Jennifer: 0:03
Welcome to Cancer Care Connections. On this week's episode, Cheryl spoke with Kara DeMott, Urgent Care Physician Assistant, and Advanced Practice Provider supervisor with Virginia Oncology Associates. Kara breaks down the typical symptoms she sees in VOA's care clinic for those undergoing cancer treatment, how to manage those symptoms at home, and when to seek medical attention.
Cheryl: 0:30
We welcome to the show today Kara DeMott. Kara has been a physician assistant since 2011. She has worked in the emergency department and urgent care settings for more than 10 years. She joined Virginia Oncology Associates in 2022 to begin an urgent care program for the patients here. In her free time, Kara enjoys camping and traveling with her husband, three sons, and two dogs. Kara, thanks so much for sitting down with us today.
Kara:
Oh, no problem. Thanks for having me.
Cheryl:
Three sons? I have three sons as well, so I feel this affinity with you.
Kara: 1:03
Yes, three sons, and now it's actually three dogs too, and a cat. It's a zoo.
Cheryl: 1:08
It's a zoo and fun.
Kara:
Always fun
Cheryl:
Always fun. What made you decide to go into the healthcare field?
Kara: 1:16
So I like to say that I'm a science nerd. Growing up I really liked math, I really liked science. I actually thought at one point I was going to be a math teacher, but then really got into science and medicine and just really liked it and liked helping people.
Cheryl:
Oh, I love that.
Cheryl: 1:30
I love that. And your background is so interesting in that you started in emergency medicine but then you decided to move into oncology. How did that come together for you?
Kara: 1:43
So I worked in the ER for about seven and a half years and then I worked in an urgent care for about three, three and a half years. During that time my sister-in-law was diagnosed with leukemia. She was 25 when she was first diagnosed and she was actually a patient here. And so I wasn't super interested in oncology at first, but I quickly learned a lot, and so over the five years that she was ill I was researching and learning things, and so when I saw that this job was open at VOA, I applied because I thought it would be a good place to merge the two things together. And it all just kind of happened to work out.
Cheryl: 2:20
Would you say that this is true, that people, when they have this personal connection to oncology like it seems like you do, have you become more attuned to it?
Kara: 2:29
Oh, definitely, I know what the patients have been through. I know what their families are going through. I've seen the mental, the physical, the social effects, all of it. So it definitely gives me a different perspective.
Cheryl: 2:40
When you first came here, and it was in 2022, what was already here in terms of emergency response, emergency care?
Kara: 2:53
So, before I came, pretty much what they would do with the patients is they would add them on for the physicians to see, or the nurses would try to work them into their schedules if they needed something acutely. But there wasn't really a set process to get those patients in to be seen on a same-day basis.
Cheryl: 3:18
And so when you got here you knew that was kind of your role, right, to bring urgent care support to the facility. What was that like for you? What was the job that you needed to tackle right in the very beginning?
Kara: 3:23
So my first several months I was actually learning oncology. I rotated with all the different teams because I didn't know all the specifics of the oncology part. I knew the emergency medicine aspect but needed to merge the those two together. So while I was training here I was also developing the program. So we had meetings to set up all of the staff, the protocols, the location, all of those little logistics that we needed to work out, we were doing when I first started.
Cheryl: 3:53
I would love to get a little more clarity on what oncology urgent care really is. What does that mean? Who can get served by that? Who, as they're hearing this, if they're hearing this show, if they have a loved one who is a patient here, what does that mean for them?
Kara: 4:11
So if our patients are having any type of acute issue things like nausea or vomiting or a rash or they're feeling poorly from their treatments they can get a same-day appointment with one of our providers in our urgent care clinic. The goal, ultimately, is to keep our patients out of the hospital, and so we don't want our patients to have to sit in the ER and wait for hours if it's something that we can take care of here in the clinic. So we can do labs. They can be evaluated by a provider. They can receive certain treatments like nausea medicines and IV fluids. And then we also work with some of our community partners to get same-day imaging. So if they need a CAT scan or an ultrasound, we can set that up for that day, or even the next day if it's needed.
Cheryl: 4:56
What has been the reaction from patients, from staff, to have this facility that wasn't here before you got here, really in a formal sense? What has been the reaction to that?
Kara: 5:08
So the patients love it because they don't like to go to the hospital. And they will say that all the time, "I don't want to go to the hospital, I don't want to go to the hospital." And of course, sometimes they do need to go and I'll encourage them to go if they have something that truly needs to be seen in the ER. But overall the patients like to come to the same place that they're seen by the same providers and to get that same day service. The staff also appreciates it because they don't have to see all of those acute sick patients added into their busy schedules. They can get patients, patients can get a little bit better care as well because it's not stacked onto a busy day already for a provider.
Cheryl: 5:49
Let's talk more about some of the things you see in the C.A.R.E. clinic in terms of symptoms, and things that you treat. What are kind of the most common things that you see?
Kara: 6:00
The most common things are nausea, vomiting, diarrhea, constipation, all the GI stuff. And that's what most people think of when they think of cancer too, they think of somebody vomiting.
Chery: 6:12
Yeah, it doesn't feel good, but what moves it from okay, I'm gonna handle it in my house to I think I need to go somewhere, but I'm not quite ready to go to the ER. Like what makes it so somebody gets in their car to come to you?
Kara: 6:28
So typically our patients are gonna call into our triage line and our triage nurses are very good at giving home remedies, things that they can try at home. So things like eating a bland diet and you know, small, simple meals throughout the day, trying their nausea medications that their physicians have prescribed. You know those sorts of things at home and then if they're not working or it's getting worse, then they set them up to come into our clinic and be seen.
Cheryl: 6:56
At least now they have a place to go that is not the ER, where they could potentially wait a very long time to get seen. So let's go through. You said the GI stuff. So the nausea and vomiting, the diarrhea, the constipation, what are some tricks to help with each of them? So if somebody is listening at home, maybe has a loved one or is maybe sick himself or herself, if they're hearing it, maybe you could sort of give us some tips and tricks so they don't even need to pick up the phone. So nausea and vomiting?
Kara: 7:27
So with nausea and vomiting. I usually tell my patients that they need to eat small, frequent meals throughout the day. It's not the time to sit down and think that they can eat a full, you know, three-course meal at one time. The smaller meals, just keeping something on their stomach, will often help alleviate the nausea part. This is also not a time to diet, you know, no diets. Of course, we always want patients to eat healthy, but it's not the time or the place for extreme dieting, by any means. We also recommend the B.R.A.T. diet, so eating bland foods. You've probably heard of the B.R.A.T. diet: bananas, rice, applesauce, toast. I tell my patients to avoid fatty, greasy, or spicy foods and also to avoid milk products. Usually, those things are harsher on the belly and so they usually work. And then also to take the medications that their oncologist has prescribed. If they're feeling ill, take the medicines. Don't be afraid to try what the doctor has given you.
Cheryl: 8:27
It goes together, the B.R.A.T. diet or a blander diet, along with the medications they've already been prescribed, it does work together.
Great. Let's talk about diarrhea. Diarrhea is a common symptom of cancer treatment and can be an area of concern for many patients. What are some tips you can give our listeners on how to deal with diarrhea at home?
Kara: 8:48
So with diarrhea, over-the-counter IMODIUM® is your friend. So if you have more than roughly two loose stools, I would say, take the IMODIUM®. Follow the instructions on the box, and take it and see if it works, and see if it helps. You know, the diarrhea part, the big thing we worry about is dehydration. So you lose a lot of your fluids through having diarrhea and so we want to prevent that dehydration part because that makes it even harder to heal and, you know, just grapple with everything else going on. So IMODIUM® is your friend. In the oncology world, it's your friend. And of course, if the diarrhea becomes uncontrollable, if it becomes bloody or black, or if something just doesn't seem right or there is fever associated with it, that's when you need to call your oncologist.
Cheryl: 9:40
Well, we also know that we have loved ones who are listening to the show and are taking care of their loved ones. And so they also want to be aware, so they know when it's time to say, alright, time to get in the car, let's get moving. Speaking about moving, let's talk about constipation. Constipation is also a common side effect of cancer treatment. What advice would you give to someone if constipation is of concern to them?
Kara: 10:06
Normally, patients will have a bowel movement every one to three days, somewhere in that ballpark. But everybody's always hyper-focused on their stools, it seems like, especially in this setting. Over-the-counter medications that work are things like Colace® and MiraLAX®, and we recommend that our patients try those, especially if they're on pain medicine. Pain medications are known to cause constipation. It's a very, very common side effect, and so if we can prevent it, that's even better. The natural approach that some people also try is a teaspoon of mineral oil. Sometimes I'll tell them to mix it with some lemon juice and try that to make things go. So it's kind of hard to say exactly how often you should be having a bowel movement because every person is different. But as long as things are moving, then we're okay. If it gets to be way too long or you have pain or blood or something out of the ordinary, that's when you should call the physician.
Cheryl: 11:06
I think it's important to discuss this, to know, too, that if somebody's feeling these things, if they are constipated, if they are dealing with diarrhea, that it is normal in some cases. But also when it's not normal, here's what you should do and when. So thank you for sharing all of this. You mentioned earlier about the need to not get dehydrated. How can you remember to take more liquids? What tips or tricks can you have so that we can avoid dehydration, which is a huge issue?
Kara: 11:40
So I recommend always having some form of liquid next to you, whether that's water, Gatorade, Pedialyte, or whatever you like. Have it next to you as a constant reminder. If you see it, you're more likely to drink it. The other thing that I will sometimes challenge my patients to do is set out two or three water bottles so they know that they need to finish them by the end of the day and they can look at them. A lot of our patients also use things like Ensure and Boost to not only help hydrate but also really to get the protein in them as well, which is needed if they're not eating and drinking a lot of food.
Cheryl: 12:16
And you have your water bottle right next to you. And you're right. It is just a visual reminder, it is just something, it's like a habit, almost. And it's important to kind of keep that habit going as far as tiredness and fatigue. That's par for the course, isn't it? That's part of having treatment, chemotherapy treatment. What can you say to patients to help them kind of deal with that?
Kara: 12:41
So you're right, the fatigue comes along with the territory. You know I often tell my patients that the body heals when you're sleeping, when you're resting. So if you're tired, it's okay to rest, like that is what your body needs to do in order to, you know, fight the cancer. It needs to have adequate rest, but fatigue is going to come along with it. So sleep when you need to, rest when you need to. Don't try to overdo it. Of course, you know we like our patients to get up and move and, you know, try to do some activity, but we also don't expect them to go to the gym every day and work out five days a week and run five miles. You know, there needs to be a balance and we want to make sure that you know you get enough rest so that way you're not exhausted all the time as well. To not push it To not push it early or not when you're not feeling 100%
Cheryl: 13:26
To not push it To not push it early or not when you're not feeling 100%.
Kara:
Correct.
Cheryl:
Most people think of hair loss when they think of chemotherapy. What are some other side effects that can happen to the hair, as well as to the skin, during treatment?
Kara: 13:42
So rashes are common. I get a lot of rashes that happen with the skin. Some drugs cause it more than others. There are lots of different forms of rashes. So if there's any type of rash that you're worried about, certainly call your physician, you know, and make sure it's looked at before it becomes, you know, worse. You know the nails can change colors, the skin can change colors too, and a lot of that is normal. It doesn't necessarily mean that it's something bad. It's just a side effect that can happen with the chemotherapy.
Cheryl: 14:14
I think that's really good to point out things that you see in your office, people coming in, kind of to normalize again the things that you see other people go through because then they'll also see oh okay, this isn't great, I mean things happening with nails and skin, not great, but at least it's somewhat normal that you've seen before.
Kara: 14:38
Right, and a lot of our patients, you know there is hair loss associated with their chemotherapy drugs. You know there's a lot of options out in today's world. I feel like you know that there are hats, there are scarves, there are wigs. There are a lot of different things that can help normalize that a little bit more and make patients feel a little bit more comfortable when they do go through such a drastic change in their personal appearance.
Cheryl: 15:02
Yeah, I'm so glad you mentioned that. Thank you. Obviously, having a cancer diagnosis can be highly overwhelming, what do you suggest might help with their mental health during this time?
Kara: 15:14
So I think it's really important that we realize that cancer is not just a physical diagnosis. This is also a mental battle as well. You know, I tell my patients, don't be afraid to talk about it, to feel like, if you need to see a therapist or support group or anything along those lines, that that's okay; that this is a lot to deal with. It's not just the physical, but the social, the spiritual aspects and mental aspects.
Kara: 15:41
There's just, there's a lot to it. And it's okay to have to process that mentally, and so it's important that we take care of our mental health as well, so that way we can physically fight the battle that we're trying to get through. I also think it is important that our patients are honest with their family members and let them know what they need or don't need. Sometimes I'll have a patient say, "My family keeps bringing me food and I don't want them to, you know, but I'm afraid to tell them no because they're just trying to be helpful," you know. So sometimes just having those honest conversations helps alleviate some of that mental stress as well that comes with it. But don't be afraid to obtain whatever type of mental health you need in the forms of a therapist, support groups, medications, whatever is needed, because this is a marathon, it's not a short sprint. And we need to make sure we have all aspects of our health addressed during it.
Cheryl: 16:38
Do you sometimes get calls into the C.A.R.E. clinic where it is a little more mental health-focused versus some sort of physical reaction to treatment?
Kara: 16:48
It's probably not the main focus when they call in. Usually, there's something else going on, but oftentimes I'll find that some patients have some underlying depression or anxiety of not knowing what's going to go on or what happens, and we can address that during their visit as well.
Cheryl: 17:08
We've talked a little bit about this. We know that some side effects from chemotherapy can be treated at home, and you've been so great in sharing tips and tricks and things that people can be looking out for that are more common. When should you call your oncologist about your symptoms? When should you call someone else to get advice on what to do?
Kara: 17:29
That's a great question. So in the medical world, we say that there are some red flag symptoms that we tell our patients to look out for, and if they have any of them, to call us right away. Call us sooner rather than later. So anytime there's any fever over 100.4, a temperature over 100.4 is what we consider a fever, and especially in a cancer patient that's important because their immune system isn't strong, and so it's harder to fight an infection. So fevers are very important for us to know about.
Kara: 18:00
Some other things are abnormal bleeding. So any blood in the urine, blood in the stools coughing up blood, wounds that are bleeding, that won't stop. That's all concerning as well and we need to know about that. Any type of nausea, vomiting, diarrhea, pain, anything that just seems like it is not right. You know, patients always say I know my body, and it's true that they do know their body. And if something feels that it's not right, alert your physician. That's the best thing to do to find out what's going on. So another red flag is any type of new or worsening pain. So sometimes our patients have chronic pain that occurs just due to their cancer; where it's at, or a mass or tumor that they may have. But if they start to have new pain or it's different from the pain that they always have, that signals to me that something else could be going on and it needs to be evaluated.
Cheryl: 18:59
Your description of the red flags is so helpful, as people are listening and thinking okay, is what I'm feeling something that needs to be addressed by someone in a medical setting? But, as you were mentioning, I'm sort of thinking about the spiking fever. So if somebody, let's say, has a fever of 101, what do you suggest they do? Do they call right away or can they sleep on it?
Kara: 19:26
I would recommend that the patients call any time they are worried about a symptom. I recommend that they call their oncology team because I would rather a patient come in and be evaluated and we check them out and make sure that everything's okay, rather than they stay at home with something going on that could potentially be bad.
Cheryl: 19:48
But it starts with a phone call, so it could be a simple phone call to the team to say, hey, is this something that I should be concerned about?
Kara:
Correct.
Cheryl: 19:58
Okay, what is your vision for the care clinic?
Kara: 20:01
So, ultimately, I would love to have one of our urgent care clinics in every single office, not just within our practice, but across the country. Right now there are some other urgent cares in academic settings, but not necessarily in the community setting. And I think it's a great way to bridge the gap between the office and the ER and it allows for that intermediate area for our patients to be seen in hopes that we can avoid the ER as well as hospital admissions.
Cheryl: 20:30
Yeah, it's all about education, especially for this show, to help caregivers, loved ones, and patients themselves understand the process a little bit more. So this very difficult journey is made just a little bit easier because there's all this knowledge around. Where can you suggest people go to get more information, to get more education about this process?
Kara: 20:54
Our website, virginiacancer.com, has a lot more resources and information that both the patients and their families can use to obtain more information if they need it.
Cheryl: 21:06
Kara, thank you so much for taking the time to share your expertise, talk about what patients should be looking for, and some of the red flags that they need to pay attention to in order to get the help that they need.
Kara:
Thank you.
Jennifer: 21:25
That's all for this episode of Cancer Care Connections. Stay tuned for our next episode, where Cheryl will sit down with Dr. Devin Miller, a gynecologic oncologist with Virginia Oncology Associates. She will break down the types of conditions a gynecologic oncologist treats, how the role differs from a medical oncologist, and the exciting new treatment options becoming available for patients with a gynecologic cancer. Don't forget to subscribe to our podcast via Apple Podcast, Spotify, or anywhere podcasts are available, or listen online at cancercaerconnections.buzzsprout.com. Cancer Care Connections is the official podcast of Virginia Oncology Associates. For more information, visit us at virginiacancer.com or find us on Facebook or Instagram at Virginia Oncology Associates.