, and it was scary to him at times. “But now that COVID-19 has subsided a little bit. It’s still around, I recommend doing some things that you enjoy. Don’t let cancer take away the joy that you still have. If you’re someone who’s active, maybe you just need to scale back on how active you are. Of course, you want to be safe. If you’re someone who likes to travel, find ways that you can still do it safely.”

Lamar found some activities that were helpful for him physically and mentally. “What helped me was being more involved in nature. I would do walks. I would sit outside and watch the clouds. I’d watch the stars at night. And I try to still continue to play basketball with my son. Obviously, he’s starting to get a little better than me. He’s getting bigger and faster, and I’m a little weaker. But I try to still do things that are fun and enjoyable.”

During part of COVID-19 restrictions, Lamar started missing the ability to do things, being self-sufficient, and even getting back into work. People asked why he was in such a rush to get back to work, but work helped him feel a sense of purpose. He felt like he had become a burden to his loved ones who had to cared for him. Lamar recommends striking a balance between accepting help and doing some things yourself. “Let others who want to help you actually help you. If you feel up to doing other things on your own, don’t shy away from that. Don’t let cancer take away a little bit of independence or a little bit of your purpose that you feel. I enjoy doing these PEN interviews, because I think we need that voice, and people shouldn’t shy away. Obviously, I’m not saying go out and be reckless. Be safe but try to do the things that bring you joy.”

People often tell Lamar that he looks so healthy and that he doesn’t look sick, which can be frustrating, since he wakes up with pains and has tumors all over. His biggest takeaway from this journey is how resilient he is. Lots of people tell him that he makes cancer look easy but don’t realize that it’s very difficult. “I just feel like life is short as it is. We all have an expiration date, and we don’t know when it’s going to come. And that’s the only thing guaranteed in life. For me, I really just feel like I want to live each day as if I’m trying to make a mark, at least be as happy as possible, chasing my goals and my dreams. I try to make sure with every encounter that I have with people that I’m not angry or bitter. I don’t want that to rub off on them, so I try to make sure that I greet everyone with a smile.”

If people don’t know specifically from his appearance since his eyebrows and hair are gone or know from someone else, Lamar prefers others to not know what he’s going through. “I don’t want people to feel sorry for me. Just treat me like a normal person, and hopefully I can pass on some positive energy and some happiness to everybody else regardless of what they’re going through to make it a kinder place here on earth.”

Lamar feels blessed about his overall quality of life. He’s at work and still travels for work as a flight chief in the Air Force. I’m not as physically active as I’d like to be. He’s doing chemo every three weeks, and will be starting radiation soon for a spot that’s remaining. The ultimate goal is to achieve no evidence of disease. He’s been in outpatient care for his entire treatment process and has been able to go to the hospital for chemo and then returns home and to work. “It’s been an absolute blessing that I cannot take for granted. But I still go through ups and downs. I have slight pains here and there. I’d love to be able to work out three to four days a week. But I’d rather take it easy and focus on my body healing from the inside out, and I’ll get back to working out more sooner or later.”

His biggest advice to renal medullary carcinoma (RMC) patients and cancer patients is don’t give up hope. “A lot of this fight is mental. Your body follows physically what you think mentally. So speak positive affirmations. Every day when you wake up even on the tough days, speak healing into your body. What you’re eating, whatever you’re drinking, it’s going to provide healing and substance. It’s going to rid your body of cancer. No matter how dark it looks or how dark it gets at any point, do not give up hope. Do not lose your spirit. Make sure you’re smiling and laughing and doing the things you love with the people you love.”  

Lamar looks forward to ongoing research of RMC. “This has been a huge purpose added to my life. Anything I can do while I’m here, I’ll do it. I’m a big advocate for more support and more research for RMC. I know each day we’re getting closer to a cure, and hopefully this won’t impact families as negatively as it has in the past.”

What’s Lamar’s parting advice to other patients? “When you come out of the storm, you won’t be the same person that walked into it, that’s what the storm is all about. When you can’t control what’s happening to you, control how you respond to it, that’s where your power is.”

Introducing Jessica Catlin, Colorectal Cancer Empowerment Lead

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Jessica Catlin Introductory Video from Patient Empowerment Network on Vimeo.

PEN’s new Empowerment Lead, Jessica Caitlin, introduces herself and her journey with rectal cancer. She also encourages anyone looking for support to reach out to her at jess@pivotsolutions.live  or on Twitter at @jesscatlin or LinkedIn.

Transcript

Jessica:

Hi, I’m Jess Catlin. I am a survivor of stage 3B rectal cancer, young onset, and I am so excited to be the new Colorectal Cancer Empowerment Lead for the Patient Empowerment Network.

I currently live in Chicago and I was here when I was diagnosed at the age of 39 with rectal cancer, only after I was turned away at age 38 because the doctors thought I was too young for colon cancer.

Obviously, being an advocate for myself was a huge part of my success in coming out of rectal cancer. I have been a survivor for five years now, so my doctor says I’m officially cured. But being empowered was a huge part of my treatment, as well, and as being a survivor too and some of the issues that have come up ever since my treatment was over.

So, I have done a variety of different things with organizations, speaking at walks, speaking to medical school students, so on and so forth. So, now being part of the Patient Empowerment Network seems like a wonderful way to really tie it all together. We’re here to help you, to answer questions, to be a source of information, inspiration. Even just to be a friendly ear because nobody knows this journey like somebody else who has been through it. As the organization’s name suggests, to empower you because we know empowered patients really have the best chance to thrive.

Listed here on my bio page are links to some of those talks and webinars, and so on and so forth, that I have done with other organizations if you want to check those out. Going forward, I will be creating original content for the Patient Empowerment Network and I don’t know what that looks like yet, I want to hear from you. I want to know what is most helpful. Is it blogs? Is it short videos? Is it webinars or panel conversations? Let me know. My contact information is here on this bio page. Please feel free to reach out or on social media as well, and please consider sharing your own story too. Even if you feel like you don’t have it all figured out or are in the middle of things right now, that can be very inspiring and helpful to someone who is following in your footsteps.

Additionally, you can also support Patient Empowerment Network with your time, talent, or treasure. Thank you so much for stopping by. Thank you for being a part of and supporting Patient Empowerment Network.

Blood Cancer Awareness Month 2022

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How to Comprehensively Explain a Medical Bill to a Patient

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Talking about difficult medical situations and finances can be challenging for anyone. When a patient is suffering or attempting to process a potentially traumatic medical condition, it’s understandable they might get more easily upset or frustrated and have a harder time listening. Still, this is the territory that comes with working as a healthcare professional, and it’s important to be mindful of a patient’s situation when discussing certain topics.

Going over a medical bill, for example, can be incredibly confusing and stressful for a patient. In fact, studies have shown that 72% of patients in the U.S. are confused by their medical bills, which can undoubtedly cause them to be further upset on top of everything else they are dealing with.  Understandably, as a healthcare professional, your day is also exhausting and stressful, but reacting negatively to a patient who is potentially struggling never helps.

While the best scenario would be healthy communication where both the patient and the medical professional speak calmly, understanding that you are both under immense amounts of stress—this is not always the case. And as a healthcare professional, it is ultimately your job to help the patient.

Patients put their trust in you, so it can be upsetting for them when the person they trust is handing them an expensive bill they can’t afford or when their claim gets denied by their insurance. These things can easily damage the trust you’ve built, which can make it hard for the patient to remain calm and understanding.

This article will offer tips and considerations for healthcare professionals to help their patients better understand the medical billing process and how to make the conversation go as smoothly as possible.

Tips for Explaining Medical Bills

The medical billing process is extensive and complex, which is often why it is so confusing for patients. For them, they see things from a very removed perspective—understandably. They are not healthcare professionals, nor do they likely have experience in complex billing processes. So when a bill is much more expensive than they were expecting, it makes sense that they might get upset.

As a medical professional, you understand more thoroughly how the process works and why costs are so high, but the patient does not. So getting defensive is never helpful. It’s important to stay calm and remember that they are not experts in billing, and they are dealing with this stressful financial situation in addition to their medical condition.

Avoid talking down to them as if they are ignorant, but do try to help them understand. It would likely not be helpful to fully explain the medical billing process and how insurance costs work, but you can try to calmly walk them through the basics to help them better understand.

This can involve talking about front-end versus back-end costs, for example. Most patients likely understand where front-end costs come from, but as back-end costs are out of sight, out of mind, those are harder for them to understand.

For a quick refresher on the two, front-end costs are costs associated with patient registration, scheduling, initial patient collections, and administration of the patient’s care and files. Back-end costs are those related to medical billing and claims management and final patient collections.

You can also briefly go over how drug costs work, as this is another factor that can make a patient’s medical bill higher than they were expecting, even if they have insurance.

Additional tips for having conversations with patients about their medical bills include:

  • Be mindful of your body language. Your words are not the only thing that can trigger a patient and make the conversation more difficult. How you use your hands, your facial expressions, and your posture can all communicate to your patient how you are feeling or even what you are thinking. So be careful and try to use friendly and open body language.
  • Don’t dismiss their feelings. It’s easy to get defensive and treat a patient like they are overreacting, but this will just make the situation worse. Even if you don’t understand things from their perspective, acknowledge that their feelings are valid. Use phrases like “I understand why you’re upset or why this is upsetting” instead of saying things like “calm down” or using negative words such as don’t, can’t, or won’t.
  • Be a better listener. Healthcare professionals often have a habit of always explaining things to their patients, and while this is necessary for some situations, it’s also important to let them speak as well. Even if you don’t agree with them or if they don’t fully understand why their medical bill is so expensive, it’s still crucial for you to hear them out and be a good listener. This can show them that you respect them and aren’t just trying to speak down to them.
  • Offer them additional help. In some cases, you might need to seek out another coworker for help. If a patient has already decided that you are against them, it can be hard to change their mind. So offer to get someone else that you know might be able to more calmly talk to them. Having another person say the same things you did might also help the patient better understand that you were being honest with them and telling the truth. If available, you can also direct them towards financial programs that can help them handle their medical bills if they are low income and need financial assistance.
  • Be kind and compassionate. Overall, the most important thing to remember is to be as kind and compassionate as possible. Kindness really does go a long way. If a patient is upset and being difficult, matching their attitude won’t help. It’s always better to rise above than to sink to someone else’s level, especially when that person is a patient dealing with a potentially traumatic condition. So always try to be as kind and understanding as possible.

Final Thoughts

Just because you are a medical professional doesn’t mean you should be an emotional punching bag for your patients. So it’s understandable that it may be challenging at times to remain calm when dealing with a difficult patient. Still, the calmer, happier, and more positive you are, the more likely your patient will reflect those things in return. Generally, happy staff equals happy patients.

Using health records software (EHR) can also help in situations where in-person communication is going nowhere. With an EHR, patients can return home and more calmly review their records on their own, which can allow them more time to process and potentially come up with more helpful questions that you can then better answer for them later. Just be mindful not to always rely on EHR to do the work for you. It’s important to still maintain a good relationship with your patients, as this can help establish that trust that is so important.

Patient and Care Partner Discuss Value in MPN Care

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Patient and Care Partner Discuss Value in MPN Care from Patient Empowerment Network on Vimeo.

 MPN Empowerment Leads Jeff and Summer talk about how they define value in Summer’s care. For instance, one important thing that brings value to them is how accessible their healthcare team is. Watch now to hear more about what they value on Summer’s journey with myelofibrosis.

Transcript

Jeff:

Alright Summer, I’m just looking at the bill for your last doctor’s appointment.

Summer:

Wow.

Jeff:

Do you think we get good value for our money? Oh. Hi, I’m Jeff.

Summer:

HI, I’m Summer.

Jeff:

And we’re your Patient Empowerment Network Network Leads for myelofibrosis. And we’re here to talk to you today about how do you define value for your healthcare dollar. What do you think is important for healthcare dollars, Summer?

Summer:

Well, really important is that the doctor and all the medical staff really listen to the patient and really aware of how the patient is doing everything. Also, that they need to explain because my doctor will come up with little charts with funny little numbers on them and something about blasts which doesn’t have anything to do with blasting like having fun. So, she’ll come out with that and explain all that.

Also, to let you know what’s going on with your medication. Where I get my medication is Walgreens Specialty Pharmacy and they’re very good. They always call me about any changes. They let me know when the order’s in. They always offer to delivery it, but I don’t think that’s a very good idea so I do pick it up.

Also, that they see the patient as an individual and respect their individuality. For example, I’m big on mind-body connection. I think there’s a huge connection doing exercise daily, eating pretty good, but I do like my sweet treats too. I don’t give that up. And Zelda, she just likes to lay around, and that’s what she enjoys. Don’t you, baby?

Jeff:

Well, a couple of things that I think are important for your value for your healthcare dollar, one is accessibility. Is your doctor easily accessible? And with the UCSD system that we’re on, we have great accessibility. They have a wonderful patient portal on the web that you can go and find out all of your results. I don’t have to keep a book of past blood test results because it’s all on the web and I can see it. And if we want to get in touch with them, there’s a way to send them a message and  they get in touch with us within the day for sure. And we can make an appointment that way. It’s really, really a good system. So, accessibility is one thing that’s really important.

Another thing is availability of specialists. Myelofibrosis is a very, very rare and unusual disease and there aren’t a lot of specialists in the whole country. We’re truly blessed to have Dr. Tanaka who is a researcher and a specialist is myelofibrosis and myeloid diseases be on call when Summer showed up at the hospital with her first incidence that led to this diagnosis. And UCSD has a number of doctors that are specialists, so we are fortunate. But you need to find a healthcare system where you have enough specialists.

And the final thing that I can think of is, you need to be your own advocate. The doctor is doing the best they can, he or she can, to solve your problem and to work within what they think is normal standard, normal practice, but they’re not mind readers. They can’t understand what is concerning you. You need to speak up, ask questions, and let the doctor know your concerns so they can address them. That’s the patient’s job as opposed to the healthcare system or the doctor’s job. Speak up.

So those are some of the ways we define value in our healthcare ‘Til next time, I’m Jeff.

Summer:

Summer. Zelda.

RMC Patient Profile: Lamar Valentina Part 1

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When Lamar Valentina shares his renal medullary carcinoma (RMC) patient journey, you can tell that he loves serving and helping others in his work and free time even as a cancer patient. As an active duty Technical Sergeant in the U.S. Air Force, Lamar has continued to work throughout his cancer treatment. When a lump on the side of his neck combined with extreme abdominal pain and flank pain concerned him, Lamar decided to have his symptoms checked out at the hospital. His RMC diagnosis came shortly before he turned 35, and his chemotherapy started about two weeks after his diagnosis.

Lamar is fortunate to have some friends who work in cancer centers, and they were connected with experts at Dana-Farber Cancer Institute, which is in Boston where his son also lives. The COVID-19 pandemic created a delay for some of his chemo, but it ended up as a benefit to give his body a break. Lamar recalls feeling some measure of relief about his tumor scans, “…we saw that there was a little bit of growth, it wasn’t alarming growth, but there was some growth, but it still hadn’t gone to where it was when I first was diagnosed, so that was the good thing that it wasn’t as aggressive as it’s known to be.”

After the things he’s gone through during his cancer journey, Lamar feels he has much to share to help other patients with what they’re going through. For newly diagnosed patients, he recommends that patients take advantage of resources and oncology therapists that most cancer centers provide. “Take the time to process the news of your diagnosis. I was sort of like a deer in headlights. Everything went blank, and I felt like I was in a nightmare of a dream, trying to wake up. So process your diagnosis and go through the emotions. You’re going to feel sad. You’re going to be depressed. You’re going to be angry. You’re going to be curious as to why you. But once you process those emotions, make sure you don’t compartmentalize those emotions and you express them to somebody whether it’s a friend, a caregiver.” 

Early after his diagnosis, Lamar decided to go full-on vegan and lost a lot of weight. “It was very frightening, because losing weight made my body become a lot more frail and weak. So I started to eat fish and chicken. His advice to other patients, “I think specific things like that definitely talk it over with your primary doctor, your medical team to make sure you’re doing what’s best for yourself and that you’re not going to hinder your treatment.”

Lamar feels fortunate to have connected with the Patient Empowerment Network (PEN) RMC Empowerment Lead Cora Connor through a Google search and found R.M.C., Inc. He also feels that the RMC community is a very tight-knit community, “I really like to pay homage to those we have lost. One of the first friends I met was Chad Alexander, Ava Cummings, Kai Penn, Da’Corey Kimbrough, Seth Calhoun, Caleb Wheeler, Feninna Vasilou, and there are so many other people I’ve met…they’ve since passed away. These are a few of the RMC warriors we have lost. I continue to fight for them and to everyone still battling RMC, I wish nothing but clear scans as we fight on the front lines together! Finding people who are going through this whether RMC or another form of cancer, I think you can relate more to cancer patients, because they understand what you’re going through.” 

Lamar advises patients to empower themselves. “You want to be able to at least know what questions to ask. And it starts with educating yourself. So I think you want to be able to go into those appointments and know what questions to ask, know if you get a certain answer to that question to know what a good follow-up question would be.” Early on in his care, he would record his conversations with his doctor to ensure he got all the information. Lamar also advises writing down questions before you go to your appointments to make sure you don’t forget about them. 

According to Lamar, being involved and learning about trial treatments are vital ways for patients to take part in their own care. “A lot of people have asked me about my treatment plan, but we’re all different. Our bodies are different. The way we can handle certain treatments are very different. So I try not to compare my care and the chemotherapy to what other people had. Because if you go based off that, you may turn down a treatment that may possibly work better for you with your genetics, and it may not have worked well for someone else, and you deny that based off their reaction to that treatment when it could be really helpful for you.”

Read the second part of Lamar’s RMC journey here…

Patient Advocacy: How To Boost Your Visibility on LinkedIn

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In my previous post, I shared with you tips to optimize your LinkedIn profile.  Recall that I recommended LinkedIn as the best social network for enhancing your professional online presence and showcasing your advocacy activities.

If you have put into practice the tips from last month, you should now have a professional-looking profile. So let’s discuss ways you can make your profile more visible on the site.

In essence, you must appear more frequently on LinkedIn, share engaging content, and engage consistently to increase your visibility.

The following are my top recommendations for increasing your activity and visibility on the platform through a daily engagement routine.

1. Share a Daily Status Update

Keep active and visible by posting a status update daily and engaging with your connections’ posts and articles in your newsfeed. LinkedIn encourages users to use specific hashtags in their posts and searches. It’s important to find hashtags relevant to your followers’ interests before you start adding them to your LinkedIn posts. It’s a good idea to observe what hashtags others in your advocacy area use on LinkedIn, as well as on other social media platforms such as Twitter and Instagram.

2. Share A Video

With LinkedIn native video, you can record a video inside the app or upload a pre-made video from your camera roll. This feature is available only on mobile, so download or update the app to make sure you have the latest version.

Tip: Go Live. In the short-term, native video on LinkedIn is still a novelty and presents an opportunity for you to stand out. With live video, you can broadcast content directly to your profile, so you can interact with your audience in real-time, drive deeper engagement, and establish your thought leadership. You will need to switch on Creator mode to be able to record live video. Here’s how to do this

3. Mention People in Your Posts

Mentioning a connection encourages engagement with your posts and comments. To mention someone in a post: Type “@” and then begin typing a name in the box.

4. Engage With Comments

Pay attention to everyone who takes the time to leave a comment on something that you post. Each time someone likes or comments on your post, their network can see it, thereby increasing the visibility of your post. When people are liking, sharing, and commenting on your posts, this acts as “social proof” to your network and beyond.

5. Nurture Relationships

Nurture your LinkedIn relationships through regular engagement. LinkedIn will notify you of trigger events (such as when one of your connections starts a new job). Take a moment to reach out to them with a personalized message of support.

6. Participate In LinkedIn Groups

Join groups on LinkedIn and start a conversation or comment on what is posted there. You will find groups by clicking on Interests > Groups from your profile or searching keywords to identify groups with interests similar to yours.

7. What You Share Matters

What you post on LinkedIn will establish you as a credible authority in your field. The key is to share relevant news, articles, and insights with your connections. Consider the type of content that will be most useful to your followers. As a thought leader, your goal is to consistently share your unique perspective on the most important industry topics.

8. Post Content At Optimal Times

Finally, be strategic about when you post. As a general rule, LinkedIn users are most active right before and after work (7-8 am and 5-6 pm), as well as during lunchtime. Experiment for yourself. Post at different times and take note of which times your particular audience is most engaged with you.

5 Ways to Get Rid of Skin Woes and Improve Skin Health

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These summer months can be a hazard to skin health if a good routine isn’t properly established. Between regular sun exposure and intense heat, your skin can react poorly to the summer climate. Constant heat and humidity can cause your skin to appear oilier than usual if you have oily skin, and rough and patchy if you typically have dry skin. These warmer months are also a prime time to get some color on your skin, but tanning will increase your chances of sunburn, premature aging, wrinkles, clogged pores, and of course, skin cancers.

With all of these potential risks, now is the perfect time to develop a summer-specific skincare routine to protect yourself from all of the harmful effects the sun can have on your skin.

Avoid Touching Your Face

First and foremost, you should avoid touching your face, especially in the hotter summer months. Throughout the day, you touch multiple surfaces, like doorknobs, car keys, and grocery carts, all of which can contain bacteria and allergens. When touching your face or rubbing your eyes, you transfer the bacteria from your hands to your pores. This transfer can cause acne and other undesirable skin flare-ups.

Similarly, everyday accessories like eyeglasses can also spread bacteria to your face, as the frames can collect sweat on your temples, under your eyes, and on the bridge of your nose. Choosing disposable contact lenses instead of eyeglasses can help you avoid these issues altogether. If you do have to wear your frames occasionally, make sure to disinfect them properly after each use to cut down on spreading any bacteria to your face.

Regardless of the season, make sure to wash your face with a clean cloth to prevent dirt, oil, and bacteria from clogging your pores. While washing your face, you should also keep your hands and surroundings sanitary. Consider using a product, like a facial cleansing bar, to balance and nourish your skin during the summer months. The combination of a consistent cleansing schedule and a fresh pair of contacts can allow your skin and eyes to breathe, which can help tremendously on hot and dry summer days.

Keep Your Skin Hydrated

The warmer seasons pose the perfect opportunity to keep your skin moist and healthy. Having hydrated skin can significantly improve elasticity and reduce fine lines and wrinkles, especially when you’re frequently exposed to the sun. Hydrated skin can also help you combat oiliness during the summer, as dehydrated skin produces more oil to make up for lack of moisture.

Make sure you’re drinking enough water each day for both your skin and your overall health. Consider investing in a reusable water bottle to motivate you and hold yourself accountable for your daily drinking goals. It’s common for people to become dehydrated during the hotter months, and dehydration can contribute to both dry and oily skin.

Wear SPF

It’s imperative to incorporate the proper skin protection into your routine during the peak summer months. This month being UV Safety Awareness Month, reminds us to take the necessary precautions to keep our skin healthy and protected against UV rays. To do this, make sure to add SPF into your daily routine, and reapply every two hours while you’re in the sun. This will not only reduce your risk of sunburn but reduce the risk of long-term damages such as cancer.

Consider Changing Your Face Wash

When developing your summer skincare routine, you should look into the benefits of your face wash. For example, in the winter, use a nourishing face wash to avoid cold, cracked skin. In the summer, you should use a face wash to draw out the excess oil your face might produce. Double cleansing is a great way to ensure you clean out your pores fully and leave your skin feeling refreshed. You may consider washing your face 2-3 times per day to ensure your pores are clean and reduce your chances of clogging.

Exfoliate Your Skin Regularly

Exfoliation is the key to brightening and smoothing your skin and can also help remove dead skin cells, especially in the summer when there is a heightened risk of sunburn and peeling. Dead skin cells also prevent the skin from breathing properly and can lead to acne and other skin problems. Exfoliate your face and body for a smooth, healthy, and lightweight complexion; but also make sure you aren’t exfoliating too much which can cause more harm than good to your skin and its barrier.

It’s essential to reevaluate your skincare routine with the change of every season. Oftentimes, your skin will react differently depending on the weather and your interaction with the sun. Prepare and protect your skin this summer with these simple steps and be mindful of your skin health all year round!

Five Things You Need to Know As a Newly Diagnosed Follicular Lymphoma Patient

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What’s important for newly diagnosed follicular lymphoma patients to know? In the “Follicular Lymphoma Treatment Decisions: What’s Right for You?” program, expert Dr. Tycel Jovelle Phillips from the University of Michigan Rogel Cancer Center shares five things newly diagnosed follicular lymphoma patients should know about your care and treatment.

 1. Understand How Follicular Lymphoma Progresses

Follicular lymphoma progresses from stage I through stage IV, though you may be diagnosed after it has progressed past early stages. Stage I is when the cancer is localized to one area, stage II is on one side of the diaphragm, stage III is on both sides of the diaphragm, and stage IV could involve progression into an organ. The grade of follicular lymphoma indicates how large the cancer cells look under a microscope, starting with grade 1 and then grade 2, grade 3A, and grade 3B. 

 2. Learn About Factors in Treatment Decisions

Several factors can play into follicular lymphoma treatment decisions. A patient’s age, overall health, comorbidities, treatment side effects, and treatment goals must be considered in treatment options. Patients in early stages may have a more aggressive treatment approach, while later stage patients may have a treatment approach that prioritizes quality of life. But the age and physical condition must also be considered in the treatment approach. Make sure to talk to your doctor about any concerns you have about factors under consideration for your treatment options. 

3. Know What to Expect for Treatment

Starting treatment for follicular lymphoma immediately is not always a given. Your doctor or care team may sometimes advise a period of watch and wait to monitor your progression instead. Reasons for waiting may include things like avoiding treatment side effects when there would be little benefit to fighting the cancer at its current stage.

4. Understand Your Role As a Patient

Follicular lymphoma patients now have more options to learn about treatment options. You can talk to patients and experts on social media or support groups to build foundational knowledge  about available treatments. Also, getting second opinions is no longer the taboo that it used to be. In fact, many follicular lymphoma specialists also encourage their patients to get second opinions, since there is not currently a standard of care. Patients should not feel like you’re doing something wrong by seeking a second opinion.

5. Discover Why It’s Important to Speak Up

Though doctors can observe some patient information in blood tests and other lab work, they  also must hear from their patients. Patients are the ones who know how you’re feeling, and this is why it’s vital for you to communicate with your doctor about any symptoms and side effects that you experience. Treatment can often be adjusted to minimize symptoms and side effects to provide patients with optimal quality of life while fighting your cancer.

By taking time to learn more about their care and treatment, follicular lymphoma patients can gain confidence to work toward the best care for your unique situation.

See More from The Pro-Active Follicular Lymphoma Patient Toolkit

MPN Patient and Care Partner Breakdown Terminology

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MPN Patient and Care Partner Breakdown Terminology from Patient Empowerment Network on Vimeo.

MPN Empowerment Leads Jeff and Summer share how overwhelming medical terminology can be. Jeff encourages everyone to ask your healthcare team questions whenever you need to. He shares that asking the right questions is part of becoming an empowered patient.

Other Videos Featuring Jeff and Summer:

Roles Reversed: Taking Care of Your Care Partner

 Patient and Care Partner Address the Mental Aspects of an MPN

 How Can Care Partners Combat Burnout

Transcript:

Jeff:

Hi, I’m Jeff.

Summer:

I’m Summer and this little darlin’ is Zelda.

Jeff:

And we’re your MPN Network Managers (Editor’s Note: Network Managers are now referred to as Empowerment Leads) for the Patient Empowerment Network. Here to talk to you today about medical terminology, which often is very confusing. Isn’t it, Summer?

Summer:

Yes, I would say very confusing. And Dr. Tanaka told me oh, you need to take a bone marrow test to determine what kind of myelo, I’m writing this down, myeloproliferative neoplasm. Anyway, Jeff can explain all that to you. To determine all that and I thought, oh my god this is so confusing. She said – she kind of set me straight and made me realize that this is really important.

Jeff:

And, so, we didn’t know, neither of us, what these things meant originally. Dr. Tanaka explained some of it to us pretty well, but then I went home and I’m interested in this, so I became, I’m Summer’s caregiver. And I started doing research, and that’s what I’m going to give you some pointers that I found.

First of all, specific words you can probably Google and find on the web and they’ll tell you want it means. There are a number of organizations that specialize, in our case myeloproliferative neoplasms and blood diseases. The LLS, Leukemia and Lymphoma Society is one of them, and the MPN Research Foundation is another. And there is plenty of information here on Patient Empowerment Network about these diseases.

So, you need to find out the answers to the questions that you have. And you will probably do some of this on your own because you’ll have, when you have your appointments with your doctor you need to ask the questions. There’s no question that should not be asked, and your doctor will be able to tell you. If  you are blessed with a good care team, they’re going to have the ability to explain to you what’s going on with your disease in simple terms and terms that mean something to you. And we are truly blessed to have Dr. Tanaka who is able to do this wonderfully.

So, ask those questions, do your own research, you need to become an empowered patient. That’s what we had to be here at Patient Empowerment Network. So the more you know about this unusual disease, in our case – in Summer’s case, myelofibrosis, or other myeloproliferative neoplasms, which by the way that means cancers of the blood produced by the bone marrow, and we found that out. So, you need to become an expert on this kind of stuff yourself because you need to become an empowered patient. That’s our advice to you.

Until next time, I’m Jeff.

Summer:

Summer and I have another bit of advice. Being married or involved with someone who, like Jeff, had all this interest, if you’re not into medical things, helps a lot because I never really think about it very much. I depend on Jeff who does a great job.

Jeff:

Thank you very much, dear.

It’s part of our concept that we’ve told you about before. You’re really apart of a team. You have the caregiver, the patient, and your healthcare provider. So, become a strong team and you’ll be an empowered team.

Until next time, I’m Jeff.

Summer:

I’m Summer and this is Zelda.