corey before after feature

Corey Pavelko turns life around with help from Case Management

April 3, 2014 Denise Pinkney

Corey Pavelko fondly calls Case Management Coordinator Wendy Barta of Blue Cross Blue Shield of North Dakota (BCBSND) his guardian angel. Since January 2012, the two have forged a remarkable bond as Corey has battled life-threatening conditions more than once.

He and his wife, Melanie, were planning to drive to Iowa for a family Christmas gathering in December 2011, when difficulty breathing prompted him to see his doctor in Willmar, Minn. When his doctor wanted to put him in the hospital, Corey asked if they could wait until after Christmas. His doctor replied, "You won't survive until Monday."

Corey entered the ICU with pneumonia and later suffered a mild stroke and required multiple blood transfusions. "I lost four to five days of my life that I can't remember at all," Corey said.

Life was not easy for 600-plus-pound Corey who battled diabetes, high blood pressure and difficulty walking. His legs were covered with open wounds and swollen from lymphedema, a condition that prevents fluid from draining due to blockage in the lymphatic system.  He also needed oxygen 24/7 and medication for neuropathy and to deaden the chronic pain from three damaged disks in his lower back.

Corey was transferred to an acute care hospital in Minneapolis where he was stabilized. The hospital could not find a rehabilitation center with a bed large enough for Corey, so he was discharged to his home.

That's when Wendy made a follow-up call to Corey as part of BCBSND's Case Management program after receiving notification of his discharge to see how he was managing at home. The program assists members who have complex injuries, illnesses or conditions and helps to improve their well-being by promoting wellness and improving quality of life. Though he lives in Minnesota, Corey has insurance with BCBSND through his wife's former employer, West Central Tribune, which is owned by Fargo-based Forum Communications.

Realizing his situation was more than Corey and his wife could handle, Wendy tracked down a rehabilitation center in Minneapolis that was willing to bring in a "Big Boy" hospital bed to accommodate Corey.

Ten days later, Corey returned home. Unable to access the upstairs bedroom, Corey had been sleeping in a recliner for the past year. Waiting for him was a Big Boy hospital bed that Wendy had arranged for him to receive. The hospital bed, equipped with a bariatric bar, allowed the Pavelkos to elevate Corey's legs above his heart to help reduce the painful swelling and heal the open wounds. What's more, the bed helped lessen Corey's chronic back pain.

While there is no cure for lymphedema, it can be controlled with diligent care of the affected limbs. Wendy arranged for a skilled nurse to teach Mel how to perform lymphedema wraps in which bandages are wrapped in graduated layers around the entire leg starting at the toes and reaching up to the mid-abdomen to encourage the body to release the lymph fluid. When the wrap is complete, Corey says he looks like the Michelin Man. Lastly, Wendy also arranged for a physical therapist to come to his home and for a home aide to assist with daily care needs.

Just five years earlier, Corey had led an active life, fishing, hunting and remodeling. He described himself as a "good-size" farm boy who wrestled and played football in high school. Those days were a distant memory to 40-something Corey who was now limited to walking 20 feet in the first floor of his home.

Turning point
Corey's health struggles continued throughout 2012. In early September, he gained approximately 100 pounds in 10 days due to the fluid buildup in his legs and abdomen.

On September 10, Corey decided to end his life.

He recalls that day and how his wife had placed towels on the floor by his chair after the lymphedema wrap. Within hours, the towels were saturated from fluid pouring from his legs, which were covered with open sores.  Corey had called Mel and she noticed something wrong in Corey's voice. She alerted her father, and they both raced to the Pavelko home, arriving in time to talk him out of his plan.

They rushed Corey to the ER, where he was then transferred to the acute care hospital in Minneapolis to help him with his medical and emotional needs. Upon discharge, Wendy arranged for a transfer to a nursing home that was willing to meet Corey's needs by providing a Big Boy bed to accommodate his 630-pound weight. What's more, the facility had physical therapists who were experienced treating lymphedema.

However, the nursing home was a three-hour drive from Willmar. Mel who worked four jobs to keep the family, which included two adopted children, afloat, was only able to visit for two hours each weekend. Wendy became Corey's cheerleader from afar, with Corey sharing his progress and successes during their phone conversations.

Alone, Corey was unflinching in his resolve to change his life. "I knew the odds were against me leaving the nursing home alive," he said. "I didn't want to die. I worked my butt off. If they asked me to walk 20 feet, I would walk 40 feet. I pushed myself with that attitude."

He returned home on Nov. 3, 2012, 100 pounds lighter. Corey doggedly did anything he could to strengthen his body, performing arm curls and walking laps in the first floor of his home. He limited his portion size to that of his petite wife.

Later that month, Corey suffered yet another setback. An ER visit revealed he had a heart condition that caused an irregular and rapid heartbeat. On one occurrence, his heart raced at 140 beats a minute for seven hours. "It felt like I was running a marathon," he said. He received medication to help control the condition and was told he may need surgery in the future.

Steady improvement
Corey continued to push himself, resolute to never return to the despair of Sept. 10. By March 2013, Corey's weight had dropped to 383 pounds. A month later, he was able to return to part-time work for the same company that had laid him off in 2009 due to the economy.

Again with Wendy's help, he overcame yet another obstacle. Due to the weight loss, Corey had 30 pounds of excess skin that hung down to his knees. On Sept. 16, 2013, he underwent surgery to remove the excess skin. "I was able to see my feet again," he said. He is grateful for Wendy's work to help resolve issues that blocked approval for the surgery.

Case Management Coordinator Wendy Barta serves as a patient advocate. Corey Pavelko regards her as his guardian angel.

Unfortunately, due to a complication from the surgery, Corey had to limit his exercises and suspend the lymphdema wraps in October. Consequently, that caused 40 pounds of fluid to build up in his legs. That same month, Corey suffered yet another setback when he learned he had yet another heart condition.

By March 2014, Corey was back on track with exercise and he continues his medical journey to address his complex health needs.

"Wendy is my guardian angel," he said. "I can't tell you how many times Mel and I thank God for her. She has done so much for us. It's hard to even fathom. When I tell people about Wendy, they say, 'What? Someone from an insurance company actually cares?' I wouldn't be here today without BCBSND's (case management) program."

"First and foremost a case manager is a patient advocate," Wendy says. "What I may have done for Corey is very small in the big picture. All the hard work and dedication has come from Corey. He is the one who has chosen to follow through with his goals we set together as a team."

"There ain't no trick," he said. "It's 98 percent mindset. You've got to want it with every breath you take, or it ain't gonna happen."

No turning back
Despite setbacks, Corey remains undeterred. Since being part of BCBSND's Case Management program, he's gone from being unemployed and sleeping in a chair on the first floor, from being on oxygen 24/7 to working and being able to climb the stairs without an oxygen tank. He had lost a total of 273 pounds, but has recently gained back some fluid weight from the surgery setbacks in September.

Case Management is one way that BCBSND shows its investment in its members. "Corey deserves to be acknowledged for how he continues to hold himself accountable for his life choices," Wendy says. "Every step he has taken not only benefits himself; it benefits his family; it benefits all people who know and love Corey; and it also benefits BCBSND as we value members striving for health and wellness. It becomes a win-win situation when both member and case manager are striving for the same goals."

As a result of Corey's progress, they are finally being able to return to some of the activities they enjoyed, like going out for Valentine's Day this year. "Mel has been with me throughout it all," he said of his wife of 20 plus years. "I wouldn't be here today without her." 

Throughout the wellness journey, Wendy and Corey have formed a special bond. "Corey will forever hold a special place in my heart," says Wendy, who encouraged Corey to tell his story.

Corey agreed because he wants to motivate others to go forth with their wellness journey no matter what curve balls come their way. "I have had so many setbacks that could have so easily derailed me," he said. "The obstacles are out there. You have to have the right mindset. You have to stand up and fight. You cannot allow yourself to become a victim. That's true in many things in life."

He hopes someday that he will meet his angel. "I don't know where I would be today without Wendy and this program," Corey said.