About Your Office Appointment
Emergencies & Phone Calls
Prescription Refills
Managing Side Effects
Test Results
Medical Records
Physical Appearance

About Your Office Appointment

Cancer Care Associates is a medical practice specializing in the evaluation and treatment of patients with problems related to cancer and diseases of the blood. The Practice physicians are board certified internists with specialties in oncology and hematology. They do not practice primary internal medicine; therefore, we recommend that you maintain relationships with your internist, cardiologist, gynecologist, etc. In order for us to serve our patients more efficiently, we would like to share some information about your appointments:

We request that you be on time for your appointment. All patients are encouraged to arrive at least 15 minutes prior to their appointment time. A blood test may be required prior to your physician or treatment appointment.

Physician appointments for new patients are one hour in duration and appointments for established patients, 15-30 minutes. Nursing visits are on a similar schedule; however; they are booked separately from a physician's appointment.

If you are unable to keep an appointment or arrive on time, please notify our office as soon as possible. We will make every effort to see you in a timely manner; however, because of the nature of our practice, it may be necessary that you re-schedule your appointment.

If you are a new patient, you will complete a Patient Registration Form and History and Physical Form. These will become a part of your permanent record. To complete this properly, you will need all health insurance information as well as the names of all physicians who are presently, or have previously treated you. It is helpful if you bring a list of all current prescription medications with you.

We encourage you to make a list of questions before each visit. In addition, you may find that bringing a friend or family member to help with communication is often beneficial.

When you come in for routine appointments, you will be asked to complete a Progress note. This will enable us to update any changes that have occurred since your last visit.

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Emergencies & Phone Calls

IN THE EVENT OF AN EMERGENCY: Immediately call the office. The office nurse will do her best to resolve the problem over the phone, have you come to the office for an evaluation or send you to the emergency room at William Beaumont Hospital in Royal Oak or Troy. If you are certain a medical emergency exists, go immediately to one of these two emergency rooms. We will be contacted upon your arrival.

If an emergency arises and you need to contact a physician after office hours, please call our regular office number, 248-551-6900 and you will be connected to our answering service. The physician on call will handle problems that arise after regular hours, on holidays and on weekends. Response to your call is usually immediate however if you feel you are unable to wait for a return phone call, please go to the emergency room at William Beaumont Hospital, Royal Oak or Troy. A physician from the practice will be contacted upon your arrival.

Please Call if Problems Occur

• If problems or changes in your condition arise between your appointments, please call our office and discuss your problem or concern with one of our registered nurses. All our nurses have special training in oncology and will respond to your call or refer you to one of the physicians in the office.
• For calls concerning medications, please have the labeled medicine, pharmacy name, location and telephone number available. Nurses call in prescription refills at the end of the day. We encourage you to get all prescription refills at the time of your office visit.
• If your phone call concerns a non-emergency problem and the nurse cannot answer your question, a physician will return your call over the lunch hour or after 5:00 p.m.

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Prescription Refills

We recommend that you anticipate your prescription refill needs and have any necessary prescriptions written during your scheduled office visit or treatment when a medical assistant reviews the medications you are currently taking or have discontinued. Please bring your pharmacy number along with the container of medicine that needs to be refilled. It is also very helpful if you obtain a printout of all prescribed pharmaceutical medications from your pharmacist. Most of the large chains have the capability to provide you with this and having it on file allows us to see at a glance all the medicines you are taking – whether prescribed by us or another physician participating in your care.

If you do not have an appointment scheduled and will be running out of your medication, please call our office as early as possible during regular office hours for your refill of non-narcotic prescriptions. Nurses typically call in prescription refills at the end of the day. On weekends and on some holidays, pharmacies are closed so you will want to make sure your medication is refilled before. Also, it is important to note that we do not routinely refill prescriptions that were not originally prescribed by one of our physicians.

Please remember that prescriptions for most narcotics cannot be called in and require a written prescription. Allow for extra time in this case should you need to come and pick up the prescription or wait to receive it in the mail.

Patients with mandated “mail-away” prescription coverage are requested to call the office two weeks prior to needing the medication. Patients are responsible for mailing the CCA prescription to the pharmacy.

Don't forget, the Royal Oak office does have an on-site pharmacy. Ask your health care provider if your prescription can be filled while you are being seen or receiving treatment.

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Managing Side Effects

1. DIARRHEA

Some chemotherapy drugs, radiation, and infection may cause diarrhea. This happens when food passes quickly through the bowel before the body gets enough vitamins, minerals, and water. Diarrhea can cause dehydration and electrolyte imbalance.

The following instruction is a guide to use if diarrhea occurs:

• Notify your physician or nurse if you are experiencing three or more watery stools per day.
• Drink 6-8 glasses of liquids per day.
• Drink fluids such as fruit juice, tea, Gatorade, and soup.
• Avoid carbonated beverages that can aggravate diarrhea.
• Eat plenty of foods and liquids that contain salt (sodium) and potassium. These are minerals important to the body and are lost when you have diarrhea.
• Avoid extremely hot or cold foods.
• Avoid milk or milk products.
• Avoid spicy or fatty foods and foods high in fiber such as whole grain bread and cereal, fresh fruit, raw vegetables, and popcorn.
• Avoid rich pastries, caffeine, alcohol and tobacco.
• Eat small amounts of food and liquids throughout the day instead of three large meals. Suggested are eggs, rice, yogurt, broth, applesauce, broiled or baked chicken and fish, pasta, canned fruit and cooked vegetables.
• If diarrhea is severe, the physician or nurse may advise a clear liquid diet for 12-24 hours.
• Keep rectal area clean and dry using mild soap and water.
• If experiencing discomfort, soak in a tub of warm water and the use of a topical cream (i.e., Desitin) may be helpful.
• Over the counter antidiarrheal products, such as Imodium AD, may be used according to package directions. Ask your physician or nurse for further information.

Call your physician or nurse if the following symptoms occur with the diarrhea:

• Lightheadedness
• Fever
• Inability to urinate for 6 hours or more and
• If diarrhea continues despite measures taken.

DIARRHEA PROTOCOL

Imodium AD, 2 capsules after first loose stool, then one capsule after each subsequent stool.  Take no more than 8 capsules in 24 hours.  If not controlled in 48 hours, call the office.

FOODS TO AVOID WHEN DIARRHEA OCCURS

• Milk and milk drinks--limit to 2 cups per day
• Meats with large amounts of tough connective tissue
• Raw vegetables with tough skins or seeds
• Dried beans and peas
• Corn
• Pumpkin, squash
• Gas-forming vegetables such as broccoli, brussel sprouts, cabbage, onions, cauliflower
• Cucumber, green peppers, rutabagas, turnips, sauerkraut
• Olives, pickles
• Tough skins on fruits
• Dried fruit
• Berries and figs
• Very coarse cereals such as bran, bran flakes, shredded wheat, granola, wheat germ
• All whole-grain, rye and wheat products
• Seeds in or on breads, rolls, or crackers
• Breads or bread products made with nuts or dried fruit
• Potato chips or other snack chips
• Popcorn
• Chunky peanut butter
• Nuts
• Coconut
• Sweets and desserts containing nuts, coconut, or fruits that are not allowed
• Cloudy juices

2. CONSTIPATION

Constipation is a common problem for cancer patients. Pain medications, certain chemotherapy drugs, poor food and drink intake as well as decreased activity can all contribute to the development of this condition. Constipation is present when there is difficulty passing a stool. While a person may normally have one stool a day, another person may move his bowels every other or even every third day; as long as the person does not have difficulty passing the stool, he is not constipated. Remember, prevention of constipation is preferable to treatment.  Your goal should be to prevent constipation rather than having to treat it. 

DIET AND FLUIDS

It is important to get enough bulk in the diet to stimulate the bowels and enough fluids to keep the stool soft. You should drink at least 6-8 glasses of fluids a day and try to eat bulk-containing foods such as fruits, vegetables, and grains. Limit your intake of foods that can contribute to hard stools, such as cheeses, meats and rice. (If you have special dietary needs, a consultation with the registered dietitian might benefit you. Your nurse can arrange for such a meeting).

ENVIRONMENT

Exercise helps stimulate digestion and prevent constipation. Simple walking is an activity most patients tolerate well. Just being out of bed as tolerated is helpful.  Responding to the urge to have a bowel movement is important in order to develop a pattern natural for you.

TO PREVENT CONSTIPATION

• Drink 6-8 glasses of fluids daily.
• Eat bulk-producing foods and limit binding foods.
• Maintain activity as much as possible.
• Develop a pattern of elimination.
• If constipation occurs, or for patients on regular doses of narcotics, the laxative protocol is initiated.

CONSTIPATION PROTOCOL:

1. Senokot 1-2 tabs orally at bedtime (5 cc syrup + 1 tab), may increase up to 8 tabs daily in divided doses.
2. If Step 1 is ineffective---Milk of Magnesia 30 cc at bedtime.
3. If the above is not effective, 1/2 bottle of Citrate of Magnesium. If you don't have results in 6 hours, take the rest of the bottle.
4. If Steps 1 to 3 are not effective, call the office.

3. NUTRITIONAL MANAGEMENT

For Nausea and Vomiting

What Is Nausea?

Nausea is defined as a feeling of revulsion to food or liquids that may or may not be accompanied by vomiting. Nausea is a common side effect of drugs or radiation. Control of nausea is important to help prevent vomiting. Vomiting often accompanies nausea, and may be brought on by food odors, gas in the stomach or intestines, motion, or drug therapy.

Those people who have nausea and vomiting due to chemotherapy or radiation will be glad to know that there are a variety of ways to help relieve these side effects through diet, medications and relaxation methods.

Helping You Eat While Nauseated

• If you are experiencing nausea and vomiting after your chemotherapy treatment, try taking your nausea medication the night before your treatment and continue through the first 48 hours after treatments (even if you are not experiencing nausea).
• Take your prescribed anti-nausea medication 1/2 hour to 1 hour before eating.
• Use a clear liquid diet to reduce the feeling of nausea. Liquids such as apple juice, cranberry juice, lemonade, fruitades, broth, Gatorade, ginger ale, 7-Up, popsicles, gelatin, tea or cola are usually well tolerated. Sip liquids slowly through a straw.
• Eat dry foods like toast and crackers, especially after awakening in the morning.
• Use smaller portions of food that are low in fat since they are easier to digest and move through the stomach faster. If you are eating smaller portions of low fat foods, be sure to eat more often to keep up with your calorie and protein needs.
• Try salty foods.
• Avoid overly sweet foods.
• Avoid greasy foods.
• Avoid mixing hot and cold foods.
• Avoid liquids at mealtimes. Take them 30 to 60 minutes before or after eating.

4. GENERAL NUTRITION

Good nutrition is always important while receiving your cancer treatment. You need an adequate daily supply of calories, protein, vitamins, and minerals in order to promote healing. A good diet will help to promote healing and aid in minimizing side effects. An appointment to speak with a registered dietitian may be arranged through the nurses.  Here are some recommendations to aid in promoting good nutrition:

• Drink two or more cups of milk daily. Cheese, cottage cheese, ice cream, or yogurt may be substituted.
• Eat at least two 4-ounce servings of meat daily. Eggs, cheese, beans, or peanut butter may be substituted.
• Eat at least two fruits daily. One should be a citrus fruit, such as orange, grapefruit, or tomato.
• Eat at least two servings of vegetables daily. Please include dark green vegetables or a dark yellow vegetable.
• Eat at least four servings of grains or breads, such as bread, cereal, oatmeal, rice, or pastas.
• Liberally add butter.
• To increase calories and protein, eat nourishing snacks or add liquid supplements such as Instant Breakfast, Ensure, or Sustacal.
• Drink plenty of fluids; 4-8 glasses daily (1-2 quarts).

You may wish to eat six to eight small or "light" meals rather than two or three regular meals daily. Don't allow yourself to feel either "too empty" or "too full". To avoid nausea, keep in mind you may wish to avoid greasy, fried, or spicy foods. If you find cooking smells annoying, keep in mind that cool or chilled foods have little aroma. Remember to eat slowly and chew food well. A pleasant atmosphere or meals enjoyed with friends and family often help to stimulate your appetite. Enjoy desserts as they provide needed calories and carbohydrates. Dietitians are able to provide additional recommendations and recipes.

5. ORAL HYGIENE

Patients receiving chemotherapy may experience mouth sores.  Here are recommendations for care of the mouth:

• Brush your teeth gently with toothettes or a very soft brush four times a day (after meals and at bedtime).
• Rinse your mouth well with a rinse made of one-teaspoon salt, one-teaspoon baking soda to one quart of water.
• Rinse after meals and at bedtime. Use as prescribed starting the day of your first treatment.
• Examine your mouth daily for redness, bleeding, or white patches.
• Check with your physician before having any dental work done.

Call your physician for the following:

• White patches in mouth;
• Sores or blisters in mouth;
• Bleeding from gums; or
• Temperature over 100.5 F orally.

Special care for sore mouth, dry mouth, or difficulty swallowing:

• Avoid highly acidic foods and juices such as tomato or orange juice.
• Use spices sparingly.
• Avoid alcoholic beverages and mouthwashes that contain alcohol.
• Put foods in blender to make them easier to swallow.
• Eat soft, moist foods.
• Eat frequent, small meals.
• Leave dentures out, avoid tooth picks and dental floss.
• Try artificial saliva.
• Use cold foods instead of hot foods.

Disability Forms

At some time during your cancer treatment, you may have to apply for a medical leave of absence from work or realize that you must communicate with insurance companies and financial institutions about your inability to work. In all these cases, you must complete a disability form. The staff of Cancer Care Associates is committed to your total care and can help to make this process a little easier.

In order to speed up the process and complete the form correctly, there are several things that you can do. There are always two portions to the claim form---the patient's and the physician's. Please be sure to complete your portion in its entirety.

Patients are always asked the following questions.

1. Your last date worked.
2. If you were hospitalized, where and when your confinement began. This is particularly important to fill in, since you may have been hospitalized outside of the William Beaumont Hospital facilities and we wouldn't be able to secure that information.
3. Do you want to or plan to return to work in the future? If so, the approximate date.
4. You will be asked if you are physically or mentally able to manage your financial affairs, or if the form is being completed by an individual who has "Power of Attorney" for you.
5. Please be sure to sign your portion of the form after it is completed.

In order to expedite this process, please tell us where you want us to route the form. Some patients ask that we mail it to them or an institution, but others ask to pick it up in the office.  Also, please indicate the date that you need this form completed by our staff and physicians. Remember, CCA must complete a portion on the form.  This requires pulling your chart and securing information, filling in the requested information and securing your physician's signature. Your physician may be on rotation at the hospital or out of the office, so it is imperative that you to give this process as much time as you can. There is a $10.00 fee placed on your account for the completion of these forms. If you have any questions about this process, please call at Medical Records at 248-551-6944.

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Test Results

As a patient undergoing treatment for cancer, you will likely find yourself undergoing many physical tests involving laboratory, x-ray, and nuclear medicine. You will want to get those results as soon as possible. Many of these tests are done at both of our offices but many are also done at the Beaumont Hospitals. Most tests are completed within 1-4 days. If a test is done outside of the Beaumont system, we have no control and cannot estimate the time it takes to receive results. If you are to have any diagnostic testing scheduled, please do not leave our office without a prescription.

If you are having difficulty scheduling your appointment please contact our office so that we can assist you.

We think of your care as a partnership, and the staff will make every effort to get your test results as soon as they are available. Remember that your doctor reviews every test result before it is communicated to you so additional time may be necessary.

In order to get your results as soon as possible, you should refer to the chart below. It indicates the test and the working days required in order to process the test. Working days are Monday through Friday.

RADIOLOGY & NUCLEAR MEDICINE

Reports for the following procedures can be obtained in 1 to 4 working days from the Beaumont Hospitals, but usually require at least 2 days:

Bone Scans                     MUGA Scans

Mammograms                 Other Scans

MRI

Wellpointe Imaging Center (located in suite B50 of the Wellpointe Medical Building) guarantees results back within 24 hours for the following:

CT Scans                        X rays

Ultrasounds                    Doppler Ultrasounds (deep vein thrombosis)

Bone Density Studies

We view your care as a partnership, and the staff will make every effort to get your test results as soon as they are available

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Medical Records

Because of patient confidentiality, we cannot release information about our patients without the patient's written consent. If you have a question about this, please consult our medical records department at 248-551-6944.

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Physical Appearance

Please call before visiting any of these businesses - - most are not open 7 days per week.

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