Ep. 91 – LiveWell Talk On…Cancer and Self-Care (Nancy Yeisley, MSW, LISW, OSW-C)

Ep. 91 – LiveWell Talk On…Cancer and Self-Care (Nancy Yeisley, MSW, LISW, OSW-C)

cancer and self-care

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Host: Dr. Dustin Arnold, chief medical officer, UnityPoint Health – St. Luke’s Hospital

Guest: Nancy Yeisley, oncology social worker, Nassif Community Cancer Center

***This episode was recorded prior to the COVID-19 pandemic. Some services discussed in the podcast may not be offered at this time due to the pandemic.***

Dr. Arnold:
This is LiveWell Talk On cancer and self-care. I’m Dr. Dustin Arnold, chief medical officer at UnityPoint Health- St. Luke’s hospital. Cancer is more than a diagnosis and treatment. It brings with it many other challenges for the patient and their loved ones. Joining me to talk more about support provided for cancer patients and caregivers is Nancy Isley, an oncology social worker at Helen G. Nassif Community Cancer Center. Welcome.

Nancy Yeisley:
Thank you. Glad to be here.

Dr. Arnold:
You know, as I was mentally preparing for this podcast and beyond thinking of all the brilliant comments I was going to have. I think the theme today is you can’t be passive in your health care. You have to be a partner. It’s a team sport and be involved with it. You just can’t be passive would you say that’s true?

Nancy Yeisley:
Yes. And I think with that, when I think about support, whether you’re facing cancer or other serious health problems, is the idea of being active and not just your physical wellbeing, but your emotional, your spiritual wellbeing, all of it. We very much take that approach at the Helen G. Nassif Community Cancer Center. We want to help you in every aspect of your life to be as well as you can be.

Dr. Arnold:
What are some basic recommendations you have for patients to do beyond their doctor’s appointment or chemotherapy session to be well, if you will, a team member on the team to make them better. What do you recommend?

Nancy Yeisley:
You know, first of all, we always recommend to everybody, bring somebody to your appointments with you. Whether it’s for that support or that extra set of ears to be able to ask questions, take notes. When you’re taking in stressful information, most people aren’t going to retain it all. And being able to think of things from different angles and ask different questions is very important.

Dr. Arnold:
When I was in private practice and paper gowns that patients wear. I would always leave the room and say, go ahead and get dressed. We’ll come back in and talk about what the plans are. Because I can only imagine somebody sitting in a paper gown is not listening to what I’m saying.

Nancy Yeisley:
Very true. And then they’re not going to be as truthful and give as in depth of an answer about things.

Dr. Arnold:
Absolutely they’re saying let me get through this so I can get my clothes back on. So no, you’re absolutely right. That’s a patient advocacy and having a partner, an advocate is a good thing.

Nancy Yeisley:
And as far as thinking about the emotional wellbeing in thinking about taking in everything that’s happening to you, one of the things I tell patients as an oncology social worker, my role is to make sure we’re not just thinking about your medical care. But we’re thinking about what we can do to support you and your loved ones. In being able to help you through this challenging time and being able to support you in every aspect. I think that starts things rolling that, we care about you as a person. And we want to help acknowledge that there is an impact beyond the actual medical care to your emotional wellbeing. What kind of support you need through that. So we try to just, for that reason I meet with every new patient right at their first visit.

Dr. Arnold:
So is it a balancing act? Because I’ve heard cancer patients say, I don’t want my cancer to define who I am.

Nancy Yeisley:
Absolutely.

Dr. Arnold:
So I can imagine they should do some supportive care but also balance that. Can you tell me about that or how that work integrates into your workflow?

Nancy Yeisley:
Yeah, so I would start out with just saying being able to acknowledge that it does have an impact because saying it has zero impact it’s kind of one end of the continuum. And saying it totally defines me as the other end of that continuum. So like most things, trying to find a balance in between. Acknowledging the way that the stress of a cancer diagnosis impacts you and your family as a whole. Being able to be open to support from others. Partly as a Midwestern nurse, we’re really, we’re tough. We’re strong, we work hard, we do. It’s hard to acknowledge, much less ask for help from other people in trying to help people see that that’s okay to do.

Dr. Arnold:
You’re starting to see the end of the World War II generation, where it was actually kind of, you didn’t talk about cancer. Like it was like somehow, that just amazes me when I would have patients that would be reluctant to acknowledge that they have cancer or discuss it, because there’s like a social stigma to it, which just blows my mind. I mean, can’t even imagine that now.

Nancy Yeisley:
Very true. And so then when you start to talk with people about their family history from that medical standpoint, much less, people are shaped by their experiences. And so thinking about how people are dealing with a cancer diagnosis, , if they had other people in their family diagnosed. Is this something that there’s a family history of where they could maybe have learned from other people who they’ve seen gone through this? Much less have any idea of how to deal with this at all. And so yeah, it can be very interesting. Some families talk about more things than others. And the generational piece as well.

Dr. Arnold:
Absolutely. That’s always just amazed me. I still don’t understand that social sort of stigma that used to exist. But times have changed. You talked about you sit down and talk to them and kind of do some detective work to find out where they’re at in that continuum you mentioned. What other self care resources do you provide in the Helen G. Nassif Community Cancer Center?

Nancy Yeisley:
I would talk to people about a whole team of support that we have for them. And the idea is that we go wherever the patient goes. We’re not assigned to one office or location, but having some continuity for those support services for patients is important. You know besides myself, as a social worker, we also have oncology dietitians that are very key in people’s care. Cancer exercise specialist, care coordinators. One thing that is really I think wonderful, our staff. Everybody on our team are people that have really, excelled within their profession and they found their niche in the specialty of oncology and they’re certified specialists within oncology. Just brings that extra level of expertise, much less that right bedside manner type of person who really helps key into those needs of patients.

Dr. Arnold:
Yeah, I think there’s two specialties that I see, where ancillary staff, nursing staff, social workers, physical therapy, that they’re there because they want to be there and that’s oncology and psychiatry. I think the nurses and the staff on the psychiatry floors want to be there. They have some, an advocacy for mental illness. Then that’s why they’re there. I think same with your cancer center. I think people migrate there. It’s not, well I just took this posting as a young nurse because it was available.

Nancy Yeisley:
Right, it wasn’t just because it looks interesting.

Dr. Arnold:
Right, I truly believe that. I truly, as we’ve talked to the, talking yourself and I’ve known you for a long time as well as other subject matter experts from the center. It really truly you do grasp how they want to be there and they have a passion for it.

Nancy Yeisley:
Yeah, we really try to listen to our patients too and what they want for support. As we add more support services, lots of it comes from feedback from patients. We’ve added acupuncture because patients have asked for it. So we’ve gone out and looked into it and found a provider that’s that good fit and really fits with our philosophy of patient and family centered care. We’ve really been taking off in our integrated wellness services too with massage and with acupuncture, with aroma therapy. As well as healing energy and essential oils. We’ve had within exercise patients asking for more things along the line, of yoga and we’ve had people ask for Tai Chi. So we started Tai Chi and before you know it we’ve got two Tai Chi classes going because the patients are really benefiting. So we really look for that feedback from patients as well as how to help enhance those support services available.

Dr. Arnold:
But no goat yoga or anything like that?

Nancy Yeisley:
No goat yoga. We’ve got some pet therapy going in the radiation center. But so far those are dogs not goats.

Dr. Arnold:
So no goats yet? Alright. What are some warning signs in your experience, and you can use your experience outside of oncology as well, but what are some warning signs that the emotional support system for this patient the wheels are about to come off. What do you see? What’s are some red flags to you that perhaps you need to intervene or escalate intervention?

Nancy Yeisley:
You know, looking at patients right from the beginning, getting that read, called baseline assessment from that first visit. So we know kind of previously, who is your support system. Who are your go to people? Whether that’s the people that are literally at the appointment with you or outside of the doctor’s office, who’s there for you. So we know kind of going in who we need to keep an eye on to begin with who might not have much support and then we can look for if there’s changes in that support. But also just looking at, we do a baseline depression screening. Depression and anxiety issues can be pretty normal within reacting to cancer diagnosis and looking for those changes. People who are, there’s changes in their memory and just changes in their ability to recall information. Can often come along with somebody who’s got some more emotional support needs.

Dr. Arnold:
I think every physician has had this experience in their career and some of us more than others, but you’re taking care of a patient for 10 years and let’s say they have some sort of chronic illness, emphysema. And they just progressed to get worse and every appointment over those 10 years, the spouse is with them. You know the spouse on a first name basis and really get to know the family. And then they pass the pass away, the patient passes away and then you see the spouse as a patient, not just as an advocate. And you realize they haven’t seen a doctor in 10 years because they’ve been busy because they’ve been taken care of others and neglect themselves. Do you see that sometimes?

Nancy Yeisley:
Yes, we do. And in fact within the last few years we’ve really keyed in more and more on the needs of the caregiver, the family caregiver, both at the Nassif Community Cancer Center as well as UnityPoint. You know, we work together. Especially with UnityPoint palliative care in that to look at identifying those needs of the caregivers and try to do things to help support that family caregiver along the way. We hold a retreat at Prairie Woods twice a year. We do other support visits sometimes just with the family member, without the patient. Who we can do a better job of supporting that caregiver so that they aren’t missing their doctor’s appointments. So that they are having somebody to talk to. If they are also eating well and get them to see as best as we can. That’s part of taking care of your loved one, is taking care of yourself or you won’t be there. You talked about other experiences. I can remember working in the ICU and being called down because there was a need for home health to get set up right away. And that’s unusual in the ICU. You don’t usually and but it’s because the patient brought in, was the caregiver at home for somebody. So, for instance, adult children. Dad’s now in ICU, but dad was the one taking care of mom. So now what are we going to do?

Dr. Arnold:
You may recall, I have at home patients that have home ventilators that I see them in the home. I mean the loved one that’s taken care of and that is their full time job. And they can’t, I mean, they can’t go to the grocery store unless they have a support system to help. And it really is a significant responsibility. Yeah, I think you hit it on the head though earlier with your comment about being in the Midwest. And I think they don’t want to be a burden. I hear that so often when we talk about in the life issues with patients is they don’t say, well, I have this religious fulfillment in my life and I’ll let nature take its course, or I want to live until I’m 105. They say, I don’t want to be a burden on my family. That’s the first thing they say and I respect them for that. You know, I think that’s being a responsible family member, but also we’re here to help and their family wants to help. And I think that’s so true with the patients. One last question. How did you end up at the cancer center? Why did you choose oncology? Because you used to be with hospice palliative care program.

Nancy Yeisley:
Yes. So my dad had cancer and that really, when I was young in my social work career, he had cancer and it really made me want to think more about helping people with cancer. And so I worked for hospice, for about 10 years. Worked when St. Luke’s started a palliative care program, worked with them. So then I was taking care of patients, a good share of them had cancer. But then now I’ve narrowed that scope farther.

Dr. Arnold:
Kind of getting upstream in the process.

Nancy Yeisley:
Yeah getting upstream in the process, but also narrowing down to instead of taking care of mostly cancer patients and some other diagnoses to being just cancer.

Dr. Arnold:
Taking care of a loved one or a patient. It’s a big responsibility. And the last thing that you want to hear when you come home at the end of the day is your spouse or your kid tell you, for a doctor at least, to tell me they’re sick. Oh my gosh, you’ve just been doing that all day. And I always think about the family members because they’re doing it 24/7 with no breaks. And I admire them, I really do. There’s a special place in heaven for those family members. Really great information day. Thank you so much for taking the time to talk about this. Again, this was Nancy Yeisley oncology social worker at Helen G. Nassif Community Cancer Center. For more information, visit communitycancercenter.org. If you have a topic you’d like to suggest for our live well talk on podcast, shoot us an email at stlukescr@unitypoint.org and we encourage you to tell your family, friends, neighbors about our podcast. Until next time, be well.

 

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