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Archive for March 2015

"...until there is a cure."

Saturday, March 28, 2015

I won't be able to find a cure for Bennett alone.

This is why it is so incredibly meaningful when a friend shares Bennett's video on Facebook, or when a friend retweets Bennett's story on Twitter, or wears our Bennett's Brigade t-shirt, or walks (even leads) a Great Strides Walk or gives a donation to the CF Foundation in honor of Bennett.



Just last night, my friend Jenny was on Facebook asking to purchase a Bennett's Brigade t-shirt for her son to wear at the St. Charles, Missouri Great Strides Walk.  When I double-checked on the size t-shirt she had ordered for her little one, she explained that she was buying a size up for Alex to "last him a couple of years" because, she said, "we will do this until there is a cure."

I cried.

With those 9 little words, Jenny reminded me how I am not alone in this.  Not now.  Not later.

As Bennett's mama, I know I will do this year and after year.  I will walk.  I will ask for donations.  I will share his story.  But always lingers a little fear inside me: "Will this year be different? Will anybody come?  Will anybody give?  Will anybody care?"

Each year, I fear I am alone in this.  And yet, each year, I am gracefully shown: I am not.

The Great Strides for a Cure for CF Walks that Bennett's Brigades participate in all around the country are about hope.

Our Walks are celebrations of the money raised, to date, for a cure - and celebrations of the support and love that surrounds Bennett as he fights this terrible disease.  I am so touched that there are friends who I haven't seen in more than 15 years who are leading Walks in their areas, asking for participating and donations from their friends for my son.


This weekend we have to finalize our order for our Bennett's Brigade tshirts.  If you haven't already gotten one and want to, please email me at breckgamel at yahoo.com by Monday, 3/30.  It's hard to believe Great Strides 2015 is here!!

For anyone interested in walking or donating in honor of Bennett at any of our CF Great Strides for a Cure Walks across the country, please sign up or donate using the links below:



Thank you to the many of you who remind Brian and my family that we are not alone in our battle with Cystic Fibrosis and our efforts to find our son a cure.  It is the consistent love and support that brings us hope in the midst of despair!

We are so honored to have you join with us in this fight!!  We're #InItForBennett!!

Advocating on Capitol Hill for Bennett

Wednesday, March 25, 2015

This past week, I traveled with all three kids to DC to advocate on Capitol Hill for Bennett and all those with Cystic Fibrosis  (Brian had to stay back to work).  This year, I took Oliver to advocate with me.

This was my third year to participate in the Cystic Fibrosis Foundation's annual "March on the Hill" day in Washington DC.  It is a special day where the CF Foundation arranges meetings with Congressmen and their staff so CF caregivers, friends and family can communicate our need for a cure.  

Those with Cystic Fibrosis are not allowed to come to CF events such as this one, due to infection control issues.  The CF Foundation recommends that no two people with CF be within 6 feet of each other as they can inadvertently get each other sick.  So, while Bennett couldn't be there.  Oliver was there for him instead.  (My mom watched Avonlea and Bennett for the day.)



After a morning of training, more than 100 CF advocates emerged on Capitol Hill to speak on behalf of those with the disease.  One of my first appointments was with Congressman Barton (who happens to share a birthday with me - random!).  I attended this meeting alongside the Northeast Chapter of the CF Foundation's Executive Director, Amy, and Debbie, also from Dallas, whose sister died from CF in 1979.



I just had to mention this sweet lady, Krista (in red), Congressman Barton's Counsel and Legislative Director because she was absolutely fantastic.  She knew so much about CF before we ever came, because she studied up on it.  To my surprise, Krista had already found Bennett's video and was incredibly up to date with the newest information about CF as she had recently attended a meeting put on by the CF Foundation for Congressmen and their staff.  Krista was such a delight to meet, making our first Congressional meeting a really great one!  

As CF advocates, we had several requests when we met with the Congressmen and their staff.  First, we asked them to support the EACT (Ensuring Access to Clinical Trials) which makes permanent that those with rare diseases who participate in clinical trials not have to count as income up to $2,000 in compensation which they receive for participating in those clinical trial.  Doing so has previously jeopardized the health insurance and social security disability benefits of those with rare diseases like Cystic Fibrosis.

This is particularly important issue for those with CF as 1 out of every 2 children with CF and 1 out of every 3 adults with CF are on Medicaid and/or Social Security Disability.  It would be very sad if patients had to face the choice of participating in clinical trials, which helps the entire CF community, OR losing their health insurance because they made too much money due to clinical trial compensation.

Cystic Fibrosis is an orphan disease.  That means the number of CF patients in the US is small. Those who qualify for clinical trials for CF drugs is even smaller.  I'd hate to see that even fewer patients would be available to help us test a cure.

The good thing is the EACT has been the law for the last few years but it had a "sunset" clause on it, which meant it expired at some point.  Now, there is an effort to make EACT in to a law permanently.  It's a bipartisan effort and hopefully should pass.



On our second visit of the day, our team met with  Congressman Pete Sessions.  Congressman Sessions was very playful and seemed to really enjoy having Oliver in his office (as seen by the picture above).  Sessions shared he is also a caregiver of a child with special needs as he has a son with Down Syndrome.  It was nice to be able to see Congressman Sessions as a father and caregiver, just as I hope he saw us as desperate parents wanting to make way for a cure.

Outside of asking for the Congressmen to support the EACT, we asked for robust funding for the National Institutes of Health (NIH) and FDA.  Both government departments are crucial to the Cystic Fibrosis Foundation's research for a cure.  The CF Foundation uses basic human research, supported by the NIH, to build upon our own research.  Once a medication is found, the CF Foundation works diligently and swiftly with the FDA to get the drug to market as fast as possible.  The CF Community raises it's own money for a cure but uses help from the NIH and FDA to help expedite a cure.



Another Congressman that we had the privilege to meet was Congressman Bill Flores.  I have met with Congressman Flores for the past 3 years and greatly appreciate his sincerity every time.  Oliver and I are constituents of Congressman Flores and really enjoy having created a positive relationship over the years.  Texas has around 1,744 CF patients and 16 CF Care Centers.  Scott and White, one of Bennett's hospitals, is in Congressman Flores' district.  


We enjoyed meeting with all of the Congressman.  But, Oliver's favorite Congressman is the one best known to him as "Pops."

Congressman Fleming was actually on his way to votes after our meeting with him so he invited his grandson to help him vote on the House floor - something only children get to do. I had to watch from the Gallery.  But here is where Oliver did the most for CF on Capitol Hill and didn't even realize it:

On the floor of the US House of Representatives, Oliver helped his "Pops" vote.  But, between votes, different Congressmen, delighted to see a child on the House floor, came up and spoke with him.  I watched from the Gallery as he shook hands with men and women who represented states near and far.

I knew Oliver wasn't exactly able to capture in his little mind what a cool thing he was getting to do. But I was soaking it up for him, watching from above.  I watched my little first grader speaking with the adults, sitting there in his little khaki's and button up shirt, looking around, listening to the sounds of the gavel being hit and watching the lights brighten up as votes were cast.

At one point, Oliver seemed to unknowingly catch the attention of Congresswoman Debbie Wasserman-Schultz.  This is most interesting because it seems that often the Republican Representatives and the Democratic Representatives tend to mingle together in their respective parties on the House floor during votes.  But Congressman Wasserman-Schultz is a Democrat.  Congressman Fleming is a Republican.

I watched as Congresswoman Wasserman-Schultz came over and began speaking to Oliver, who was standing beside his grandfather.  She struck up a conversation with Oliver and then with Congressman Fleming, who at some point mentioned to Congresswoman Wasserman-Schultz that Oliver was doing something important at the Capitol today - he was advocating on behalf of his little brother, who has Cystic Fibrosis.

I could see there was some sort of agreement going on between the three of them.  But I couldn't tell what.  Later, I learned that during that conversation, Wasserman-Schultz shared with Oliver and Congressman Fleming that she knew what Cystic Fibrosis was.  In fact, she revealed, she has an extended family member with the disease.  And to my surprise, she then turned to Congressman Fleming and said, "Look, I'd love to help.  I'm on Appropriations [Committee].  So, call upon me for any help."

What a powerful moment for me, as a mother, to see my son, on the floor of the US House of Representatives, connecting two legislators who came together, across party lines, in support of those with Cystic Fibrosis.  Oliver had done it.  He had gone to Washington DC, advocated for his brother, and walked away with another fighter, US Congresswoman, in our corner.  I couldn't have been more proud of him.  

Oliver's treat for such a great job: Ice Cream at the US Capitol's Creamery!


I wanted to make sure that I mentioned my friend and fellow CF mom, Rebecca, who became the CF Foundation's newest National Advocacy Chair.  Rebecca and I first new each other only via Facebook through the "CF Mamas" Facebook group.  Now we are real life friends.  It's pretty neat.  I am very proud of having Rebecca in this place.  One of my favorite things Rebecca said during the event was, "CF Advocacy is not political.  It's personal."  This is so true.



At the end of March On The Hill, the CF Foundation invited my dad, Congressman Fleming, to speak to all of the 100+ CF advocates that joined March On The Hill for a dinner.  Senator Markey (not pictured) also spoke.  After dinner, the CF advocates who represented their family members and friends on Capitol Hill shared their stories of the day.  It is always so amazing to hear how receptive our legislators are to our message:  "We are close to a cure.  Help us make that happen faster!"




I am thankful for a father who is not only supportive of his little grandson's daily fight against CF but who is a champion in the United States House of Representatives for all those with Cystic Fibrosis!



And I am thankful for a little 7 year old who advocates for his little brother, not just each day at school and at home, but also in our nations' Capitol.

Bennett's Story, through the eyes of children

Sunday, March 15, 2015



This year, I let Oliver and Bennett tell what it's like for them to deal with Cystic Fibrosis every day.

I was really touched by their sweet comments and how this topic brought up emotions so naturally for the both of them.

To my surprise, both my five year old and seven year old understand cystic fibrosis really well.  Watch Bennett light up at the end when he talks about "all the people."

Help us find a cure for Bennett: http://fightcf.cff.org/goto/bennettsbrigade2015.

If I can't have a better MyChart, maybe I can hack the system?

Thursday, March 12, 2015

I recently wrote a blogpost about patient portals and how one of the most popular patient portals, EPIC's MyChart, fails patients/caregivers like me.  Part of the main reason MyChart doesn't work for me is because it works around the doctor/hospital's needs and not mine, as the patient.

So I thought I'd share a few of the ways I wish my hospitals' Patient Portal worked better (see below) as well as share resources I've found that go beyond the Patient Portal and allow me to hack the system so I can get better care for Bennett until my hospitals' patient portals catch up.  

Five Requests of My Own MyChart Patient Portal:
1.) Give me initiation access to my clinicians.  I wish MyChart allowed me to contact my clinicians when I wanted to, rather than having to wait for them to contact me first.  Without electronic access, I am forced to call my hospital's answering service.  If I am able to leave a message, the clinician calls me back.  About half of the time the clinician calls me back, I accidentally miss the call, which usually means we play phone call throughout the day and sometimes in to the next day.  How much easier it would be to be able to contact my clinician electronically, at the best time for me AND the clinician can contact me back at the best time for them.  It's a better use of their time and mine.    

2.) Give me access to my health records, including Bennett's X-ray and CT scan images.  By having access to what my doctor knows about my son's condition, I am better able to ask thoughtful questions and have meaningful conversation during our clinic time.  Access to Bennett's records make me a better and more empowered patient/caregiver and gives the clinician more time to do other things as well.  I find it potentially harmful not to have access to Bennett's records because without access, there is a chance that I will miss something that otherwise might be considered or caught.  Although my clinic gives me a paper handout of our CF Care "Action Plan" after ever visit, this paper easily gets lost at home.  Why not have this information online like the way I organize the rest of my life? 
This is the kind of image I'd like access to electronically.  The way I currently hack the system is by taking pictures of Bennett's images from the doctor's computer screen at Clinic.  But there has to be a better way.
3.) Give me trend data on my son's test results.  I wish MyChart showed me how my son's test results have changed over time, particularly with regard to weight.  Weight is such an issue for CF patients.  I'd like to see how Bennett has been doing and study at what points he was doing better or worse to see if there are more things I can do to help him continue to put on weight and stay healthy.

4.) Allow me to pay a bill online.  As is often the issue for patients of chronic diseases, I'm drowning in medical bills.  I'd love to pay online and stop the overflow of bills I receive in the mail each month.

5.) Send me appointment reminders.  My hospital's MyChart sort of already does this.  But what if MyChart actually sent me a Google Calendar or iCalendar reminder that put my appointment right into my calendar?  How amazing would that be?

Since, at this point, my hospitals' patient portals do not provide me this kind of healthcare access electronically, I wanted to share a few resources I have found that are beginning to help patients bridge the gap between what currently exists and what patients like me still need:

Three Patient Portal System "Hacks" I'm Using For Now
PicnicHealth
This is a phenomenal resource and one I am *so* excited currently exists.  It allows patients to see their own medical records, INCLUDING their x-ray and CT images!!  It's a paid private service that serves the patient and works with the patient's hospital/clinics (all of them!!) to get the data all in one place.  While PicnicHealth hasn't yet optimized their platform specifically for Cystic Fibrosis care just yet, even in it's current state, it's incredibly helpful for complicated patients like Bennett with chronic diseases.  Check out this demo: https://demo.picnichealth.com/#timeline  


* CareZone

This is a free app that I really love because it allows me to scan my prescription bottles in to the system using my smartphone camera and then keeps all the important information in my app database so that I can always have access to Bennett's up-to-date medication list (such as we often need when I visit a new doctor).  In addition, CareZone has a reminder feature that tells me when Bennett's prescriptions expire and when meds need to be refilled.  I also love that I can indicate through the app when we take a med so that I can actually keep track via percentage of how well we are doing each week adhering to our medication routine.  This tracking helps me focus on the one or two meds that we sometimes seem to forget so that we can evaluate if there is a better time or day or better system at home we could put in place in order to make sure medication is given.

* BetterPHA

This isn't an patient portal but it does things that the patient portal might otherwise do - such as contact my CF care team, set up doctor appointments or reordering meds - and so much more!!  BetterPHA (the PHA stands for Personal Health Assistant) is a service that patients access through an app.  Although the service is not free, BetterPHA seems well worth the price for all that it does. The way that it works is BetterPHA assigns patients their own personal health assistant/live person whose sole job is to make your life easier when it comes to the cognitive burden of healthcare.  The sky is the limit on what BetterPHA can do.  But the things I've asked my PHA to do include refilling meds, scheduling Bennett's CF appointments, requesting records from Avonlea's pediatrician to update her school records, researching nebulizers, adding my family to the Pulmozyme Co-pay Card program and looking in to insurance issues.  BetterPHA is a unique service for both patients and caregivers, CF or not.  I highly recommend!

* SmartPatients

This free website is really fantastic for connecting patients together centered around meaningful conversation.  I am currently a part of a fabulous and very robust Facebook group called "CF Mamas", the one thing the CF Mamas Facebook group can't do is open the conversation up to other patients in similar situations.  So, I really love how SmartPatients allows patients from other communities, such as the IBD/Crohn's or COPD community to share their experiences.  What is it like to raise a child with a chronic illness?  How do you create a Parent Advisory Council at your hospital?  What are the best pharmacies in the area?  These are all questions that could benefit from conversation with a larger community.  

While the two resource below are are not currently accessible to me, I believe both of the following resources offer some really great patient-centric ideas.  One day, if we ever have a CF-specific Patient Portal/Dashboard, this is the kind of stuff, I'd hope it could do:

* iHealthNY - I ran across this website recently and had hoped it was available for more than those in NY but apparently it's a custom-made dashboard for NY residents.  It's not something patients like me can utilize but I think it has some really wonderful elements that I wish CF patients had in a CF Dashboard.  Things I love most about iHealthNY include: access to your health record, quick access to your healthcare team, searchable interface that searches both the internet and your own records, medication information

SolutionReach - I don't know much about SolutionReach except that I came across their video about their service and I think they are on to something.  For example, SolutionReach, a patient portal advertised to medical/dental practices says they allow the patient to check in online (think: no more CF clinic waiting rooms!), gives patients a way to provide reviews on their doctor and clinic experience and access to useful feedback surveys.   Although this video and this service is meant for clinicians, I very much wish some of the elements in SolutionReach were elements I had access to in MyChart.  See their video here: http://youtu.be/2OmGg61AVxQ

Why MyChart isn't My Chart

Monday, March 2, 2015

For the average patient, patient portals aren't that interesting or necessary.  But, for those who deal with chronic illnesses like Cystic Fibrosis, patient portals can be extremely beneficial in health care.


Over the last few weeks, I have been working diligently on a number of projects within our efforts to redesign the current CF Care Model.  I have been participating in "environmental scans" of different aspects of CF Care - looking at the current way of doing things and looking more deeply in new ways of doing things.  One of CF care aspects I have been most interested in evaluating is the patient portal system.

One of the most popular patient portals available these days is EPIC's MyChart.  In fact, both of current Bennett's hospital systems (Baylor/Scott and White and Children's Medical Center - Dallas) use the MyChart patient portal.


At the CF Care Model redesign meeting several months ago, discussions began dreaming up ideas for a "CF dashboard" of sorts - a web-based interface that would provide individually relevant information about where we have been, where we are and where we might be going in our CF journey (specific ideas included in a CF dashboard might be tracking patient data, access to medical records, access to CF registry, list of medications, instant connection to our CF docs, etc.).

But, I have found some gentle push back on the idea of a CF dashboard.  Usually, I find those who aren't very interested in the concept will say: "Why would I need something else? I already have MyChart."

Well, I recently thought to myself: "Self, maybe I should list my reasons why MyChart doesn't work for me and why I need more.  So, that's what I did.  In this post, I will list why MyChart isn't good enough for patients with chronic illnesses.  And in a following post, I'll share about some current resources that offer more.  I'd love feedback from others in the CF community or chronic illness community on what works and doesn't work with regard to patient portals and MyChart.

Why MyChart isn't My Chart

1.) MyChart provides very little actual patient health information. 

MyChart allows the doctor/health system to determine what information to release to the patient. While some hospital/doctor systems do release some medical record information, both of Bennett's hospitals release almost none at all.  What good is an electronic medical record that patients have access to if they don't have access to their information?

For example, here's a side-by-side picture of both of Bennett's hospital systems' MyCharts and the information we receive in his MyChart:



It's obvious, there is hardly anything of value in Bennett's MyChart, except maybe his vital signs.  If I would ever want to go back and read about Bennett's clinic visit - what we talked about, what his doctor decided to do in the way of treatment, etc., I would not be able to rely on his MyChart.

The only notes from Bennett's last clinic visit state the obvious: "Patient seen in clinic today."

Since MyChart doesn't provide Bennett's medical records, if I would like a copy of them, I have to contact the hospital and to get a paper copy of his medical records which often takes weeks and costs money to me as the patient/caregiver.

2.) MyChart is poorly organized.  


There is no search feature or ability to find information quickly.  Therefore, I must scroll through all of Bennett's test results to find the one I'm looking for.  Since we have tests at each quarterly appointment, it doesn't take long for that list to be extensive.  This makes it very difficult to compare his test results very easily.



3.) MyChart is driven by the doctor/hospital system, not the patient.

I don't control much of anything in MyChart.  My doctor does.  For example, I cannot send self-initiated messages to my healthcare team.  I can only reply to messages my healthcare team has sent me.

I can get test results, but only some of them, and only the one my doctor initiates.

I can get appointment reminders. And if, and only if, my hospital provides me access, I can create a new appointment through MyChart.

Refills can be requested through the app...but only for specific listed medications, the ones the clinic decides to make available.

I prefer to have a patient portal that is patient-centric, not hospital/clinician-centric.

4.) For every hospital system of which we are a patient, we have a different MyChart.

Bennett has been cared for by three separate CF care centers/hospital systems over the course of his five years.  That means that I have to flip back and forth between his different patient portals.  This is what the healthcare industry calls "a silo" - a separation between two parts causing the inability to communicate.

I do like that the patient portals do allow for multiple patients in the same system.  But, for Bennett, we need one system for all of his hospitals and specialists.
See the red notification under "Heath Reminders?"  To turn off the notification, I have to call my clinic, find the appropriate person and ask for it to be taken off.  Ain't nobody got time for that.




5.) The patient has no ability to input information.

See the little red notification in the image below?  I can't make that go away.  It's a notification on the hospital/clinician's side of the patient portal indicating Bennett needs to get a flu shot or his immunizations - things he got months ago.  But, since MyChart is controlled by the hospital/clinician, the only thing I can do to get that little red notification away is to call my clinic and track down the right person who can click the right button to make that go away.  Ain't nobody got time for that.

It can be very frustrating that MyChart is mainly used by the hospital/clinic to push information to the patient, rather than working with the patient to share information.



6.) Patients cannot sign up for MyChart with their phones.  

They must log on to a desktop version of MyChart first.  This is difficult for patients who don't have access to a desktop/laptop, which is so very many patients these days as most Americans access the internet through their smartphones.


In my next post, I'll share some of the current patient-centric portals that exist that I would love to see accessible for patients, particularly those with chronic illnesses like cystic fibrosis.  My hope for posting this information on Bennett's blog to help facilitate a change for patients like Bennett who need greater access to medical records for better healthcare.