Is your Indianapolis doctor a lifesaver?

Is your Indianapolis doctor a lifesaver?

When a baseball-sized brain tumor threatened Kelsey Stewart’s life a year ago, he immediately sought highly rated doctors to treat his cancer.

After the terminal diagnosis, Stewart, his wife and daughter created a list of questions: How does this cancer grow? Will I be one of the 5 percent of patients who live past one year? Is financial help available if necessary?

Four Indiana University Health doctors, including highly rated neuro-oncologist Stephanie Wagner, helped to answer questions and educate Stewart, 45, on his disease prior to surgery, through 12 rounds of chemo and radiation and during follow-up care.

“Dr. Wagner or her staff has always been available to discuss any issue almost immediately, which is very unusual for any physician,” he says.

Today, the Fishers resident says he owes his life to everyone involved, including his family doctor, highly rated Debra Moreland, who first discovered the tumor. Stewart’s defied the odds so far, and he’ll continue to take the chemotherapy drug Avastin to help prevent recurrence, which occurs in most patients within a year. “They say the cancer is gone,” he says.

Stewart stands among almost 30 percent of Angie’s List members who took an online poll and credit doctors with saving their lives or the life of someone in their immediate family. Members who’ve suffered from cancer, heart problems, chronic diseases, depression and emergency situations say they’re here today thanks to family doctors, oncologists, cardiologists and many other providers.

Although the details are unique, what the stories have in common are patients actively engaged in their health care, while doctors and their staff demonstrate technical skill and compassion in the midst of crisis.

Prepared patients save lives

Getting the proper diagnosis and quality care, which could potentially save your life, involves not only finding the best doctor possible, but looking out for your own health by understanding your medical history, researching any symptoms and treatment options, along with openly communicating with your provider.

“You are your own best advocate,” Wagner says.

Marifran Mattson, a health communications professor at Purdue University, agrees. To help with diagnosis, she says patients need to discuss their health and family medical history with their doctor.

But while 96 percent of Americans agree that health histories are important, only 30 percent say they’ve actually compiled one, according to a survey by the Centers for Disease Control and Prevention.

Your medical history should include documentation of current ailments and symptoms, says Dr. David Newman-Toker, associate professor of neurology and otolaryngology at Johns Hopkins University and chairman of the annual Diagnostic Error in Medicine International Conference.

By providing this information, he says patients help to prevent misdiagnosis. “Despite all of our newfangled technology, studies show that the history of the patient’s symptoms constitutes anywhere from 60 to 80 percent or more of the diagnosis,” Newman-Toker says.

Good doctors will draw this out of the patient, he says, but it’s in the patient’s best interest to be prepared. If it’s complicated, create a timeline of symptoms. “Anything you can do to give the physician a better sense right off the bat enhances their ability to make an accurate diagnosis,” he says.

A two-way street

Doctors should listen, ask questions, explain their logic and not be afraid to express uncertainty. Newman-Toker warns a red flag includes dismissive, arrogant doctors, or conversely, nervous Nellies. “They don’t seem to know what they are doing.” he says. “They say, ‘It could be a million different things and we have to order a lot of tests’ without explaining why your case is different or unusual.”

After experiencing multiple symptoms, including swelling in her chest, arms, neck and face; trouble breathing; and chest pains, Angie’s List member Diane Marsh became more active in her health care in 2008.

She researched her symptoms and kept medical records. After visiting six doctors in two years with no improvement, the 43-year-old Mooresville resident continued to seek other opinions.

Marsh then received a referral to Dr. John Fehrenbacher, a highly rated cardiothoracic surgeon with Indiana University Health, who was the first doctor to realize she had histoplasmosis, a fungal infection. “I’m glad I never gave up,” Marsh says. “He gave me my life back.”

Fehrenbacher, who believes his treatment saved Marsh’s life, says in 30 years, he’s only seen about 10 cases of the swelling that can cut off blood flow to the lungs and kill untreated patients.

“A lot of people get histoplasmosis, but a lot of people don’t get inflammatory response in lymph nodes,” he says, noting his cardiology background helped him spot the issue

Doctors believe Marsh contracted histoplasmosis from particles in the air near her home where a fungus grows on the ground. Swelling from the infection starts in the lungs. In Marsh’s case, it caused an infected and swollen lymph node in her chest that pinched her superior vena cava, the second largest vein in the body.

“I have no doubt that he has prolonged my life,” Marsh says of Fehrenbacher. “I could not imagine living with the symptoms I suffered two years ago.” After insurance, Marsh says she paid $100 for the surgery and estimates it would have cost $70,000 without coverage.

Keeping costs under control

Patients, like Marsh, who undergo lifesaving treatments often rely on insurance to help cover costs, but bills can still add up. Stewart, who wrapped up chemotherapy treatments in January, paid a $6,000 deductible before fees were 100-percent covered. Average cost to remove an adult brain tumor is $53,700 at IU Health, says Kris Karol, hospital spokesman.

Without insurance, Stewart estimates 12 months of chemotherapy would cost him $120,000. He also received the injectable chemotherapy drug Avastin that he says would ring up at $20,000 per month for his treatment.

“If we did not have [insurance] we would have to search out other means of payment and help,” he says.

Patients and medical staff should work together to keep costs affordable, which is an important part of lifesaving health care, says highly rated cardiologist Dr. Jack Hall.

“The medicines we use are expensive,” he says. “Everybody’s insurance changes every year. It changes what medicines patients can be on, what tests they can and can’t have. It’s confusing and frightening for the patients.”

Hall sees patients through The Care Group at St. Vincent Heart Center and The Care Group at Lebanon, both highly rated practices.

Angie’s List member Bruce Bowers of Carmel says Hall saved his life in 2010. During a routine exam that was part of follow-up from a 2006 mild heart attack, Hall felt the bulge of an aortic aneurysm when examining Bowers’ chest and immediately sent him to another doctor for an ultrasound, and emergency surgery followed. Doctors told Bowers if the aneurysm had ruptured, it likely would’ve killed him.

Bowers is thankful for Hall, but the doctor instead acknowledges the entire team for giving quality care. “It takes so many people — doctors, nursing staff, discharge, respiratory therapists, office workers  — and that’s just in the hospital,” Hall says. “I refuse to take all the credit.”

Today, Bowers is back to gardening and walking. “I’m alive and kicking,” says Bowers, who found out after the surgery his father died from an aneurysm. This and thoughts of losing his own life has inspired him to encourage his family to monitor their risks for the same condition.

Life-saving detective work relies on good communication

Unlike the immediate fix a heart surgery can provide, some symptoms take decades to resolve. After battling depression for 30 years and seeing countless doctors ranging from psychiatrists to endocrinologists, member Sherry Rosenthal can’t thank ob-gyn Dr. David S. McLaughlin enough for what she views as nothing short of heroics in late 2010. She says the hormone replacement therapy he administered lifted her fatigue.

The Carmel resident, 66, pays about $360 out of pocket for the therapy every three months, which she says is worth every penny. “He gave me my life back,” says Rosenthal of the highly rated doctor. “Even if you’re with the best doctor in the world, if you don’t ask [questions] and be your own advocate, you won’t get the best treatment.”

McLaughlin strives to partner with his patients at Women’s Specialty Health Centers in Noblesville, Ind., offering several treatment options and recommending second opinions when surgery is on the table. “This isn’t rocket science,” McLaughlin says. “The key starting point is to listen to the patient.”

For patients who don’t feel comfortable pushing for themselves or just want help sorting through confusing bills and insurance claims, they can use a patient advocate, says Adrienne Muralidharan from highly rated Allsup Inc., a national company based in Belleville, Ill., that offers disability claim services.

Many hospitals offer patient advocate services. In addition to the financial side, advocates can get patients to appointments. Doctors say patients can also advocate for themselves by reporting any unusual changes in their health.

Benefits of regular visits, long-term relationship

In 1999, member Monroe Hall of Avon had a routine physical with Dr. George Elmes, a highly rated internist and family practice doctor with Indy Internal Medicine Consultants. During the exam, Elmes asked if Hall had experienced any health changes, which resulted in a discussion about chest discomfort he experienced while exercising.

Elmes recommended Hall see a surgeon because he felt his patient’s life could be at risk. Two weeks later, Hall had a quadruple bypass surgery. “I would have had a massive heart attack that probably would have killed me,” he says.

Seeing patients two to four times a year helps Elmes know them physically and emotionally, and he says it helps him catch health issues, such as Hall’s heart problems. “The ability to develop that relationship fosters respect and fosters cooperation in terms of what needs to be done,” he says, acknowledging Hall is a model patient by following treatment plans, taking medication and exercising.

Experts stress the importance of having a primary care physician, like Elmes, who may be able to spot problems before they progress to the stage of an ER visit, which can save you money.

Depending on the complexity of the health issue, the fair market price — the amount providers typically accept as payment in full — for a doctor’s office visit in Indianapolis can range from $105 for a 15-minute exam to $214 for an extensive problem, approximately a 40-minute exam, according to Healthcare Blue Book. ER visits range from $378 for a very minor problem to $3,049 for a life-threatening situation not involving an overnight stay.

Patients who see highly rated rated Dr. Walter Beaver, a family physician with American Health Network in Noblesville, undergo an annual 90-minute physical as part of his concierge health services. The physical includes lab work to develop personalized wellness plans and costs $1,500, which isn’t covered by insurance but is included in patients’ out-of-pocket annual fees. Typical annual exams are less extensive and covered under insurance.

Angie’s List member Margaret Wilson believes a 30-year relationship with Beaver helped him save her life twice. Beaver discovered a benign tumor in the northside Indianapolis resident’s stomach in 2000 and cardiac issues that led to implantation of two stents in her heart in 2010.

Annual exams help save lives, says Beaver, who says he finds one or two early bladder or kidney cancers through routine urine screens each year.

“Surgeons and interventional cardiologists hold people’s lives in their hands routinely,” he says. “Most of the rest of us are trying to deal with each patient’s health as it presents itself to us. At times, it means making the right decision or the right referral. It is less dramatic, but not less important.”

- with additional reporting by Matthew Brady

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