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By: Dr. Laura Mantine
Love is all around this month, especially on Valentine’s Day, when we take time to turn to those closest to us and say those three magical words. However, if you have a loved one who suffers from advanced cardiac disease, one of the best ways to show how much you care may not come in a sentimental card or a box filled with chocolates. Instead, it may come from calling hospice. Oftentimes, people don’t realize that hospice care is an option for people who suffer from advanced cardiac disease. Instead, these patients often spend their final days and months in and out of the hospital, receiving treatments that do little to improve the course of the disease. Hospice offers a supportive program of holistic care designed to help patients manage symptoms, forego emergency room visits and receive convenient, compassionate care right in their places of residence.
The estimated annual cost of heart disease is about $200 billion each year. Heart disease is the leading cause of death in the United States across all demographics. Heart disease accounts for 17.8% of hospice deaths, second only to cancer (30.1%). During hospice care, cardiac patients are monitored by a team of physicians and nurses, who administer medications and treatments to keep them as comfortable as possible. Social workers can access valuable community resources. Chaplains and counselors provide emotional and spiritual care for the patient and family. Volunteers can sit with patients, read to them or help them with light household chores, and allow caregivers to get some much-needed respite.
End-stage heart failure is often marked by an abrupt, dramatic decline, followed by recurring recovery and stability until sudden death. Patients are ideal candidates for goals-of-care conversations when they have severe refractory heart failure or extensive symptoms of cardiac insufficiency, have tried or cannot tolerate maximum medical management and are not candidates for curative therapies or surgical interventions. Hospice care addresses a wide range of symptoms, including shortness of breath, chest pain, weakness and functional decline. Eligibility for hospice may require documentation of progressive loss of functional capacity over years, progressive failure to respond to therapies and a desire to discontinue curative treatment. Patients should check with their physician to see whether they are eligible for hospice based on their history of congestive heart failure, arrhythmias or heart attacks. The physician may also consider any coexisting diseases like HIV, diabetes, respiratory illness or kidney disease when transitioning a patient to hospice care.
In addition to increasing a cardiac patient’s quality of life, hospice often increases the cardiac patient’s quantity of life as well. In a study reported in the March 2007 Journal of Pain and Symptom Management, congestive heart failure patients who chose hospice survived 81 days longer than those who did not. Even when modern-day technology or surgery can no longer offer hope, patients with late-stage cardiac disease need to know that help is always available. Hospice allows these patients to experience as much joy as possible in their remaining days while minimizing their discomfort and pain.
Centers for Disease Control and Prevention, National Center for Health Statistics. (2016). Multiple Cause of Death 1999-2015 on CDC WONDER Online Database. Data are from the Multiple Cause of Death Files, 1999-2015, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program.
Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association. Circulation. 2017;135:e1–e458. DOI: 10.1161/CIR.0000000000000485.
National Hospice and Palliative Care Organization. (2018). NHPCO Facts and Figures 2018 edition.
Ziaeian, B., & Fonarow, G. C. (2016). The Prevention of Hospital Readmissions in Heart Failure. Progress in cardiovascular diseases, 58(4), 379–385. doi:10.1016/j.pcad.2015.09.004
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.
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 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.
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.
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.
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
By: Dr. Margarita David Ph.D., RN
Pancreatic cancer affects over 60,000 people in the United States. Continue reading to learn more about pancreatic cancer in honor of Pancreatic Cancer Awareness Month.
Pancreatic cancer is a cancer that develops in the pancreas. The pancreas helps regulate the metabolism of sugar and aids in the digestion of foods.
Although the exact cause of pancreatic cancer is still unknown, some risk factors that may contribute to the development of pancreatic cancer include:
Many of the symptoms of pancreatic cancer are also common with other types of cancers. These may include:
There are several ways that pancreatic cancer is diagnosed:
Three blood tests can help diagnose and treat pancreatic cancer:
If blood work and imaging indicate the possibility of having pancreatic cancer, a biopsy (a tissue sample from the pancreas) is taken to confirm the diagnosis. A biopsy is the gold standard for a definitive pancreatic cancer diagnosis.
Pancreatic cancer can be extremely painful, making your quality of life more difficult toward the end of life. Hospice care allows people to live their final stages in peace by providing:
The end of life can be a very stressful, uncomfortable, and anxiety-provoking time. A hospice team can help provide the comfort the patient needs physically, emotionally, and spiritually.
Hospice care takes care of you physically and emotionally during the end of life. The team consists of a social worker and chaplain who will work with you and your family to ensure your spiritual needs are met. Hospice provides compassionate care that is supportive of both the patient and their families through the end of life and throughout the grieving process.
Caring for sick loved ones can be an exhausting endeavor, which is why hospice care takes over your care so that your family gets a much-needed break. Your hospice team can also coordinate respite periods for your caregiver.
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.
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.
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.
While these laboratory studies may be helpful to the clinician when considering patient appropriateness for hospice services, they are not required for patient admission.
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.
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.
By: Laura Mantine, MD
It is a fact that only 25% of deaths occur at home while nearly 80% of Americans would prefer to die at home. Unfortunately, many individuals will die in hospitals, while receiving care that is not consistent with their wishes. It’s important for older adults to plan and let their caregivers, doctors, or family members know their end-of-life preferences. In honor of National Hospice and Palliative Care Month, we want to highlight the fact that hospice is not a place- it is an approach to care.
Increasingly, people are choosing hospice care at the end of life in order to remain at the place they call home. Hospice provides comprehensive comfort care as well as support for the family. In hospice, attempts to cure the person’s illness are stopped. However, this does not mean discontinuing all treatment. A good example is an older person with cancer. If the doctor determines that the cancer is not responding to chemotherapy and the patient chooses to enter hospice care, then the chemotherapy will stop. However, other medical care may continue if it is helpful.
Hospice is an approach to care, so it is not tied to a specific place. It can be offered in many types of settings including home, hospitals, nursing homes, assisted living facilities, and dedicated hospice facilities. Most care is provided at home with a family member typically serving as the primary caregiver, but it can also occur in a nursing home or any other place the patient calls home. Hospice staff will make regular visits to the patient’s residence and are on call 24 hours a day, seven days a week. Although hospice provides a lot of support, the day-to-day care of a hospice patient is provided by family and friends. The hospice team coaches family members on how to care for the patient and even provides respite care when caregivers need a break. Respite care can be for as short as a few hours or for as long as several weeks.
Hospice care brings together a team of people with special skills among them nurses, doctors, social workers, spiritual advisors, and trained volunteers. Everyone works together with the patient, the caregiver, and/or the family to provide the medical, emotional, and spiritual support. The hospice team will manage the patient’s symptoms, teach the family how to provide care, and provide bereavement counseling.
Hospice is provided for a person with a terminal illness whose doctor believes he or she has six months or less to live if the illness runs its natural course. Although there is a six-month time designation, hospice can be provided for as long as the person’s doctor and hospice care team certify that the condition remains life-limiting. Many people who receive hospice care have cancer, while others have heart disease, dementia, kidney failure, or chronic obstructive pulmonary disease. Enrolling in hospice care early helps a person live better and longer, decreases the burden on family, and prepares family members for their loved one’s passing. Families of people who received care through a hospice program were more satisfied with their loved one’s end-of-life care. Also, hospice recipients were more likely to have their pain controlled and less likely to undergo tests or be given medicines they did not need.
Remember, hospice stresses care over cure. The goal is to provide comfort during the final months and days of life while providing ongoing support to the patient and family for whatever time remains.
By: Dr. Margarita David Ph.D., RN
November is National Alzheimer’s Disease Awareness Month. Alzheimer’s is a progressive brain disorder that cannot be reversed. This disease declines the person’s ability to think, remember, and carry out familiar tasks.
The progressive decline in patients with Alzheimer’s is due to the loss of communication between neurons. The neurons are responsible for sending messages from the brain to all parts of your body.
The frontal lobe is responsible for your social and emotional skills, motor functions, language, and cognitive functions. When the frontal lobe is damaged, you may experience:
The parietal lobe is located at the back of the skull. It is responsible for your senses such as touch, taste, sight, smell, and temperature. Damage to the parietal lobe can affect any of these functions.
The temporal lobe’s primary function is to keep your memories. Damage to this lobe will make it hard to retain new information.
Commonly, individuals that develop Alzheimer’s are usually over the age of 65, but people under this age may develop it as well, which is considered early-onset.
The early signs of Alzheimer’s may begin with memory problems and difficulty learning new things or information due to damage in the brain’s hippocampus.
Other degenerative brain diseases include:
Vascular dementia is caused when you have had multiple strokes, which can cause brain damage which leads to the loss of memory in older adults.
Parkinson’s is a disorder that affects the central nervous system, which affects your movement and will often include tremors in certain parts of your body.
Frontotemporal dementia affects both the frontal and temporal lobes. As this type of dementia progresses, the nerve cells in these lobes are lost causing them to shrink, ultimately affecting behavior, movement, and ability to communicate.
A rare genetic disease that causes damage to nerve cells in the brain and eventually breaks them down progressively.
During the early stage, you may still function independently and continue your normal activities of daily living, such as driving, working, and participating in social events. However, you may experience lapses in your memory, such as forgetting words that are familiar to you.
The middle stage of Alzheimer’s is also known as the longest stage as it can last for years. During this stage, you may experience more pronounced Alzheimer’s symptoms, including confusing words in a conversation, refusing to do self-care such as bathing, and mood changes.
In the late stage of Alzheimer’s disease, the symptoms become more severe as you lose the ability to hold a conversation or control your movements. Worsening memory and significant changes to your personality also occur.
As Alzheimer’s symptoms progress and get worse, hospice care includes symptom management and providing emotional and spiritual support to you and your family.
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, we are taking a stand and raising awareness for the immense need to stop bullying.
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.
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.
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.
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.
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.
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 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.
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!
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.
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.
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.
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:
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 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.
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.
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.
By: Laura Mantine, MD
Ovarian cancer is cancer that grows in a woman’s ovaries. Damaged or deformed cells start to grow out of control. Although treatment has a high rate of success if the cancer is found at an early stage, in many cases it isn’t discovered until advanced stages when the cancer is harder to treat. A biopsy, or small surgery, is often performed when ovarian cancer is suspected. This is done to confirm the disease by taking tissue and fluid samples for analysis. Some ovarian tumors are benign, which means they don’t grow into cancer. Treatments for ovarian cancer vary based on the stage of the disease, but often include surgery and aggressive chemotherapy. These treatments may come with distressing side effects like pain, sleep problems, nausea, fatigue, loss of appetite, anxiety, or depression.
Facing ovarian cancer is difficult. It can have a big impact on your physical and emotional health, all of which may cause enormous stress for both you and your family. But you don’t have to face this alone. Treating the pain, symptoms, and stress of cancer is just as important as treating the cancer itself. Palliative care and hospice care are forms of supportive services available to people with cancer. Supportive care focuses on providing comfort, relieving pain or other symptoms, and improving quality of life. Supportive care doesn’t cure disease. The main difference between these two types of care is that you can receive palliative care at the same time you are receiving treatment, whereas hospice care begins after stopping standard cancer treatments for end-of-life management.
Once you decide to no longer receive chemotherapy or other standard cancer treatments, transitioning to hospice may be beneficial for both you and your family. When you choose hospice care, it means that the goals of treatment have changed with a shift from curative to comfort-based care. Hospice care is usually offered at the end of life, when you’re expected to live less than six months. The aim of hospice is to care for you rather than attempt to cure the disease.
Hospice care is very personalized. Your hospice care team will focus on making you as comfortable as possible. They will work with you and your family to create a care plan that best suits your goals and needs for end-of-life care. A hospice team member is generally on call 24 hours a day to provide support. You may receive hospice care in your home, a special hospice facility, a nursing home, or a hospital. A hospice team usually includes doctors, nurses, home health aides, social workers, clergy members or counselors, and trained volunteers. Services may include medical services, supplies and equipment, medications to manage pain and other cancer-related symptoms, spiritual support and counseling, and short-term relief for caregivers.
Medicare, Medicaid, and most private insurance plans will cover hospice care. Most U.S. insurance plans require a statement from your doctor that you have a life expectancy of six months or less. You may also be asked to sign a statement that you accept hospice care. Hospice care can continue for longer than six months, but your doctor may be asked to give an update on your condition.
Getting supportive care, whether palliative care or hospice care, can be beneficial to your mental and physical well-being. Talk to your doctor, family, and friends about your supportive care options.