Friday, November 20, 2020

November is Pancreatic Cancer Awareness Month


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By Dr. Jennifer Chuy, medical oncologist at Montefiore Health System and assistant professor, Medicine, Albert Einstein College of Medicine


As our nation mourned the passing of Supreme Court Justice Ruth Bader Ginsburg, another legend, Jeopardy host Alex Trebek also recently succumbed to pancreatic cancer this month.


Pancreatic cancer is the ninth most common cancer in men and the eighth most common cancer in women in the United States. More than 57,000 people will be diagnosed with pancreatic cancer this year in the United States. In New York alone, 3,700 people are diagnosed with pancreatic cancer each year and 2,900 people will die of the disease annually. Despite advances in treatment, five-year survival rates remain at 9%.  


What is the pancreas?


The pancreas is an organ located behind the stomach. It releases enzymes to help digest food and produces hormones, such as insulin to control sugar levels in the blood.


What causes pancreatic cancer?


Risk factors for pancreatic cancer include:

-smoking

-obesity

-chronic inflammation (pancreatitis)

-older age

-family history


Up to 10% of all pancreatic cancer diagnoses are associated with an inherited syndrome. One important example is the hereditary breast and ovarian cancer syndrome, associated with mutations in the BRCA1 or BRCA2 genes (genes that have been found to impact a person's chances of developing breast cancer).  

Lynch Syndrome, also known as hereditary nonpolyposis colorectal cancer, is associated with genetic mutations that affect a person's ability to repair damaged DNA and may also increase one's risk of developing pancreatic cancer. If you or your family member are concerned about your family history of cancer, you should ask your doctor if genetic testing is right for you.


What steps can you take to protect yourself and loved ones?


Stop smoking and lead a healthy lifestyle with a diet low in fat and engage in regular physical activity.

Pancreatic cancer is often difficult to diagnose because signs and symptoms tend to be nonspecific and a routine physical exam and blood work may not detect the condition early on. You should call your doctor if you have non intentional weight loss, persistent abdominal or worsening abdominal pain that radiates to the back, jaundice (yellowing of the eyes and/or skin), dark-colored urine, light-colored stools, new onset diabetes, unusual bloating, or new onset diarrhea, especially with fatty foods. Your doctor can order a blood test or scan and make a referral to a gastroenterologist to see if you need further evaluation.


What treatment options are available?


Depending on the stage of pancreatic cancer, people may be offered chemotherapy, radiation, and/or surgery. In a small group of people, immunotherapy and targeted therapy may also be an option. It is important to find a cancer center where care is coordinated closely by a team of providers who specialize in the treatment of pancreatic cancer.  


Where can I find more information about pancreatic cancer and clinical trials?


Clinical trials are an important way to provide access to new and promising treatments that may not yet be available to the rest of the general population. This is especially important for pancreatic cancer where we are in desperate need for more effective therapies.  


May the legacies of RBG and Alex Trebek live on and may new therapies on the horizon bring hope to all those afflicted.


I have listed the online resources below to provide additional information about pancreatic cancer.


Pancreatic Cancer Action Network

pancan.org

American Cancer Society

cancer.org

American Society of Clinical Oncology

cancer.net

Tuesday, November 17, 2020

De-Stressing Daily Rituals When a Loved One has Dementia or Alzheimer’s

De-Stressing Daily Rituals When a Loved One has Dementia or Alzheimer’s
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By Jane Sadowsky-Emmerth, RN, Partners in Care, an affiliate of VNSNY


Anyone who has a relationship with someone suffering from Dementia or Alzheimer’s knows that even the simplest tasks in daily life can become true challenges—for both caregivers and the family members themselves. 


Something as innocent as making and enjoying a morning cup of coffee or tea can turn into an exhausting and frustrating experience—especially with challenges like COVID-19 causing additional stress. Coping is difficult enough on good days, we don’t need the little joys of life to become a burden too.


As a registered nurse and clinical case manager at Partners in Care, a licensed home care agency affiliated with the Visiting Nurse Service of New York, I know there are countless potential obstacles that can make even daily rituals extremely difficult for caregivers. My colleagues and I have come up with some ideas for communicating that we hope will help caregivers maintain patience and a sense of calm when they are reaching their breaking point. Setting yourself up for success as much as possible will create a more positive and productive environment for both you and your suffering loved one alike.


Accentuate the Familiar


Be sure to continually remind your family member of the person, place and time. Say “I’m…, we have breakfast together every day, remember we laughed about my new mask.” This helps a person with dementia feel grounded in what they know and allows them to feel safe with that knowledge for however long they can. 


Observation is Key


As noted in the tip above, familiarity can help lessen the frustrating aspects of dementia, when the patient can grasp onto something being told to them or something they can come to expect. Notice what their favorite foods and drinks are, how they take their coffee. Do they like variety in day-to-day meals, or do they like consistency? Also try to notice which times of day they seem to be more clear or confused, and adjust your caretaking accordingly. If you know they are most disoriented during the morning, know you will need to be more repetitive and patient.


Try New Conversation Tactics


Since conversations with dementia patients can repeat and tend to loop around again and again, try to listen carefully and then reword the question or emphasize a different point to help keep the communications flowing. Re-clarifying and altering the question slightly can go a long way. Also, though it is tempting when conversing with someone with dementia to fill every silence, sometimes you do have to give the person some time to think before they respond.


Involve the Patient


Instead of calling all of the shots with simple tasks like getting dressed and ready for the day, involving your loved one can help foster engagement and self-respect. You can make suggestions—“It’s hot outside today, so let’s wear something with short sleeves”—but let them choose which short-sleeve shirt. You might also have a selection of cloth masks to protect against COVID-19, and ask which one your loved one wants to wear. Try this when going grocery shopping too: ask which flavor or which brand of a product they think you should buy. Allowing them to have input in small decisions may allow them to feel a little bit of the independence they have lost again.


Be Mindful of Your Reactions


Even if your loved one is suffering from a very severe form of dementia, they will still react to you based on your tone of voice and/or facial expression. Be mindful of not letting your frustration show. It is difficult, but take a deep breath, put a smile on, and keep your tone positive. It can make world of difference. 


Know When to Take a Break


Sometimes there is nothing left to do but simple step away for a short while. This is one of the most important things you can do to take care of yourself as a caregiver. If things have become aggressive or simply too overwhelming, walk away for a few minutes (as long as it is safe). Give yourself some time to collect yourself and try to return with a different facial expression. 


Jane Sadowsky-Emmerth is an RN and clinical case manager at Partners in Care, an affiliate of The Visiting Nurse Service of New York. VNSNY is the largest not-for-profit home- and community-based health care agency in the United States, providing quality private care services. For more information please visit www.partnersincareny.org or call 1-888-735-8913.


Tuesday, November 3, 2020

Caring For Our Veterans: VNSNY Salutes Those Who Served


VNSNY Veterans Hospice Care: Saluting Those Who Served

Joseph Vitti, Director of the Hospice Veterans Program at the Visiting Nurse Service of New York, liaison, salutes a VNSNY Hospice patient and WWII veteran following medals ceremony.







By Chandra Wilson, November 9, 2020


One warm summer day, in a New York high-rise apartment, a bedridden World War II veteran receiving care from Visiting Nurse Service of New York Hospice and Palliative Care received an unexpected surprise. The veteran, Edward Flanagan, had enlisted in the Navy after his beloved older brother died in combat and went on to see action in the Pacific theater. He later became a successful bank executive and active member of the community in his hometown of New Rochelle, New York—but like most war veterans, he was shadowed by memories, some more painful than others. It also saddened Mr. Flanagan that his Naval medals and discharge papers had gone missing.




VNSNY Hospice Veterans Program Director Joseph Vitti was at his bedside with duplicates of the medals he had earned, and a copy of his discharge papers as well, thanks to Joe’s hard work and determined outreach to the Department of Defense and the National Archives. In the presence of Edwards’ wife and a family friend, Joe awarded the medals one by one, briefly explaining what each represented before pinning it on Edward’s chest: the American Campaign Theater Medal, the Asiatic–Pacific Theater Medal, the World War II Victory medal.


Efforts like these have led the national We Honor Veterans campaign to award the VNSNY Hospice Veterans Program the highest rating: Level Five. 


Developed and run by the National Hospice and Palliative Care Organization with the aid of the U.S. Department of Veterans Affairs (VA), We Honor Veterans collaborates with hospices, state hospice organizations, and VA facilities to spread awareness among U.S. military veterans of the end-of-life care and benefits that are available to them. We Honor Veterans upgrades their hospice partners on the basis of how well they’ve fulfilled the requirements for each level, which range from providing veteran-centric education to staff and volunteers and identifying patients with a military history (Level 1) to developing or strengthening partnerships with VA medical centers and veterans organizations like the VFW and American Legion (Level 5). Level Five emphasizes care for Veterans of the Vietnam War, many of whom experience chronic and debilitating oncological and neurological symptoms as a result of exposure to Agent Orange.  


This year, in the midst of the coronavirus pandemic, VNSNY has expanded its Veterans Outreach Program beyond Hospice, and has enlisted Christopher Webster—himself a proud 16-year disabled U.S. Army Veteran—as the program’s Outreach Liaison for VNSNY Home Care. Made possible thanks to a grant from the Mother Cabrini Health Foundation, this important program was created to enrich veterans’ lives by offering support and guidance wherever needed, providing essential equipment to disabled veterans at no charge, and helping veterans and their families navigate the often-confusing application processes to obtain the veterans’ home care benefits to which they are entitled—much as VNSNY’s Hospice Veterans program does for Hospice patients. 


“It is my honor to assist my fellow vets in securing those benefits that can help them to reach their highest functional level and stay safe at home in their community,” says Christopher Webster, who draws on his personal experience as an Army combat and flight medic during multiple deployments to better empathize with and advocate for the veterans in his care.


“As a vet myself, I understand some of the challenges service men and women face as they age or cope with serious illness,” Webster adds. “Working with VNSNY, my team and I are able to connect vets and their families with the high-quality health care and services they not only need, but so richly deserve. It is truly a privilege to get to know and assist America’s military heroes.” 


Joseph Vitti, who has been with VNSNY for five years now and directs the VNSNY Hospice We Honor Veterans program, served in the Global War on Terror. Both VNSNY programs make veterans and their families aware of their benefits and help them get their documents in order, which can often be a daunting task. Joe and Chris, along with other VNSNY Veterans Program team members, including former Army medic Sung Yoon, who saw active duty in Afghanistan, guide Vets and their families through the maze of the Veterans Affairs healthcare system on a daily basis. They also train staff members and volunteers to understand the impact that wartime combat can have on veterans, even decades later—most commonly, post-traumatic stress disorder and survivor’s guilt.


“When working with hospice veterans, it’s important to remember that many have already faced life and death on the battlefield,” says Vitti. “Veterans are selfless people who want to help others. Now, they’re asking a hospice team and their family or friends to take care of them, and they often find it hard.” 


If a veteran’s case is difficult, a member of the team may use telehealth or make an in-person visit to the patient’s family to offer support as well. Members of the VNSNY Veterans Outreach team regularly connect with veterans organizations across New York City’s five boroughs to maintain relationships with them and take care of other veteran-related matters. Several times a month, they orchestrate intimate ceremonies like the one with Mr. Flanagan, honoring hospice veterans for anything from an act of courage in combat to aiding fellow veterans in their community.


Especially for these heroic patients, the recovery of medals and papers provides a sense of pride and sometimes end-of-life closure, while the ceremony itself shines a bright light on the veteran’s military service achievements at any point in the journey of life. 


“Every war veteran has a unique story,” says Joe. “The work we do and our partnership with We Honor Veterans make it possible for us to let veterans in New York City know their service has not gone unnoticed, and that it is greatly appreciated.” 


Veterans outreach programs with the Visiting Nurse Service of New York ensure that U.S. veterans receive full hospice benefits related to their military service. The VNSNY Hospice We Honor Veterans program also provides end-of-life care that recognizes and takes into account their wartime experiences. For more information, please call: 1-800-675-0391 or download this brochure.


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