Archives for 2014

Loving Summer During Cancer Treatment

Loving Summer During Cancer Treatment

After a long and cold winter, summer has finally arrived. As much as we look forward to this season, summer also brings with it challenging health and lifestyle issues for those with cancer, especially those undergoing chemotherapy and radiation.

Nearly all chemotherapy agents can cause skin to be more sensitive to the sun resulting in skin reactions and possible sunburns. For those taking medications that cause a rash, the sun can intensify the skin response and worsen the rash. Skin that is now or has recently been exposed to radiation treatmentis especially sensitive to the sun’s rays.

Particular chemotherapy drugs that may lead to more intense skin reactions and possible sunburns include:

  • 5FU (5 Flourouracil)
  • Methotrexate
  • Dacarbazine
  • Mitmomycin
  • Vinblastine
  • Tamoxifen
  • Biologics (for example Cetuximab, Tarceva)

Many antibiotics also cause the skin to be more sensitive, which can lead to skin reactions or rash after sun exposure. Some of these include:

  • Ciprofloxacin
  • Levaquin
  • Tetracycline
  • Doxycycline
  • Bactrim (TMP-SMX)

Other medicines that oncology patients may be taking that can lead to sun sensitivity:

  • Lasix (Furosemide)
  • Hydrochlorothiazide
  • Benadryl
  • Aleve and Feldene
  • Cardiac medications-ask your doctor
  • Compazine (prochlorperazine)

What can you do help prevent skin sensitivity reactions from the sun?

  • Limit sun exposure during the hours of 10am and 4pm. During these hours, the sun is most intense.
  • Be sure to cover areas of skin that are undergoing radiation or have been recently radiated with either a complete sun block (for example, zinc oxide) or clothing.
  • Use a broad spectrum sunscreen with an SPF of at least 30 (both UVA and UVB protection). Reapply after 2 hours and after swimming.
  • Don’t forget your lips! Use a lip balm with SPF 15 minimum.
  • Protect your head and ears, especially if you have hair loss. Wear a wide-brimmed hat. Your scalp is very sensitive and will burn easily.
  • Keep surgical scars well covered. The sun may darken the skin at the scar.
  • Wear protective clothing. Light colors reflect the light. There are now many SPF clothing options available.
  • Be mindful of dehydration. Drink before you become thirsty and at least 8 glasses of water per day, more with exposure to heat and sweating.

Undergoing treatment for cancer during summer does not limit you to a life indoors—by following these simple precautions, you can still enjoy the summer months ahead.

Preventing Colorectal Cancer – Second in the Colon Cancer Series

Preventing Colorectal Cancer – Second in the Colon Cancer Series

The focus of the second blog in the colon cancer series has a focus on preventive aspects of colorectal cancer. A third blog looking at pharmacalogical prevention of colon cancer will follow later this year.

       Physical activity:  Regular physical activity through either work or leisure appears to reduce the risk of colon cancer by almost a third when comparing the least physically active to the most active individuals. 

       Fruits, vegetables,red meat and animal fat: There are a number of studies which have  shown a mild protective effect of fruit and vegetable consumption. Excessive consumption of fruits and vegetables does not seem to better than what is offered in a balanced diet (an apple a day seems to be adequate). A diet low in red meat and animal fat also appears to have protective benefit independent of fruit and vegetable consumption. However, it has to be pointed out that there was one large study which did not show a clear benefit of fruit and vegetable consumption regarding the risk of colorectal cancer.

       Dietary fiber: There is some controversy regarding the benefits of dietary fiber and colon cancer risk. However in a recent large review of 25 studies it was concluded that high intake of dietary fiber, in particular cereal fiber and whole grains, was associated with a reduced risk of colorectal cancer.

       Folic acid and folate: It is not clear if there is a role for folate (which is food-derived) or synthetic folic acid used in food supplements in the prevention of colon cancer. There was one large study suggesting a reduced colon cancer risk for individuals taking 800 mcg of folate or more per day. However, other studies did not confirm any benefit of folic acid with one study even raising the question of increased colon cancer risk with folic acid supplementation.  

–        Vitamin B6: There is a modest association between higher Vitamin B6 intake and decreased colorectal cancer risk.

–        Calcium: There are several large studies which suggest that high calcium intake either through supplements or dietary intake reduces the risk of colorectal cancer. Calcium supplementation may be effective in reducing the risk of colorectal adenomas which are benign growths which later can turn into cancer. Calcium supplementation is recommended by the American Society of Gastroenterology to prevent colon adenomas.

–       Vitamin  D: A number of studies have shown  an association between low Vitamin D blood levels and increased colorectal cancer risk. However the data regarding the benefits of Vitamin D supplementation in preventing colorectal cancer have been conflicting and there are important studies ongoing trying to answer this question.  

–      Magnesium: Based on a large study from Scandanavia with more than 60,000 participants, there appears to be a signal that higher magnesium intake is associated with a reduced risk of colon and rectal cancer.

 With summer upon us, let’s celebrate with lots of physical activity and don’t forget that apple a day!

Ensuring Accuracy in Your Lab Results

Ensuring Accuracy in Your Lab Results

When patients come into the Green Bay Oncology office, many times they are required to have blood taken for one or more tests.  How can we be assured that the testing is accurate? The answer is through quality assurance.

The phlebotomist (person who takes the blood) greets the patient and identifies them by asking for their name and date of birth. That information is compared to the labels that have been printed specifically for that patient.   Blood is drawn from the arm, finger, hand or a catheter inserted directly into the vein.  Labels are immediately affixed to the tubes.

The tests are then performed on the blood in accordance with a strict array of company policies and government rules which include stringent quality control.  Periodically, the lab is tested and inspected by an outside regulatory agency.   They will check to see if we have done and documented these actions in accordance with the regulations.

The accuracy of the instruments we use is checked daily by running control samples with known values. Only after the control values are correct and the instrument has passed this test, will the patient’s blood sample testing be performed. The result of the patient’s blood test is then reviewed by a laboratory professional after which it goes directly into the patient’s chart electronically, avoiding error caused by incorrect transcription.

Green Bay Oncology East and West Green Bay sites have laboratories within the clinics to assure the quickest, most efficient lab results possible.  Both are equipped with state-of-the-art instrumentation, operated by a knowledgeable staff.  Green Bay Oncology also has sites outside of Green Bay, which include Sturgeon Bay, Oconto Falls, Sturgeon Bay, Escanaba and Manistique.  We rely on the proven skill and commitment to quality of each facility we partner with in those communities.

The Green Bay Oncology Lab staff is passionate about quality assurance for our patients, and we pride ourselves on strict quality control.

Navigating the Insurance Maze

Navigating the Insurance Maze

Healthcare costs are a key concern for people with cancer. Patients and family members need to determine how they will pay for treatments. Some patients do not have health insurance. Even for those with coverage, certain treatments and charges may not be included or paid in full. Patients may need help filing or appealing health insurance claims. Additionally, patients need to plan for indirect costs, including lost time from work, added child care and transportation and travel expenses.

There are steps you can take to manage your finances before, during and after treatment. For example, you can:

  • Speak with your physician and ask for a timeline for your treatment
  • Learn your insurance plan’s oncology benefits, mail-order pharmacy benefits, preauthorization, referral and claims appeal rules
  • Assess your anticipated medical expenses and whether your income might be reduced
  • Consider reducing unnecessary expenses
  • Speak with creditors early if you expect difficulty making payments
  • Check to see if you have home mortgage or car payment insurance to help cover expenses during your illness
  • Take advantage of disability plans if needed during your treatment and recovery
  • Seek access to co-payment programs that help insured patients meet their pharmaceutical co-payment expenses

Health insurance helps pay for costly medical treatments and can protect patients and their family from financial hardship. There are different types of private and public health insurance programs. Some people have private health insurance coverage either through an employer (often called a “group plan”) or through an individual policy that they have purchased. Some patients qualify for public or government-funded health insurance programs, including Medicare or Medicaid. The eligibility requirements and enrollment process can be complicated, but financial case workers and social workers can advise and help patients through the process. The single most important consideration for enrolling in public programs is to apply as soon as patients think they may qualify for programs. Many programs have waiting lists or waiting periods before covered benefits and services take effect.

Millions of people living in the United States do not have health insurance or do not have enough medical coverage. Some people may lose their insurance coverage or let it lapse when they leave or change jobs. Others who cannot afford the cost of private insurance may not realize that they qualify for government programs or other types of assistance. Or, patients may find out after they are diagnosed with cancer that their insurance does not cover the prescription drugs or treatment they need.

It is important for patients with health insurance to know what is covered and how to protect their benefits. This is not only important for newly diagnosed patients, but also for survivors who will need follow-up visits.

There are steps that patients and family members can take to manage their health finances and get the most from their coverage. They can:

  • Keep a copy of all claims and related paperwork, such as letters of medical necessity, bills, receipts, requests for sick leave, as well as a written record of phone conversations with insurers
  • Check health policies often to determine what services and medications are covered
  • Obtain proof of previous health insurance coverage from former employer and/or insurers
  • Pay premiums on time and in full to avoid lapse in coverage
  • Learn what to do if a claim is denied
  • Know the laws designed to protect patients and provide continuation of medical coverage (for example, COBRA, HIPAA, Family and Medical Leave Act, Americans with Disabilities Act)

Cancer survivors who lose, leave or change jobs may be eligible to remain in their employers’ plan under COBRA, a federal act that requires some companies to offer continuous health coverage for up to 18-36 months. Even though individuals must pay the entire premium (including the portion that the employer used to pay on their behalf), COBRA may be a better choice than an individual medical insurance plan. The COBRA plan may not be the least expensive option but is will provide continuation of coverage.

Feel free to contact the social worker or financial counselor at the oncology clinic for assistance in answering your questions or directing you to the appropriate resources. The following websites are resources to guide you if you have insurance questions as well:

A Thank You to Our Nurses…

A Thank You to Our Nurses…

May 6th is National Nurses’ Day. Thank you to every nurse at Green Bay Oncology. You demonstrate our core values every day with your knowledgeable care and compassion for our patients.  I appreciate your dedication to our organization and for setting a standard we can all look up to.  Once again, thank you.

Happy Nurses’ Day

Happy Nurses’ Day

In two months, a new crop of medical school grads will show up for their first day of internship. They’ll be dropped, diapered and sniveling, onto a hospital ward and expected to go fix sick folks. 

That first year, the smart ones will learn to practice medicine from the nurses (not the other doctors). The truly lucky ones, the ones who find an oncology nurse to mentor them, will learn all they’ll ever need to know about dedication and compassion. 

Why are oncology nurses such a special breed? Because they choose to work in a field most people shun. And it’s intense. It’s hair loss and fever, fear and fervent hope, victory and tears all day every day. It’s not for the weak. 

Oncology nurses are highly intelligent, and they’ve got compassion gritted under their fingernails. They care, truly care, about their patients – probably more than it’s safe to. They pay a high price for it. But they wouldn’t choose anything else. 

This May, spend some time with an oncology nurse if you can. Watch what they do for a living. And prepare to be moved. 

Happy Nurses’ Day.

All-inclusive Lung Cancer Screening & Consultation

All-inclusive Lung Cancer Screening & Consultation

A better chance of catching lung cancer early. A better chance of beating it.

Now available for eligible participants ages 55-80 with 30+ pack years of smoking.*

Lung cancer is the leading cause of cancer death, and its symptoms often appear when the cancer is in a more advanced stage. Our Low-Dose CT Scan works to detect lung cancer earlier and with lower exposure to radiation. Plus, unlike most other screenings, participants receive a full consultation before the screening and after the results from our highly trained and supportive providers, all for the special self-pay rate of $250.**

To find out more or to schedule a lung cancer screening for yourself or a family member,

call 920-884-3135 or 866-884-3135.

*30 pack years is equivalent to smoking: 2 packs per day for 15 years, 1 pack per day for 30 years, 1/2 pack per day for 60 years.

**Health Savings Account (HSA), cash, check, and credit card accepted at the time of screening (not currently covered by most insurance).

Doctor’s order not required.

HSHS-GBO Logo

You Have Questions, Call Us For Answers

You Have Questions, Call Us For Answers

With all the technological advances we have today, the basic telephone is still very vital to our everyday life. At Green Bay Oncology we use a phone triage process. Anyone who calls the clinic will be greeted by one of our receptionists at either of the Green Bay locations. A call can be as simple as transferring a caller to another staff member or as complex as a new patient referral.

The three to four receptionists managing incoming calls during regular business hours answer calls in the order they are received. These messages are then entered into the secure electronic health record (EHR) in a message similar to an e-mail.

Once this message is received, the receptionist determines the appropriate department to respond to the message. More often than not, with the large variety of reasons a person may call, this message gets sent to the phone triage nurse. There are three to four registered nurses (RN) that manage these messages in order of both the urgency and time received. Many calls related to appointments, treatment, side effects, and prescription refills can be handled by a nurse reviewing the patient chart and then answered relatively quickly. If further medical advice is needed from a provider (physician or nurse practitioner), they will receive a message either electronically or via phone. They will then respond back to the RN, who will complete any steps, such as refilling a prescription, and then get back to the caller. The more information the caller can provide initially the better, as this can expedite the whole process.

Calls arrive steadily throughout the day while GBO staff members are also managing the patient care within the clinic. Providers typically have full schedules and answer their messages before they start their day, between patients, on their lunch hours and after hours. Every call is important and will be responded to with full attention of the team. Know that emergency situation calls always take precedence over those requiring less urgent attention. For example, a patient who is experiencing worrisome side effects would take precedence over a routine prescription refill at that moment. This is what the triage system is set up to do, so that every patient and every situation is given the time and attention that is needed. The number of calls per day varies, but it is not uncommon for over 50-75 calls to be active at one time in a day.

GBO has eight clinic sites, and over 5,000 patients. We at GBO work with many other medical facilities to coordinate the best care for our patients whether in person or via phone.

When you have questions, our telephone triage team is ready to help. Call us at 920-884-3135.

I Am an Oncology Nurse

I Am an Oncology Nurse

Throughout my nursing career, my roles have changed like the seasons.

I spent my first few years building a solid foundation of skills in post-surgical, vascular, trauma and wound care; and eventually felt ready to take on a new role in nursing. I had heard great things about oncology nursing and remember thinking, “How could one area of nursing be so different?” After working at Green Bay Oncology for 6 months, I knew. It was different. It was…special. To work with such compassionate individuals is the most inspiring work I have done so far.

Oncology nursing combines nursing skills, knowledge, care and compassion to make the patient and family experience as positive as possible before, during and after the cancer journey. It requires the unique ability to build strong relationships and act as a liaison between the patient, family and caregivers. It is hard work, but I am often humbled by the kindness and grateful nature of our oncology patients and their families. Oncology is truly a great field to work in.

Don’t get me wrong, nursing can be and often is a demanding job. The nurse encounters demands both physically and emotionally. Oncology nursing doesn’t escape these demands. In many ways, it can be more emotionally taxing then other fields. It can also be more emotionally rewarding.

I have yet to have a day where I felt it was too much to handle, mainly because of the supportive relationships between coworkers and the patients who give so much back to each of us, whether intentionally or not. The kind words of appreciation and recognition along with the many treats and gifts from our amazing patients and their families are powerful and valued. The strong bonds between coworkers is fostered by GBO’s commitment to their employees and helps us live out our clinics values every day.

The oncology nurse can serve the patient population in several different ways. We provide direct patient care, and also have opportunities to work as practitioners, educators, administrators, researchers, patient navigators and more. As oncology nurses, we have a large support system nationally, within the Oncology Nurse Society (ONS), and locally, with the Northeastern Wisconsin Oncology Nurse Society (NEWONS). Here, within these support systems, oncology nurses from different clinics and hospitals can connect, continue education and share experiences. ONS has helped provide standards and certifications for oncology nurses and also provides funding to oncology nurses who want to further their education. ONS doesn’t only help the nurse, but the patient as well; patient advocates fight for funding and patients’ rights on Capitol Hill and are lobbying for the patients’ best interest daily.

Oncology nursing is not just a job; it truly is a calling. It is also the most rewarding thing I have done in my career so far.

I am no longer a nurse. I am an oncology nurse, and am very proud to say that.

Katie Olmsted Photo

Begin With the End in Mind (part 1)

Begin With the End in Mind (part 1)

April 16th marked National Healthcare Decisions Day. It’s intended to get people thinking about – and there’s no nice way to say this – dying. 

“Why on earth would I want to do that?” I hear you saying. Well, you don’t. Not really. And neither do I. In fact, the only thing worse than thinking about dying is – never bothering to think about it at all. 

Sound like a paradox?

Think about the following statistics:

  •        75% of Americans wish to die at home
  •        70% of Americans die in a hospital or nursing facility
  •        70% of Americans don’t have advanced directives

Stephen R. Covey, in 7 Habits of Highly Effective People, tells us that to succeed at anything we first have to clearly state what we want. He calls it “beginning with the end in mind.” And studies clearly show that outlining your end-of-life wishes well in advance significantly increases the chances that things will happen your way.

I’m going to die one day and have some strong preferences about how that goes down. My wife Sara knows my preferences because we talk about it every few months. These conversations aren’t the downer you’d think they are. We’ve gotten pretty good at it.

Why is this such a priority for me? Because I’ve seen what happens without advance directives. And it’s devastating.