HeartBeats Episode 20: Having Chronic Pain? Lee Health has a Solution!

Host

Welcome, I'm Cathy Murtagh-Schaffer, and I'm your host for this episode of heartbeats. This podcast is brought to you by Shipley Cardiothoracic Center, an educational series dedicated to providing our patients and the community with information and education about our cardiothoracic surgery program, Lee Health, and matters affecting your health. Today. We're talking to Sharon Krispinsky RN, who is the coordinator for Lee Health's chronic health program, and Rowe Hudson, who is the director for Lee Health solutions. Their program helps patients manage chronic pain, diabetes, heart disease, and other chronic disease issues. Welcome, and thank you both for being here today, Sharon, you sent me some statistics from the program;78% of your participants are trying to manage heart disease and high blood pressure, 44% are trying to manage arthritic issues and 32% are managing diabetes. Your program deals with an extensive list of disease entities, and they're not easy ones, chronic health issues plague our patients daily lives and for some can make life absolutely miserable. It's really great to know there's this type of support available. Rowe, maybe we can start with you by asking you to give us a general overview of what Lee Health solutions is and what it has to offer.

Rowe Hudson:

Sure, Lee Health solutions offers programs that can help the individual take a more active role in their health. We teach participants the self-management skills needed so that they can successfully manage their condition, and in many cases significantly improve their condition. We offer both inpatient and outpatient services and on the inpatient side, we offer our certified diabetes care and education specialists. Their role is that they provide bedside diabetes education to the patient so that when they are discharged, it's a safe discharge, and the patient has steps that they can follow up with once they're at home to ensure that they have everything they need to successfully manage their condition. From there, those same patients may then convert to our outpatient program where we have a 10-hour comprehensive diabetes self-management program that teaches people pretty much everything they need to know to successfully manage their disease. Everything from what is diabetes, what are the symptoms, how does diabetes manifest itself in the body, what steps can you take as an individual with diabetes on how to properly manage it through the foods that you eat, the exercises that you do, the self-care through blood sugar testing, or checking your feet, getting eye exams, all of these things we want to properly equip the individuals so that they have everything they need to be successful and then we're here to support them.

Host:

Do they have to inpatients in order to access your program? Or can they be from the ambulatory sites?

Rowe Hudson:

So they can be from ambulatory. In fact, the majority of our patients were not previously inpatients, we have both. So physicians in the community referred to us, patients themselves, if they have diabetes, they can reach out to us and then we can then reach out to their physician, we can do that too. So really we have numerous ways for people to access the program, but the bottom line is we want people to get the education that they need. Many people think that all they need to do is go to the doctor, take the medications that they need and just follow what the doctor says. But there are so many things beyond that, and that's you know, the programs that we offer that's what we try to empower them; to know that they really have the power to manage and improve their condition significantly.

Host:

I think that's a great point, particularly in diabetes. I know a lot of patients are surprised when you talk to them about their feet or talk to them about getting an eye exam. What does that have to do with my diabetes? Well, that's the point they don't know, but those are important aspects of diabetic care.

Rowe Hudson:

Yeah, and we don't want them to have any surprises. We don't want anyone, we've heard this before; Somebody that comes to see us for the first time, I wish I had known. We want to try to remove that and give them everything that they need to successfully manage the condition. So in addition to the diabetes program that we offer, we also have a pre-diabetes program called the diabetes prevention program. This is geared to individuals who have been diagnosed with pre-diabetes with the goal of significantly reducing the chance that they will develop diabetes. It's mainly geared toward lifestyle improvement in two key areas, one being weight loss if they need to lose weight, we focus on that as well as activity. We'll talk a little bit more about some of the outcomes. If we can, we get an opportunity. We also have programs for gestational diabetes. So women who become pregnant and developed diabetes, and then we also have a team of registered dieticians who can work with individuals really for any type of health condition. Whether someone wants to lose weight, whether they have kidney disease, whether they just want to eat healthier to ward off disease in the future, we have different programs that can help.

Host:

That's great. I love the fact that this is available for our patients because so many of our heart patients here in Shipley have these specific issues. So it's wonderful to know there's someplace to get them to

Sharon, which programs do you manage?

Sharon Krispinsky:

Yes, well I manage four chronic health programs that are complementary to the community. I have a chronic disease self-management education program, a chronic pain program, and HIV program. The chronic disease program, we can actually take out to employers and teach these tools and skills to employees at any company as well.

Host:

That's wonderful. That's fantastic.

Sharon Krispinsky:

These programs were originally developed at Stanford University and they're taught worldwide and as well mentioned, they're very outcomes driven. And we'll share with you some of those outcomes,

Host:

Rowe, talk to me a little bit about how you're measuring the effects of your program.

Rowe Hudson:

You know, we're always constantly evolving our programs based on the outcomes that we see based on new technologies. We're constantly looking at our performance and what we can do to improve. So for example, if you look at our diabetes program, one of the markers that we use to measure success in the program is the hemoglobin A1C test. The hemoglobin A1C for anyone who doesn't know is a blood test that can determine someone's diabetes control, how well they're controlled. The goal of someone who is well controlled would be an A1C around 6.5, maybe upwards to 7, or perhaps a little lower than that. What we see on average is that our, our hemoglobin A1C is for our patients after they've been in our program for six months, they have a reduction of 1.3% or 1.3 points. So, that would be as an example, you have somebody that comes in with an A1C of 8, which is too high, it means their diabetes is uncontrolled. Six months later, they're at 6.7, which would be in that range that we would see now, of course, people who start much higher may have even more of an improvement as we continue to work with them, we see that. If we're talking about gestational diabetes, we're looking at the birth weight of the babies once they're delivered. Macrosomia is a condition of a high birth weight. Any baby delivered 8 lb, 13 ounces or higher is considered in that condition, and that is a complication of uncontrolled diabetes during pregnancy. We measure our birth weights of our patients after they've delivered and ours run right around 7 to 7.3 pounds, which is right in there with a non-diabetes delivery, which is great. As it relates to our weight management program, we look at pounds loss by percentage, we see about a 5% weight loss in about three months, which is pretty average, or that's what's your goal is. That is the recommended amount. So, and then our diabetes prevention program, as I mentioned earlier, we're looking at weight loss and we're looking at exercise and we see 78% of the individuals at the three-month mark are exercising at least 150 minutes a week, which is what we're shooting for. 55% of them have achieved the weight loss goal. At that point.

Host:

I know that diabetes is a big issue for a lot of our patients, and especially adult-onset diabetes. I have a family member who has a devil of a time managing his sugars. Sharon, why do you think people have such a hard time controlling their sugars and how does your program help them manage their sugars? What's new out there in the way of glucose management?

Sharon Krispinsky:

Well, diabetes is such a complex disease. There are so many variables that affect your blood sugar, such as what you eat. You know, how many carbohydrates are you consuming? Your physical activity, are you active, are you not, and stress? And then also we have to remember physical stress. So if you become ill with a cold or the flu or COVID, or you have surgery or an infection, all of that's going to impact your blood sugars. So it is very complex, but at Lee Health solutions, our Lee diabetes care program will teach participants the tools necessary to manage this condition. There's so much new out in the market, whether we're talking about inhaled insulins or insulin via patch, where you can put a patch, we have continuous glucose monitoring out there.

Host:

I've seen those, I like that idea.

Sharon Krispinsky:

Yes, where you could see it on your smartphone. We have long-acting insulins, much longer even than 24 hours now that we can utilize. Even with our pills, our oral agents, we actually have agents that really affect the root cause of what is causing type two diabetes. When I started many years ago in 1980s, we only had one class of medications and those are drugs that affected the pancreas, but we have so much more on the market now.

Host:

I know, it seems like every time I turn the TV on, there's a new drug for diabetes out there.

Rowe, how does Lee Health solution stay on top of the continued advances and understanding that we have in the management of chronic disease?

Rowe Hudson:

Yeah, that's a great question. You know again, with the evolving of technology and the advances in medical science, it's important that we do keep up with the information so we can better educate our patients. So, our team, of course, through continuing education, they're involved with whether that's something more formalized or honestly meeting with some of the drug representatives to learn about the new medications, the device representatives, whether it's a continuous glucose monitor that Sharon mentioned, or whether it's an insulin pump. We have to be constantly updated on those items so that we can then teach the patients appropriately. We also talk with other health systems and compare notes, whether that's on the inpatient side or the outpatient side, what are you doing? What works for you? And then we get to share with them what we're doing. So it's a constant task that we continue to undergo.

Host:

Well, working in medicine is all about staying on top of things, for sure. I think we are called lifelong learners for a reason.

Rowe Hudson:

Yeah, for sure.

Host:

One area that seems very in this particular region is chronic pain and chronic pain can be so debilitating for people. As we know, this type of pain plays a huge role in our opioid abuse problem. Sharon, what strategies do you teach patients with chronic pain to help them cope?

Sharon Krispinsky:

Well, when we have pain, very often, we think the first thing we should do is go to our medicine cabinet, pick out some Tylenol or a nonsteroidal or something our doctor may have prescribed. But what we forget is that there are so many tools that we can utilize to manage pain, such as some of the things we teach is mindfulness, guided imagery, relaxation body scans, distraction techniques, positive self-talk. There are foods that we can eat to decrease the inflammation in our body, and we teach that. Very often when you're in chronic pain, many patients are surprised to know that one of the best treatments is physical activity, that we have to stay active. So we teach a gentle flexibility program. Also, we talk about pacing and planning because we can have increased pain by overdoing activity, but we also can have increased pain by under enduring. So we talk about that delicate balance and pacing and planning tips, just to name a few.

Host:

Those are great ideas. We actually started a research study for our post-op cabbage patients using virtual reality and as a distraction technique. We were seeing some really interesting results in decreased levels of pain so patients didn't need narcotics. We need to continue that, it got disrupted with COVID, but it had a great start. I think the whole idea of other ways to manage pain is really important to get out to the community because we do have a big problem with opioid abuse here in Fort Myers.

Sharon Krispinsky:

Cathy, I'll share with you in our chronic pain program, patients self-report a 52% decrease in their chronic pain scores after attending this six-week workshop. So it really is quite effective in helping people to manage their pain.

Host:

That actually brings up a question, both of you have mentioned the terms of the length of your program. Do you encourage people to come back or do they come back? How is that managed?

Sharon Krispinsky:

Well, with our chronic pain, chronic disease programs we do encourage people to take them, they're complimentary. So let's say six months, a year later, they feel like they're not remembering or utilizing the tools that they were taught. They are always welcome to come back to one of our programs again, and then with our other programs, let's say our diabetes programs, they can always access our registered nurses or registered dieticians and see them in consult again.

Host:

That's great. Do you guys have a website that people can go as far as you do?

Rowe Hudson:

We do, if you go to Lee health.org at the top click on services where we are listed there with all of our services.

Host:

Another very important program is managing HIV. I'm always amazed at how far we've advanced in the care of patients with HIV. Now HIV is considered another chronic illness like diabetes and heart disease. Sharon, can you talk a little bit about this program?

Sharon Krispinsky:

Yes. Our HIV self-management program is our newest program that we are hoping to launch in the next few months. This program is similar to our chronic disease, but it has tools unique to how to monitor your HIV status. So looking at some of the lab values, it also talks about a symptom checker. So you will know if your symptoms come on, you know, very severe or atypical, or you have a fever or altered mental status that that's a time you need to consult with your doctor. We also talk about sex and intimacy and how to communicate your HIV status to your loved ones. So there's unique tools specific to this program to help you manage HIV.

Speaker 1:

That's great. I started my career as a PA working with HIV 30 years ago and nothing like that existed. In fact, we had no idea what HIV was at the time, kind of like this round of COVID, but I'm so glad we've progressed so far.

COVID has really impacted services here at Lee and we've had to become very agile in how we remain connected to our patients grow. Rowe, what was your strategy for managing these programs during COVID?

Rowe Hudson:

Yeah, it certainly was challenging, especially at the beginning because the services that we offered our in-person services. Whether people came in individually to meet one-on-one with an educator or whether they attended a group program, we really had to think on our feet and look at what opportunities we had. Of course, one that jumped out to us along with everyone else is the use of technology. So we did quickly adopted the telehealth platform that we could use both in individual sessions, as well as in groups. We've continued to use it and it's really been very well received. Yeah, I can really see, even when we go back to being able to offer group education, we'll continue it because it makes it so convenient. I don't think anyone knew how much we would adopt this and how well it really has changed our day-to-day lives.

Host:

I will tell you this, that just before COVID hit telehealth was a concept that we were working with playing with and trying to get set up. But what happened was once COVID hit, we had to really move on this and all of a sudden it became a reality between the months of March in December of last year, we did 79,000 telehealth visits. That's how real this got. I think you're absolutely right, this is here to stay.

Speaking of COVID Sharon, do you think you will develop a program for what we're calling the long haulers, those with persistent symptoms or neurological deficits due to COVID?

Sharon Krispinsky:

Absolutely, I'm just in the infant stages of marketing our chronic disease program for COVID long haulers. Because if you think about the symptoms that are seen with COVID long haul conditions there, such as migraines, shortness of breath, difficulty concentrating, body aches, and the chronic disease program can help with all of those symptoms because those symptoms are somewhat unique to anybody with a chronic health condition. So yes, again, learning tools such as mindfulness and gentle physical activity programs and how to eat nutritiously, how to get a good night's sleep because many COVID long haulers might have trouble sleeping. That can all be helped and impacted by attending our programs.

Host:

Yeah, I think, although we're getting a handle on COVID with the vaccine and the transmission of COVID, I think that the future is going to be around the management of symptoms left over from COVID. There's a lot of people out there with these long-lasting symptoms. So it'll be good that Lee is providing a place for folks to go and help manage those symptoms. You guys are doing a fantastic job.

Really appreciate you both being here today. I had no idea we had such a robust program for chronic illness. What number can patients call if they'd like more information or to join in one of your programs?

Rowe Hudson:

Anyone interested in any of our programs can call (239) 424-3120 to get more information. As I mentioned earlier, they can go to Lee health.org and click on the, our services link at the top of the webpage. Sharon had mentioned that the programs that she offers are complimentary, so there's no charge for those programs. I did want to mention the programs that I discussed related to diabetes and weight management and what have you, some of them are covered by Medicare and commercial insurance. So if you're interested in those programs, certainly give us a call and we can help navigate you through that.

Host:

That's excellent.

Sharon Krispinsky, and Rowe Hudson from Lee Health Solutions. Thank you so much for the great information until next time. I'm Cathy Murtagh-Schaffer, and this has been HeartBeats, Shipley Cardiothoracic Centers podcast, dedicated to bringing research innovation and education to our patients and the community.