If you're living with a chronic illness, you're in the right place.

Thursday, October 17, 2013

Illness and Spirituality

2:39 PM Posted by Stephanie Horgan , ,

Spirituality is a topic that I have a strong interest in, but one I want to tread lightly on, as this is a highly sensitive topic. Religion can be polarizing, similar to politics, so in honor of the government drama going on, I will dip my toe ever-so-slightly into this topic, and may dive deeper in the future. To start off, here is an image from one of my favorite holiday gifts a while back, entitled "Nuns Having Fun." There's something to be said about not taking yourself too seriously, no matter what religious beliefs you have. 

What brought my attention to this was reading the most recent Caring for Crohn's blog entry entitled, "Losing My Religion." It brought up this wonderful intersection of religion and chronic illness. Any illness brings with it challenges, often lifelong, that have a major impact on a person's quality of life. With physical illness, the unpredictability and stigma of the disease can produce mistrust for the patient, not only of his/her own body, but of a higher power that would allow such illness to occur. Integrating personal suffering into a religious worldview can be a challenging task, and one that ebbs and flows throughout life. For as many people that turn toward religion when life gets tough, there may be just as many that turn away. This is why I am careful to at least touch on this topic in my sessions with a patient, but do so in a gentle manner, as there can be many deep emotions around a person's faith. 

I came across a study about chronic pain patients which looked at the relationship between religion/spirituality and physical health, mental health, and pain. The researchers found that "private religious practice (e.g. prayer, meditation, consumption of religious media) was inversely related to physical health outcomes, indicating that those who were experiencing worse physical health were more likely to engage in private religious activities, perhaps as a way to cope with their poor health." I can attest in my own life that the worse my health gets, the more I need to rely not only on other people, but faith. When times are good and illness is in remission, there many not be as much of a pull towards seeking a higher power. The study also found that "forgiveness, daily spiritual experiences, religious support, and self-rankings of religious support, and self-rankings of religious/spiritual intensity significantly predicted mental health status." This doesn't necessarily mean that if you are not spiritual, that you will have worse mental health, but it does show that some of the spiritual principles mentioned above may improve a person's mindset. 

Its well known that religion and spirituality can be a very helpful coping mechanism in the face of suffering with a chronic illness. I see many of my oncology patients talk about their relationship with a higher power and see the comfort it brings them as they go through treatment. There is also much research on Mindfulness and Quality of Life, which although meditation not necessarily associated with any one religion, it has often been paired with Buddhism or New Age theories. I recommend checking out Mindfulness programs, sometimes called MBSR (Mindfulness Based Stress Reduction), in your area if you are looking to start a general spiritual practice. Its more of a discipline of learning to be still and in the present moment. I don't know a religion out there that wouldn't advocate for this. I've also seen Mindfulness and Guided Imagery combined with certain religions, as it is truly just a method of connecting to yourself, and can enhance your current spirituality. Mindfulness provides quiet space for stress to dissolve, and gets you in touch with your breath and bodily sensations. Whether it leads to any other spiritual practice or not, its a great way to slow down from the chaos of our culture, and just be. 

To close, I will leave you with some helpful links if you are looking to live more mindfully. Happy zen time! 
Live Mindfully - Try free online links and mp3 downloads
UCLA Mindful Awareness Research CenterFree online meditations through the web or iTunes

Sunday, October 6, 2013

Affordable Care Act

3:17 PM Posted by Tiffany Taft , , ,
Greetings.  I'm here to talk about the government shutdown.  Ha, just kidding.

Who knew how powerful Mr. White really was?
We're 5 days into the implementation of the Affordable Care Act (aka "Obamacare") and, political ideologies aside - really really far aside - I wanted to go over some of the important parts of this law for people living with a chronic illness.  You know, in case you're like me and didn't have time to read all 2,000 pages; I've reviewed several reputable sources for this information which hopefully will summarize some of the key points.  I'll leave the arguing of the merits or abominations of this law to the pundits, politicians, and anyone else who likes to debate social issues.

Pre-existing condition clauses are a thing of the past.  Under the ACA, insurance companies can no longer exclude a person from coverage due to a chronic condition.  In addition to this, they're supposed to offer affordable plans and not increase premiums if you have a chronic illness that may require expensive treatments.  This may be, in my opinion, the most important aspect of ACA for the chronic illness community.

Prevention of "insurance gaps."  According to a 2011 survey, 25% of adults between the ages of 19 and 64 experienced some time without health insurance, most likely the result of changes of employment status.  70% of those with a gap in coverage had it for at least 1 year.  That's a long time to go without insurance if you have a chronic condition.  Those who tried to buy their own insurance often reported trouble finding something they could afford, and most had trouble doing a worthwhile comparison of the available plans.  Under the ACA, insurance exchanges will provide a viable alternative should a person need it if they lose their employer-based health insurance.  Health insurance is critical for those with chronic illness, and often people will stay with unpleasant jobs because they need their insurance and fear no viable alternative.

Continuity of care.  Related to insurance gaps, jumping between insurance carriers can lead to your go-to physician who's been managing your condition to go from in-network to out-of-network which results in interruptions in care.  Being able to avoid losing these critical physician-patient relationships solely because of a change in insurance plan is a big plus.

Emphasis on integrated care.  You probably haven't heard much about "Patient Centered Medical Homes."  When I first read about this concept, I thought they were talking about nursing homes.  Nope.  This is a new(ish) integrated model for primary care that the ACA advances to possibly be the new way of doing things in medicine. The basic gist is to have your primary-care physician head up a team of medical professionals who facilitate care for you and a group of patients that they're assigned to.  They not only look at your health, but the health of a group as a whole.  The emphasis is on self-care and self-management.  Under this model, there should be much-improved access to care with same-day appointments, proactive tracking of your condition(s), and integrated electronic health records to make sure nothing falls through the cracks and the sickest patients get the most attention.  Sounds nice, doesn't it?  The jury is still out if medical homes really do what they say in terms of improving care and cutting costs.  But it seems they are here to stay.  It does seem to be a reversal of the super-specialization in medicine that's been popular over the past few decades.  If you have more than one chronic illness, you understand how frustrating this disjointed "I only treat a certain part of your body" approach can be.  I've seen clients who have been to 6 specialists for various problems and while each one gave the person a diagnosis, none of them actually talked to each other.  Even within the same health system with the same health records.  So I'm hopeful about this shift.

Those are some of the highlights of the ACA and how it may impact people living with a chronic illness.  Love it or hate it, there are some changes in this law that should have significant impacts.  Like everything else, we'll have to see how things shake out.

Dr. T