RX for Change: Confronting the health care crisis in Kansas

Dec. 7, 2005

Editor's note: In a series of stories this week, Harris News Service and the Harris Group newspapers in Kansas examine the growing cost of health care and its effects on the state's residents.

By Matt McNABB

Hutchinson News

Densmore Hart and Dr. Claude Brachfeld came to an agreement early on about his care at Hutchinson Heart.

Hart, an avid golfer, told the physician he planned on walking the Old Course at St. Andrews, in Scotland. It's nearly 3.5 miles from the first tee to the historic Swilcan Bridge.

For someone as active at Hart, who at 70 still works full-time and regularly plays in competitive golf tournaments — the distance might not sound so daunting.

But earlier this year, Hart realized he had a problem, when he walked about a half-mile to board a boat while on vacation.

“I made the boat, but I barely made it,” he said. “It got so bad I couldn't walk from the first tee to the first green.”

So in mid-November Hart underwent his second atherectomy - a procedure that clears plaque from the walls of leg arteries, relieving blockages and improving blood flow.

Brachfeld uses a catheter with a rotating blade for the short procedure to scrape plaque, and most patients are walking again within two hours.

“They just talk you through the whole deal,” Hart said. “The next thing you know, you think you've been there five minutes and you're done. It's really remarkable.”

Statistically speaking, Kansas falls in the middle of the pack among the 50 states in terms of major illnesses and their causes.

In Kansas, as in the nation overall, cancer- and heart-related health problems cause the most deaths. Last year in Kansas, 321.8 people per 100,000 died from cardiovascular complications - 24th in the country — and 200.9 per 100,000 deaths were caused by cancer — 18th nationally. The two health problems accounted for about 61 percent of all deaths in Kansas.

In the 2004 edition of the United Health Foundation's America's Health rankings, Kansas was 13th in prevalence of smoking, at 20.4 percent of the population. That was an improvement from 22.1 percent in 2003. The state ranked 24th in prevalence of obesity, at 22.6 percent of the population, slightly better than 2003 but far from its 1990 measure of 13.1 percent.

Cancer cases at the year-old Tammy Walker Cancer Center at the Salina Regional Health Center largely follow national numbers, said Pam Ehlts, certified cancer registrar.

Most cancers treated there involve the prostate, she said, followed by breast, lung and colon/rectum cancer.

“When I look at prostate cancer, our statistics are a little bit higher, in terms of diagnosis,” Ehlts said.

However, she didn't know if that was because doctors do a better job of diagnosing the disease or because of the older male population prevalent in the 20-county service area.

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While new cases of heart disease might be increasing because of the country's aging population, current cases climb because of medical advancements.

“As we get better at treating the disease, the prevalence increases because people don't die,” Brachfeld said.

From 1995 to 2004, diagnoses of diseases associated with the circulatory system tend to follow along with populations. Sedgwick and Johnson counties are at the top; Stanton, Greeley and Wallace counties are at the bottom.

Of the five major risk factors for heart disease — family history, diabetes, high blood pressure, smoking and high cholesterol — most of the patient base has at least three, if not all five, Brachfeld said.

Hart said he was a smoker for about 25 years, quitting in 2000. He'd also had minor issues in the past with high blood pressure and high cholesterol.

“But I couldn't quite figure out what was going on, with all the cramping and the inability to walk,” he said.

When he asked Brachfeld about what caused him to become his patient, the doctor replied: “Blame your parents. It's hereditary.”

People can't do anything about their family histories, and the risk factors of diabetes and high blood pressure are not reversible, but they are treatable with meticulous treatment, Brachfeld said.

Smoking, though, is a completely preventable risk factor, as is living a sedentary lifestyle, he said.

And doctors' recommendations are the same before and after a diagnosis.

“Treatment and prevention are exactly the same issues and the same set of ideas,” Brachfeld said.

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That's not the case with cancer, where the primary focus is treatment after diagnosis.

While Hutchinson Heart's program has cardiovascular outreach centers in nearby Lyons and McPherson, the Cancer Center of Kansas, based in Wichita and led by Dr. Shaker Dakhil, has 11 satellite locations across the state, including Dodge City, Chanute and Parsons.

“The idea was ... people had to drive from the Colorado border down to Wichita, and from the Missouri border from the other side, and the Nebraska border,” Dakhil said. “We thought that we needed to make cancer centers accessible to them.”

Eleven physicians based in Wichita operate the satellite locations, along with local staff.

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Larger cancer centers across the state — Hays, Garden City and Topeka — are valuable resources to their communities, said Dr. Larry Beck, an oncologist at Tammy Walker in Salina.

“I think the cancer centers, the biggest function is drawing the multiple disciplines that care for cancer under one roof,” he said.

The centers also help draw higher-quality cancer doctors to an area and help foster relationships between medical professionals, Beck said.

Cooperation between cancer treatment and physical therapy should be natural, he said, because of how fatigued the disease and treatment process makes patients.

The centers also serve as a local option for treatment that cancer patients might not otherwise have.

“Just the other day we had someone that said, ‘I was going to M.D. Anderson Cancer Center (in Houston) and our transportation fell through,” Beck said. “We heard about the Tammy Walker Cancer Center, and here we are.' ”

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The night before the atherectomy, Hart said he wasn't nervous. He's been through it before, and with good results.

“The leg that was completed, it's just so much lighter,” Hart said. “I really haven't been released yet to hit the treadmills, to really give it a good checkout.”

But after the second procedure, he plans to put his legs to the test, in a familiar setting. Hart and some family members planned to leave for Arizona for a golfing venture about three days after the procedure. Brachfeld encouraged Hart to walk a few holes.

“He asked me to,” Hart said. “He said, ‘Give me a report.' ”