Thank you to our Veteran Volunteers

By Nichole Williams, MSW


FRH Mem. Day


We at Front Range Hospice would like to wish all of those who have served our Country a wonderful Memorial Day!

As part of the We Honor Veterans Level IV program, Front Range Hospice matches veteran volunteers to veteran patients.  This program developed out of the need for special care of veteran patients, due to their unique circumstances at the end of life.  In matching veteran volunteers with veteran patients, it is important to assess veteran volunteers’ military history and experience, to ensure there are no barriers in them serving patients and families.

As the Volunteer Coordinator for Front Range Hospice, I gather information from the veteran volunteers regarding what branch they served in, what their rank was, and if they were a combat veteran or non-combat veteran.  In addition, I inquire about their loss history, assess their level of comfort in being with the dying, and assess their comfort level in being with patients as they share their emotions.  I also discuss any service related trauma that they may have, and how they manage any ongoing mental health needs that they may have.

Veteran volunteers bring their military background and experience to their work in hospice, which allows them to offer life review and healing to patients who are veterans.  Being a veteran volunteer takes special skill and awareness.  Patients who are veterans feel a sense of comradery and connection when being visited by a veteran volunteer as they share common experiences, language, badges of honor, and stories of serving in the military. The services that veteran volunteers provide give patients and their families a sense of connection, a place to have their stories be “heard”, and for them to be themselves.

I want to say thank you for the tremendous service that our veteran volunteers, Jerry Kuntz, and Brian Strong, provide to our veteran patients, and the many other patients that they serve.  Both Jerry and Brian have brought their own experience and life stories, as well as an understanding of what patients who are veterans’ needs are.  They have both honored many patients who are veterans with the We Honor Veteran certificates, assisted in the pinning ceremony, and paid respect to patients by wearing their branch uniform when they visit.  Thank you Jerry and Brian!!!

For more information on how to get involved with the Front Range Hospice Veteran Volunteer Program or Hospice Services please contact us at 303-957-3101 or 970-776-8080.

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Amyotrophic Lateral Sclerosis (ALS)


By Victor Montour

Amyotrophic Lateral Sclerosis or better known as ALS is a progressive neurodegenerative disease that affects the nerve cells in the brain and spinal cord. A-myo-trophic comes from the Greek language. “A” means no. “Myo” refers to muscle, and “Trophic” means nourishment – “No muscle nourishment.” When a muscle has no nourishment, it “atrophies” or wastes away. “Lateral” identifies the areas in a person’s spinal cord where portions of the nerve cells that signal and control the muscles are located. As this area degenerates it leads to scarring or hardening (“sclerosis”) in the region.


The progressive degeneration of the motor neurons in ALS eventually leads to the demise of the motor neurons. When the motor neurons die, the ability of the brain to initiate and control muscle movement is lost. Voluntary muscle action is progressively affected, people may lose the ability to speak, eat, move or breathe. The motor nerves that are affected when you have ALS are the motor neurons that provide voluntary movements and muscle control.

There are two different types of ALS, sporadic and familial. Sporadic which is the most common form of the disease in the U.S., is 90 – 95 percent of all cases. It may affect anyone, anywhere. Familial ALS (FALS) accounts for 5 to 10 percent of all cases in the U.S., Familial ALS means the disease is inherited. In those families, there is a 50% chance each offspring will inherit the gene mutation and may develop the disease.

Recent years have brought a wealth of new scientific understanding regarding the physiology of this disease. There is currently one FDA approved drug, riluzole, that modestly slows the progression of ALS in some people. There is not a cure or treatment that halts or reverses ALS.

Who gets ALS?

Based on U.S. population studies, a little over 5,600 people in the U.S. are diagnosed with ALS each year. (That’s 15 new cases a day.) It is estimated that as many as 30,000 Americans have the disease at any given time. According to the ALS CARE Database, 60% of the people with ALS in the Database are men and 93% of patients in the Database are Caucasian.

Most people who develop ALS are between the ages of 40 and 70, with an average age of 55 at the time of diagnosis. However, cases of the disease do occur in persons in their twenties and thirties. Generally though, ALS occurs in greater percentages as men and women grow older. ALS is 20% more common in men than in women. However with increasing age, the incidence of ALS is more equal between men and women.

There are several research studies – past and present – investigating possible risk factors that may be associated with ALS. More work is needed to conclusively determine what genetics and/or environment factors contribute to developing ALS. It is known, however, that military veterans, particularly those deployed during the Gulf War, are approximately twice as likely to develop ALS.

Facts You Should Know

  • ALS is not contagious.
  • The life expectancy of a person with ALS averages about two to five years from the time of diagnosis
  • Once ALS starts it always progresses, eventually taking away the ability to walk, dress, write, speak, swallow, and breathe and shortening the life span.
  • ALS occurs throughout the world with no racial, ethnic or socioeconomic boundaries and can affect anyone.
  • Military veterans are approximately twice as likely to develop ALS.
  • The onset of ALS often involves muscle weakness or stiffness as early symptoms. Progression of weakness, wasting and paralysis of the muscles of the limbs and trunk as well as those that control vital functions such as speech, swallowing and later breathing generally follows.
  • There can be significant costs for medical care, equipment and home health caregiving later in the disease.

ALS and Hospice Care

The nurses at Front Range Hospice know most people with ALS experience several, if not many, of the following symptoms: respiratory insufficiency, fatigue, problems with mobility, pain, dysarthria, dysphagia, problems with secretions, involuntary emotion expression disorder (IEED), depression, insomnia, and constipation. These symptoms and less common symptoms are addressed by our hospice nurses along with possible interventions to maximize ones comfort and dignity.

If you would like more information about ALS or would like more information about Front Range Hospice please call 303-957-3101 or 970-776-8080 or email us at



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No Ugly Crying

By Victor Montour


February 27th wasn’t a typical Saturday around our house. We started the day as usual, getting up out of bed to let the dogs out. The sun was shining bright, with the cool sent of moisture in the air from the long cool night left behind. It was a glorious morning to be thankful for.

As the morning grew older my imagination started to awaken. I started imaging what the party we sent the RSVP to was going to be like. You see this is the first time I have ever been invited to a hair cutting party. Now you’re wondering what the heck is a hair cutting party. So let me explain.

In January a lovely lady we recently become friends with was diagnosed with stage 4 lung cancer. With a diagnosis like this I’m not sure I could handle myself with the grace, strength and love like she has. Her smile continues to light up any room she is in. Listening to her talk about her chemo treatment and her end of life plan with such confidence is amazing.

While she is planning her chemo treatment, putting her end of life plan in place and finding new housing for herself she has planned a unique party complete with friends, champagne and a full on head shaving. You see she didn’t want to go through the process of her hair falling out from her chemo. So, she chose to take control of the situation and turn something that could be devastating to a person into a time of love and joy.

The time has come for us to head to the party. In our invitation is a card that has been bedazzled with miniature pink daisies. A lady could never use to much color. We are now making our way to the destination listed on the invitations “Hanas Hope”. With a 60 minute commute ahead of us I started wondering what kind of place is Hanas Hope? I’ve never heard of it and to add to the excitement I opted to not Google the location.

When we arrived it was clearly a hair styling salon. We entered the salon and I must say I was in disbelief. I couldn’t believe what I was about to be witness to. The salon was not your typical hair salon. It didn’t have the overwhelming smell of perm solution or the subtle smell of hair coloring chemicals. What it did have was a very unique, welcoming feel to the salon. It was filled with all natural hair care products and an endless array of hats, scarves, head scarves and hundreds and hundreds of wigs. It was clear to us that Hanas Hope specializes in helping women maintain their dignity and beauty.

We were greeted by the owner who escorted us to an area in the shop which had a large dining room table and comfortable lounge furniture for us to relax and enjoy some Champaign. As the party started up we were all given a hand embroidered hanky with the words “No Ugly Crying” embroidered along the diagonal of one corner of the hanky.

The time has come for us to gather around the hair stylist’s chair. As the gentile hum of the hair clipper’s started you could hear the song pretty women start to play throughout the salon. For some the emotions were too much to handle so they quietly excused themselves from the group to take a minute to recompose themselves. Most of us remained at her side making jokes to lighten the mood while a few of her tears slowly rolled down her rose colored cheeks.

The actual hair cutting only took a couple of minutes. What happened next was amazing. The stylist finished cutting her hair and then placed the wig she had chosen on her head. Immediately the tears stopped flowing, the champagne toasts started. The smile and light of joy in her eyes as the stylist started cutting and shaping the wig to a custom fit was just amazing. When the stylist was finished cutting the wig, it was amazing. Our friend looked just like she did when she walked in the door. The hair style was amazing. I couldn’t believe how real and how amazing she looked. If I wasn’t present to witness this amazing transformation I would have never guessed she was wearing a wig.

I couldn’t imagine that day being anything better then it was. We all left feeling grateful we could be a part of something so special. I was so grateful the day was filled with love, joy, laughter and No Ugly Crying.

If you would like more information Front Range Hospice please call 303-957-3101 or 970-776-8080 or email us at

Watch out for our next blog: Amyotrophic Lateral Sclerosis (ALS)





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With Gratitude and Blessings

By: Nichole Williams, MSW Volunteer Coordinator


Volunteer Brenda and her therapy dog Lilly

In honor of Volunteer Appreciation Week 2016, I want to personally say thank you to all of our volunteers for their commitment, their time, and the incredible service.   Hospice would not be hospice without all of the amazing volunteers!!!

I have been working at Front Range Hospice since the beginning of the year, and I have been given the honor of working with our incredible volunteers through my role as the Volunteer Coordinator.  I have worked in hospice for 12 years, and know the value of the volunteer services.  It is such a pleasure to interact with each of them, to learn about their lives, and walk with them side by side as they provide incredible care to the patients and families that we serve here at Front Range Hospice.  I want to say thank you to ALL of our volunteers, for their kindness, their compassion, their time, and their ability to share with others in their end of life journey.

I asked two of our volunteers to share a little about what it is like to “be a hospice volunteer”:

Brenda shares:

I have been a volunteer of one sort or another for most of my adult life. I started as a pink lady at 18 (I was always taken for a candy striper because I looked so young), and have volunteered for a lot since then.  I volunteered for Attention Homes here in Boulder, as a respite house-parent, a mental health hot line called First Call for Help and one year as a Court-appointed Special Advocate (CASA). When my kids were little, I started two different support organizations for parents (Informed Parenthood – hosted speakers on issues relating to young children, and a Boulder chapter of a national organization supporting parents of gifted children.) I was active in those for several years.

When my dogs started bringing in what I call Goat-heads on their feet, I was challenged to discover the offending plant responsible, which expanded into an interest in identifying native plants. I took and then taught courses in the Native Plant Master program through the CSU Extension office. I volunteered through the Boulder Parks and Open Space department surveying rare plants in Boulder, and also with the Boulder County Parks and Open Space department in evaluation of revegetation projects.

When I was asked to serve as a Lay Eucharistic Minister for my church, I felt completely unworthy for that position, but I discovered how valuable and appreciated a few minutes of my time can be. My more recent volunteer positions are 7 years at the Longmont Humane society, walking dogs, working with them on behavior issues, and working as a receptionist at their clinic. I worked for one year at WOLF, which is a wolf and wolf-dog sanctuary west of Fort Collins. That was really cool.

In regards to why I volunteer as a hospice volunteer, I think that the short answer is because I can, and I get to take my dog. “Because I can” might seem confusing, but it’s like when I volunteered at the animal shelter. So many people would say, “Oh, I could never do that, seeing all those poor dogs. It’s so sad.” I’d tell them “You should try it, you might be surprised”. Hospice is like that. A lot of people think that they couldn’t do it, that it would be too emotional. So, I took my own advice with hospice, and tried it. When you realize what a few minutes of your time can mean to someone, how could you say no?

I volunteered at another hospice organization a few years ago, doing Pet Therapy with my white German shepherd, Maggie. But when she died suddenly of cancer, I didn’t think that my other dog, Lilly, was ready. Now I regret holding her back for so long. After getting her certification, a request came in from Front Range Hospice, and Lilly has been a real hit.

It’s always rewarding to be greeted with a big smile, and to know that the client is saying nice things about us to other people. But the most rewarding, I think, was the memorial service. I had to go through a memorial service in the atrium of a facility, to get to the stairway to visit a client upstairs. When I got to the stair landing, a woman stopped me, petted Lilly said “It’s OK.  My mother really liked dogs.” I went on up to my visit, and when I came back, the woman stopped me again and asked if I would take Lilly to say hello to her daughter, on the opposite side of the atrium. As we moved slowly and quietly around the back of the group, so as not to be disruptive, almost every person there reached out to pet Lilly as we passed and smiled a deep, heartfelt smile.  It was powerful, communal, experience, and a reminder that we touch not only the patient and their families, but sometimes the larger community as well.

When I talk to someone about my volunteering through Front Range Hospice with my dog Lilly, it usually starts with a complement to Lilly, and a question on what breed she is. (White German Shepherd and husky).  When I tell them that she’s a therapy dog and we see hospice patients, they sometimes say that they’ve thought of doing pet therapy work with their own dog. I explain to them that becoming certified as a therapy dog is really not as hard as they might think and I tell them how to go about it. Some organizations, like hospitals, have a rigorous training and testing program. For others though, the dog’s basic temperament is the most important. There are so many things you can do, from helping CU students to de-stress during finals week, to helping young children learn to read, by reading to your dog, and of course, hospice.

Pamela shares:

My father was diagnosed with terminal cancer in May 2004.  He immediately went into hospice care at home. He was only expected to live for approximately 6 weeks.  He lived for 5 additional months.  Partly because of his attitude and strong nature, and also because of the hospice care he received at home.  Hospice care enabled him to visit with family and friends, to continue many of the activities he enjoyed (golfing, wood work, etc.) and to have closure to his life.  They (hospice staff) were there for both of my parents during this time and they never felt alone in the entire process.

The most rewarding experience in hospice volunteering is meeting some incredible people who I otherwise would have never known, and being able to share their life experiences and thoughts.

Hospice volunteering is a unique experience.  It can be hard because you know that someone is approaching their end of life.  You know that they will pass and watching it can be hard.  It can be wonderful because you can make someone laugh during a difficult time, give them comfort, let them know they (and/or their family )are not alone, and just sit there and be a presence.  You learn that there are some unique wonderful people in the world, and you got to meet one of them and have them be a part of your life.

When someone knows that I do volunteer hospice work (I also volunteer at Longmont Humane Society), they usually comment on how they would never be able to something like hospice as it would be so hard to be around someone dying.  It is hard at times.  It is also something that I know we will all experience.  If I can make a positive effect for an individual or their family, then my life is enriched beyond understanding and I have gained more than anything I could have possibly provided to them.

Hospice volunteering takes a big heart, time, and a willingness to walk with patients and their families as they are dying.  It takes a person who is able to “be” with a person in their end of life process.  Walking this path with people can mean bearing witness to heartache, suffering, pain, grief and loss, and having to say goodbye.  The volunteers who provide care to the patients of Front Range Hospice are a tremendous gift to not only the patients and families, but also to the rest of the hospice team.  Our patients often have a deep connection with their volunteer, they truly are part of the team!

If you would like more information about Front Range Hospice and how to get involved in the volunteer program call 303-957-3101 or 970-776-8080 or email us at

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What to Ask When Looking For a Hospice

By Victor Montour


When people are trying to make decisions about which hospice to enroll in most want to choose a hospice that will deliver the best possible care for whatever time they have left. In order for most people to do this they need advice or information. So here’s my advice.

  • As a consumer you have the right to choose the hospice of your choice. It is unlawful for a healthcare professional to pressure you or make you use a hospice that you have not chosen.
  • You can ask your doctor for advice. Your doctor may be able to tell you the names of the hospices he or she have used in the past and their experience working with them. But also ask your doctor if he or she has a financial relationship with that hospice. Some doctors are employed by hospices, and may have a financial incentive to refer. So beware.
  • If a referral to hospice needs to be made while you’re in an acute care hospital setting, again you will want to ask if the hospice is affiliated to or owned by the hospital. Again beware, some hospital systems require their staff to refer to the hospital owned hospice with little regard to the patients wishes or choice. Remember you have the right to choice and must be allowed to choose the hospice you want to use.

As you are doing your due diligence I recommend you call the hospices in your area. Set up a time to interview your choices. During this interview you as a consumer should find out what you can expect from the hospice.

  • What services they provide? And when are the services provided? Listen to see if the hospice will work around your needs and preferences or are you put into a model of care that is centered around the hospice and its staff.
  • Does the hospice provide all four levels of hospice care?” (That’s routine home care, inpatient care, continuous care at home, and respite care). Medicare-certified hospices are required to provide all four, but many don’t. To learn more about the four levels of care in hospice check out our blog Do You Know The Four Levels of Care
  • The most important question to ask “Is your hospice certified by The Joint Commission or the Community Health Accreditation Program?” Abbreviated as TJC and CHAP, these are organizations that visit and inspect hospices regularly. As a consumer you have the right to see the results from the inspections. You will want to look for any patient care issues. A hospice with a large number of deficiencies or more deficiencies in patient care should be avoided as a consumer.
  • Another very important question to ask is “Are your physicians board-certified in hospice and palliative care?” This is a good indication that a hospice takes its medical care very seriously.
  • You will want to ask the hospice” Do you allow your patients to utilize their PCP while receiving hospice services?” If the hospice tells you, you have to use the hospice physician, beware again. As a consumer you have the right to use your primary care provider as the physician to direct your care on hospice. This being said, you may have to change physicians if you choose to be placed in a skilled nursing facility or are receiving care in a facility that only allows physicians to provide care that are credentialed to provide care in the said facility.
  • Ask does the hospice measure and improve the quality of care that they provide to their patients? If they reply yes your next question needs to be How?” Any hospice that doesn’t have a quick and clear answer for this question probably isn’t serious about patient care.
  • Does the hospice have any special programs or other certifications?
  • You could ask what makes their hospice stand out among the rest.

Finally, one last word of advice. Choosing wisely takes time. So start thinking early about what hospice you’d want when the time comes. How early? People typically enroll in hospice very late. More than half of patients in the U.S. enroll in the last three weeks of life, and about a third enroll in the last week. That’s too late to make careful decisions. So start asking questions now. Think of it as insurance, so when the time comes — as it will, for all of us — you’ll be ready to make a thoughtful choice that’s consistent with your preferences.

If you would like more information about Front Range Hospice please call 303-957-3101 or 970-776-8080 or email us at


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Metastatic Cancer

By Victor Montour

What is metastatic cancer?

Metastatic cancer is cancer that has spread from the original place the cancer started to another place in the body. Any tumor formed by metastatic cancer cells is called a metastatic tumor or a metastasis. Metastatic cancer has the same name and the same type of cancer cells as the original or primary cancer. For example, breast cancer that spreads to the lung and forms a metastatic tumor is called metastatic breast cancer, not lung cancer. Most people who sure come to cancer sure come to metastatic cancer.

Can any type of cancer form a metastatic tumor?

Virtually all cancers, including cancers of the blood and the lymphatic symptom can form metastatic tumors. Although rare, the metastasis of blood and lymphatic cancers to the lung, heart, central nervous system, and other tissues has been reported.

Where does cancer spread?

The most common sites for metastasis are listed in the table below. Although most cancers have the ability to spread to many different parts of the body, they usually spread to one site more often than others. Please note the table below excludes the lymph nodes for several types of cancers.

Cancer type Main sites of metastasis
Bladder Bone, liver, lung
Breast Bone, brain, liver, lung
Colorectal Liver, lung, peritoneum
Kidney Adrenal gland, bone, brain, liver, lung
Lung Adrenal gland, bone, brain, liver, other lung
Melanoma Bone, brain, liver, lung, skin/muscle
Ovary Liver, lung, peritoneum
Pancreas Liver, lung, peritoneum
Prostate Adrenal gland, bone, liver, lung
Stomach Liver, lung, peritoneum
Thyroid Bone, liver, lung
Uterus Bone, liver, lung, peritoneum, vagina

How does cancer spread?

Cancer cell metastasis usually involves the following steps:

  • Local invasion: Cancer cells invade nearby normal tissue.
  • Intravasation: Cancer cells invade and move through the walls of nearby lymph vessels or blood vessels.
  • Circulation: Cancer cells move through the lymphatic system and the bloodstream to other parts of the body.
  • Arrest and Extravasation: Cancer cells arrest, or stop moving in small blood vessels called capillaries at a distant location. They then invade the walls of the capillaries and migrate into the surrounding tissue
  • Proliferation: Cancer cells multiply at the distant location to form small tumors known as micrometastases.
  • Angiogenesis: Micrometastases stimulates the growth of new blood vessels to obtain a blood supply. A blood supply is needed to obtain the oxygen and nutrients necessary for continued tumor growth.

The ability of a cancer cell to metastasize successfully depends on its individual properties. Not all of the steps above are needed for metastasis to occur.

Symptoms of metastatic cancer

Some people with metastatic tumors do not have symptoms. Their metastases are found by x-rays or other testing. When symptoms occur, the type and frequency of the symptoms will depend on the size and the location of the metastasis.

Can you have a metastatic tumor without having a primary cancer?

No, a metastatic tumor is always caused by a cancer cell from a primary cancer located in another part of the body. However, in some patients a metastatic tumor is diagnosed but the primary tumor cannot be fund, despite extensive test, because it either is to small to see or has completely regressed. The pathologist knows that the diagnosed tumor is metastasis because the cells do not look like those of the organ or tissue the tumor is found in.

Treatment for metastatic cancer:

Your oncologist will work closely with you on a treatment plan and provide you options with the most successful treatment for the primary or metastatic cancer you or your loved one may have. We recommend that you talk with your oncologist or primary care doctor about your treatment goals and options. With this conversation we all so recommend you talk to your family and doctor about options if treatment fails or is not an option due to a decline in health.  It is never too late to have the conversation about your end of life wishes.

If you would like more information about Front Range Hospice please call 303-957-3101 or 970-776-8080 or email us at

Watch out for our next blog: What to ask when looking for a hospice.


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Thank you, Social Workers!

By Lydia Appling, MSW, LCSW

thank you

Please join all of us at Front Range Hospice this month by showing your appreciation for social workers. Front Range Hospice would like to say to all of our fellow Social Workers….. Thank you…. We thank you for your hard work and your dedication to ensure the clients in our communities are well served.

Social work is a profession concerned with helping individuals, families, groups and communities to enhance their individual and collective well-being. It aims to help people develop their skills and their ability to use their own resources and those of the community to resolve problems. In hospice social workers meet people who have the impression social workers only help low income families who need help to apply for public assistance. You can find a social worker anywhere now days. You can find them in schools, healthcare systems, counseling centers, military bases, judicial systems, legislation or perhaps in line at the grocery store. Ones income does not dictate who may utilize the services provided by a social worker.

There are a vast array of areas a social worker may focus their career on. Most people think of a social worker as a child and family social worker who makes their primary focus to protect vulnerable children and support families in need of assistance. You will be surprised to learn that Social workers help people solve and cope with problems in their everyday lives. One group of social workers, clinical social workers, also diagnose and treat mental, behavioral, and emotional issues that most people deal with on a daily basis or perhaps during a crisis. The social worker is an invaluable role needed in the healthcare field.

Social workers provide an enhanced level of communication. It all starts at a basic level of listening to hear the specific needs, then assessing to understand the need of a patient or the family. While following up with the patient and family to ensure the needs have been met. During this time the social worker is building trust, offering respect and dignity while providing support and compassion without judgment. Advocacy, advocacy, advocacy. A social worker is your best advocate, another primary intervention the social worker uses to help someone communicate their needs while empowering people to take action or control for themselves.

It is this commitment to help individuals, families, groups and communities to enhance their individual and collective well-being that makes social workers a very special group of people. We are willing to give a little of our self for the wellbeing of a stranger. That being said, I found the following quote on line and it just resonated with me. “Doctors and Nurses Cure The Patients, But The Social Workers Heal The Families”.

If you would like more information about Front Range Hospice please call 303-957-3101 or 970-776-8080 or email us at

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