Thriving on Nutrition Support
Note From Our Advocates Ann Weaver, Senior Consumer Advocate Fall is upon us, and the holidays are not far behind. The changing seasons remind me how we adapt to — and sometimes even welcome — cooler weather amid the beauty of the season. The events that create the need for TPN are often difficult; it can take time to adapt to a new life.
In this issue, we focus on change through one consumer’s story of new diagnosis, an overview of insurance changes and open enrollment, and tips on how to prepare for open enrollment. We also take a look at IV drug shortages impacting the HPN community and profile our growing Iowa pharmacy team.
Stay informed. Stay involved. Open Enrollment
The process for an insurance change is simple:
Remember to keep ThriveRx informed of changes to your insurance to avoid unnecessary costs or disruption of service. Let us know if your insurance is changing this fall or at the beginning of 2019 — or if you receive a new insurance card. We are here to make handling insurance changes a little easier. If you would like to join our ThriveRx family, email us at firstname.lastname@example.org.
• Send a picture of your new card to email@example.com. • Our HPEN reimbursement team will review your information and update you on any benefit changes. • Re-sign your medical release and admission consent for new insurance. We’ll request information and orders from your care team if required by your plan.
What are people saying about ThriveRx? “Thank you to our advocate and the entire ThriveRx team for making Addie and our family’s life better through awesome service!” — Heather Wegley, mom of Adaliese
ThriveRx provides high-touch care for individuals with complex gastrointestinal disorders who require enteral or parenteral nutrition. We believe everyone deserves the opportunity to thrive and live an empowered life. TO LEARN MORE ABOUT HOW WE CAN HELP YOU THRIVE ON NUTRITION SUPPORT, VISIT THRIVERX.DIPLOMAT.IS.
A DIVISION OF DIPLOMAT
SPECIALTY INFUSION GROUP ®
Consumer Spotlight • Jeanette West I was not new to the medical community when I started having symptoms that led to my need for TPN. I was a practicing OB-GYN in New England and made a point to practice in a thorough, detailed manner. I felt a sense of accountability to my patients and helped them with their medical complexities — or, at the least, I would guide them in the right direction. In 2014, I was diagnosed with Ehlers-Danlos syndrome, mitochondrial disease, and dysautonomia. I started struggling with weight loss, suffering from dramatic postural orthostatic fluctuations, severe gastrointestinal symptoms, and a continuous battle with dehydration. After multiple hospitalizations and hydration/nutrition concerns, I was left with limited IV access and an overall deteriorating quality of life. My illness forced me to stop practicing. I went from a physician to a full-time patient. Through my journey, I have learned the importance of being your own advocate as a patient and relying on the support of others while trying to access medical care. It was through my own research that I found ThriveRx. I was at a point in my care where I needed nutritional support, but the coordination of care was not straightforward. ThriveRx became the hub for my nutrition needs. Having the support of the dietitian and nurses (and their ability to work closely with my physician) helped minimize gaps in therapy and streamlined care. With the help and support of the ThriveRx team, I feel as though my life is turning around. I can eat more and feel an overall sense of hope.
I am married and the mother of three boys ages 12, 14, and 16. Our family enjoys outings such as hiking, skiing, and traveling. In my free time, I enjoy volunteering as a ski trainer, coaching gymnastics, and practicing the art of flying trapeze. Currently, spending time with my family is at the forefront. Through all of this, I have come to realize that, as my children get older, I don’t want to miss a single second. Since starting TPN, I have been able to travel with my family. We are traveling to Spain this summer. My outlook has gone from hoping tomorrow will be doable to feeling like I’m on track and things are getting better. As a physician and a consumer, I would tell others new to TPN that the first step is acceptance — knowing it’s okay to be on TPN. It can be overwhelming, but you will get used to it. Soon it becomes second nature and a part of you. If possible, allow yourself a support person — someone who will go to the appointments and hospital with you; it can be tiring, and it’s helpful to have someone by your side to advocate and support you. And always use sterile technique!
Staff Spotlight • Iowa Pharmacy Team “I am very proud to lead this diverse and dedicated team of people. Since Day 1, everyone has been committed to taking care of our patients. We have grown so much since we started, and it is a real pleasure to come to work every day and see this team in action.” — Adam Reyna, director of pharmacy operations
Not far from the state capitol in the heart of Iowa is a Diplomat Specialty Infusion Group pharmacy. The pharmacy is staffed by a skilled and compassionate team dedicated to meeting the needs of ThriveRx consumers. This month, we spotlight this team. Gary Clark has been a clinical pharmacist for 27 years. Gary has experience in infusion and as a clinical pharmacy manager. He holds a Bachelor of Science in pharmacy
and a Doctor of Pharmacy (PharmD) from Drake University. Gary’s hobbies include woodworking, bicycling, and traveling to see his children and grandchildren. He proudly boasts that his daughter has followed in his footsteps and is a hospital pharmacist. Pharmacy technician Heather LeClair is nationally certified through the Pharmacy Technician Certification Board. Heather has been a technician for 10 years, including six in infusion pharmacy. She and her husband, Steve, have a puppy named Shiloh. Heather enjoys reading, fishing, camping, and board games. Clinical pharmacist Vinh Ly received his PharmD at Drake University and has
experience in home infusion, hospitalbased pharmacy, and retail pharmacy. Vinh and his wife are anxiously awaiting the arrival of their first child. The newest member of the Iowa team is certified pharmacy technician Jessica Lolwing. She has five years of infusion experience, and she enjoys reading and biking. “I like to think that I help our families by being a good listener and being there for them when they need someone. I love the people we serve and count myself blessed to be able to talk to them every day.” — Heather LeClair, pharmacy technician
IV DRUG SHORTAGES Since 2011, nearly every component of parenteral nutrition has been in short supply at one time or another. Home infusion providers must remain vigilant in monitoring for potential shortages and developing strategies to deal with them. The goal is to minimize changes in IV nutrients provided to consumers, minimizing nutritional risk or disruption to their regimen.
Why do shortages occur? NATURAL DISASTERS: This was never more evident than when Hurricane Maria devastated Puerto Rico, the location of a Baxter manufacturing plant. With the temporary halt in production, there were many shortages of TPN components that lasted several months. MANUFACTURING INTERRUPTIONS: This can be the result of a quality issue at the manufacturing plant or a lack of raw materials. PRODUCT DISCONTINUATIONS: When one manufacturer stops producing a product, it can put a strain on other manufacturers as they work to increase production to keep up with demand.
How do we work around them? PREMIXED TPN: During shortages, we have used two shelf-stable TPN products that contain dextrose, protein, electrolytes (Clinimix), and lipids (Kabiven®). Dietitians and physicians will carefully evaluate a consumer’s current formula to see if a substitution with one of these products would be a good fit to temporarily meet their needs. MULTI-ELECTROLYTE PRODUCTS: If an electrolyte is in short supply, it is often possible to provide some or all of it using a product such as Hyperlyte® or Nutrilyte®. These products contain pre-set amounts of potassium, sodium, calcium, magnesium, acetate, and chloride. CONSERVATION EFFORTS: Sometimes there is a need to temporarily reduce the amount of a component in a consumer’s TPN. This is typically done when there are no alternative products to substitute and is necessary to maximize our inventory. ENTERAL SUPPLEMENTATION: In situations where a TPN component is running extremely low, consumers might be asked if they can tolerate foods or medicine
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by mouth to supplement intake. For example, in the calcium shortage in 2011, some consumers took chewable calcium supplements and it was removed from their TPN. IMPORTATION: During extreme shortages, the FDA might allow importation of certain products into the U.S. from other countries.
Our goal during a shortage is to ensure that all of our consumers’ needs are met. When therapy changes are made or alternative products are used, we tighten clinical monitoring to ensure all nutrition parameters remain within the recommended guidelines. We have a team dedicated to managing current shortages, anticipating potential shortages, and directing the clinical team so that we are using our onhand supply efficiently and providing alternative products when appropriate. This attention to detail allows us to continue providing the expert clinical support that defines us.
CONTACT US Call 888.6.THRIVE Fax 888.401.8557
A DIVISION OF DIPLOMAT
SPECIALTY INFUSION GROUP ÂŽ
7167 E. Kemper Road Cincinnati, OH 45249
T H R I V E R X C O N S U M E R E D U C AT I O N
ThriveRx is proud to offer ongoing educational opportunities for all consumers. Our webinars, tips, and kits are designed to give consumers the tools they need to thrive on nutrition support. UPCOMING CONSUMER WEBINAR: SBS, Renal Failure, and Hydration Therapy Consumers and their caregivers will learn about kidney dysfunction as a potential long-term complication of short bowel syndrome, as well as strategies for prevention. Speaker: Maria Karimbakas, RD, CNSC; ThriveRx Clinical Nutritionist Date: 1 p.m. ET. Thursday Nov. 8 To register for this webinar, visit thriverx.diplomat.is.
The information herein is for educational purposes only and may not be construed as medical advice. Diplomat Pharmacy Inc. takes no responsibility for the accuracy or validity of the information herein, nor the claims or statements of any manufacturer. Copyright ÂŠ 2018 by Diplomat Pharmacy Inc. Diplomat, Diplomat Specialty Infusion Group, and ThriveRx are registered trademarks of Diplomat Pharmacy Inc. All rights reserved. DSIG-214784-1810