My Hero

My Hero

Oprah’s guest pointed to the place above her collarbone where the tumors first appeared. It’d been a hard fight, with one particularly close call, but she’d made it and now she was a survivor – even a hero. Cue tears from the audience.

Normally I’d have been moved, crying along with the show and applauding the brave woman on Oprah’s couch. I loved stories about women who faced their fears and came out stronger. I wanted to be one of those women.

But the thing was, I had a lump, too. It was in almost the exact same spot as hers. It’d been there for a few weeks now. They’d told me in the clinic that lymph nodes come and go all the time, that I shouldn’t worry if it went away in a week or so, but that I needed to call them back if it didn’t.

But it hadn’t gone away. The thing was getting bigger – a lot bigger. And now there was a new one starting on the other side of my neck. And I wasn’t up to facing it. I was twenty-three years old, about to start a new job as a real estate agent, and the brave woman on Oprah’s couch was mocking me.

I wasn’t feeling any braver when I drug myself back to the clinic. And brave wasn’t on the menu when I had the biopsy, either.  And when I finally heard someone say aloud what I already knew – “cancer” – brave had skipped town.

When you’re in a situation that threatens your future, you can’t know at the time that everything’s going to work out all right. All you know is fear. You’re afraid of the lymphoma, you’re afraid of the chemotherapy that’s supposed to save you, and you’re afraid every next test will tell you something you don’t want to hear.

They must’ve smelled it on me because it seemed that every nurse, every receptionist, practically every person I saw at GBO put in something extra to help me feel less afraid. And they were calm. They’d been there and done that, and their calm reassured me.  I will never forget those wonderful people. They’ll always be a special part of my life.

But there’s just something about Dr. Jaslowski.

Ever met him? He’s soft-spoken and a little shy. He’s so casual that you can almost forget how much information he’s got in his head, and how brilliantly he can use it. He’s gentle and reserved. But then when you most need and least expect it, he wraps you in this huge kindness and you realize he’s the best person on earth.

There was this one day late in my course, and I’m in clinic for treatment. It was almost routine by then, but for some reason fear had gotten out of the barn and was galloping off with me. My chest was tight, and my mind couldn’t fix on anything to ground me. It felt like trying to catch hold of a branch while falling from a very tall tree. I was a mess.

I’m sure Dr. J had a million other things to do right then. I know it would’ve passed eventually and I’d have been fine eventually. But he came to me in that dark place, and helped walk me out of it. I can’t even recall everything he did or said. I just remember feeling unhinged before he came, and somehow afterwards I could remember where I’d started from and how far and how well things had come.

How do you say thank you for something like that?

All I could think to say, remembering the day I’d seen the brave woman on TV and finally admitted to myself I had a problem was, “Dr. J, you’re my hero.”

He looked a little confused for a second, a bit uncomfortable before replying, “But…you’re the hero. You’re the one doing all the fighting.”

Now how do you not love a guy like that?

Financial Counselors: A Must Have in Oncology

Financial Counselors: A Must Have in Oncology

As an innovator in the oncology field, Green Bay Oncology

has created a solid financial counseling program to ensure that no patients have to carry the financial burden that may accompany a cancer diagnosis by themselves. By sharing our story, the financial counseling team hopes other cancer programs can benefit from our experiences to either develop their own financial counseling services or to enhance existing services.

Our Story

The financial counseling position at Green Bay Oncology began as a 1 person team 10 years ago when our group consisted of 7 physicians and 6 clinic locations.  At a time when prior authorizations for IV chemotherapy were still unheard of, the financial counselor’s basic responsibilities consisted of meeting with uninsured patients who needed to start treatment and working with the pharmaceutical companies to get free drug, if available. Over the next few years, however, the financial counselor position continued to grow along with patient demand and began to include assistance for oral anti-cancer agents as well.

Given the growing complexity of cancer care, along with the increase in the number and cost of oral anticancer therapies, it is no surprise that the financial counselor program quickly became an important part of Green Bay Oncology. In 2015, Green Bay Oncology aligned with Hospital Sisters Health System St. Vincent Hospital, becoming part of the regional cancer center and making us the largest oncology group in northeast Wisconsin.

Today, we have a team of 6 counselors assisting 9 medical oncologists, 3 pediatric oncologists, 3 radiation oncologists, 1 gynecology oncologist, 8 nurse practitioners, and 3 physician assistants across 6 cancer center locations in northeast Wisconsin and the Upper Peninsula of Michigan.
In our comprehensive cancer program, financial counselors follow patients from the start to the completion of their treatment journey and are an integral part of the patient’s experience. We act as a liaison between the patient, the provider, and other clinic departments, as well as the patient’s insurance carrier. Efficient communication between all of these individuals and departments is the core of our program’s success. Jerry WinklerWe are also fortunate to have providers who understand the key message concerning financial toxicity and its potential to impact patient outcomes.

“Medicine in general, and oncology in particular, used to believe that money shouldn’t be a consideration in treatment,” said Green Bay Oncology provider Mitch Winkler, MD. “This led us to act as if ‘money was no object’ where cancer treatment was concerned. We feared that considering financial factors would harm our patients or impede their care. But by neglecting financial factors in cancer treatment, we’ve exposed our patients to terrible harm.”

Our Process

The financial counselor’s job begins before the patient steps foot in our clinic. Acting as an advocate for patients, our benefits specialist will first verify their insurance benefits to ensure patients are in-network with our physicians.

Once treatment is prescribed, whether IV, oral, or radiation therapy, the financial counselor will immediately verify that the treatment is indicated for the patient’s diagnosis, checking the National Comprehensive Cancer Network (NCCN) Compendium and/or the Medicare Compendium.

Next, we verify whether the patient’s insurance requires prior authorization. If so, we initiate the authorization process immediately to ensure that treatment can start within three to five days.

Once we’ve obtained the authorization approval, we continue to follow the patient to ensure that if treatment continues longer than anticipated, the approval does not lapse. We are able to generate a notification in our electronic health record (EHR) that will alert us of an expiring authorization two weeks before the expiration date. We can then go into the patient’s chart and determine if re-authorization is needed.

For patients treated with oral therapies, our financial counselors initiate the first prescription fill with specialty pharmacy to verify insurance approval and make sure the medication is affordable for the patient. The financial counselors first meet with patients while they are in the clinic, explain how specialty/mail-order pharmacies operate and—depending on their insurance—discuss co-pay assistance.

After meeting with the patient, we fax the prescription along with the patient’s demographics, current medication list, and copies of insurance cards to our single point of contact at the specialty pharmacy. Because we have a pre-existing relationship with this point of contact, communication is often quick and easy, helping to ensure that the medication gets to the patient in a timely manner.

Our pharmacy contact will notify us if an authorization is required. Once we receive that notification we then submit to the insurance company for the approval. When approval has been obtained, we notify the pharmacy and the financial counselor is then given a date when the patient is scheduled to receive his or her medication. We then verify that the patient has an appointment scheduled for a toxicity evaluation within 10 days from the date the medication is received.

Financial Assistance for IV & Oral Therapy

If the physician is ordering a treatment that is not yet FDA approved for the patient’s diagnosis, or not indicated (i.e., off-label), we will always try to get approval through the insurance company first. If we receive a denial from the insurance company, we then go straight to the pharmaceutical company and apply to the patient assistance program in hopes to receive free drug assistance for our patients. We do not ask patients to fill out any patient assistance forms; all forms are completed and sent in by the financial counselor. All that is needed from patients is their signature and, if required, income documentation to ensure eligibility.

When patients are first diagnosed and prescribed treatment, one of their first concerns is usually “How am I going to afford this?” Most will have insurance to assist them with their treatments and appointments but, as we all know, the out-of-pocket maximums on insurance plans just keep getting larger. It is important to meet with patients before they start treatment and discuss cost and options to help alleviate any financial burdens of cancer treatment.

Depending on the type of treatment, we will go over options, such as foundation assistance on the national level (Patient Advocate Foundation, Patient Access Network Foundation, CancerCare, etc.) or on the local level. For example, in northeast Wisconsin we have some great local foundations, such as Ribbon of Hope and the Ovarian Cancer Community Outreach (OCCO), to help reduce not only treatment costs, but everyday living costs as well.

Once approved, we will add these foundations to the patient’s EHR and take care of all submissions for payment. Claims are sent to the foundation before patients receive a bill. This process is in place to alleviate as much of the financial burden as we can from patients in hopes of reducing any anxiety caused by additional bills and/or collection phone calls.

For commercially-insured patients who do not qualify for foundation assistance and/or for whom there are no funds available for their diagnosis, we will turn to pharmaceutical company co-pay cards. These drug-specific cards can be a great option for reducing out-of-pocket costs. There is no income limitation for these cards so long as patients give us their consent to enroll them; financial counselors can take care of everything, including submitting charges on their behalf.

In 2015 alone, we saved our patients $573,328.50 on their oral chemotherapy co-pays. This amount is only from three of the main specialty pharmacies we use: Accredo, Diplomat, and Community Pharmacies. Recently, in 2016, the financial counseling team worked closely with the hospital’s charity foundation and reached out to donors to create a specific fund for our patients on oral therapy that could be used when all other foundation funds were exhausted.

With the constant increase of insurance plans’ yearly out-of-pocket maximums, the amount of money our program saves our patients each year continues to grow. Figure 1, page 7, illustrates exactly what was paid to our clinic from foundations and pharmaceutical co-pay cards. This does not reflect the full grant amount that was issued to patients. In 2015, between IV and oral chemotherapy assistance, the financial counselors at Green Bay Oncology saved patients more than 1 million dollars!

 Financial Assistance for Radiation Oncology

Unfortunately the radiation oncology world is a little bit different in terms of financial assistance. There is very limited access to patient assistance for radiation oncology patients when it comes to treatment; for that reason we like to meet with these patients before they start radiation therapy.

Our financial counselors provide patients with an overview of their insurance coverage, including their out-of-pocket responsibility, what they’ve met, and how much they have remaining. Also, specific forms (see page 5) are given to each patient, depending on their type of coverage, i.e., commercial, Medicare Advantage, or Medicare and a supplement. This information helps give patients an idea of how much they may be responsible for.

We also talk to these patients upfront regarding payment plans, as well as Community Care/Charity Care if they feel this is something they would be eligible for. Patients are also made aware that a financial counselor will be given their treatment plan in order to verify that everything is indicated and authorized prior to their beginning therapy.

Due to the success of these forms in our radiation oncology department, our goal is to meet with and provide these same benefits to all patients in the medical oncology clinic by 2017.

At Green Bay Oncology, our financial counselors do not just handle the above-mentioned duties. Financial counselors are constantly involved in projects, creating new processes and building teams within other departments to continue driving our cancer program forward.

Financial counselors work closely with social workers and nurse navigators to make sure patients are taken care of both inside and outside of the clinic, including ensuring patients have all the necessary appointments scheduled, transportation to and from the clinic, or assistance to help with everyday bills that seem to take a backseat when medical bills start accumulating.

Our team also works with outside resources to enroll eligible patients in Medicaid. Financial counselors can also refer underinsured patients to the proper resources to gain the additional coverage they need going forward, such as Medicare supplemental plans and/or prescription coverage (Medicare Part D). The open communication between departments is a prime example of how our cancer program strives to always put patients first. Financial counselors work closely with physicians to develop and continually update clinical pathways. These disease-specific pathways help standardize our approach to how we treat our patients while showing payers that we are consistent in our treatment plans. Counselors verify that all treatments are listed in the NCCN Compendium while taking into consideration the cost of the therapy—not only for the patient, but also for the clinic.

The financial counselors are the patient’s direct point of contact for any and all billing concerns. Patients are instructed to call their financial counselor with any questions or concerns they may have once they start receiving bills. We work with patients to set up payment plans tailored to their comfort level.

Community Care applications are also given to patients once all other assistance options have been exhausted. Some factors taken into consideration while processing Community Care applications include annual household income, household size, assets and debt information, and the past three months of bank statements. Once the signed application and all required financial documentation are returned, financial counselors process these and inform patients of the amount of assistance for which they have been approved.

On top of all medication authorizations, including chemotherapy and retail prescriptions, our team also authorizes any radiology imaging that is ordered by providers, as well as molecular lab testing such as chromosome analysis, BCR/ABL, and JAK2 orders. It’s very important to verify coverage for any testing ordered by physicians to prevent that financial burden from falling into our patients’ laps.

When our clinic does receive a denial from a payer on any physician-ordered treatment, it is our financial counseling team’s responsibility to appeal. We will draft a letter to send to the payer along with all supporting documentation, such as compendium listings, FDA indications, insurance policies, etc. Our team is proud to say it’s not very often that the denials are upheld once our appeals are submitted.

Working for a hospital system that understands the need for financial counselors is imperative. We hear far too often while attending conferences around the region that cancer programs are trying to “prove” to their leadership that a financial counselor position is feasible. We think to ourselves, “What? You have to prove it?” Don’t the numbers speak for themselves? Institutions that do not think they need financial counselors should answer these questions:

• What does your Patient A/R (Accounts Receivable) stand at?

• How are your patients affording their treatments?

• How much are you writing off as charity?

• How many patients are you sending to collections?

Financial counseling is not only a service to assist the patients; it also guarantees the clinic is going to get paid. It’s 2017 and the cost of care is going to continue to climb. Committing as a practice or program to be financially responsible to patients has to be at the forefront.

By attending multiple ACCC meetings (the Financial Advocacy Network [FAN] Meetings, Oncology Reimbursement Meetings [ORMs], and the National Oncology Conference) our financial counselors have experienced ample opportunity for networking with other clinics across the country who have continually expressed their desire to learn more about our comprehensive financial counseling program. We have provided consulting services to several other cancer programs in Wisconsin and Michigan, helping them replicate our financial counselor position within their own program. ACCC meetings have opened our eyes to the fact that there are far too many cancer programs that are unaware of how they can help mitigate financial toxicity for their patients. It is vital for us to educate the cancer community on the importance of financial toxicity prevention. Won’t you join us?

Gretchen Van Dyck is a financial counselor, Green Bay Oncology at HSHS St. Vincent Hospital Regional Cancer Center in Green Bay, Wisconsin

To view the complete ACCC Patient Assistance & Reimbursement Guide 2017: click here

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.


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.



What does it mean when your doctor or nurse practitioner orders a CBC on your blood?

The complete blood count (CBC) is a series of lab tests that gives important information about the main elements of the blood. These include the WBC, or white blood count, the RBC, or red blood count, and the platelets. It also includes the hemoglobin and hematocrit.

Each of these components is valuable in its own way to determine the diagnosis of many disorders and conditions, and also to monitor them, once they’ve been diagnosed. Symptoms such as fatigue, weakness, infection, or bruising are just some of the many reasons to do a CBC.

A brief description of each component:

WBC (white blood count or leukocyte count): White blood cells are disease-fighting cells that protect the body against infection.A high white cell count, or leukocytosis, often occurs when infection anywhere in the body sets in, as the white cells try to fight it. Normally the white cell count is approximately 4,000-10,000. Lower than normal white cell counts are also referred to as leukopenia. Some medications, including chemotherapy, can lower the WBC. Some viral infections can also lower the white cell count, as can toxic reactions to chemicals.

The WBC is further broken down by categorizing the white cells into groups which include neutrophils, lymphs, monos, basophils and eosinophils. This is called the white cell differential. Valuable information is obtained when searching for a diagnosis as each type of white cell has its own purpose in the blood.

RBC (red cell count): Red blood cells carry oxygen from the lungs to the rest of the body. With a low red cell count, the oxygen level to the body is less than is needed. This results is anemia, which can be treated in various ways, depending on the type of anemia. Severe anemia may require a blood transfusion. Increased red cells, or polycythemia, can also be a problem, making it difficult for the oxygen to move from the lungs to the body.

Hemoglobin: a molecule in the red cells that is the vehicle for the transportation of oxygen.

Hematacrit: measures the amount of space taken up by the blood cells. The hematacrit and the hemoglobin are good indicators of anemia or polycythemia.

Platelets: the smallest blood cells, are also called thrombocytes. Too few platelets are known as thrombocytopenia, while too many are called thrombocytosis. Platelets are necessary for clotting of the blood. Too few can cause abnormal bleeding, while too many can be responsible for blood clots forming in the blood vessels.

There are many situations where a CBC is necessary. It can be part of a routine check-up, a follow-up to monitor treatment, or part of an evaluation based on a patient’s symptoms.





Palliative Defined

Palliative Defined

‘Palliative’ (p`alle `aytiv) or ‘Palliate’ (p`allee `ayt): the relief of physical, emotional, psychosocial and spiritual symptoms with or without cure of the medical condition. Simply put, palliative care seeks to assist you in living the best day you can live, every day.

Unfortunately, for many people, it is synonymous with hospice and, therefore, death. Whether speaking to patients, families or other health care providers, the reaction to the word ‘palliative’ is often the same: hands up, step back, shake head and an emphatic, “no-no, it’s not time for THAT.”

Consider for a moment that palliative care (relief of symptoms whether or not the underlying condition can be cured) has become a medical specialty, just as cardiology, neurology, nephrology and many others are. Palliative care has taken the concept of holistic symptom relief, combined it with a team approach and is focused on the prevention and relief of suffering while supporting the best quality of life for patients (and loved ones) facing a serious illness.

Unlike hospice, palliative care does not require a terminal prognosis. Palliative care seeks to provide the physical, emotional, psychosocial and spiritual care that is often needed throughout the course of a serious illness, diagnosis to conclusion. Palliative care can and should be utilized while receiving aggressive treatment to prolong life, as well as to ease the symptoms of dying.

Studies have shown that people who receive palliative care can live longer, with greater quality of life than those who do not receive palliative care. Before you step back, shake your head and say “it’s not time for THAT,” ask yourself why you wouldn’t deserve the very best YOU-based care that WE can provide.

Opioid-Induced Constipation

Opioid-Induced Constipation

Opioids are effective pain relievers, but commonly cause changes in your bowel habits.  Why does this happen?  These medications increase the amount of time it takes stool to move through the gastrointestinal system.   They are also able to partially paralyze the stomach so that food remains in the stomach for a longer period of time.  Additionally, opioids reduce digestive secretions and decrease the urge to pass stool.  Often, laxatives and/or stool softeners are prescribed/recommended at the same time as the pain killers.

How can you prevent this from happening?  You can make changes in your lifestyle by:

  • Increasing your dietary fiber (whole grain breads/cereal, fruits, vegetables, nuts, and seeds)
  • Increasing decaffeinated fluid intake to at least 8 cups/day
  • Increasing exercise or physical activity (15-30 minutes/day)
  • Increasing time and privacy for toileting

What options are available for treating constipation if lifestyle changes are not possible or effective?

  • Colace (docusate sodium) 100mg 1-2 capsules once or twice daily
  • Miralax (polyethylene glycol) 17 GM (1 capful) once or twice daily
  • Milk of Magnesia (MOM or Magnesium Hydroxide) 30 ml once daily
  • Senokot 1-2 tablets once or twice daily

Always contact your healthcare provider’s office if you have not had a bowel movement in 3 days.  Occasionally, rectal interventions are recommended if the above measures are not effective.  Rectal interventions are as follows:

  • Suppositories
  • Enemas
  • Rectal irrigation
  • Manual evacuation

HIPAA – How Does It Apply To Me?

HIPAA – How Does It Apply To Me?

As a clinic, Green Bay Oncology has an obligation to follow the HIPAA rules set by the federal government. HIPAA is a federal law that protects the privacy of personal health information. It stands for the Health Information Portability and Accountability Act. It gives patients control over who, outside of necessary medical professionals and insurance companies, has access to confidential medical information. Physicians can share medical records with other physicians and clinics when referring a patient to them or communicating with other physicians already involved in the patient’s care. Insurers require basic information to process claims and approve procedures and medications.

When a patient completes the initial paperwork at the first appointment, a notice of privacy practices is given to let patients know that Green Bay Oncology will use and disclose health information for treatment purposes, payment activities and healthcare operations without written consent or authorization. This also explains patient rights related to protected health information. Patients are then asked to sign an acknowledgement of receiving a copy of these practices. Patients also receive a copy of the HIPAA form whose purpose is described below.

How can I or my loved ones obtain my information?

When a patient completes the initial appointment paperwork, a HIPAA release form is completed. This form allows patients to indicate who can receive verbal information from our clinic. This allows someone other than the patient to call into the clinic to get medical information, appointment information and/or billing information as indicated by the patient.

Patients have the right to obtain their written medical information from our facility. They also have the right to release their written medical information to family members, friends or others. In order to have information released, a patient must sign an authorization allowing this transaction. A medical records associate will then verify the information is complete and process the request. This form can be mailed or faxed for completion. In rare circumstances, a verbal authorization can be obtained via phone call with two Green Bay Oncology employees. This is only allowed by exception.

What happens if my loved ones need my information after I pass away?

Any rights granted by the above forms ends when a patient passes away. If records are needed from a deceased patient’s chart, the personal representative of the deceased patient’s estate must present the paperwork that gives him or her the authority to act on behalf of the deceased and then request the needed records.

The exception to this is if records are requested by a physician to treat another family member. The records would be released directly to the health care provider who is treating the surviving relative. Authorization for releasing records of a deceased patient are also not required when releasing health information to funeral directors, medical examiners, law enforcement and for research purposes.

While many of us are used to seeing the HIPAA paperwork in all of the healthcare facilities we go to, we often forget the reason for these laws. It is more than just paperwork to complete. At its essence, HIPAA protects each of us as individuals and gives us much tighter control over our healthcare information.

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.