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Close up of woman’s hands folded on her lap with a doctor holding a clipboard with medical chart

Cervical Cancer Awareness Month

By: Dr. Laura Mantine

The cervix is the organ that provides an opening between the vagina and the uterus. Normally, old or damaged cells in a woman’s cervix will stop dividing and are replaced by healthy, young cells. Cervical dysplasia occurs when these old or damaged cells continue to divide in the superficial layer of the cervix. When cervical dysplasia is not treated, it can grow and spread into the deeper tissues of the cervix, developing into cervical cancer. Cervical cancer is a common malignant tumor of the female reproductive system. In the world, cervical cancer is the third most common type of cancer. However, the use of Pap smear screening has made it far less common in the United States.

Detection

Regular Pap smear screening tests can detect cervical dysplasia long before it develops into cancer. Cervical dysplasia is 100% treatable when identified early. Once cervical cancer has developed, the prognosis varies depending on the cancer’s stage of advancement as well as a woman’s age, general health status and comorbid conditions. It generally does not produce any symptoms in its earliest stages. When symptoms do occur, they may indicate that the cancer has progressed to more advanced stages. Symptoms may include abnormal vaginal bleeding or discharge, low back or pelvic pain, pain during intercourse and periods that are longer and heavier than usual.

Treatment

Treatment of cervical cancer begins with seeking regular medical care throughout a woman’s life. Regular medical care allows a health care professional to best evaluate risks of developing cervical cancer, perform Pap smear screening, and promptly order further diagnostic testing as needed. The goal of cervical cancer treatment is to permanently cure the cancer resulting in complete remission of the disease. Cervical cancer treatment plans are multifaceted and individualized to the type and stage of the cancer with consideration of a patient’s coexisting diseases or conditions. Treatment of cervical cancer or cervical dysplasia may include a combination of surgery, chemotherapy or radiation.

Potential Complications

Cervical cancer can lead to life-threatening complications especially if they go undetected and untreated. Complications are caused by an abnormal rapid growth of old or damaged cells in the cervix that can spread to other organs, such as the lungs, bladder, liver and intestines. Over time, the spread of cancer interferes with organ function and vital body processes. Serious complications can include recurring cervical cancer after treatment and infertility due to treatment.

Hospice Care

In cases in which cervical cancer has progressed to an advanced stage and has become unresponsive to treatment, the goal shifts away from curing the disease and focuses on symptom management. Hospice care is available to help people in their last phases of an incurable illness live as fully and comfortably as possible. Hospice care for a patient with advanced cancer focuses on quality of life and is designed to address a wide range of symptoms including pain, poor appetite, shortness of breath, nausea and vomiting. Hospice patients with advanced cancer experience fewer hospitalizations, emergency calls and invasive procedures. Hospice patients have lower costs of care and greater likelihood of dying in their preferred setting, compared to patients not referred to hospice. Hospice will provide medications and supplies and provide inpatient care when a patient’s symptoms cannot be managed at home. Hospice can also provide around-the-clock care in the home to manage acute symptoms if needed. Also, a hospice clinician is accessible any time of day or night to ensure symptoms are managed as soon as possible. Lastly, hospice care also provides emotional support that benefits advanced cancer patients and their families. Timely and appropriate identification of hospice eligible patients increases the likelihood that patients and their families will benefit from compassionate, end-of-life care.

References:

National Hospice and Palliative Care Organization, NHPCO Facts and Figures, 2018 Edition. Retrieved from: https://www.nhpco.org/research/

American Cancer Society, Cancer Facts & Figures 2019 Retrieved from: https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2019.html

What are Palliative Care and Hospice Care? 2019. National Institute on Aging. Retrieved from: https://www.nia.nih.gov/health/what-are-palliative-care-and-hospice-care

Teno, et al. (2004). Family perspectives on end-of-life care at the last place of care. JAMA, 7;291(1):88-93

Elderly father and adult child sitting and having a serious discussion

End-of-Life Conversations

People often shy away from talking about end-of-life wishes. In fact, the Conversation Project found that although 92% of people feel it’s important to discuss end-of-life wishes, only 32% actually do. But it doesn’t have to be a scary topic that you avoid. In fact, it’s incredibly important to have the discussion.

Dear Caregiver,

As your loved one grows older, they may be hesitant to talk about their end-of-life wishes. And you may not want to bring it up because it forces you to face the fact that they won’t be here forever. Trust us, we get it. However, it is incredibly important to talk about it. Here’s why.

Gives Them the Chance to Die Well

End-of-life conversations give us the chance to die well. What does that mean? It means our wishes are known and followed, and we have the opportunity to live our life – right up to the end – the way we choose to.

By discussing their end-of-life wishes, you will have a better understanding of how they want things to happen. This will prevent you from needing to try to guess or figure it out on your own.

Makes it Easier on Family and Caregivers

That brings us to our next point. Knowing what a person wants makes it easier on those caring for them. If you discuss it with your loved one, you don’t have to worry about making the right decisions on their behalf because you already know what they want. If you don’t discuss it, you may worry if you are doing right by them. Talking about what they want and having a clear plan eliminates this pressure.

It’s also not uncommon – in situations where the patient becomes unresponsive, such as in a medical emergency – for the family to argue over what the right decision is. This just creates added and unnecessary stress and trauma for everyone. All of which can be avoided by knowing and understanding your loved one’s wishes ahead of time.

Starting the Conversation

Your loved one may already know what their end-of-life wishes are. They might just be unsure of how to bring it up. Maybe they just need you to start the conversation. But how do you?

This Conversation Starter Guide is a wonderful tool to help us get the conversation started. It includes prompts to answer to help cover all the bases. Encourage your loved one to fill it out, with you or on their own. Then, you can sit down together and talk about their answers. If you have this guide printed out, you can take your own notes and save it so you are prepared.

Keep the Conversation Going

It’s important to keep the conversation going. Our wishes can change over time so it’s important to keep one another updated.

End-of-life planning isn’t about dying – it’s about living. Understanding your loved one’s end-of-life wishes allows you to understand how they want to live their last months, weeks, and days. So, start the conversation and keep it going.

Close up of hand overtop elderly loved one’s hands

Choosing Hospice: How to Know the Time is Right

A life-limiting illness comes with a lot of difficult decisions to consider. One of those decisions is when it may be time to consider hospice care. This can be an intimidating decision to make, so we are sharing some tips to help you determine when the time is right.

Understanding Hospice

Hospice is an interdisciplinary approach to end-of-life care. When a patient and their family choose hospice, they are choosing to switch the focus from curative treatment to comfort care. This simply means the goal is now to manage the patient’s pain and other symptoms to keep them as comfortable as possible. Symptoms hospice can help treat include pain, shortness of breath, and restlessness.

Many people think hospice is a place. However, this is not true. Hospice care can be provided wherever the patient calls home, including their own home or a nursing facility.

Patients are generally considered to be eligible for hospice when a physician determines they have a life expectancy of six months or less.

Hospice Does Not Mean You’re Giving Up

One misconception is that when you choose hospice, you are giving up. This is not at all the case. Hospice is not just about the dying process, it’s about the end-stage of the life-limiting illness, as well. When you choose hospice for your loved one, you are choosing quality of life for them. No more treatments that make them feel sick in attempt to buy them more time. Just focusing on making sure they are comfortable and at peace for whatever time they have.

How to Know the Time is Right

So how do you know it’s the right time to consider hospice? Below are some of the common indicators:

Remember, these indicators are just guidelines and do not replace a physician’s evaluation. If you think it may be time for hospice, talk to your doctor. You can also contact us at anytime to learn more.

Close up of girl hugging her legs and sitting by the window with view of holiday lights outside in the background

Tips for Navigating Grief This Holiday Season

The holiday season is here, and what is a time of joy and togetherness for most can be a time full of sadness and grief for others. The holidays are meant to be spent with those we love, so how can you be expected to feel like celebrating when someone you love is no longer there to celebrate with you?

If you are missing a loved one this holiday season, here are some tips to help you take a step back from the grief and survive the holidays.

Tip One: Be prepared for grief triggers.

Let’s be honest, they are everywhere during the holidays. Preparing for these triggers and having a plan for coping with them can sometimes make the triggers more manageable as you encounter them.

Tip Two: It’s okay to take a break from togetherness.

Plan to get some space from the holiday chaos if you need it. Being surrounded by family and friends is great, but all at once can be emotionally overwhelming and hard to overcome. Don’t feel guilty about your grief. It is important to be conscious of your limits and take some time to recollect yourself.

Tip Three: Seek gratitude.

The holidays are a time to gather together, eat good food, and share what we’re thankful for. If you’ve recently lost a loved one, it can be hard to feel thankful when you are grieving. Although you may be focusing on the loss, try to remember the good things that relationship brought into your life. Search for that gratitude.

Tip Four: Decide which traditions you want to change or keep.

Acknowledge that things will be different this year. Some holiday traditions will remind you of your lost loved one, but it is okay to limit which of these you allow yourself to remember or not. Take time to prepare for which traditions will make you happy and which will overwhelm you.

Tip Five: Say yes to help.

Although you may normally be the one to host during the holidays, this year may be too much to take on alone after losing your loved one. Accept help when it’s offered. Remember that there is no shame in saying yes. Those who love you want to help.

Feel Joy Through the Grief

The holidays can be hard for those who have recently lost a loved one. Grief can be especially unavoidable during these times, but it is important to remember that you can still feel joy through the grief. Taking these tips into account can help you prepare for that grief and make your holidays more enjoyable.

Elderly man giving himself a breathing treatment using a mask

COPD Awareness Month: Hospice Referral Guidelines

By: Laura Mantine, MD

Chronic lung disease is the 4th most common cause of death among older adults in the United States. More than 3 million people worldwide died of COPD in 2015, representing 6% of all deaths that year. People dying from COPD frequently experience difficult and uncomfortable symptoms that lead to distress and panic. They commonly have disabling respiratory symptoms including severe breathlessness, limited tolerance for activity, and intractable coughing. They are also usually oxygen dependent, often experience anorexia with weight loss, cachexia, and ultimately become dependent on others for their activities of daily living.    

COPD and Hospice Care

Despite the symptomatic needs of individuals dying from end-stage COPD, only 30% of individuals receive hospice care before death. It is not clear why the rate of hospice use for patients with COPD is so low, but several explanations have been offered. The most important may be that few patients with severe COPD have discussed end-of-life planning with their clinician. Furthermore, many patients and clinicians do not view COPD as a terminal illness and feel it is more chronic in nature. Also, there may be a lack of awareness that patients enrolled in hospice can continue to receive treatments for COPD. Due to the fluctuating course of COPD, it is often difficult to accurately estimate a patient’s life expectancy which may contribute to low hospice utilization rates.

Hospice Eligibility Guidelines for COPD

While end-of-life-care is an appropriate topic to discuss with all patients, several factors have been suggested that should prompt a discussion with patients who have severe COPD. One factor is simply that a clinician would not be surprised if a patient with COPD were to die within the next 6-12 months. A clinician should consider hospice referral in a patient with COPD if they are dyspneic at rest or with minimal exertion, have progressed to the point where they spend most of their days at home, have experienced repeated ED visits (one or more each quarter) due to infection or episodes of respiratory failure, have endured repeated hospitalizations (one or more each quarter) and no longer wish to be admitted and the patient no longer wishes to be intubated.

The major hospice eligibility guidelines for COPD are:

There are other important clinical factors that also may support a patient’s hospice eligibility. These are:

Abnormal laboratory findings may also trigger a hospice referral such as:

While these laboratory studies may be helpful to the clinician when considering patient appropriateness for hospice services, they are not required for patient admission.

How Hospice Can Help COPD Patients

COPD is a significant health issue around the world. It is ultimately a fatal disease and patients are under-referred to hospice care. Hospice, with its strong interdisciplinary approach, has been shown to improve quality of life for patients with end-stage respiratory disorders like COPD.

Please contact us if you have any questions about how our team can help COPD patients.

References:

Hospice Eligibility for Patients with COPD. Serena J. Scott, MD, Barry D. Weiss, MD, Ellyn Lee, MD, College of Medicine, University of Arizona.  https://uofazcenteronaging.com. June 2017.

When to refer patients with advanced COPD to palliative care services. Rebecca Strutt. Breathe (Sheff). 2020 Sep; 16(3): 200061.

Referral to palliative care in COPD and other chronic diseases: A population-based study. Kim Beernaert; Joachim Cohen; Luc Deliens; Dirk Devroey; Katrien Vanthomme; Koen Pardon; Lieve Van den Block. Respiratory Medicine. Volume 107. Issue 11, P1731-1739. November 1, 2013.

depressed young schoolgirl with stop bullying text on notebook helpless and scared as victim of bullying

National Bullying Prevention Awareness Month

Bullying is defined as abuse and mistreatment of someone vulnerable by someone stronger, more powerful, etc. Unfortunately, bullying is nothing new. However, with each new technological advancement we see, bullies find a new outlet to use to prey on their targets. In honor of National Bullying Prevention Awareness Month, Apreva Hospice is taking a stand and raising awareness for the immense need to stop bullying.

Bullying Can Occur at Any Age

Typically, we think of bullying as being something that occurs among adolescents. However, bullying can occur among any age group, race, or gender. Any instance of mistreatment or seeking to hurt someone or make them feel badly is considered bullying. It can happen at school, at work, or even among friends and family.

Bullying Doesn’t Always Stop When You Go Home

Although they can be wonderful means of keeping in touch with old friends, social media and other online communication platforms can negatively contribute to bullying. The days of going home to escape a bully are long gone. Now days, bullies can just log on to their computer or grab their phone and pick up right where they left off. In some instances, bullying can be more extreme online because the bully feels more confident when hiding behind a screen. Some even create a fake social media profile to target those who are more vulnerable.

The Impact of Bullying

Bullying can impact a child in many ways. It can weigh on them emotionally and physically and can have a negative impact on their relationships with friends and family.

Emotional and Social Impact of Bullying

Kids who are bullied often have a difficult time making friends and maintaining healthy relationships. If no intervention occurs, they can develop something called “learned helplessness,” which means they feel as though there is nothing they can do to change the situation. As a result, they give up. This can ultimately lead to severe depression.

As a bullied child grows into an adult, they may continue to struggle with issues with their self esteem and may have a difficult time developing and maintaining relationships. Understandably, they may also have a hard time trusting people, which can have a major impact on relationships.

Physical Impact of Bullying

The physical impact of bullying goes beyond the bruises of physical bullying. Children who are bullied often experience anxiety which can result in health issues due to the stress on their body. This can include things like ulcers, headaches, stomach aches, or simply getting sick more often.

Impact of Bullying on the Family

Bullying does not only cause harm to the child who is bullied. It can also affect their parents and siblings. Parents may feel helpless. They may also feel as though they failed to protect their child and, in turn, start to question their parenting abilities. However, it is important to remember, no one can predict who a bully will target. Parents should never feel responsible for the choices a bully makes and should instead focus on helping their child heal from the bullying. The bully is the only person to blame.

Bullying Can Have a Lasting Impact

Bullying is not only painful in the moment- it can also have a lasting impact on those targeted. Studies show the effects of bullying last well into adulthood and may have a greater impact on mental health than originally thought. Our experiences growing up – both positive and negative – shape how we view things and ultimately who we become as adults.

Stop Bullying

According to stopbullying.gov, quick and consistent response from adults can help stop bullying over time. It is important to send a clear message that bullying is not acceptable. We can all do our part to help stop bullying. If you see someone being bullied, don’t be a bystander. Use these tips to become an upstander!

Caregiving During COVID-19

By: Laura Mantine, MD

During periods of crisis, like the COVID-19 pandemic, family members and close friends continue to provide daily care for their loved ones. These caregivers provide the initial response and defense for individuals who are often battling chronic medical illnesses. Like many first responders, caregivers often experience stress due to heavy workloads, fatigue, and anxiety. There are important steps that caregivers can take to help manage and cope with this ongoing pressure.

Important Steps for Caregivers to Take

Caregivers should develop habits and strategies to maintain their own physical health and emotional well-being. A caregiver can reduce transmission of a virus by diligent personal and patient hygiene. Washing hands with soap and water for at least 20 seconds frequently throughout the day has been shown to reduce viral spread. It is also important to wash your hands during food preparation, toileting, and blowing your nose, coughing, or sneezing. To be at your best, be sure to eat healthy, balanced meals, maintain a regular sleep routine, and find chances to exercise whenever possible. There is also a constant barrage of pandemic-focused news that can be overwhelming, so try to limit your intake to a certain time or times each day, and do not mistake social media opinion for fact. Remember to take care of yourself, as your loved one’s well-being relies on your ability to maintain your own.

Caregiver Burnout

Over any amount of time, caregiving can be physically, mentally, and emotionally exhausting. Caregiver burnout can happen in any caregiver-patient relationship, but the risk is heightened in times of increased stress like the COVID-19 pandemic. When suffering from burnout, a caregiver may experience hopelessness, overwhelming anxiety, sleep problems, or difficulty coping with everyday tasks. Although caregiving is a major responsibility, it shouldn’t completely overtake an individual’s life. Make time for yourself and take breaks when possible. Use these spare moments to listen to your favorite music, read, or work on a hobby. Also, stay connected to friends and family. Social distancing doesn’t mean total isolation so reach out to friends and family regularly for casual chats and wellness checks. Consider spending time together virtually, whether by watching a movie over a video chat session or playing games together online. If you live with loved ones, find ways to help and support each other.

During these uncertain times, caregivers remain a valuable constant for their loved ones. Please stay physically and mentally healthy as you perform your crucial role.

References

“Family Caregiving During the COVID-19 Pandemic.” Scott R BeachRichard SchulzHeidi DonovanAnn-Marie Rosland. Gerontologist. 2021 Jul 13;61(5):650-660.

“Ensuring Adequate Palliative and Hospice Care During COVID-19 Surges.” Jean Abbott, MD, MHDaniel Johnson, MDMatthew Wynia, MD, MPH. JAMA. 2020;324(14):1393-1394.

Close up of hands administering CPR on a chest that is glowing in the heart area, indicating cardiac arrest

Sudden Cardiac Arrest: What It Is and What To Do

A leading cause of death in the United States, sudden cardiac arrest claims the lives of more than 356,000 people each year. This includes 23,000 youth under the age of 18. It is a life-threatening health emergency in which the heart suddenly stops beating, and it can occur in people of any age, including those who appear to be otherwise in good health.

When a person goes into cardiac arrest, they collapse and do not respond or breathe normally. They may also gasp or shake, similarly to a seizure. It is critical that the person gets help immediately, as it can lead to death within minutes. With October being Sudden Cardiac Arrest Awareness Month, we want to help raise awareness and explain what it is and what you can do when someone experiences this medical emergency.

What is sudden cardiac arrest?

As previously mentioned, sudden cardiac arrest is a health emergency in which the heart suddenly stops beating. It is life-threatening, and survival depends on people nearby calling 911, as well as starting CPR and using an AED (if available) as soon as possible. An AED (automated external defibrillator) is a portable, electronic device that is used to help someone who is experiencing sudden cardiac arrest. It analyzes the heart’s rhythm and can deliver an electrical shock to help the heart re-establish an effective rhythm.

Is it the same as a heart attack?

Sudden cardiac arrest is not the same as a heart attack. A heart attack is a blockage in coronary arteries that interrupts blood flow to the heart. The website stopcardiacarrest.org does a great job of explaining the differences between a heart attack and sudden cardiac arrest. It describes sudden cardiac arrest as being electrical and a heart attack as being plumbing.

To summarize the differences between the two, someone experiencing sudden cardiac arrest is unresponsive and not breathing, and they may gasp or shake. It can happen to anyone of any age, and people nearby must start CPR immediately to increase the likelihood of survival.

In contrast, someone experiencing a heart attack may experience pain in their chest, neck, or left arm. They may also experience shortness of breath, sweating, or nausea. A heart attack most often occurs in people over the age of 65, and responsive victims do not need CPR.

However, you should call 911 for someone experiencing either.

What should I do?

Cardiac arrest happens suddenly so it’s important that you know what to do so you can act quickly if you are nearby when it occurs. So what do you do when someone is suddenly unresponsive and breathing abnormally or gasping for air? According to the American Heart Association, here is what you should do:

  • Ensure the scene is safe.
  • Check for a response. Sudden cardiac arrest victims do not respond when you tap them or ask if they are ok.
  • Shout for help. If someone is nearby, tell them to call 911 and bring an AED as quickly as possible (if one is available). If you are alone, call 911 and find an AED (if one is available).
  • Check to see if they are breathing. Abnormal breathing or only gasping for air is a sign of cardiac arrest.
  • Start CPR. If the person is not breathing or is gasping for air, begin CPR right away. Push down at least two inches in the center of their chest at a rate of 100 to 120 pushes a minute. Allow the chest to come back up to its normal position after each push.
  • Use an AED. Anyone can use an AED. Turn it on as soon as it arrives and follow the prompts.
  • Continue CPR. Continue to administer CPR until the person begins to breathe or until someone with more advanced training arrives to take over.

What Hispanic Heritage Means to Me

As the end of National Hispanic Heritage Month grows near, we are shining a spotlight on Director of Business Development, Nereida. We asked her what Hispanic heritage means to her. Thank you, Nereida, for sharing your story with us!

Nereida’s Story

Hispanic/Latin/LatinX heritage and culture, to me, means family.

I was raised with a large, loving family. Food, music, and family created a sense of warmth, love, and good times. At the center of it all, our matriarch, my Abuela Juana. She moved to the United States from Puerto Rico in the 60’s. She was always in the service of others. From being a social worker to a home health aide, she was love, selflessness, and caregiving exemplified.

I became a nurse because of her. After her stroke, I experienced first-hand the weight of not having advance care planning in place. 9 children, 46 grandchildren and 40 great-grandchildren had to come together to make decisions on her behalf.

After a long illness, she needed hospice. Seeing how hospice allowed us to be family and experiencing that gift, I was drawn to hospice after 19 years of nursing.

My passion, drive, advocacy, and love for hospice is fueled by the love for and from my Abuela. I am honored to carry on her legacy in the service of others while assisting people and families at a pivotal moment in their lives.

Graphic of multi-racial women wearing pink breast cancer awareness women

Breast Cancer Awareness Month

Breast cancer is one of the most common cancers among women in the United States, second only to skin cancer. It’s a disease in which the cells in the breast grow out of control. There are several types of breast cancer, but there are two that are most common. Invasive ductal carcinoma is when the cancer cells begin in the ducts and then grow outside them into other parts of the breast tissue. Invasive lobular carcinoma is when the cancer cells begin in the lobules and then spread from there to the breast tissues that are close by. It is possible for both of these invasive cancer cells to spread to other parts of the body.

Symptoms of Breast Cancer

Symptoms of breast cancer can vary from patient to patient, and some may not experience any at all. However, some common symptoms one may experience are:

If you have concerns about any symptoms you are experiencing, see your doctor right away.

Risk Factors for Breast Cancer

There are several factors that can put a person at higher risk for developing breast cancer. Some are beyond our control, while others we can change. One of the main factors that puts a person at risk for breast cancer is being a woman. Although men can get breast cancer, women are at higher risk.

Risk Factors Beyond Our Control

How to Lower Your Risk for Breast Cancer

Hospice Care for Breast Cancer Patients

If you or someone you love has been diagnosed with breast cancer, and curative treatment is no longer an option, hospice may be right for you. Please contact us to learn more about how the Apreva Hospice team can help.

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