Living with Chronic Health Issues
I honestly never thought I would have a reduction in pain. But I found that I just really had to make a lot of changes and that has made a big difference in how I feel.Thelma Gerow
Thelma Gerow can pinpoint the exact day when her pain began. “December 6, 2005,” she says. That was the day she fractured her back in a fall. Four days later, she sustained a ruptured spleen and a hole in her small intestine following a car accident. Gerow underwent abdominal surgery at Dartmouth-Hitchcock Medical Center (DHMC) that month, followed by back surgery two months later. “I’ve got hardware and screws holding my back together. I’m half bionic!” jokes the spunky 75-year-old from Perkinsville, Vermont.
But she doesn’t joke about the chronic pain, which kept her out of work for a year. “There were some days where I could barely get out of bed,” she says. Gerow’s primary care physician referred her to the DHMC workshop, “Living a Healthy Life with Chronic Pain,” which is led by Primary Care Health and Wellness Coaches Andrea Z-Covey and Inger Imset at DHMC’s Heater Road building.
The chronic pain workshop is one of two that are regularly offered by Z-Covey and Imset; the other is “Living a Healthy Life with Chronic Health Conditions” and a third, “Living a Healthy Life with Diabetes,” is being added in early 2017. The pair are master trainers for these patient self-management programs, which were designed by the Stanford Patient Education Research Center. Christine Dyke, coordinator for DHMC’s Health Coaches/Peer Leadership program, says the Stanford method was chosen because “it is evidence-based. We were also able to embed Inger and Andrea in Primary Care, giving them direct access to clinicians and staff for referrals. We thought this would provide a great opportunity for success.”
Dyke notes that the workshops are part of Dartmouth-Hitchcock’s (D-H's)Population Health initiative, which focuses on giving patients and community members the tools they need to lead healthy lives and to, ideally, stay out of the hospital. “Diabetes and obesity are at an all-time high, and we’re at a point where one in five people will die of a lifestyle-related disease,” Dyke says. “These workshops provide the nutritional and lifestyle guidance that people desperately need, and help them find a supportive path to healthier and happier lives.”
The six-week workshops meet weekly for 2-1/2 hours, and participants learn about exercise and diet (the Stanford method stresses portion size using the “My Plate” method), and lifestyle changes that will help them lead healthier and more active lives. Over the past two years, they have had nearly 150 workshop participants and led workshops not only at DHMC, but also at D-H’s Lyme Clinic; the Lebanon Senior Center; the Upper Valley Haven in Hartford, Vermont; and the Veteran’s Administration Hospital in White River Junction, Vermont. “We’re trying to get closer to where the patients are and make it possible for a wide range of people to participate,” Dyke says.
Gerow was skeptical when she started the workshop for chronic pain sufferers. “I thought their suggestions, such as exercising to manage pain, were totally useless and would only lead to more pain. But, my diabetes was totally out of control, and I wanted to lose weight, so I decided to give it a try,” says Gerow, who concurrently participated in another DHMC workshop, “Managing Pain Before it Manages You,” taught by Laura Cottle.
She kept pain and food journals, as Imset and Z-Covey suggested, tracking what she ate and noting the activities that made her pain worse or helped alleviate it. She made weekly action plans and started exercising by walking her dogs twice a week, eventually working up to walking every day for about a mile. “For a long time I didn’t do much walking or very much of anything, partly because I was in a back brace from my waist to my neck,” she says. “But I noticed that just moving helped and that exercise actually relieved the pain.”
Gerow also embraced the other workshop suggestions, which included physical therapy, deep breathing exercises and relaxation therapy. “We were amazed at how she threw herself into it because, quite frankly, she was the biggest disbeliever going into it,” says Imset. “It’s been wonderful to see what she’s accomplished.”
Gerow seems astonished by her transformation. She lost more than 120 pounds through exercise and diet changes, improved her insulin levels, and is no longer taking prescription pain medications. “I surprised myself by believing that I could take responsibility for my circumstances and control my wellness,” she says. “I honestly never thought I would have a reduction in pain. But I found that I just really had to make a lot of changes and that has made a big difference in how I feel. Now I get out of bed at 4:30 every morning, get going with housework and taking care of my pets, and I still sometimes work 72 hours a week with the developmentally disabled.”
Julie MacAdam was inspired to start moving again after participating in the “Living a Healthy Life with Chronic Health Conditions” workshop. The 47-year-old Lebanon resident is diabetic and has suffered from fibromyalgia for more than 20 years, and wasn’t able to exercise at all just a year ago following a fall. She started her action plan by marching in place during commercials while watching television and has progressed to walking for longer periods of time five days a week, often in DHMC’s hallways. To improve her balance, she also takes a twice-weekly Tai Ji Quan: Moving for Better Balance® class offered by DHMC’s Rehabilitation Medicine Department, which is taught by physical therapists Dawna Pidgeon and Mary Ellen O’Brien. In the process, MacAdam has lost 80 pounds, eliminated her narcotic pain medication and cut back on her insulin dose.
“I take a third of the medication that I used to take,” says MacAdam, whose blood sugar readings are now in the normal range due to her weight loss. “Having less stress on my joints has made a tremendous difference because my rheumatologist confirmed that every pound you lose takes three pounds of pressure off your knees. So that’s 219 pounds of pressure off my knees. My knees are pretty happy right now!”
“It has been a joy to watch all the work Julie has done to make her health better,” says Patricia L. Min, MD, a DHMC general internal medicine physician and MacAdam's primary care physician.
“The workshops are a great way for people to be in a room full of their peers, people who understand them and their health conditions and to realize that they’re not alone,” says Imset, noting that the workshops are open to anyone in the community. “We talk about people’s barriers to self-care and then throw it out to the group so they can problem-solve together. So they learn from us, but also from each other.”
D-H’s Vice President of Community Health Sally Kraft, MD, MPH, notes that clinical evidence shows peer support leads to improved patient outcomes. “These classes also build from Dartmouth-Hitchcock’s culture of engaging patients as partners in creating health,” she says. “We want to provide patients with the skills and the knowledge so they can confidently manage their health needs. This is the right thing for our patients and our community.”