Sí, hablamos español.

When we schedule an appointment with a doctor in Northwest Arkansas, most of us can be fairly certain that our doctor will be able to communicate with us and that we will understand everything they say. Even if we're not sure of the meaning of a particular word or phrase, we will feel comfortable asking the doctor to clarify. We can assume we will leave their office knowing what was done at that appointment, what treatment is coming, and what medications have been prescribed. That is not typically the case for our neighbors who are Spanish speakers.

That is why Hope Cancer Resources employs a full-time Spanish interpreter. The challenge of being able to understand the language of Oncology is magnified when one is not in full command of the language the doctor speaks. Kathy Taylor assists cancer patients and their families as they go through cancer treatments and other medical visits related to their diagnosis. She provides a level of comfort to them as they make their way from diagnosis to recovery.

Living in Japan as a child, Kathy remembers feeling isolated by her inability to read and understand the language around her. She took her first Spanish class in 7th grade, and enjoyed the language enough to continue her studies through high school, majoring in Spanish in college. During her college studies she spent a year in Seville, Spain immersing herself in the culture even more.

But a degree in Spanish is not all that is needed to be a successful interpreter. Kathy is currently preparing for the next phase of testing for certification through the National Board of Certification for Medical Interpreters. The coursework she has completed included instruction on anatomy and other medically-focused vocabularies that an interpreter may need to be familiar with at a doctor's appointment.

Additional instruction on what it means to be an interpreter is also part of her training. For example, interpreters must use the same meaning, same inflections, and same "register" of language as the person being interpreted. "Register" refers to the level of vocabulary being used. An interpreter is not allowed to change the statement being made based on his or her own experience or what they believe the person "really" means... what they say must perfectly match what is said by the person they are interpreting.


Kathy is available to meet with every new patient at Highlands Oncology Group clinics who requests an interpreter. She initially meets the family in the waiting room and gives them an idea of what to expect for that day. She may also ask a few questions to better understand the patients' unique situation, and so that she can help patients remember questions they may have for the doctor during their appointment. The staff at Highlands also turn to her when they need to provide additional information to patients over the phone.

Cancer treatment is a frightening situation for anyone, and language can be a barrier to successful adherence to treatment plans. If a plan is not followed as prescribed, recovery can be slower, or simply not possible. With Kathy providing this vital service to the Spanish speaking patients treated at Highlands Oncology Group, she is helping us meet our mission of providing compassionate, professional cancer support and education to the Northwest Arkansas region today and tomorrow.

Colonoscopies: What can you expect?

It's March - Colon Cancer Awareness Month - so we have been sharing information about colon cancer in this space, on Facebook and Twitter, and in our monthly e-newsletter. We've emphasized the need for awareness of the risks and symptoms, and provided information on recommended prevention methods. But we know that one of the most important things an individual can do to prevent colon cancer is also one of the least likely things an individual will do, simply because the thought of having it done makes most people uncomfortable.

Many of the misconceptions and fears regarding a colonoscopy stem from a basic ignorance of what the procedure entails, and how it's performed. To help ease some of those fears, we thought it might help to share a briefing on how to prepare for, and what to expect from a colonoscopy from the U.S. Department of Health & Human Services website:

How to Prepare for Colonoscopy

The doctor usually provides written instructions about how to prepare for colonoscopy. The process is called a bowel prep. Generally, all solids must be emptied from the gastrointestinal tract by following a clear liquid diet for 1 to 3 days before the procedure. Patients should not drink beverages containing red or purple dye. Acceptable liquids include:

• fat-free bouillon or broth
• strained fruit juice
• water
• plain coffee
• plain tea
• sports drinks, such as Gatorade
• gelatin

A laxative or an enema may be required the night before colonoscopy. A laxative is medicine that loosens stool and increases bowel movements. Laxatives are usually swallowed in pill form or as a powder dissolved in water. An enema is performed by flushing water, or sometimes a mild soap solution, into the anus using a special wash bottle.

Patients should inform the doctor of all medical conditions and any medications, vitamins, or supplements taken regularly, including:

• aspirin
• arthritis medications
• blood thinners
• diabetes medications
• vitamins that contain iron

Driving is not permitted for 24 hours after colonoscopy to allow the sedative time to wear off. Before the appointment, patients should make plans for a ride home.

How is colonoscopy performed?

Examination of the Large Intestine

During colonoscopy, patients lie on their left side on an examination table. In most cases, a light sedative, and possibly pain medication, helps keep patients relaxed. Deeper sedation may be required in some cases (Tip: don't hesitate to ask your doctor about this option if you are interested). The doctor and medical staff will monitor vital signs and attempt to make patients as comfortable as possible.

The doctor inserts a long, flexible, lighted tube called a colonoscope, or scope, into the anus and slowly guides it through the rectum and into the colon. The scope inflates the large intestine with carbon dioxide gas to give the doctor a better view. A small camera mounted on the scope transmits a video image from inside the large intestine to a computer screen, allowing the doctor to carefully examine the intestinal lining. The doctor may ask the patient to move periodically so the scope can be adjusted for better viewing.

Once the scope has reached the opening to the small intestine, it is slowly withdrawn and the lining of the large intestine is carefully examined again. Bleeding and puncture of the large intestine are possible but uncommon complications of colonoscopy.

Removal of Polyps and Biopsy

A doctor can remove growths, called polyps, during colonoscopy and later test them in a laboratory for signs of cancer. Polyps are common in adults and are usually harmless. However, most colorectal cancer begins as a polyp, so removing polyps early is an effective way to prevent cancer.

The doctor can also take samples from abnormal-looking tissues during colonoscopy. The procedure, called a biopsy, allows the doctor to later look at the tissue with a microscope for signs of disease.

The doctor removes polyps and takes biopsy tissue using tiny tools passed through the scope. If bleeding occurs, the doctor can usually stop it with an electrical probe or special medications passed through the scope. Tissue removal and the treatments to stop bleeding are usually painless.

Recovery

Colonoscopy usually takes 30 to 60 minutes. Cramping or bloating may occur during the first hour after the procedure. (This is due to the carbon dioxide used to inflate the colon.) The sedative takes time to completely wear off. Patients may need to remain at the clinic for 1 to 2 hours after the procedure. Full recovery is expected by the next day. Discharge instructions should be carefully read and followed.

Patients who develop any of these rare side effects should contact their doctor immediately:

• severe abdominal pain
• fever
• bloody bowel movements
• dizziness
• weakness

There are many stories in the news this month about the value of getting a colonoscopy, and some, like this one, that detail personal experiences with the screening test. Across the board, the most common complaint patients share about the procedure is the colon prep that requires patients to drink a gallon of less-than-delightful liquid to clean out the colon. Colon cancer is the 2nd most deadly form of cancer, and the 3rd most diagnosed form of cancer in men and women in the United States. Surely a day of unpleasant preparation is worth the effort when compared to the alternative - a diagnosis of colon cancer.

For information about our Save-A-Life program that assists patients with the costs of colonoscopies and other cancer screening tests, contact Christina Bostian at 479-361-5847 or by email.

Treating the Whole Patient

If you have spent any time with a cancer patient as they underwent treatment, you probably know that the physical effects of the disease are only one part of the journey. A change in an individual's ability to function as they did pre-diagnosis causes a tremendous amount of stress. Fear of the unknown - and even the fear of the known - can also cause a patient to endure a level of stress that can be detrimental to their emotional health. These stresses can affect relationships with caregivers and other loved-ones, as well as their ability to function at work or perform routine tasks.

1 in 2 men and 1 in 3 women will be diagnosed with cancer in their lifetimes, according to American Cancer Society estimates. Nothing can prepare a person to receive a diagnosis that can be potentially fatal. And even when a patient has successfully made it through treatment and is declared "cancer free", there still may be a tremendous amount of residual worry.

The National Cancer Institute addresses stress and cancer on their website: 

Studies have indicated that stress can affect tumor growth and spread, but the precise biological mechanisms underlying these effects are not well understood. Scientists have suggested that the effects of stress on the immune system may in turn affect the growth of some tumors. However, recent research using animal models indicates that the body’s release of stress hormones can affect cancer cell functions directly.

A review of studies that evaluated psychological factors and outcome in cancer patients suggests an association between certain psychological factors, such as feeling helpless or suppressing negative emotions...

Every time a staff member at Hope Cancer Resources interacts with a cancer patient or their family members there is an opportunity to provide emotional support. Even the smallest thing - like providing a brochure - can reduce a patient's stress level. Our licensed oncology social workers help patients and caregivers cope with emotional distress through counseling, education and  information on support groups offered in our community. 

Here's a story of one of our patients who received emotional support from Hope Cancer Resources:

"Jason" is a cancer patient, married with three grown children. When we met him, he was suffering from chronic pain stemming from a previous accident as well as increasingly acute pain related to his cancer diagnosis.  Jason refused all but the mildest forms of pain medication. His pain was so extreme that he considered ending his life.

 Jason had never been to a counselor. He had always been strong and able to "handle anything on my own." Not wishing to burden his family, he kept his suffering to himself, but doing so had taken its toll on this once vibrant person who had already overcome many obstacles in life. Were it not for the insistence of his physician, Jason might never have sought help. By the end of his first therapy session, however, he shared what a relief it was to have a safe place to talk about both his physical and emotional pain.   

Over the next several weeks, he and one of our licensed counselors met on a regular basis and explored his beliefs about asking for help as well as his fear that taking strong pain medications would cause him to develop an addiction.  Subsequently, Jason felt comfortable discussing and pursuing additional options for pain relief with his physician.    

By his fourth session, there was nothing less than a remarkable change in Jason.  Physically, he appeared "lighter," peaceful and well rested, but it was the change in his outlook on life that really made an impression. His focus had shifted completely.  Whereas Jason had previously been plagued by persistent thoughts of death, he now talked in great detail of his renewed relationship with his wife, their summer travel plans, and resuming hobbies he enjoyed.  With a big grin on his face, he came in one day to simply say, "I've got a lot to live for."

If you know someone who is undergoing treatment for cancer and could benefit from the emotional support services we offer, contact one of our social workers at 479-361-5847.  

March Colon Cancer Awareness

For many years, we have been spreading the word about colon cancer screenings and their potential to save lives. Recently, our claims were backed up in the New England Journal of Medicine. According to an article printed in the New York Times, the results of a research study show a correlation between colonoscopies with polyp removal and a 53% reduction in deaths from the disease. The five-year survival rate for colon cancer found in an early, localized stage is 90%. Now, we just have to convince more people to get screened.

Colon cancer (also called colorectal cancer) is the third most common cancer in both men and women as well as the third most deadly. While incidence rates have been decreasing for most of the past twenty years (colon cancer used to be the number two cancer killer), increased awareness and prevention education is still vital because early stages of the disease do not typically show any symptoms. And, while the number of total diagnoses has been declining, the number of younger adults being diagnosed has been on the rise. Knowing your risks, the symptoms, and how to get screened in a timely manner is potentially life-saving knowledge.

"What are my risks?"
The biggest risk of colon cancer is associated with age. According to the American Cancer Society, 91% of cases are diagnosed in people 50 years of age and older. Other medical or hereditary factors that increase your risk include a family history of the disease, a personal history of other colon-related diseases such as chronic inflammatory bowel disease, and certain inherited genetic conditions. Studies have also found that people with type-2 diabetes are at higher risk.

Non-medical, and easily modifiable risks include obesity, physical inactivity, a diet high in red or processed meats, alcohol consumption, long-term smoking, and possibly very low intake of fruits and vegetables. Consumption of milk and calcium and higher blood levels of vitamin D appear to decrease colorectal cancer risk in research studies.

"What are the symptoms?"
As we mentioned before, early stages of colon cancer typically do not show any symptoms, which is why screenings are so important. More advanced stages of the disease may cause rectal bleeding, blood in the stool, a change in bowel habits, and cramping pain in the lower abdomen. In some cases, anemia can result from blood loss within the bowel, which would cause symptoms such as weakness and excessive fatigue.

Recommendations:
Beginning at age 50, your doctor should start encouraging you to get a colonoscopy. If the results show no polyps or areas of interest, you should plan to schedule another screening in ten years unless you have risk factors that would suggest more frequent follow up screenings. Discuss your personal follow up plans with your physician.

Another screening option is the Fecal Occult Blood Test (FOBT) that can be done at home in the privacy of your own bathroom. Throughout the month of March we have FOBT kits available at no cost. Simply stop by our office at 5835 W. Sunset in Springdale to pick one up, and follow the directions on the package.

If you experience any of the symptoms listed above in yourself or your loved ones, you should pursue evaluation by a medical professional as soon as possible. If your doctor prescribes a screening test and you are unable to pay for one, contact our Save-A-Life program coordinator, Christina Bostian, for information on how to apply for assistance from Hope Cancer Resources. We're here for Northwest Arkansas with support for the journey and education for life.