Wednesday, September 16, 2015

The Search for Integrative Physicians Covered by Insurance

I was so excited to find a wonderful Integrative Oncologist, only to discover that Integrative Oncology is not covered by insurance companies and is classified as "experimental."  Really?  You've got to be kidding! 

So if you're an oncologist and choose to look at cancer from a more holistic perspective, and include in your treatment wild and crazy things like diet, exercise and stress relief, you're thrown out of the club?  No frigging wonder there aren't more integrative physicians!

Let's take a look at what's going on here.  First, let's start with the definition (From Integrative Medicine article in US News and World Report) 
Integrative medicine combines state-of-the-art, conventional medical treatments with other therapies that are carefully selected and shown to be effective and safe. The goal is to unite the best that conventional medicine has to offer with other healing systems and therapies derived from cultures and ideas both old and new. 
Integrative medicine is based upon a model of health and wellness, as opposed to a model of disease. Whenever possible, integrative medicine favors the use of low-tech, low-cost interventions. 
The integrative medicine model recognizes the critical role the practitioner-patient relationship plays in a patient's overall healthcare experience, and it seeks to care for the whole person by taking into account the many interrelated physical and nonphysical factors that affect health, wellness, and disease, including the psychosocial and spiritual dimensions of people's lives.
Radical concepts aren't they?  So where's the rub? I'm guessing it has a lot to do with that middle paragraph and the notion of "based on a model of health and wellness versus disease" and "favors low-tech, low-cost interventions."  Big pharma can't make any money if you're healing your cancer with diet, supplements and yoga. Likewise, who needs all those hospitals and doctors if we as individuals take responsibility for our health?

But we do still need doctors, and we do still need traditional treatments and even those incredibly expensive drugs.  Integrative medicine is not just about natural, alternative therapies, it's about "uniting the best that conventional medicine has to offer with other healing systems and therapies."

How do you find Integrative Minded Physicians?

You may not be able to find Integrative Oncologists covered by your insurance, but you may be able to find Integrative Primary Care Physicians or Internists that are covered. That doesn't mean that everything they prescribe is covered, but you can at least have the benefit of someone who shares your values and approach. And that's important. Remember in an earlier post where I talked about the patient-physician relationship? Never underestimate the power of that relationship.

Wednesday, September 9, 2015

Why your oncologist may not be open to non-traditional therapies

Although I'm a big proponent of alternative and holistic therapies, I try not to get caught up in medical establishment bashing.  I believe the majority of oncologists do care about their patients and put their best interests ahead of profits. That said, I believe the system itself is in need of attention. When a large portion of an oncologist's income comes from chemotherapy administered in their office, there are bound to be problems. The same is true when the majority of drug research is funded by pharmaceutical companies that profit from the drugs.

I highly recommend this three-part Forbes series by Dr. Robert Pearl, MD. He addresses three very important issues with the current system. 

  1. How Manufacturer-funded research compromises patient care - Discusses how money motivates bias in medical research.
  2. When Money Motivates Cancer Treatment Options - Talks about the bias that takes place when doctors own their own diagnostic and therapeutic equipment.
  3. Are Oncologists recommending the best treatments for patients? - Highlights the lingering problem of physicians buying and selling prescription medications to patients – at a profit.

Tumor markers, PET scans and other measures

It's hard not to get caught up in the numbers, especially the dreaded CA 27-29 tumor marker. Mine went through the roof this time, up almost 100 points, the highest it's ever been. My first response was panic, fear, and an overwhelming sense of dread.

Thankfully it didn't last very long. Pretty soon I came to my senses and decided the number didn't mean the cancer was worse. I was certain that it was in fact, better. I felt better, much better. If the cancer was anywhere close to where it had been when I started this journey or worse, there was no way I could feel this good, both physically and mentally. I blew it off and went on about my week.

The day after the blood tests, I had a PET scan, so I decided not to fret unless the PET scan results suggested I should. Today I got those results, and low and behold, they were good. As is typical of my life, the results were......mixed, weird, a bit perplexing, especially when considering the elevated tumor markers. The PET summary read....Mixed response of mild progression and predominantly mild regression.  My oncologist was concerned about the tumor marker number, but happy with the PET and said "stay the course" believing I was still taking the Ibrance and Femara cocktail.

The nurse practitioner, who I see more than the oncologist, asked me to reconsider going back on  Ibrance and I told her I would think about it. It's tough to know what to do at this point. I feel strongly that my alternative approach is working, but I also believe in hitting it with whatever we have. That said, I can't get my head around the side effects, and particularly the weakening of the immune system.

Breast cancer tumor marker image from MIT Spectrum.

Explaining why the CA 27-29 number was elevated

After doing more research, my best guess for why the number went up was because of dying cancer cells. At least that's what I choose to believe.  I found this in a description of the tumor markers.

Levels usually drop following effective treatment, although they may spike in the first few weeks after treatment is started, a result of dying cancer cells spilling their contents into the bloodstream.

That's my story and I'm sticking to it!