How do I contact my nurse from home?

One of the most common questions we get from our patients is, how do I contact my nurse from home. About 6 months ago we created the Providence Regional Cancer System Nurse Line. To contact us simply call your main clinic number and asked to transferred to the nurse line. At this point you will be asked to leave a message. We ask that you provide the following information:

• First, and most important, leave a message! Many times people call and hang up (instead of leaving a message). We cannot know that you called us unless you leave us a message.
• Provide your name, first and last. Please speak slowly and clearly and spell your name for us. This will help us to quickly find your records and locate your nurse.
• Leave a phone number where we can reach you. If you don't leave a phone number we will use whatever number is listed in your medical records. However, often times this is your home number and you're not at home. If you leave us the number that you know you will be at we can get back to you that much faster.
• Tell us as much information as you think we need. The nurse line receives 150-250 phone calls a day. We triage these calls and call back our patients accordingly.

If you have a suggestion for how we can make our nurse line better please e-mail us. As a new system we know that there are kinks we need to work our and we would love your feedback as to how we can better serve you.

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Just because it's natural doesn't mean it's safe

Do you head to the health food store to find out what natural remedies will boost your immune system, or help minimize the side effects related to cancer treatment?

If so, do you take the extra step to share this information with your cancer physician? Many people do not talk to their doctor about what supplements they are taking. Often they have no idea it’s a topic they even need to bring up with their physician. That may be due to the common misconception that if something is natural, it can cause no harm. However, sometimes the opposite is true.

A natural herb or mineral supplement can be processed by the same enzymatic pathways in our bodies as the medicines prescribed by your physician, including cancer treatments. This means, in some cases, an herb which is considered relatively safe to take on its own may lead to negative consequences when taken at the same time as a certain medication.

For example, the antidepressant St. John’s Wort can make the chemotherapy agent Irinotecan (Camptosar, CPT-11) less effective. The important take home message is this: Make sure to tell your physician about everything you ingest, whether it’s an over-the-counter medication, regularly prescribed medication, or an herbal supplement.

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• What can naturopathic care do for me?

Lymphedema prevention strategies

Prevention strategies are the most important whether or not you already have swelling. Following these strategies will help prevent lymphedema altogether, delay its onset, or slow its progression. The strategies are designed to prevent injury or overuse of the involved extremity. The precautions apply to the involved extremity and include:

• Applying lotion/moisturizer to prevent dry skin and cracking
• Good nail care – to include trimming of calluses and avoidance of cutting cuticles
• Use of gloves while gardening, landscaping, or using chemicals to prevent cuts, scrapes, and burns
• Protection of the skin via sunscreen and bug repellant
• Use of an electric razor to prevent nicks and scrapes
• Thorough cleansing of scratches/punctures with soap and water followed by application of an antibiotic/first aid ointment to prevent infections
• Slowly increase the length of time and intensity of daily activities, including gym routines
       *Avoid long periods of repetitive activity if you have not been doing that activity much before (i.e. painting your house all day)
       *Take breaks during periods of intense activity
       *There are no limits to what you can do; you just need to get there slowly!
• Avoid blood pressure or blood draws (In the case of emergencies, do not limit access to this extremity)
• Wear loose fitting clothing and jewelry
• Participate in aerobic activities (something that gets your heart pounding and makes you sweat) if cleared by your physician
• Inform you physician immediately if you develop signs/symptoms of infection, which include fever, chills, fatigue, nausea/vomiting and/or a red, swollen extremity, which may be painful and warm/hot to touch. Treatment should be sought within 12 hours of onset of these symptoms.

If swelling has already started
In the early stages, when swelling comes and goes, the best treatment typically includes use of a compression sleeve, and potentially the use of a self-massage and an exercise program. The sleeve is worn during activities that induce swelling and the self-massage can be used to help reduce swelling or prepare the body for activity. Compression sleeves are not recommended for nighttime use.

When swelling becomes constant, treatment is geared towards reducing the limb down to its smallest size prior to being placed in a compression garment. Treatment of this kind is called complete decongestive therapy, or CDT. It includes compressive bandaging, manual lymphatic drainage (massage), skin care, patient education, and therapeutic exercise. Treatments vary between patients, but are typically performed 3-4x/week for 60-90 minutes. Treatment may take as little as 2 weeks, but may last more than 2 months depending on the severity of the swelling. These treatments propel the trapped fluid into the working portions of the lymphatic system, where it will be put into the blood, leaving the body as urine. After size reduction is complete, a compression sleeve is used for long-term maintenance.

Integrative care basics and what others are saying

Integrative Care includes services that cancer patients can use in addition to traditional medical treatment (such as chemotherapy). Within the Providence Regional Cancer System, Integrative Care consists of acupuncture, naturopathy, oncology massage and therapeutic yoga. Each has its own specific benefits, but all of them share one, perhaps, unexpected benefit.

Many patients tell us that participating in these services gives them a sense of control, during a time in which they feel like they have little control. Says one patient who took part in Therapeutic Yoga, “I feel like I have some sort of control over my disease now, instead of just being ‘along for the ride.’” Here’s a brief look at the benefits of each service – to learn more, visit the Integrative Care section of the Providence Regional Cancer System Web site:

• Acupuncture helps reduce/treat symptoms such as nausea, fatigue, pain, dry mouth (also known as xerostomia).
• Naturopathy focuses on examining what lifestyle modifications you can make to live a healthier life (during treatment and beyond), as well as expertly guide you through the use of supplements and herbs in a safe and effective way.
• Oncology massage helps provide comfort as well as ease the pain and discomfort that often accompany cancer and cancer treatments. The resulting relaxation helps to significantly reduce stress.
• Therapeutic Yoga offers an opportunity to truly connect the mind and body. What happens when your cancer treatment is complete? You can continue these services on an ongoing basis. They can help with your overall healing process as well as support your immune system after treatment, too.

So what are real patients saying about integrative care? Check out some of their quotes:

• “In general, I experience an immediate sense of relief/increased relaxation & well-being after participating in any of these services.”
• "This oncology massage has been vital in my efforts to survive stage IV breast cancer. My therapist is very professional and makes every effort to interact with me and my need for therapy."
• "I think that going (to acupuncture) each week while having chemo really kept the nausea symptoms away."
• "(Dr. Aschtgen) helped change my perspective on the options available to me. He also made suggestions regarding diet and supplements which I have appreciated. In all, my visit here was a wonderful experience."
• "The (yoga) class always leaves me feeling renewed, grounded, 'back on track' and physically relaxed. My lymphedema appears to be an ongoing issue, but the class is a great support for my system."

To learn more, or register for a service, call 360.412.8951.

What is lymphedema and where can I get help?

Lymphedema is the collection of excess fluid in an arm or leg (or surrounding areas) that results from damage to the lymphatic system.

The lymphatic system has two jobs:

1. Fighting off infections, viruses and cancer cells
2. Transportation of proteins and waste products, which are used cells (muscle, blood, bone, etc.) that your body will recycle and reuse

When this system is damaged from cancer or its treatments, fluid, protein and used cells back up into the involved extremity, causing it to swell.

What is the lymphatic system?
Up until now, you have probably heard all sorts of information about your immune system, white blood cell counts, and infections. These make up half of your lymphatic system’s daily duties, one if which is to recognize and take care of bacteria, viruses and cancer cells. The other half of its job is to filter and transport all of the by-products made by the body during the course of the day, such as the old red blood cells, muscle cells, bone cells, etc. Along with recycling these cells, it hauls around protein to provide energy and even absorbs many of the nutrients from our food!

These fluids travel along small vessels that are just below the skin from the tips of our fingers and toes up towards the center of our body. Along the way, fluid is processed in lymph nodes to make sure it is safe to be put back into circulation. The main stopping points are the groin, for the legs, and the armpits, for the arms. Once it passes a checkpoint, the cleansed fluid joins your blood in your heart. It is then free to be filtered by your kidneys and liver.

Where do I go for more information about lymphedema?
Your best bet is to see a lymphedema therapist who can assess your specific situation and provide the most appropriate education. Lymphedema therapists are available at local Providence facilities, including Providence Centralia Hospital (PCH), Providence St. Peter’s Hospital (PSPH) and Providence Sound Home Care and Hospice in Olympia (PSHCH).

These services are provided by physical therapists (PT) at PCH and occupational therapists (OT) at PSPH and PSHCH. You must have a referral from your physician for a “PT Evaluation” or “OT evaluation” depending on the requested facility along with a diagnosis of lymphedema.

Contact information is as follows:

• Providence Centralia Hospital
  914 S. Scheuber Road
  Centralia, WA 98531
  360.330.8720
• Providence St. Peters Hospital 
  410 Providence Lane NE
  Emilie Gamelin Pavilion 3rd Floor 
  Olympia, WA 98506-5166
  360.493.4159
• Providence Sound Home Care and Hospice
  3432 South Bay Road NE
  Olympia, WA 98506
  800.869.7062

You can also find some basic information on the National Lymphedema Network’s website at www.lymphnet.org. The areas of most beneficial information are under the Lymphedema FAQs tab at the top left. All of the options under this tab will provide additional useful information. The information on this website is all based on research and scientific findings.