10 Important Things to Know About In-home Medical Visits
Learn what you can expect from in-home medical care.
This article first appeared on Next Avenue.
When my husband, Dale, was diagnosed with type 2 diabetes in 2007, at the age of 46, his doctor prescribed medication, he attended a nutrition class and was instructed on testing his blood glucose level.
Dale had annual physical exams, which monitored his blood pressure and A1C level (an average of blood glucose over time).
We assumed doing all of this would also mitigate the increased risk of heart disease that presents with type 2 diabetes.
It most likely was a fatal assumption.
Dale died of a sudden, massive heart attack, the main artery blockage known as the “widow maker,” two days before Thanksgiving, on Nov. 20, 2018.
The longer a person has diabetes, the higher their chances are of developing heart disease.
According to the Centers for Disease Control and Prevention, 30 million Americans have diabetes and 90% to 95% of them have type 2 diabetes. Most cases are diagnosed after age 45. According to the American Heart Association, adults with diabetes are two to four times more likely to die from heart disease than those who don’t have diabetes.
The longer a person has diabetes, the higher their chances of developing heart disease. This is because high blood glucose from diabetes can damage blood vessels and the nerves that control the heart, according to the National Institute of Diabetes and Digestive and Kidney Diseases, which is part of the National Institutes of Health.
“Total management of the disease should include diet, exercise, regular cholesterol testing and glucose monitoring,” said Dr. Jane E.B. Reusch, a cardio-endocrinologist at the University of Colorado Anschutz Medical Center in Aurora, Colo. She also practices at the Rocky Mountain Regional Veterans Affairs Medical Center in Aurora.
Hyvelle Ferguson, now 46, was just 33 and pregnant when she was diagnosed with type 2 diabetes. “I began taking care of myself, but after I had my baby, I reverted back to my old ways, eating anything I wanted,” says Ferguson. “I thought I’d be OK if I was taking my medication.”
At 41, Ferguson suffered a stroke, and three weeks after being released from rehab, suffered a heart attack. Her main artery was 99% blocked. She underwent quadruple bypass surgery, but that wasn’t the end of her health problems.
“I called myself a professional patient, in 2014 to 2015, I was in the hospital every month,” she says. “Every time I went to the doctor, something else was wrong.”
Ferguson began taking stock of her life, researching how she could control diabetes instead of allowing the disease to control her. She adopted a healthier diet and began walking for exercise. “At first, it was just to the mailbox, and I went a bit farther each time,” she says.
Although she still has many challenging days, Ferguson now volunteers with the American Heart Association and is an advocate for its Know Diabetes by Heart. The new program is partnership between the group and the American Diabetes Association to help inform doctors on educating their patients with diabetes about the risks of heart disease. It also tells patients with diabetes questions to ask their doctors.
Of course, not all patients with diabetes will develop heart disease, and Reusch points out that many other factors play into the risk. “A1C is very important, but cholesterol should also be monitored closely in diabetes patients,” she says. “So many factors play into it, including genetics.”
Care guidelines endorsed by many cardiologists require all diabetes patients to be placed on a low-dose statin drug, despite a patient’s lipid numbers (measuring cholesterol and fats in the blood), says Dr. Jorge Plutzky, a cardiologist with the Brigham and Women’s Hospital and Harvard Medical School in Boston. Statins lower cholesterol levels in the blood.
“We make recommendations based on what we know,” Plutzky says. He points out numerous studies showing that diabetes patients who hadn’t previously suffered a heart attack and were placed on low-dose statin drugs had a “striking reduction” for the risk of heart attack.
“I thought I’d be OK if I was taking my medication.”
Plutzky says doctors have known for years that diabetes increases the risk factors for heart disease, but didn’t understand why blood glucose drugs didn’t reduce the heart disease risk. “We just didn’t have the right drugs yet,” he says. “Great strides have been made just within the past three years.”
Plutzky says doctors and patients should know that certain new inhibitor drugs combined with statins can reduce the risk of heart disease in patients with diabetes. “The Know Diabetes by Heart (web page) has this information, as well as all the latest information that needs to be put out there,” he says.
He advises people with type 2 diabetes not to wait for their doctors to bring up the topic of heart disease. And he says patients should continue to see their primary care doctors or endocrinologists to help manage their disease.
Another preventive measure is one that coulld have saved my husband Dale’s life. It’s called coronary artery (or cardiac) calcium screening, and more hospital systems, including the one near my small town, offer it at a relatively affordable cost ($99 at my hospital). The test is for individuals at high risk for heart disease and uses computerized tomography (CT) scans to measure the calcium build-up in the coronary arteries. A health system’s screening program may also involve a cholesterol screening, body mass Index reading, an A1C screening and other tests.
Gary Heimbach, 70, of Bull Shoals, Ark., was diagnosed with type 2 diabetes in 1993 at 58. When his wife heard about coronary artery calcium screening, they both scheduled an appointment to have it done.
Although Gary had no previous symptoms, his results indicated he’d already suffered a previously unknown heart attack. Further testing revealed a 95% blockage in a main artery and a 50% blockage in another. “They put a stent in and I haven’t had any problems since,” he says. “It was painless and saved my life.”
Ferguson stresses taking proactive measures, such as informing yourself and taking advantage of all available resources to reduce the risk of heart disease. “I want people to know they can live, they can fight the smart fight,” she said.
Learn what you can expect from in-home medical care.
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