Season’s Grievings

Author: Sonia Malhotra, MD, MS, FAAP, and Director of Palliative Medicine and Supportive Care at University Medical Center New Orleans

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The Holiday Season is one full of celebration, joy and gathering for so many.  But for many individuals, especially those living with a serious illness, the Holiday Season can seem like more of a burden than a joy. Coordinating appointments, making sure there are enough supplies to last through days when pharmacies and stores are closed, and contacting healthcare providers are only some of the challenges those living with a serious illness have to face.

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Additionally, the Holidays often bring about stressors, anxiety and grief over the inability to travel and the loss of other abilities, the diagnosis of a serious illness, and often the loss of loved ones.

Palliative Medicine is the interdisciplinary care of patients with serious illness such as cancer, blood disorders, heart disease, neurologic disease, liver and kidney disease and advanced lung disease to name a few.

It provides this level of care in 4 areas:

  1. Pain and Symptom Management, including managing symptoms that affect the quality of life
  2. Communication about Healthcare Decisions, Plans of Care and Coordination of Care
  3. Emotional & Spiritual Support for Patients and their Caretakers
  4. Hospice, End-of-Life Decision Making and Support, and Bereavement Services

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November marked the celebration of National Hospice & Palliative Medicine month. 

However, each month in the life of our patients LIVING with serious illness brings awareness of the challenges and struggles we need to celebrate. Serious illness and Palliative Medicine are NOT about end-of-life care. Rather, Palliative Medicine and its care of the seriously ill focuses on finding ways to ensure that our patients and their caretakers are LIVING with the best quality of life they possibly can.2017-NationalHospiceMonth_Logo

So how can patients and their families survive this Holiday season with a Serious Illness?

  1. Establish Priorities: Choose the Holiday traditions and activities that have the most meaning to you. Create and prioritize activities based on your state of mind and energy level.
  2. Depend on Loved Ones to Fill In: This can be especially tough for those who like to do things independently. However, it is important to be realistic about what you will have energy to do. Ask for assistance, take assistance when it is given and be clear about your own limits.
  3. Plan Ahead: This is especially important if you have dietary restrictions while undergoing treatments. Talk to your healthcare team about rescheduling treatments that may leave you feeling under-energized during important family gatherings or traditions.
  4. Be Selective with Your Time: Do things and be with the people who energize you, not those who deplete you. Don’t feel the pressure to fulfill obligations, do the things that matter the most
  5. Acknowledge and Share Your Feelings: It is okay to feel sad, anxious and even angry. Give yourself the permission to have these feelings and share them with trusted loved ones and healthcare professionals. Use support groups and online communities as often or as little as you need.

The Holidays can be a stressful time for those living with a serious illness and those caring for a loved one with a serious illness. Keep in mind that nurturing yourself and allowing others to nurture you will help in the celebration and reflection of these times.

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Feast Your Eye On This: A Thanksgiving Menu You Won’t Regret

Author: Rosetta Danigole, UMC Lead Clinical Dietitian – Nutritional Services

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Thanksgiving is almost here.  It’s time to feast and spend time with family.  But while Thanksgiving and the rest of the holiday season brings joy to many, it can also be the cause of food anxiety.

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Take a deep breath – traditional seasonal fare also offers plenty of good opportunities for healthy eating.

The fall season offers so many nutrient packed foods that can nourish not only your body but your spirit. Listed below are some dietitian approved tips for avoiding overindulging and taking the worry out of those holiday meals.

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Remember always that healthy eating is a lifestyle. Moderation is the key to staying on your healthy eating path through the holidays.

Here are some tips to keep in mind as you prepare tomorrow’s feast or sit down to enjoy.

Make it healthy:

  • Choose seasonal foods. Roasted fall vegetables add a festive touch to the table. Think about sweet potatoes, carrots and turnips.  It’s a simple dish but these roasted vegetables combined with olive oil and low sodium herbs can be a good start to a healthy meal.
  • Add winter squash to your holiday table. Roasted, baked or steamed, winter squash makes a delicious and nutritious side dish.  Add your favorite spices such as nutmeg, ginger and cinnamon for a healthy alternative.
  • Make the cranberries a hit. Cranberries contain powerful anti-agers. Try to find either fresh or low sugar canned instead.
  • Prepare a guilt-free dessert. Baked, poached or roasted fall fruits are a great alternative to sugary pies and other sweets. Try apples and pears and even apricots, peaches and plums sprinkled with holiday spices like nutmeg and cinnamon.

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Enjoy it!

  • Start with nuts. Instead of munching your way through the sour-cream dip before dinner, pick the walnuts out of the nut bowl. Eating 12 halves 30 minutes before a meal will convince your brain you’re not all that hungry.)
  • Practice the flip. Try this tip –it’s called flipping” your meal: Make the side dishes the main choices along with your white-meat turkey. Make the higher calorie choices a small side dish. When everyone else is waddling out, you’ll be feeling great.
  • Find a healthy balance. Try to balance your plate with lean proteins, heart healthy whole grains and veggies. If those options aren’t available, just remember to pace yourself.
  • Eat some of everything. Yes, including the pumpkin pie.  Just be mindful of portion sizes. To be sure you are getting the right portion size, use your hands. For the average woman, the palm of your hand is two to three ounces – your thumb is equal to one teaspoon. Take less and savor it more. You’ll end up feeling better after.
  • Dig in to the turkey. Turkey breast is super lean: just 44 calories, 1 gram of fat and no saturated fat per skinless ounce.
  • Don’t reach for seconds right away. Still hungry after your first serving? Wait 20 minutes, have a glass of water, and check in with your body before going for seconds.
  • Stay hydrated. Add sparkling seltzer water to cranberry or pomegranate juice for a festive, low-calorie drink (and it’s alcohol free, if so desired). Pomegranate juice is loaded with anti-oxidants and helps fight inflammation.

As you navigate the rest of the holiday season, remember that a healthy dietary pattern is higher in vegetables, fruits, whole grains, low- or nonfat dairy, seafood, legumes and nuts; moderate in alcohol; lower in red and processed meat; and low in sugar-sweetened foods and drinks and refined grains.

For a list of healthy New Orleans-style Thanksgiving recipes, download our free recipe book.

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Happy Thanksgiving to all!

A Patient’s Perspective: Life with Pulmonary Hypertension

Author: Millie Ball, UMCNO Pulmonary Hypertension Patient

We all have our stories.

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But one thing is true of most of us: We hadn’t heard of pulmonary hypertension until a doctor told us we had it.

Over-simplified, PH is high blood pressure that affects the arteries in your lungs.

It affects the heart, and it is progressive — and it is terrifying when you look it up online. Singer Natalie Cole died of PH.

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My advice to new patients: Stop looking it up online.

What is Pulmonary Hypertension?

Pulmonary Hypertension (PH) is different from regular hypertension. PH is high blood pressure in the lungs. It can affect both genders and all ages and ethnicities. Symptoms include shortness of breath and swelling of the feet. Undiagnosed and untreated, it can rapidly lead to death but fortunately specialized treatment is available. The Comprehensive Pulmonary Hypertension Center (CPHC) at UMCNO is one of a handful of centers in the south that are certified by the Pulmonary Hypertension Association to provide state-of-the-art diagnosis and treatment by nationally recognized PH experts.

Babies can be born with PH. Generally, there are five types, caused by health issues ranging from blood clots to lupus to drug use to heart disease (congenital or otherwise), sleep apnea, to who knows what.

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Dr. Bennett deBoisblanc, who’s Professor of Medicine and Physiology at LSU Health New Orleans and one of the PH physicians in the Comprehensive Pulmonary Hypertension Center (CPHC) at University Medical Center New Orleans (and has a bunch of other titles), jokes that some patients are said to have idiopathic PH, “because we are the idiots and don’t know its cause.”

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Everyone calls him Dr. Ben, because most stumble over the French name of this native New Orleanian…Bwa-blon is semi-close.  An avid daily runner, he’s a nationally respected researcher in PH, who has won awards for the way he relates to patients, and for his work in Charity Hospital’s Intensive Care Unit during Hurricane Katrina. He makes patients laugh, gives us his cell number, and makes us feel — despite what we might have read — that everything will be all right.

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As do his LSU colleagues who I have seen as well at the UMCNO Comprehensive Pulmonary Hypertension Center: LSU Associate Professor of Medicine, Dr. Matthew Lammi (he also gives his cell number), Pulmonary/Critical Care Fellow Dr. Sneha Samant and CPHC Nurse Coordinator, Monique Brown, a master organizer, who makes PH patients feel like they are her friends. Tulane School of Medicine physicians, including Dr. Lesley Saketkoo and Dr. Shigeki Saito, also are a core part of the CPHC.

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So how do you end up with this exceptional team?

Shortness of breath is a typical first symptom, as are fatigue, heart palpitations, dizziness, swollen ankles — in other words, the same symptoms as too many other illnesses. Some patients go several years undiagnosed before finding a specialist who has worked with PH patients.

My first symptoms showed up three years ago, when I thought I had been hit with 24-hour flu during a Thanksgiving visit to a mountain town in North Carolina, 4,118 feet above sea level. I had spent vacations there for years, with no problems.

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My second night there, I threw up, my heart raced, I was nauseated and didn’t feel like eating. It lasted 24 hours.

I returned to the mountains over New Year’s, and it happened again, also on my second night.

In the spring, my husband and I flew to Denver, the mile-high city, 5,280 feet above sea level. I felt woozy in the airport, and came down with the similar issues by early evening. The next day, we drove up to Minturn, CO, 7,861 feet. I went to bed for three days, vomited, my mind confused. “I need to go to Urgent Care,” I finally murmured.

A nurse put a pulse oximeter on my index finger to measure the oxygen level in my blood. It was 61. “Is that bad?” I asked. She shared a glance with another nurse. Healthy people usually have 95-99 percent oxygen, but anything over 90 is OK.

High altitude is not my friend.

The first thing I did was buy a pulse oximeter at a drugstore. Then I called a pulmonologist, who ordered a pile of tests, and walked me up and down his office hallway, shaking his head, and saying he was surprised I could be so chatty when most people with my blood oxygen numbers could barely breathe.

I was diagnosed with sleep apnea, a disorder in which you stop and start breathing repeatedly while you sleep. Untreated, it can cause heart damage, and increase the risk of Alzheimer’s, say some researchers. My tester told me that I was one of four patients in eight years whose oxygen level dropped into the 60s when I slept.

The pulmonologist ordered a continuous flow oxygen concentrator, which sucks oxygen out of the air and pumps it into a tube linked to a CPAP (continuous positive airway pressure) mask when I sleep. It’s not pretty.

I passed the other breathing and heart tests. But at our final meeting, the doctor said, “You either need to see Dr. Bennett deBoisblanc at LSU or go to the Mayo Clinic.” I cried.

I saw Dr. Lammi and Dr. Ben, and underwent a heart catherization, the gold standard test for PH at UMC in August 2015. I was told that I have PH, but a mild case. Blood pressure meds were prescribed. And Dr. Ben said I should weigh 130; I told him I was born weighing more than that, but I’m trying.

Linda Gates, who has had PH 15 years, heads a support group that I now attend. Another woman, from Houma, who has had PH more than 17 years leads a support group there. When they were diagnosed, there was no treatment for PH. It was almost a death sentence. Now there are more than 15 medications. Some types of PH respond better than others.

Linda had just returned from Iceland when I met her, which was encouraging. Travel is my passion, and my job was writing about travel.

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Unfortunately, the Medicare-mandated company that was supposed to supply my medical equipment sent me big clunky oxygen tanks that you can’t take on an airplane. I was told, quietly, by an employee, that my chances of getting a small portable oxygen concentrator were slim. You have to have an FAA compliant oxygen concentrator to fly in commercial airplanes, where pressurization is the equivalent of being 6,000 to 8,000 feet above sea level.

Fortunately, I was able to pay for one, $2,500 for a Inogen One 3 G that weighs five-pounds and totes like a crossover purse when I exercise or fly. That’s me, wearing my oxygen concentrator and walking my 11-pound, white Havanse pup many mornings in Audubon Park.

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To fly, each airline requires its own letter of permission from a doctor. “Hello, Monique, I need Dr. Ben to sign another letter!”

As I write this I’m on yet another trip — three airline letters required: United, American and Etihad Airlines from Abu Dhabi. There’s our regular luggage, plus my portable oxygen concentrator, my constant flow oxygen concentrator, my CPAP, and my dear husband, Keith, who helps lug it all around with me. We’re doing our bucket list destinations: a while back tulips in Holland and this month ruins in Petra, Jordan.

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Thank you, Dr. Ben, Dr. Lammi, Dr. Samant, Monique, Linda Gates. I don’t know where I’d be if I hadn’t found you all at UMC.

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For more information on PH and the CPHC at UMCNO go to www.umcno.org/cphc.

Give It Your Heart and Sole

Experts have known for a while that certain healthy habits are essential to good heart health. Even simple changes can reduce your risk for heart disease – and lifestyle changes have even been shown to help reverse damage in people already diagnosed with a heart condition.

Heart disease is this country’s No.1 killer, but according to the American Heart Association New Orleans, many deaths from heart disease can be prevented each year by adopting a heart-healthy lifestyle.

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Find time to exercise

Doing some form of exercise – whether it’s working out at the gym, taking the stairs instead of the elevator, or starting a walking program – can improve heart health, according to the AHA. Walking at least 30 minutes of day can help lower your blood pressure, improve your cholesterol profile and help you reduce your risk of coronary heart disease. A recent eight-year study of 13,000 people found that those who walked 30 minutes a day had a significantly lower risk of premature death than those who rarely exercised

Thousands of people will be taking this critical message to heart, and making a commitment to leading a heart healthy life at Saturday’s AHA New Orleans Walk in Champion’s Square.

At this annual event, participants join with others and generate a renewed commitment to heart-healthy living through walking.

In addition to a commitment to daily exercise, other lifestyle changes can reduce the risk factors for heart disease, heart attack and stroke.

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Eat a healthy diet

A healthy diet is one of the best weapons to fight heart disease, according the AHA. Foods consumed can affect risk factors such as high cholesterol and high blood pressure. Eating fatty foods plays a part in the buildup of fat in your arteries, which can lead to blocked arteries of your heart and to the risk of a heart attack. A healthy diet consisting of lean proteins, vegetables, fruit and whole grains can help improve heart health. If you’re overweight, set weight-loss goals. Even losing a small percentage of your body weight reduces your risk for heart disease.

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If you smoke, stop.

The American Heart Association (AHA) says diseases caused by smoking kill more than 440,000 people in the U.S. each year. One out of every five smoking-related deaths is caused by heart disease.

Smoking causes an instant and long-term rise in blood pressure, increases heart rate, reduces blood flow from the heart, damages blood vessels and doubles the risk of stroke.

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Top 3 Recommendations for a Healthier Heart

  • Find time to exercise: Brisk walking for as little as 30 minutes a day has proven health benefits, such as providing increased energy and circulation, as well as reduced risk of heart disease.
  • Eat a healthy diet: Eat more fruits and vegetables, whole grains, low-fat dairy, fish, poultry, and nuts. Cut back on sugary foods like soda and on red meat. In general, stay away from foods high in salt, cholesterol, saturated fat, and trans-fat.
  • If you smoke, stop: Smoking can seriously damage blood vessels and increase your risk for heart disease.

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Tips for sticking with your heart healthy lifestyle changes:

  • Start small. Make promises that you can keep. Rather than trying to go the gym every day, aim go three times a week and add more walking each day. Instead of overhauling your entire diet, try replacing sugary treats with healthier options, like fruit.
  • Take a gradual approach. Making lifestyle changes may take time. Don’t expect miracles overnight. Try replacing one unhealthy behavior at a time.
  • Don’t go it alone. Talking about your resolutions and finding support can help you reach your goals. Try forming a group or take a class with others who have common goals. Having support and being able to talk about your struggles can make sticking to your plan less overwhelming.

Problematic Pancreatic: What to Know About Pancreatic Cancer

Author: Jennifer Gnerlich, MD, UMC Surgical Oncologist and Assistant Professor of Clinical Surgery at LSU Health New Orleans

More people are being diagnosed with pancreatic cancer now than ever before. Currently, cancer of the pancreas accounts for 7 percent of all cancer deaths in the United States. This year, an estimated 53,670 adults will be diagnosed with this disease, and more than 43,000 of them will die. (Source: American Cancer Society)

November kicks off Pancreatic Cancer Awareness Month at UMCNO’s Cancer Center, so our staff is working to get the word out about this disease.

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Here is what you should know:

  • Most people are diagnosed with pancreatic cancer between the ages of 55 years old and 85 years old.
  • Men and women are equally affected by pancreatic cancer.
  • The number one risk factor for pancreatic cancer is smoking and tobacco use.
    • Please call the American Lung Association’s Lung Helpline at 1-800-LUNGUSA (586-4872) if you need help in quitting tobacco use and smoking, or phone us at UMC at (504) 702-5178. 
  • Individuals with BRCA mutations (associated with breast cancer) have an increased risk of pancreas cancer.

There is NO screening test for this disease. You need to be aware of the possible presenting symptoms of pancreatic cancer, which include:

  • Jaundice (yellowing of the skin or eyes)
  • New onset of pain in the upper abdomen/belly or back pain
  • Indigestion or upset stomach not relieved with Tums or Pepcid
  • Pale, smelly, floating, or light colored stools that may look oily in the toilet
  • Unexplained weight loss
  • New diagnosis of diabetes, especially in people over 50 years old
  • New diagnosis of clots in veins or arteries
  • Pancreatitis

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If you have any of these symptoms, please see your primary care physician or contact the Cancer Center Monday through Friday at (504)702-3697 for an appointment.

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Getting checked is important. Pancreatic cancer has a five-year survival rate of 8%, but with appropriate care that survival can be as high as 27%. Treatment will usually include a combination of chemotherapy, radiation, and surgery.

Just as every person is unique, so is his/her pancreatic cancer. This is why every patient is discussed at a multi-disciplinary tumor board where a panel of experts in fields such as medicine, radiation, surgery, radiology, and pathology can discuss the case and determine the best treatment for that individual.

If you have been diagnosed with pancreatic cancer or want additional information, please contact the UMCNO Cancer Center as soon as possible.

About Dr. Gnerlich

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Dr. Gnerlich is a board-certified surgical oncologist specializing in upper gastrointestinal cancers in the pancreas, bile ducts, liver, stomach, esophagus and retroperitoneal sarcomas. A fun fact – While Dr. Gnerlich was completing her undergraduate degree, she was scouted to go into professional acting. She loves to run half-marathons, especially at Disney World. Dr. Gnerlich is excited to join the staff at UMC because of the “great team we have here.” She hopes to bring new procedures like HIPEC (hyperthermic intraperitoneal chemotherapy) to UMC for patients with certain types of cancer that have spread throughout the abdomen.

To make an appointment with Dr. Gnerlich or one of our cancer specialists, please contact (504)702-3697 or (504) 702-5700.