Tagged Chronic Disease Care

Asthma, More Deadly With Age, Takes Heavy Toll On Older Adults

In early June, Donna Bilgore Robins stood on a patio in Beaver Creek, Colo., under a crystal-clear blue sky and tried to catch her breath.

She couldn’t.

With mountain vistas around her, Robins felt as if she was drowning. She gasped for air hungrily again and again.

Robins knew all too well what was happening. Something — some kind of plant?  something in the mountain air? — had triggered her asthma, a lifelong condition.

She also knew she was in danger, even with a rescue inhaler at hand. “I don’t slowly get sick — I just drop,” said Robins, who with help from her husband was soon on the road to seek medical attention over 100 miles away at National Jewish Health in Denver, a leading hospital for people with respiratory conditions.

For people like Robins, 63, diagnosed with asthma as a young child, aging with this condition can be fraught with difficulty.

Death rates for older adults with asthma are five times that of younger patients, according to a new review of asthma among seniors. And medical complications are more common.

As the prevalence of asthma climbs in people 65 and older, more seniors will grapple with its long-term impact. Estimates vary, but up to 9 percent of older adults are thought to have asthma — a respiratory condition that inflames the lungs and interferes with breathing.

With the advance of years, physical changes take a toll. People’s lungs become less elastic, their chest walls more rigid, and the muscles that help power the respiratory system less strong, exacerbating breathing problems, explained Dr. Michael Wechsler, a professor of medicine and co-director of the Cohen Family Asthma Institute at National Jewish Health, and co-author of the new review.

Compromised vision, fine motor coordination and cognition can make it difficult for seniors to use inhalers correctly. Fewer than half of older adults with asthma do so, some research suggests, and many people on fixed incomes can’t afford these expensive medications, which can cost up to $300 a month.

Judith GrahamNAVIGATING AGING

With age, the immune system’s response to inflammation — a key contributor to asthma — becomes blunted, making it harder to fight off infections that can trigger asthma exacerbations.

Other biological changes, notably shifts in patterns of inflammation, may reduce older patients’ response to inhaled corticosteroids such as Advair or Flovent — medications that need to be taken daily to control inflammation.

“Either patients have more inflammation and they need higher doses or they have a different kind of inflammation and steroids may not work as well,” Wechsler said.

Then, there are other medical conditions such as chronic obstructive pulmonary disease, congestive heart failure and heart disease that can coexist with asthma and complicate diagnosis and treatment.

Research shows that older adults tend to prioritize other medical conditions over asthma, perhaps because they minimize symptoms and underestimate their impact, suggested Miichael Wolf, a professor of medicine at Northwestern University’s Feinberg School of Medicine in Chicago.

“Older adults have a tendency to ignore difficulties with breathing,” noted Dr. Rachel Taliercio, a pulmonologist at the Cleveland Clinic. “Instead of thinking this could be asthma, they think, ‘I’m overweight, I’m out of shape, I’m getting older, and this is normal at this time of life.’”

Physicians can be slow to recognize asthma as well. “In the elderly, sometimes the only manifestation of asthma is shortness of breath and a cough,” said Dr. Kaiser Lim, a pulmonologist and critical care specialist at the Mayo Clinic in Rochester, Minn. “But some primary care doctors kind of shrug off these symptoms.”

Up to half of older adults with asthma haven’t been accurately diagnosed, according a review article in The Lancet. That includes people with adult-onset asthma who first developed this condition in middle age or later.

Wechsler tells of a patient who started coughing, wheezing and becoming short of breath in his 60s. Diagnosed with chronic obstructive pulmonary disease by two physicians, he was given a rescue inhaler but was not treated for ongoing airway inflammation. When the patient failed to improve, he went to National Jewish, which performed a round of sophisticated tests that indicated asthma.

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“I prescribed a high dose of inhaled corticosteroids in combination with a long-acting bronchodilator, and he came back a month later and said, ‘I don’t know what the hell you gave me, doctor, but I haven’t breathed this well in five years.’ ”

When Robins arrived in Denver, with an acute asthma exacerbation, her treatment was far more difficult.

Diagnosed with severe allergies and intractable asthma as a child, she’d lived full time in a dormitory at National Jewish from age 6 to 8, along with a group of youngsters with life-threatening variants of these conditions.

Robins learned to hide the severity of her illness in the years that followed.  “Everyone knew I had asthma, but no one except a few close friends and family knew how bad it was,” she recalled.

Youth afforded her a form of protection. “Even when you have setbacks, there’s a vigor and a lust for life when you’re young that will not be denied,” Robins said.  “You feel you’re invincible, and even if you don’t feel great, it’s like, so what, I’ll get better.”

Despite asthma exacerbations that required hospitalization, Robins managed fairly well until she reached her 50s. “Things became very different as I got older,” she explained. “I couldn’t recoup from exacerbations as easily. The episodes were longer. The periods where I felt decent were shorter.”

In Denver, Robins hoped she’d stabilize in a few days. Instead, she stayed nearly seven weeks, being treated with a higher dose of intravenous steroids than she’d ever had, before returning home to Florida in late July.

Toward the end of her treatment at National Jewish, Robins reflected on growing older with a serious chronic illness. “I used to feel like I was in control of my asthma,” she said, “but I’m not in control anymore, and that has been very difficult to accept.”

“I know now that I can’t get away with putting this on the back burner, the way I did when I was younger,” she continued. “You realize you have to adjust to a different lifestyle, and if you’re not smart about what you can and can’t do, you’ll pay the price.”

Acknowledging her vulnerability after years of toughing out being sick is an ongoing challenge. “It’s empowering to know that you’re doing as much as you can to be healthy. But it’s scary at the same time,” Robins said. “It doesn’t mean you can change things. But you’re doing what you can.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

Categories: Aging, Navigating Aging

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Lag In Brain Donation Hampers Understanding Of Dementia In Blacks

Dorothy and Levi Reeves stand in their Oakland, Calif., home, holding their wedding photo from 57 years ago. Dorothy Reeves agreed to donate both of their brains after death to the University of California-Davis for research. (Anna Gorman/KHN)

OAKLAND, Calif. — The question came as a shock to Dorothy Reeves: Would she be willing to donate her husband’s brain for research?

She knew dementia would steadily take Levi Reeves’ memories of their 57-year marriage, his remaining lucidity and, eventually, his life. But to let scientists take his brain after he died? That seemed too much to ask.

“I didn’t want to deal with the idea of his death,” said Reeves, 79. “I certainly didn’t want to deal with brain donation.”

As an African-American and a former schoolteacher, Reeves is keenly aware of the history of racism in health care, including callous and sometimes deadly experimentation. Reeves said she never personally has had a bad experience with doctors or the medical system. But she’s old enough to remember the infamous Tuskegee Institute syphilis study, during which hundreds of mostly illiterate black sharecroppers were assured they were being treated for “bad blood” even as doctors withheld effective treatment over decades.

Top researchers say such wariness, while understandable, is thwarting efforts to understand and treat Alzheimer’s disease and other forms of dementia in black patients today. African-Americans suffer from these cognitive impairments at two to three times the rate of non-Hispanic whites, yet they are less likely to take part in research.

That has created a vexing challenge for scientists, who are trying to persuade more blacks to participate in studies — both while they are alive and after they die. A critical part of their efforts is asking for brain donations.

“There is a lot of terrible history that we have to acknowledge and move past,” said Lisa L. Barnes, a neuropsychologist at the Rush Alzheimer’s Disease Center in Chicago. “A lot of minority communities still feel that research involves being a guinea pig. Nobody wants to be used. Nobody wants to be a guinea pig.”

Shirley Fitch, who lives south of Chicago, said no thank you to Rush researchers on behalf of her husband, Clarence. The former university professor died last summer at age 86, seven years after being diagnosed with dementia.

“I’m hesitant because of distrust,” said Fitch. “Once my brain is donated for one purpose, who is to say it won’t be used for another purpose? It is out of your control.”

Although Shirley Fitch is participating in non-Alzheimer’s research at Rush, she said the historical abuses of black people have been “awful and hard to get over.”

Even today, blacks tend to get worse treatment from hospitals, she said. “It all gets stirred in the pot as to feelings about bias.”

Dorothy Reeves, 79, helps feed her husband, Levi, who has Lewy body dementia. Reeves, a former schoolteacher, initially declined brain donation but later agreed — for both her and her husband. (Anna Gorman/KHN)

The Knowledge Gap

The precise explanations for the disparities among blacks and whites are unknown. Until recently, most of our understanding of the pathology of dementia was largely based on studies of white patients.

“We have a real knowledge gap in accurately knowing if dementia is different in minorities as compared to whites,” said John Olichney, a neurologist and clinical director of the Alzheimer’s Disease Center at the University of California-Davis.

Scientists say blacks’ disproportionate rates of dementia may be related in part to the prevalence of disorders that raise the risk of vascular disease: diabetes and hypertension, for instance. Socioeconomic factors such as higher rates of poverty and lower levels of education also seem to play a significant role, according to research led by the University of California-San Francisco.

Despite advances in imaging technology that allows researchers to peer into the brains of live patients, studying the organ after death is crucial to a deeper understanding of the causes and progression of disease and to developing drug treatments, Olichney said.

The challenge is getting enough brains from different populations to study. It’s not just a matter of assuring potential donors that Tuskegee and other ethical debacles are in the past. To gain trust, Alzheimer’s research facilities such as UC-Davis and Rush University are also trying to diversify their staffs, collaborate with community leaders and study religious and cultural beliefs on brain donation.

For example, some African-Americans don’t want their brain separated from their body when they are buried, said Stephanie Monroe, director of African Americans Against Alzheimer’s, which is engaged in various efforts to educate people about the disease and its effects.

“Many people believe in ashes to ashes and dust to dust,” she said.

A Changing Mindset

Alzheimer’s researchers at UC-Davis recognized about 15 years ago that they needed a more representative slice of the population, especially in diverse Northern California. At the time, centers around the country were mostly studying well-educated, white people who volunteered, Olichney said.

So they started reaching out to both the African-American and Latino communities. “That was a real change in our mindset,” he said.

Today, nearly 400 patients, including about 70 African-Americans, are enrolled in its longitudinal study of the progression of dementia, and they come in yearly for memory evaluations and other tests. Of the study participants, about 270 have agreed to donate their brains after death, more than 40 of them African-American.

At the Rush Alzheimer’s Disease Center, doctors started following a cohort of African-Americans in 2004 and, some seven years later, began to seek brain donation for the study. Close to 500 African-Americans have signed up to donate after death, and 72 brains already have been donated, Barnes said.

Though she is pleased with the high rate of commitment, she noted that more works needs to be done. In another study, about 3,100 white participants agreed to brain donation, with 1,400 already donated. Recruiting African-Americans “takes a lot of effort and a lot of work,” she said. “Every year, we bring it up again and revisit it with those who are reluctant. But if someone is really firm, we don’t push the subject.”

Research on the donated brains has led to intriguing findings. One Rush study, published in 2015, found that blacks with Alzheimer’s disease were more likely than whites to have other disorders, such as Lewy body dementia. Twice as many blacks with Alzheimer’s as whites with the disease also had Lewy body dementia, in which protein deposits build up in nerve cells, according to the study. Blacks with dementia also had more severe disease of the arteries, the study found.

The number of blacks studied was relatively small — 41 compared with 81 whites — yet its findings were potentially important. That’s because the presence of other diseases in the brain means blacks may not respond as white patients do to drugs aimed specifically at Alzheimer’s.

Even for experienced research institutions, getting people to participate in donation remains complicated — in part, because families don’t necessarily agree about it among themselves.

Andrea Gourdine holds a photo of her mother, Gladys Brown, who died in 2012 after being diagnosed with Alzheimer’s. Brown donated her brain to the University of California-Davis, for research. (Anna Gorman/KHN)

Andrea Gourdine remembers clearly when her mother, Gladys Brown, started behaving oddly. Once, the elder woman forgot a stove burner was on and a dish exploded. Then she stopped bathing regularly. “And she was normally fastidious,” Gourdine said. “Something was really, really wrong.”

Brown enrolled in the research at UC-Davis, was diagnosed with Alzheimer’s in 2005 and soon after agreed to donate her brain. It won’t help me, Brown told researchers, but it could help others. She died in 2012, at 87.

Gourdine also signed up for the UC-Davis study and has consented to donate her brain. She does not have Alzheimer’s, but researchers are seeking brains of those without dementia for comparison.

She is aware of the history of medical abuse of African-Americans but says she doesn’t see any point in focusing on the past.

Gourdine’s sister, India Collins, disagrees with her sister and objected to her mother’s donation.

“I have problems with scientific research and I get very upset with scientific data and outcomes in general,” said Collins. She questions how helpful it is to African-Americans. “Why would you want to participate in their research if it does not benefit you?”

Expanding The Brain Trust

Gwen Gates, a recruiter and research coordinator at the UC-Davis center, goes to churches, health fairs and other events to build trust and develop deeper relationships among the university and minority communities. Patients and families want to know what scientists do with the brains. They worry about how relatives will react. They fear donation will interfere with funeral arrangements or their plans for an open casket.

She assures them it won’t. She explains that brain donations will help future generations, perhaps even in their own family.

Occasionally, families readily agree. Some adamantly refuse. For others, the decision is a process.

Dorothy Reeves declined brain donation initially but agreed to sign up herself and Levi, 81, for observational studies. Then she saw what the disease could do. Her husband, who has Lewy body dementia, went under a table one day to get a magazine and couldn’t find his way out. He forgot her name and those of his children.

She thought about all the other people like Levi.

“It affects people in ways you can’t imagine — regardless of your race,” she said. “It’s almost unbearable.”

Soon the researchers had their answer. Yes, she would agree to donation — for both of them.

KHN’s coverage in California is funded in part by Blue Shield of California Foundation.

Categories: Aging, Public Health

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Florida Law Will Let Patients Get All Their Drug Renewals At The Same Time

For people who take multiple medications to manage chronic conditions, traipsing back and forth from the pharmacy to pick up pills can make it harder to stick to their doctors’ orders. But because insurers often don’t allow consumers to fill partial prescriptions to make  medication renewal dates align, patients sometimes have no choice but to frequently shuttle to the drug store for refills.

Starting next year, that will change in Florida when the state’s new medication synchronization law goes into effect. The law, passed this year, requires insurers to let enrollees align the refill dates for most drugs at in-network pharmacies at least once during their insurance plan year. The insurers must pro-rate patient co-payments for partial refills.

Michelle AndrewsInsuring Your Health

The law doesn’t apply to self-funded companies that pay their workers’ medical claims directly.

Generally, prescriptions for chronic conditions are renewed every 30 days. Insurers often balk at covering a refill of a drug sooner than that, leaving patients to make a full copayment even if their doctor writes a prescription for a partial order.

The Medicare program allows beneficiaries with Part D drug plans to request less than a full month’s supply of a drug and pay a pro-rated amount.

Consumer advocates say medication synchronization isn’t as serious a problem as not having coverage for the specific drugs or not being able to afford them because of high cost sharing. Still, the hassle factor of making multiple monthly trips to the pharmacy to get their drugs increases the odds that people will miss important medications.

The new law will make a big difference for HIV patients, many of whom take at least five HIV drugs and may need medications for other conditions such as high blood pressure or diabetes, said Michael Ruppal, executive director at the Tampa-based AIDS Institute, which advocated for the bill. He cited as an example one HIV patient who was on 11 medications, some of which he received through the mail and others that he picked up at two different retail pharmacies.

“People make all these multiple stops on different dates,” Ruppal said. “He had to track it all on a calendar.”

Florida, despite being a magnet for retirees, many of whom have chronic conditions, is hardly one of the first states to address this issue. Since 2014, about two dozen states have passed laws or put regulations in place requiring medication synchronization, said Fara Klein, manager of state government affairs at the National Community Pharmacists Association.

In addition to making it easier for patients to stick to their drug regimens, the new law may encourage patients to have conversations with their pharmacists at least once a year. When they align the drug renewals, they can also ask questions about how to take a drug, side effects and drug interactions, say advocates.

“For people who are over 50, it’s so important that pharmacists will be looking out to make sure there are no bad drug interactions,” said Dorene Barker, associate state director for AARP Florida.

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

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When Wounds Won’t Heal, Therapies Spread — To The Tune Of $5 Billion

PHILADELPHIA — Carol Emanuele beat cancer. But for the past two years, she has been fighting her toughest battle yet. She has an open wound on the bottom of her foot that leaves her unable to walk and prone to deadly infection.

In an effort to treat her diabetic wound, doctors at a Philadelphia clinic have prescribed a dizzying array of treatments. Freeze-dried placenta. Penis foreskin cells. High doses of pressurized oxygen. And those are just a few of the treatment options patients face.

“I do everything, but nothing seems to work,” said Emanuele, 59, who survived stage 4 melanoma in her 30s. “I beat cancer, but this is worse.”

The doctors who care for the 6.5 million patients with chronic wounds know the depths of their struggles. Their open, festering wounds don’t heal for months and sometimes years, leaving bare bones and tendons that evoke disgust even among their closest relatives.

Many patients end up immobilized, unable to work and dependent on Medicare and Medicaid. In their quest to heal, they turn to expensive and sometimes painful procedures, and products that often don’t work.

According to some estimates, Medicare alone spends at least $25 billion a year treating these wounds. But many widely used treatments aren’t supported by credible research. The $5 billion-a-year wound care business booms while some products might prove little more effective than the proverbial snake oil. The vast majority of the studies are funded or conducted by companies who manufacture these products. At the same time, independent academic research is scant for a growing problem.

“It’s an amazingly crappy area in terms of the quality of research,” said Sean Tunis, who as chief medical officer for Medicare from 2002 to 2005 grappled with coverage decisions on wound care. “I don’t think they have anything that involves singing to wounds, but it wouldn’t shock me.”

A 2016 review of treatment for diabetic foot ulcers found “few published studies were of high quality, and the majority were susceptible to bias.” The review team included William Jeffcoate, a professor with the Department of Diabetes and Endocrinology at Nottingham University Hospitals Trust. Jeffcoate has overseen several reviews of the same treatment since 2006 and concluded that “the evidence to support many of the therapies that are in routine use is poor.”

“I don’t think they have [any therapy] that involves singing to wounds, but it wouldn’t shock me.”

Sean Tunis, former Medicare chief medical officer

A separate Health and Human Services review of 10,000 studies examining treatment of leg wounds known as venous ulcers found that only 60 of them met basic scientific standards. Of the 60, most were so shoddy that their results were unreliable.

While scientists struggle to come up with treatments that are more effective, patients with chronic wounds are dying.

The five-year mortality rate for patients with some types of diabetic wounds is more than 50 percent higher than breast and colon cancers, according to an analysis led by Dr. David Armstrong, a professor of surgery and director of the Southern Arizona Limb Salvage Alliance.

Open wounds are a particular problem for people with diabetes because a small cut may turn into an open crater that grows despite conservative treatment, such as removal of dead tissue to stimulate new cell growth.

More than half of diabetic ulcers become infected, 20 percent lead to amputation, and, according to Armstrong, about 40 percent of patients with diabetic foot ulcers have a recurrence within one year after healing.

Carol Emanuele of Philadelphia shows a photograph of a wound VAC (vacuum-assisted closure) procedure on her left foot after the amputation of her big toe. (Eileen Blass/for Kaiser Health News)

“It’s true that we may be paying for treatments that don’t work,” said Tunis, now CEO of the nonprofit Center for Medical Technology Policy, which has worked with the federal government to improve research. “But it’s just as tragic that we could be missing out on treatments that do work by failing to conduct adequate clinical studies.”

Although doctors and researchers have been calling on the federal government to step in for at least a decade, the National Institutes of Health and the Veterans Affairs and Defense departments haven’t responded with any significant research initiative.

“The bottom line is that there is no pink ribbon to raise awareness for festering, foul-smelling wounds that don’t heal,” said Caroline Fife, a wound care doctor in Texas. “No movie star wants to be the poster child for this, and the patients … are old, sick, paralyzed and, in many cases, malnourished.”

The NIH estimates that it invests more than $32 billion a year in medical research. But an independent review estimated it spends 0.1 percent studying wound treatment. That’s about the same amount of money NIH spends on Lyme disease, even though the tick-borne infection costs the medical system one-tenth of what wound care does, according to an analysis led by Dr. Robert Kirsner, chair and Harvey Blank professor at the University of Miami Department of Dermatology and Cutaneous Surgery.

Emma Wojtowicz, an NIH spokeswoman, said the agency supports chronic wound care, but she said she couldn’t specify how much money is spent on research because it’s not a separate funding category.

“Chronic wounds don’t fit neatly into any funding categories,” said Jonathan Zenilman, chief of the division for infectious diseases at Johns Hopkins Bayview Medical Center and a member of the team that analyzed the 10,000 studies. “The other problem is it’s completely unsexy. It’s not appreciated as a major and growing health care problem that needs immediate attention, even though it is.”

Commercial manufacturers have stepped in with products that the FDA permits to come to market without the same rigorous clinical evidence as pharmaceuticals. The companies have little incentive to perform useful comparative studies.

“There are hundreds and hundreds of these products, but no one knows which is best,” said Robert Califf, who stepped down as Food and Drug Administration commissioner for the Obama administration in January. “You can freeze it, you can warm it, you can ultrasound it, and [Medicare] pays for all of this.”

When Medicare resisted coverage for a treatment known as electrical stimulation, Medicare beneficiaries sued, and the agency changed course.

“The ruling forced Medicare to reverse its decision based on the fact that the evidence was no crappier than other stuff we were paying for,” said Tunis, the former Medicare official.

In another case, Medicare decided to cover a method called “noncontact normothermic wound therapy,” despite concerns that it wasn’t any more effective than traditional treatment, Tunis said.

“It’s basically like a Dixie cup you put over a wound so people won’t mess with it,” he said. “It was one of those ‘magically effective’ treatments in whatever studies were done at the time, but it never ended up being part of a good-quality, well-designed study.”

The companies that sell the products and academic researchers themselves disagree over the methodology and the merits of existing scientific research.

Thomas Serena, one of the most prolific researchers of wound-healing products, said he tries to pick the healthiest patients for inclusion in studies, limiting him to a pool of about 10 percent of his patient population.

“We design it so everyone in the trial has a good chance of healing,” he said.

“If it works, like, 80 or 90 percent of the time, that’s because I pick those patients,” said Serena, who has received funding from manufacturers.

But critics say the approach makes it more difficult to know what works on the sickest patients in need of the most help.

Gerald Lazarus, a dermatologist who led the HHS review as then-director of Johns Hopkins Bayview Medical Center wound care clinic, said Serena’s assertion is “misleading. That’s not a legitimate way to conduct research.” He added that singling out only healthy patients skews the results.

The emphasis on healthier patients in clinical trials also creates unrealistic expectations for insurers, said Fife.

“The expensive products … brought to market are then not covered by payers for use in sick patients, based on the irrefutable but Kafka-esque logic that we don’t know if they work in sick people,” she said.

“Among very sick patients in the real world, it may be hard to find a product that’s clearly superior to the others in terms of its effectiveness, but we will probably never find that out since we will never get the funding to analyze the data,” added Fife, who has struggled to get government funding for a nonprofit wound registry she heads. Not surprisingly, she said, the registry data demonstrate that most treatments don’t work as well on patients as shown in clinical trials.

Patients say they often feel overwhelmed when confronted with countless treatments.

Navy surgeon Capt. Pat McKay examines the healing progress of skin grafts on Navy Cmdr. Peter Snyder at Walter Reed National Military Medical Center. (H. Darr Beiser/for Kaiser Health News)

“Even though I’m a doctor and my wife is a nurse, we found this to be complicated,” said Navy Cmdr. Peter Snyder, a radiologist who is recovering from necrotizing fasciitis, also known as flesh-eating bacteria. “I can’t imagine how regular patients handle this. I think it would be devastating.”

To heal wounds on his arms and foot, Snyder relied on various treatments, including skin-graft surgery, special collagen bandages and a honey-based product. His doctor who treats him at Walter Reed National Military Medical Center predicted he would fully recover.

Such treatments aren’t always successful. Although Emanuele’s wound left by an amputation (of her big toe) healed, another wound on the bottom of her foot has not.

Recently, she looked back at her calendar and marveled at the dozens of treatments she has received, many covered by Medicare and Medicaid.

To help Carol Emanuele get around her Philadelphia home, she places a walker inside the threshold of the doorway to her bathroom so she can easily transfer from wheelchair or a walker in order to stay off her feet. (Eileen Blass/for Kaiser Health News)

Some seem promising, like wound coverings made of freeze-dried placenta obtained during births by cesarean section. Others, not — including one plastic bandage that her nurse agreed made her wound worse.

Emanuele was told she needed to undergo high doses of oxygen in a hyperbaric chamber, a high-cost treatment hospitals are increasingly relying on for diabetic wounds. The total cost: about $30,000, according to a Medicare invoice.

Some research has indicated that hyperbaric therapy works, but last year a major study concluded it wasn’t any more effective than traditional treatment.

“Don’t get me wrong, I am grateful for the care I get,” Emanuele said. “It’s just that sometimes I’m not sure they know what they’re using on me works. I feel like a guinea pig.”

Confined to a wheelchair because of her wounds, she fell moving from the bathroom to her wheelchair and banged her leg, interrupting the healing process. Days later, she was hospitalized again. This time, she got a blood infection from bacteria entering through an ulcer.

She has since recovered and is now back on the wound care routine at her house.

“I don’t want to live like this forever,” she said. “Sometimes I feel like I have I no identity. I have become my wound.”

Categories: Aging, Cost and Quality

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