Case study: Patient Advocate

Heather is a 73-year old retiree, who enjoys cooking for her family and friends, and taking long walks. She usually walks three to five miles every day, weather permitting. She and her husband are snowbirds, who live in Arizona during the winter months, where they are both active outdoors. On a Saturday afternoon, Heather was enjoying a movie in her living room, when she began to feel dizzy. She drank a glass of water, felt better, and decided to take her blood pressure–it was 176/84 and climbing. The week prior, Heather had experienced blood pressure spikes for the first time, which she brought to her primary care provider’s attention. Heather’s primary care provider, a physician’s assistant, ran a series of tests—EKG and lab work–the results of which were normal, and decided to take a wait-and-see approach. Heather was prescribed blood pressure medication that included a diuretic– her primary care provider suggested taking it “if needed.” Heather was also advised to see a doctor right away if her blood pressure spiked over the weekend. That Saturday, when Heather’s blood pressure registered at 176/84 and continued to rise, Heather, who has a family history of stroke, took a tablet of the prescribed blood pressure medication and asked her neighbor to drive her to a nearby hospital (Heather’s husband was out of state at the time; her daughter was a 2-hour drive away). Heather’s blood pressure was 204/87, shortly after she arrived at the hospital. The ER physician placed her on blood pressure reduction medication with IV drugs. After artificially reducing Heather’s blood pressure to what the ER doctor considered a safe level, he recommended sending her home; he suggested bringing her back to the ER if she displayed symptoms that were consistent with having a stroke. Fortunately, Heather had a medical patient advocate at her disposal–Dr. Emi—who was immediately available to address her concerns (e.g., is it safe for me to go home?) and answer her questions. After Dr. Emi reviewed Heather’s records and blood pressure readings, which had fluctuated from very high to very low throughout the day–a signal that is associated with a higher risk of stroke and heart attack–Dr. Emi convinced the ER doctor to admit Heather to the hospital for monitoring and further in-depth testing. At Dr. Emi’s urging, Heather was admitted to the hospital as an in-patient. Heather’s daughter, who had been out of town when her mother called to notify her of her blood pressure issues, arrived at the hospital shortly before Heather was transferred to her hospital room. That evening, Heather, who had been comfortably resting in her hospital bed, got up to brush her teeth and get ready for bed. Suddenly, she let out a cry—a painful cramp rushed through her entire body and her blood pressure plummeted to a dangerously low level. Heather collapsed in her daughter’s arms, who was fortunately in the hospital room with her at the time. Heather was sweating profusely; she was pale and unresponsive. Her daughter shouted for help! Five medical people rushed into Heather’s room and worked diligently to stabilize her blood pressure and get her breathing properly again. At Dr. Emi’s urging, Heather underwent a series of tests, which came back normal. It was assumed that Heather’s collapse was likely linked to excessive blood pressure medication that had been administered throughout the day. Heather remained at the hospital for two days for monitoring; after her blood pressure was stabilized with a different class of blood pressure medication that did not include diuretics, she was released from the hospital. After Heather’s release from the hospital, Dr. Emi recommended additional testing to uncover the root cause of Heather’s blood pressure spikes. Further investigation revealed that Heather suffered from severe anxiety, which can cause dramatic spikes in blood pressure. Heather also had osteoarthritis that caused severe joint pain, disfigured fingers and limited mobility. For the past 10 years, Heather had taken Mobic, a nonsteroidal anti-inflammatory prescription drug used for treating arthritis, and Aspirin, a nonsteroidal anti-inflammatory over-the-counter drug, to alleviate debilitating arthritis pain. Dr. Emi recommended a low inflammatory diet for Heather and suggested that she increase her water intake to a healthy level (based on Heather’s individualized needs). To help reduce anxiety, Dr. Emi prescribed counseling and mind-bodywellness classes. With Dr. Emi’s help, Heather transitioned from Mobic and Aspirin to curcumin, magnesium and fish oil—all known for their anti-inflammatory properties. Studies have also shown that proper magnesium levels can improve sleep quality and blood pressure management. Today, Heather has a new outlook on life—she’s had no further blood pressure issues; her sleep has improved significantly and she has no joint pain. “Thanks to Dr. Emi, I am alive and well today,” said Heather. “I doubt that I would have survived the night if I had been sent home as the ER doctor had originally requested. I am so incredibly grateful to Dr. Emi and her unwavering persistence to ensure that I was admitted to the hospital and that I received the medical care that I desperately needed, which was life-saving.”