Archives for 2015

2015 Guardian of Excellence Award

2015 Guardian of Excellence Award

Green Bay Oncology Receives 2015 Press Ganey Guardian of Excellence Award

Outstanding Performance in Patient Experience

November 11, 2015 – Green Bay Oncology is pleased to announce it has been named a 2015 Guardian of Excellence Award® winner by Press Ganey Associates, Inc. The Guardian of Excellence Award recognizes top-performing health care organizations that have consistently achieved the 95th percentile or above of performance in Patient Experience.


Award-Emblem - Hi-Res-ban_guardian_excellence

The Press Ganey Guardian of Excellence Award is a nationally-recognized symbol of achievement in health care. Presented annually, the award honors clients who consistently sustained performance in the top 5% of all Press Ganey clients for each reporting period during the course of one year.


According to Dr. David L. Groteluschen, President of Green Bay Oncology, the award represents an David-Groteluschen-Portraitimportant recognition from the industry leader in measuring, understanding and improving the patient experience. “Bottom line – everything we do has to improve the patient experience. It’s great to be acknowledged for how well we’re doing so far. But we’re pushing to exceed even this high mark for those we serve.”


press-ganey-holdings-inc-logo  “We are proud to partner with Green Bay Oncology,” said Patrick T. Ryan, CEO of Press Ganey. “This award is a testament to the organization’s leadership in delivering patient-centered care. By achieving and sustaining this level of excellence, Green Bay Oncology demonstrates their commitment to reducing patient suffering and advancing the overall quality of health care.”


About Press Ganey:
Press Ganey Holdings (NYSE: PGND) is a leading provider of patient experience measurement, performance analytics and strategic advisory solutions for health care organizations across the continuum of care. Celebrating 30 years of experience, Press Ganey is recognized as a pioneer and thought leader in patient experience measurement and performance improvement solutions. Our mission is to help health care organizations reduce patient suffering and improve clinical quality, safety and the patient experience. As of January 1, 2015, we served more than 22,000 health care facilities. For more information, visit

What is the blood test BMP?

What is the blood test BMP?

Chances are, if you’ve had your blood taken in the past, the doctor or nurse practitioner may have ordered a BMP to be done on that blood specimen.  What is a BMP, exactly?  A BMP, or basic metabolic panel, is actually 8 tests that measure your kidney function, fluid balance, and blood sugar. Abnormal results may indicate a problem that needs to be addressed.

The BMP includes the following tests:

Kidney Tests:

  • BUN (blood urea nitrogen):  A waste product filtered out of the blood by the kidneys.  An elevated BUN may indicate abnormal kidney function, liver disease, or heart failure.  A low number may indicate malnutrition.
  • Creatinine:  A waste product produced in the muscles, also filtered out of the blood by the kidneys.  The creatinine level is another indication of kidney function.  A low value may indicate low muscle mass or malnutrition.  A high value may indicate a chronic or temporary decrease in kidney function.

Fluid Balance (Electrolytes):

  • Sodium:  One of the major salts in the body fluid. It is important for the body’s water balance and nerve and muscle function.  A low value may indicate the use of diuretics, diarrhea or adrenal insufficiency.  A high value may indicate kidney dysfunction, dehydration, or Cushing’s syndrome.
  • Potassium:  Vital to cell metabolism and muscle function.  A low value may indicate the use of diuretics or corticosteroids such as prednisone or cortisone.  A high may indicate acute or chronic kidney failure, Addison’s disease, diabetes, or dehydration.
  • Chloride:  Helps to regulate the amount of fluid in the body and maintain acid/base balance.   A low value may indicate emphysema or chronic lung disease.  A high value may indicate dehydration, Cushing’s syndrome or kidney disease.
  • CO2 (Carbon Dioxide):  Used to help detect and/or monitor electrolyte imbalances.  A low value may indicate kidney disease, toxic exposure or severe infection.  A high value may indicate lung disease including COPD.
  • Calcium- Is a light alkali metal which can be associated with malnutrition, osteoporosis, and malignancy. It is essential for development and maintenance of healthy bones and teeth. Calcium is also important for normal function of muscles, nerves and blood clotting.  A low value may indicate Calcium, Magnesium or Vitamin D deficiency, malnutrition, pancreatitis, or neurological disorders.  High values may be associated with kidney disease, hyperparathyroidism, cancer, or excessive vitamin D intake.
  • Glucose- Also known as blood sugar, is the body’s energy source. A relatively constant level of glucose must be maintained in the blood. This test is used to identify and/or monitor diabetes.

These tests can rapidly indicate several common acute conditions requiring immediate medical treatment, such as dehydration, diabetic shock, hypoglycemia, or renal failure, to name a few.  The BMP is a smaller version of the CMP (comprehensive metabolic panel), which includes these tests, plus tests for liver function. The CMP will be discussed at a later date.


Reducing Hospitalizations

Reducing Hospitalizations

Green Bay Oncology is dedicated to reducing hospitalizations through patient education and prompt triage. We understand that patients usually prefer to be in the comfort of home and loved ones. We strive to maintain a low hospitalization rate.  Every attempt is made to keep patients educated and prepared in the event that a new or unusual side effect appears.  In case of a life threatening emergency, we encourage patients to call 911 or go to their nearest emergency room.  For non-life threatening emergencies often times patients can be evaluated and treated at GBO, thus helping avoid emergency room visits and hospitalizations as often as possible.

Contacting our office as early in the day as possible allows GBO a better opportunity to review patient concerns and address them in clinic.  We have a dedicated team of triage nurses trained to evaluate patient needs promptly and effectively. These nurses have direct lines of communication with all of the Green Bay Oncology providers.

Some examples of when to call GBO include:

  • Temperature above 101 or shaking chills
  • Inability to drink or retain four 9 oz glasses of liquid in a twenty-four hour period
  • Uncontrolled pain
  • Persistent nausea and vomiting
  • Sudden onset of shortness of breath or a change in your normal breathing status
  • Unusual bleeding or bruising
  • Uncontrolled diarrhea

In many cases, patients can be seen by the doctor or nurse practitioner and be treated with supportive measures such as intravenous fluids for rehydration purposes or medications to control stomach upset.  It is our goal to get all patients safely through treatment. By keeping patients and their care team educated on when to contact Green Bay Oncology, we can together reduce unnecessary hospital admissions, emergency room visits, and continue to strive for a symptom-free or an improved clinical state.

Aspirin and Gastrointestinal Cancer: It May Keep the Doctor Away

Aspirin and Gastrointestinal Cancer: It May Keep the Doctor Away

I recently came across a great review article from the UK titled “Aspirin in Gastrointestinal Oncology: New Data on an Old Friend” and I wanted to share some insights I learned from this review.

Aspirin has been around for over 100 years and had been used for a long time to treat pain, inflammation and fever. It later was discovered that it is a powerful inhibitor of blood platelets which subsequently made it one of the most important components in the treatment and prevention of heart attacks and strokes. In tissue cells and in blood platelets it blocks an enzyme called cyclooxygenase.

There is good evidence that aspirin reduces the risk of colon and other gastrointestinal cancers. One study from the UK with more than 20 years of follow-up evaluated over 7500 patients who had taken aspirin for the prevention of stroke and heart attacks. Once the follow-up period passed the 10-year mark, it became evident that patients who had taken aspirin once daily for 5 years or more, had a reduced risk of colon cancer. Subsequent large studies also showed that aspirin reduced the risk of getting stomach or esophageal cancer as well as the risk of dying from stomach or esophageal cancer. However these benefits did not manifest themselves until 8 to 10 years after starting aspirin. This observation is similar to what was seen with aspirin and colon cancer prevention and explained by the fact that it takes a long time for gastrointestinal cancer to progress from a precancerous growth to an obvious cancer.

An  exception to this is a condition called Lynch syndrome where patients develop colon cancer and other cancers at a younger age. Here the protective effect of aspirin is already noted after 4 to 5 years.

Once a cancer has formed, a big concern is that it will spread to other places in the body forming sister growths (metastases). In an analysis of all the large British aspirin prevention studies it was noted that patients who developed colon cancer while on aspirin had a substantially lower risk of forming metastases which brings me back to  blood platelets. One intriguing hypothesis is that platelets may protect circulating tumor cells from being detected by the immune system and by aspirin disrupting this process, circulating colon cancer cells could be eliminated by the body’s own immune cells.

We can expect more research data to be presented in the future how our old friend aspirin protects against cancer.

Benign Blood Disorders – Polycythemia

Benign Blood Disorders – Polycythemia

Low red blood cells or hemoglobin called anemia is the most common blood disorder world-wide.  However, some patients have hemoglobin that is too high called polycythemia.  Polycythemia can be caused by a bone marrow disorder caused polycythemia vera or from other causes outside the bone marrow called secondary polycythemia.  Distinguishing between the two became much easier about ten years ago with the discovery and testing for Janus Kinase 2 (JAK-2) mutations.  Janus was the Roman god of gates and this protein regulates the production of red bloods cells.  When is mutated, red blood cells are continuously produced causing a high hemoglobin.  Treatment of polycythemia vera is removal of the extra blood in a process called phlebotomy.

Secondary polycythemia can be caused  by conditions that cause low oxygen levels in the blood.  Extra red blood cells are then produced as a compensation.  Common causes include tobacco smoking and sleep apnea.  Other causes can include congenital heart disease, carbon monoxide exposure and being born with an abnormal type of hemoglobin.  The best treatment for secondary polycythemia is treating the underlying condition such as smoking cessation or the treatment of the sleep apnea.

To Port or Not To Port – Advantages & Disadvantages

To Port or Not To Port – Advantages & Disadvantages

Most of our patients who receive chemotherapy, and some patients who receive other therapies for blood disorders, have had a port catheter (or port for short) placed by recommendation of their medical provider for very good reason.  A port catheter is a device placed “centrally” into a large, main vein and is generally located in the upper chest area.  It is an alternative to an intravenous catheter (or IV for short), a device placed “peripherally” into an arm or hand.  In comparing a port to an IV, there are advantages, disadvantages and risks to both.

Advantages of a port:

  • Access to a port is into the port mechanism; not directly into the vein. This avoids puncture wounds and damage directly to the vein.
  • The port is generally very visible and easily felt, resulting in safer, more efficient access than an IV site. A safe, suitable IV access site can be difficult to locate for some patients.
  • Some medications, can cause serious, sometimes permanent, tissue damage if they come in contact with the skin.  This can occur more easily with an IV access, but would be very rare with a port.
  • The port access site is prepared with a sterile technique; IV access is a clean technique.
  • The port can be used for delivering fluids, medications and transfusions; for drawing labs; and for PET/CT dye injections for scans (power ports).  IV access with treatment generally requires two venipunctures; one for lab draws and then the IV access for treatment.
  • The port can remain accessed with a needle up to seven days if no complications arise; an IV is generally limited to four days.
  • The port can be permanent and used as long as it is needed; IV access is always temporary.  Ports can be removed if no longer needed.

Disadvantages of a port:

  • If the port is not being used at least every four weeks, it must be flushed to keep it safe for use.
  • Port placement requires a surgical procedure; IV access does not.

There are risks to both port and IV procedures.  These risks are very low. 

  • Infection
  • Occlusion or blockage of line
  • Dislodgement of port or line
  • Damage to the port

A port is a very useful tool for both the patient and the healthcare team.

Advance Directives: Your Choices for Your Future

Advance Directives: Your Choices for Your Future

90% of people say that talking with their loved ones about end -of -life care is important, but… only 27% have actually done so.

As medicine has advanced and life expectancy has increased, our society has come to see the subjects of dying and death as taboo. The topics are often avoided out of fear and discomfort. However, there are some things medicine simply cannot stop. Dying and death are inevitable but, how your end-of-life care is managed is in your hands.

In general terms, Advance Directives are documents that speak for you when you are unable to do so. These documents are created, by you, to specifically outline your wishes, beliefs and values regarding your health care. The specifics of: long term health care, mental health care, breathing machines, tube feedings and other medical procedures can be addressed per YOUR wishes. Here we’ll briefly address two of the most commonly seen Advance Directive documents (electronic links provided below).

Living Will: 

  1. A Living Will document details your wishes for only the time period when you are close to death or in a vegetative state. It does NOT allow for another person to make health care decisions for you.

Durable Power of Attorney for Health Care (DPOA-HC) 

  1. A DPOA-HC allows you to appoint a “health care agent” who will be able to make health care decisions for you, ONLY in the event that you are unable to do so. This document does not go into effect until two physicians “activate” it by documenting that you lack the capacity to make these decisions yourself. It is vitally important that you chose a person who knows, understands and will follow your wishes.
  2. In the state of Wisconsin, there are several document options; each considered to be a DPOA-HC. The most commonly seen are: The State of Wisconsin Durable Power of Attorney for Health Care, Respecting Choices and Five Wishes. While the details of the document vary, the goal is the same.

Just as important as completing an Advance Directive is making sure it gets to where it needs to be. Providing your healthcare team and your loved ones with the document(s) allows for more open, honest communication focused on your wishes, hopes and dreams.

Advance Directives allow you the opportunity to discuss and document what is important to you so your end-of-life experiences can be just as meaningful as the way you’ve lived your life. While Advance Directives cannot encompass every possible medical scenario, they can provide the basis for thoughtful, YOU-based end-of-life care.

Electronic links to assist in your end-of-life planning:

  3. Five Wishes documents are available through Green Bay Oncology
  4. “My Health Care Wishes” is an electronic Advance Directive Manager, allowing you to keep your documents easily accessible via smart phone or other devices.

Fertility and Cancer

Fertility and Cancer

Cancers and blood disorders are being diagnosed at earlier stages and earlier ages.  This is positive as treating earlier stage cancers allows for better treatment outcomes than treating the later stage cancers generally does. However, the treatments we often prescribe – surgery, radiation, chemotherapy, additional medications – can affect a patient’s fertility.

Fertility is defined as the ability to produce young. Fertility effects from treatment can be permanent or temporary.  To protect this ability, it is important to address fertility concerns early in the cancer diagnosis so proper planning can be done.

Common diagnoses whose treatments affect fertility include:

  • Breast Cancer
  • Lymphoma
  • Prostate Cancer
  • Testicular Cancer
  • Leukemia

The key to successful protection is communication with your healthcare provider. Each patient situation is evaluated and can often be treated with options such as freezing eggs or sperm. It takes time to arrange and complete these procedures. You and your provider team can discuss any delays in treatment and balance this with the quality of life that can be provided by future children.

Do We Have More Breast Cancer Here?

Do We Have More Breast Cancer Here?

It began simply enough. An inquisitive colleague asked me if we have more breast cancer in our area than elsewhere. I had been asked this before, and I still did not know. But I should know.

The “Big Three” cancers in the US are prostate, lung, and colorectal for males and breast, lung and colorectal for females. Together these problems encompass half of our cancer problems. Over 31,000 Wisconsin residents were diagnosed with cancer in 2013 and 30% of the females with cancer had breast cancer. (A little less than 1% of all breast cancers are in men.) We expect 4300 new Wisconsin women to be diagnosed with this in 2014. Breast cancer incidence started rising in 1981, reached a plateau from 1986-2000, then slowly fell. Breast cancer deaths fell slowly after 1991. Was this due to mammography, which took hold in 1980-1990? Largely so.

Breast cancer incidence declined in our state by 8% between 1995 and 2010. Wisconsin’s breast cancer mortality also declined 27.9% over that time frame. The efforts of many different groups are reflected in this improvement. There are the obvious factors of mammography, improved surgical and radiation techniques, advances in oncology drugs, and genetic testing. In addition, there is breast cancer awareness, self-examination, improved socioeconomic status, attention to obesity, and caution regarding menopausal hormone therapy.

Are all women at risk? Certain risk factors cannot be modified: age, heredity, ethnicity or race. Obviously female gender is the most notorious. Factors that are avoidable or can be manipulated include weight reduction, excess alcohol consumption, and exposure to hormones.

When analyzing a population’s incidence of cancer, it is important to also be aware of the age group involved. Aging is a distinct risk factor for cancer. If a woman is currently 20, her risk of developing breast cancer in the next ten years is less than 1 in 1700. But if she is 60, the risk is 1 in 29. Certain features modify a population’s risk: poverty, irregularities of reporting, and race. Additional factors exist too. It goes beyond “air and water quality.”

So, do we have more breast cancer here? Wisconsin’s incidence of breast cancer for 2006-2010 was 122.5 per 100 000 females. This contrasts with 128 for Brown County, 143 for Door, 100.7 for Kewaunee, and 123.7 for Outagamie. The statisticians interpret these numbers in light of a concept termed confidence intervals. That is the statistical way of asking if these numbers are different. When one applies confidence intervals, we discover these numbers are not different. The ranges overlap meaning the incidence of breast cancer in Brown, Door and Outagamie County is essentially equal to that of Kewaunee County or to Wisconsin overall. Although it shocks our awareness, it should not provoke the Door County residents to migrate 9 miles south to Kewaunee.

Why have people asked these questions about incidence? Are we more aware of friends’ health in our electronic age? Are we and our friends getting older, falling into the ever-higher risk groups? Is the rate truly rising and no one realizes it? We need to focus on the things we can control. Strides have been made in the past 20 years.

Hay más casos de cáncer del seno en nuestra ciudad? Es normal a preguntar esto. Cáncer del seno es muy común en los EEUU, lo más común afectando mujeres. La perspectiva para cáncer del seno ha mejorada durante las última 2 décadas.

La incidencia del cáncer del seno depende en muchos factores diferentes. Incluyen edad, herencia o raza. Tambień hay obesidad y uso de hormonas despues de la menopausa.

El riesgo de cáncer del seno en nuestra ciudad es semejante al resto de Wisconsin y EEUU. Latinas tienen 25-30% baja tasa comparada a blancas no hispanas.

Por más informacioń:


A Game of Chance…Not Entirely

A Game of Chance…Not Entirely

Earlier this month the New York Times ran an article titled “Cancer’s Random Assault.” It described the results of a study published in Science Magazine that proposes the majority of cancer can be chalked up to random bad luck.

The authors of the study; Dr. Christian Tomasetti, a mathematician, and Dr. Bert Vogelstein of John Hopkins School of Medicine; reported that approximately ⅔ of the cancers they studied were due to random genetic mutations and only about ⅓ were due to hereditary or environmental causes. In other words, ⅔ of the cancers studied were due to bad luck and the rest was due to things we can control or prevent.

My initial reaction was a defensive one. Surely these scientists were not proposing that cancer was due to having been dealt a poor hand at life’s game of cards. However, upon reading the article I understood the quest they had proposed.  They were merely asking the question, “How much is due to chance? Is it just some bad statistical lottery?” The results were provocative and surprising.

Many people want to know what they can do to prevent cancer. Many who have cancer are filled with the guilt that they have possibly contributed to their disease. The more we know and understand the forces and circumstances to cancer development the better position we are in to prevent or cure the disease.

We have known for some time now that cancer is driven by cell mutations. Basically, when healthy cells divide, errors occur. Sometimes errors can lead to uncontrolled cell growth and ultimately cancer.  Statistically speaking, the more cells that divide and copy, the more likely a cell will make an error that leads to cancer. For example, people who are repeatedly exposed to cigarette smoke have increased lung cell injury. This leads to increased cell division to repair the damage. Over time, the increased cell division increases the likelihood a mutation will occur that may lead to a lung cancer.

But not all tissues are as cancer prone as others. The large intestine is more prone than the small intestine. The lungs and skin are more prone to cancer than say, the spleen. Why is that? Why do some people get cancer and others do not?

Their research more clearly defines just how much cancer development is due to environmental and hereditary factors. The rest is due to presumably random complex genetic functions. This highlights the need for more research in areas such as genetic profiles and stem cell growth, repair and patterns.  It is this direction that holds the future of cancer cure and prevention.

It important not to take away the message that “Gee, getting cancer is just bad luck!” We have the ability to improve our chances; our luck if you will. Between ⅓ to ½ of all cancers can be prevented by lifestyle modification. That’s a lot!

If I can improve my odds of not getting cancer as much as 30 to 50%  by behaviors I choose; maintaining a healthy diet and weight, not smoking, and wearing sunscreen; and the actions I take; regularly undergoing cancer screening for breast, colon and skin cancer; I will take those odds.