Dianne, a 59-year-old female member started experiencing headaches and blurred vision. The signs and symptoms pointed to a potential brain tumor, a very scary and complex medical issue. In addition, she had a history of heart-related issues further complicating her situation.
Dianne had a history of heart-related issues, including high blood pressure and two heart attacks. In addition, both of her parents had died from heart disease. She had eight different doctors with little to no collaboration across specialties and at the onset of the new symptoms, was told that she may have a brain tumor.
Many members don’t have the knowledge or resources to navigate a complex diagnosis. This can be a very scary situation, and if not managed correctly, can lead to unnecessary or inappropriate care. In this case, Dianne engaged with a Registered Nurse (RN) certified in case management for help.
By having a complete view of Dianne’s medical history, the case manager was able to “connect the dots.” Applying clinical expertise, she determined that Dianne may be suffering from a pseudotumor cerebri, or “false brain tumor.” A pseudotumor cerebri is a disorder where pressure builds up in the skull from too much cerebrospinal fluid (CSF). Causes can include obesity, other treatable diseases, and some medications. Treatment can span from healthy lifestyle changes to costly, complicated stenting or shunting.
First, the case manager ensured that Dianne received the right diagnosis early on to avoid unnecessary visits and testing. Then, she coordinated with her neurologist to support the member in making lifestyle changes in the areas of diet, exercise, and stopping smoking.
Today, Dianne is on fewer medications, both prescription and over-the-counter. She’s lost thirty-five pounds, has more energy, and is more active. She also reduced her nicotine intake and reported that she “hasn’t had stamina like this in years.”
Dianne’s recent magnetic resonance angiography (MRA) was stable and she only needs to follow up with her neurologist every six months. She avoided stenting, which has an average direct cost of $13,863, and shunting, which has an average direct cost of $15,797 per treatment. Costs could have been even higher as some people need multiple treatments over time. In addition, her cardiologist is pleased with her health improvement, noting that Dianne is more alert and walking much better.
Dianne and case manager built such a tight relationship, that Dianne asked the case manager to be at her vow renewal ceremony. She believes that had it not been for the case manager, she may not have been here for it.