Lifesavers Come Through in a Complex Case

Laura Mathiasen (left) follows up with Dr. Teresa Whitley (center) and case manager Sandy Remell, R.N.

Laura Mathiasen has been an athlete most of her life—playing competitive softball, swimming and even teaching physical education for awhile—until a devastating disease sidelined her with a vengeance.

Aptly named, Cyclic Vomiting Disease is every bit as terrible as it sounds, but rarely diagnosed in women over 30. Laura remembers the day it started in 2006. She woke up in pain and started started vomiting uncontrollably. “At first, I thought it was the flu, but it just kept happening.”

Episodes would wrench her body, leaving her weak and weary and with nowhere to turn. At times, she’d pass out from the pain. Her mother and her friends did the only thing they knew to do in an emergency: Call an ambulance.

“The ED complex case management program was started because we recognize that navigating the healthcare system in its current state is daunting.”

—Seth Kaufman, M.D.

The Emergency Department is no place to treat chronic pain, but Laura didn’t have many choices. She’d visited doctors and clinics from the Bay Area to the foothills, and no one had a definitive answer. Some even suggested it was a psychological condition, which made her furious.

She moved in with her mother in Suisun City when she could no longer care for herself and wrestled with other serious ailments, such as renal failure and pancreatisis. Soon, the ED staff at NorthBay Medical Center began to recognize her on sight. She felt powerless and lost.

Enter Sandy Remell, R.N., Complex Case Manager, who after more than 30 years in the business knows a thing or two about how to navigate the healthcare system. Her assignment from boss Shelley Stelzner, director of Outpatient & Complex Case Management, was to focus on individuals who would benefit from outpatient care assistance, by working to coordinate varied outpatient services to address chronic medical conditions.

“The ED complex case management program was started because we recognize that navigating the healthcare system in its current state is daunting,” explains Seth Kaufman, M.D., medical director of the Emergency Department. “We understand that patients with chronic conditions need assistance in finding an avenue to address their long-term healthcare needs.”

Seth Kaufman, M.D.

In Laura’s case, it was difficult to get a handle on the disease. She might be fine for a month or two at a time, then sick for months. No one could figure out what triggered her symptoms. “She was a complex conundrum,” says Shelley.

Sandy’s role, as Laura’s case manager, was to facilitate access to appropriate care services. First, Sandy helped Laura find a primary care physician. Sandy coordinated a visit with Dr. Teresa Whitley, an internist in the NorthBay Center for Women’s Health, who Laura calls, “My hero.”

“If it weren’t for Dr. Whitley, I wouldn’t be here today,” says Laura. “Before I met her, I was ready to give up. And everyone who knows me knows that I’m not a quitter. But I was so desperate that I told my mom that the next time you find me, just let me go. But Dr. Whitley was patient, she listened to me, and she knew I didn’t just want pain medication—I wanted answers. I wanted solutions.”

Additionally, Sandy coordinated specialist care services for Laura through the UC Davis Gastro-Intestinal Clinic, with testing and procedures. Medications were also tried, however were unsuccessful at eliminating her symptoms long-term.

While researching physicians who specialize in treating cyclic vomiting patients, Sandy discovered a physician at UC Los Angeles who would see Laura, as long as her insurance would approve the visit. Sandy secured authorization and the appointment, which was not easy, as the UCLA specialist only sees patients a few days per month. As luck would have it, an appointment was available for Laura within a month.

A customized medication plan was developed that successfully addressed Laura’s symptoms. “It was a lengthy process, however Laura’s case is a perfect example of how a case manager can intervene on a complex condition and coordinate care for successful outcomes,” says Shelley, who notes that Sandy is a phenomenal patient advocate and coordinator of care.

“Sandy is perfect for this role,” she adds. “She has an excellent rapport with our Emergency Department staff and strives to build effective working relationships with the patients.”

Dr. Kaufman agrees.“Sandy has filled in the gaps linking the Emergency Department treatment to the primary care and specialty clinics,” he notes. “She has assisted many patients such as Laura who were frustrated and in need of a definitive solution.”

Laura knows that she may need medication to hold this disease at bay the rest of her life, but she has a plan, and a team at NorthBay she can count on. That, she says, has made a world of difference.

“They’ve given me back my life again.”

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