Updated 

Avoiding doctors? Price of that decision may surprise you


An angry-looking blemish is found to be MRSA (methicillin-resistant staphylococcus aureus). Odd back pain reveals pancreatic cancer. A nagging virus or bacterial infection then morphs into life-threatening sepsis.

Yes, these situations are extreme, but sadly, they happen. And it is often to those who don’t address symptoms early.

Although it is one of the top-spending nations per capita for health care (about $8,400 a year), the United States leads among industrialized nations in preventable deaths for people younger than 65. A 2012 study in the journal Health Affairs found the U.S. to lead European nations such as France, Germany and the United Kingdom in preventable deaths despite outspending them on health by about 2 to 1. For instance, half of all cancer deaths fall into the preventable category, according to the American Cancer Association.

Most people know early detection is key to successful cancer treatment. But some doctors and health practitioners contend there are plenty of other major illnesses that start small and can be overlooked for too long.

Dr. Andrew Cash, a valley spine surgeon, says many backaches he sees are indeed classic degeneration cases. But he also cautions that some chronic back problems coupled with fever, chills and dramatic weight loss could come from cancer in tumors on nearby organs such as the pancreas or kidneys.

“Usually the most concerning part is an extreme amount of weight loss. The tumor is eating all the protein, not you,” he says.

Aortic aneurysms, or bulges in the aorta wall, also can cause back pain. If the aneurysm ruptures, death can occur within minutes. Cash emphasizes that these are not common situations, but a nagging back problem that doesn’t respond to over-the-counter pain medicine and lasts longer than six weeks must be checked out.

Cash also says more than 95 percent of his patients do not need surgery, but simply referrals to chiropractors, pain management clinics or physical therapists. And a thorough exam upfront to rule out the bigger problems first brings a sense of relief.

“No one discipline is going to fix everybody. … You always want to look at the noninvasive first to see what happens,” he adds.

REASONS FOR DELAY

Cash and other doctors hear a combination of reasons patients put off care. Busy schedules and cost are the biggest factors. With the Great Recession, there is a growing trend of putting off medical services and viewing them as a discretionary expense.

A 2009 Kaiser Family Foundation report found one in four Americans delayed seeing a doctor in the past 12 months because of cost. The report also said 16 percent of respondents put off surgeries or a doctor visit tied to chronic illness. In 2012, a Gallup poll found about three in 10 Americans put off medical care, again, because of high costs.

But concierge medical practices such as Dr. Robert White’s Executive Health and Wellness Center are thriving in the west valley. White charges an annual fee to clients and a co-pay in exchange for prompt and thorough care. About 95 percent of the time, patients get a same-day visit and wait times are typically five to 10 minutes, he says. He averages about 40 minutes with each patient.

All of this comes at a cost, of course. Individuals pay a $1,750 annual fee and families up to four pay $3,200. White asserts that the business model “quadruples” the patient-physician relationship and as a result creates a scenario in which patients are far more in tune with their sniffles, aches, pains and bumps for early diagnosis. White encourages an annual physical exam as a preventive measure. His physicals take two hours, and include a cancer screening, stress test and body fat composition check, among other tests.

“A lot of this is a breakdown of the doctor-patient relationship,” he says. “You don’t get enough time. (In most cases) it’s an hour wait and 10 minutes with the patient.”

Even with a more informed patient, White is still shocked by some of the calls he receives.

“Believe it or not, people call me for chest pain and shortness of breath. Forty percent think they just need heartburn medicine,” he says. “Some patients can’t get it through their head that even if they don’t feel bad, things can get bad. … It’s like falling off a cliff then shopping for parachutes.”

White has seen his share of odd cases in which a simple pain turns out to be something more. He has seen strained calves that are actually a blood clot issue. He warns that during flu season, streptococcal bacteria, which cause strep throat, should be watched for. So should a stronger strain such as the one found in pneumococcal meningitis, which can kill within a few hours. He himself is a two-time cancer survivor and credits early detection for his positive outcome.

Susan VanBeuge, an assistant professor in the University of Nevada, Las Vegas School of Nursing, says chills, fever and other flu-like symptoms that have not responded to over-the-counter treatment after 24 hours are cause for a doctor visit. And, she says, skin conditions, such as infections that bring redness, swelling and pain, and also have a pustulant wound also require a visit.

DECEPTIVE SYMPTOMS

VanBeuge, who has been a practicing nurse for 20 years plus, will tell you that a couple of decades ago methicillin-resistant staphylococcus aureus was seen only in hospitals. The condition has been widely publicized in the past five years for spreading beyond hospital walls. Defined, MRSA is a “staph” infection that is highly resistant to the first lines of antibiotics. In some cases, MRSA sufferers will need a 30-day regimen of antibiotics, she says. If MRSA gets into the bloodstream, it can be fatal. In many cases, MRSA can simply look like a stubborn blemish, but “what lies beneath sometimes can be much worse,” she says.

The spread of the bacteria strain has created a population of MRSA carriers who have the bacteria on areas of their body such as the skin, nasal passages or fingernails but do not have symptoms of illness. But if the bacteria penetrate a cut or scrape, infection can occur.

Other infections gone unchecked can cause a condition known as sepsis, in which the body has a severe response to bacteria or germs. Inflammation throughout most of the body usually ensues and death occurs in most cases that are not contained early. Sepsis can be hidden in tests by antibiotics already in the system, VanBeuge says, making it sometimes difficult to diagnose. Some pneumonia cases can also be sepsis in disguise. An older person with a chronic illness such as diabetes is likelier to have greater complications from basic illnesses that can turn into sepsis than a younger healthy person, she says.

VIGILANCE REQUIRED

Skin cancer is the most common form of cancer in the U.S., according to the Centers for Disease Control and Prevention. Melanoma, the deadliest skin cancer, accounted for nearly 62,000 cases in 2009, the most recent statistical year available according to the CDC. More than 9,000 of those cases were fatal.

Awareness of one’s sun exposure history and a familiarity with skin changes are keys to detecting skin cancers early, Comprehensive Cancer Centers of Nevada medical oncologist and skin cancer expert Dr. Wolfram Samlowski says. He says those whose skin has little dark-colored pigment, which allows for tanning, and have experienced prolonged sun exposure in their younger years are at a higher risk for melanoma. Suspicious spots to watch for include recurring scabs, crusts, open sores and bumps that change in shape and color. There is also what’s referred to as the ABCDE rule when looking at skin spots. The acronym stands for: asymmetry, border irregularity, color variation, diameter (larger than 6 millimeters, or the size of a pencil eraser) and elevation.

“I think something that is persisting and changing is probably more important than size. I don’t want to mislead people, but there are melanomas smaller than a pencil eraser,” he says.

Although most melanomas tend to be brown or black, about 15 percent are not pigmented and there are those that are pink or purple in color, too. Samlowski says it’s important for people to check covered areas such as the scalp, ears (and behind them) and back. Skin cancer can also surface in areas routinely covered by clothing, he says.

“I tell patients to take a cellphone picture,” he says. “The memory is kind of flawed … but the eye is very good at comparing those pictures.”

 

Rules for posting comments

Comments posted below are from readers. In no way do they represent the view of Stephens Media LLC or this newspaper. This is a public forum. Read our guidelines for posting. If you believe that a commenter has not followed these guidelines, please click the FLAG icon next to the comment.