33 minute read
Marking Breast Cancer Awareness Month
According to the American Cancer Society, the good news is we are making progress. Breast cancer death rates declined 40 percent from 1989 to 2016 among women. The progress is attributed to improvements in early detection, a new personalized approach to treatment and a better understanding of the disease.
After skin cancer, breast cancer is the most common cancer diagnosed in women in the United States. Breast cancer can occur in both men and women, but it's far more common in women.
When breast cancer is detected early, and is in the localized stage, the five-year relative survival rate is 99 percent.
Many breast cancer symptoms are invisible and not
Progress: “Little by little becomes a lot”
–anonymous By Christine Fanning
noticeable without a professional screening, but some symptoms can be caught early just by being proactive about your breast health. That means doing monthly breast selfexams and scheduling regular clinical breast exams and mammograms.
In other news, although a decades-long decline in the breast cancer death rate continues, breast cancer incidences are on the rise by 0.3 percent per year since 2004, largely because of rising rates of local stage (confined to the breast) and hormone receptor-positive (HR+) disease. (Women with hormone receptor-positive cancers tend to have a better outlook in the short-term.) The increase in rates of HR+ breast cancer is likely driven in part by the increasing prevalence of excess body weight and declining fertility rates – risk factors that are more strongly associated with this subtype. In contrast, incidence rates have decreased for hormone receptor-negative breast cancer, which is associated with poorer survival.
The lifetime risk of a breast cancer diagnosis is now rounded to 13 percent (12.8 percent, previously 12.4 percent), which still equates to about 1 in 8 women diagnosed with breast cancer in her lifetime.
The 10-year probability of a breast cancer diagnosis is highest for women in their 70s (4 percent), whereas the 10-year risk of breast cancer death is highest in women in their 80s (1 percent).
As of January 1, 2019, there were more than 3.8 million women with a history of breast cancer living
in the United States. This estimate includes more than 150,000 women living with metastatic disease, three-quarters of whom were originally diagnosed with stage I, II or III breast cancer.
Consider the stories of two area women who joined the ranks of breast cancer survivors:
Leah-Kay Ducato Rudolph
“I was due to have my annual routine mammogram in March of 2020, but COVID disrupted my
schedule. When I finally went in September 2020, it was discovered I had 'won the booby prize.’ What? Me? There is no history of breast cancer in my family, I have few risk factors, and being postmenopausal, thought I was out of the woods with fibrocystic breast disease. However, a small 9 mm lump found on the mammogram was not there in March 2019 at my prior appointment when I had my first ultrasound for ‘dense breasts’ and not palpable. I will always wonder about the scenario that may have played out had I had the mammogram in March 2020 - would it have been too small and missed, giving it the opportunity to grow larger (and spread) by 2021? Very possibly...
A biopsy of the tumor showed it to be invasive lobular carcinoma, grade 2, ER POS (90%), PR NEG (0%), Her-2 NEG (1+), Ki-67 10%. Lobular is considered a sneaky cancer that travels, so an MRI was performed and demonstrated the cancer appeared to be localized and caught early.
In November, Dr. Kristine Kelley performed a lumpectomy. The lump and four sentinel nodes were removed. A biopsy of the actual tumor coupled with an Oncotype DX score showed I would benefit from chemotherapy, followed by radiation, followed by endocrine therapy. However, I was fortunate: margins were 'clear;’ the four lymph nodes removed were clear; my Oncotype DX score, which indicated the need for chemo, while borderline, was low. There was a lot to be thankful for.
Four infusion treatments of chemo were scheduled. About two weeks after the first chemo treatment, my scalp became extremely painful to the touch. My physician husband, Ken, did some research and as itching is a form of pain, believed that Neutrogena T/Gel shampoo would give me relief and it did! My short, wavy hair was starting to fall out. Everyone began buying me cute (and greatly appreciated) hats. One's head does get very cold without any hair.
About a month after I finished chemo my hair began to grow back, grey, soft and curly; hair grows 1/4 inch a month after chemo. Inevitably, shortly after I noticed my eyebrows were sadly thinning, and then my eyelashes. I took it as a good thing as that meant the chemo made it to my
head. Of course, I already knew that, having experienced the memory losses and annoyances of ‘chemo brain.’
I finished radiation treatments with some redness under my breast and a yeast infection. I used an over-the-counter astringent powder used to make a wash, rather than yet another antibiotic to solve the yeast infection.
On April 14, 2021, 38 years after giving birth to my first child, I started taking Tamoxifen. I will take it for five years to hopefully prevent a recurrence as it blocks estrogen. It does have side effects; my postmenopausal night sweats have returned and occur at any hour of the day.
I have since learned at least five other women I know were diagnosed with breast cancer this pandemic -- one is a first cousin who ironically had intraductal cancer 15 years ago and now has lobular -- and another dear friend has passed due to a reoccurrence. I was advised to have genetic testing, and I'm grateful to report there were no markers for cancer; even so, my daughters are considered high risk and have been advised to begin routine mammograms at age 40. In the next five years, I'll alternate mammograms with MRIs every six months.
I’m considering this journey a ‘blip on the screen,’ I have turned it all over to the Lord. It has been comforting to know so many people cared, and prayers were all I needed -prayers for patience, healing and of course, strength to do what I had to do.
My faith, family and friends have, and will, continue to support me, thanks be to God.
– Leah-Kay
Ducato Rudolph, Clarks Summit
Deb Stone
“I live in Old Forge with my husband Bill and
daughter Liz. I was 35 years old when I was diagnosed, and had given birth to our beautiful baby girl just four months prior to receiving the diagnosis. I found a lump in my breast and doctors initially thought it may be a postpartum blocked duct. Upon further examination (mammogram, ultrasound and then a biopsy) I was diagnosed with breast cancer. I received my diagnosis on Presidents' Day and will never forget the surreal feeling. I had been on an emotional high from having our baby girl and this diagnosis was a jolt to my joy. I was young, had no
family history of breast cancer, no detectable risk factors, no reason to be watchful for breast cancer. Hearing the news took my breath away. ‘What now?!’ I thought. Immediately, family and friends came forward to offer assistance. I needed to act quickly, but I needed to become educated on my type of breast cancer. I was scheduled for additional testing and consultations with medical professionals including surgeons, oncologists and radiation oncologists. We had to understand how pervasive the cancer was, if there were detectable metastases to other areas, etc. The educational process and treatment were swift, as it needed to be. I had been told that my cancer had grown exponentially in just a few weeks from the time of biopsy to my next ultrasound.
My course of treatment was chemotherapy in advance of surgery to shrink the cancer. I had four rounds of chemotherapy, one round every three weeks for a total of 12 weeks. An ultrasound was conducted after two treatments to confirm that the cancer was shrinking. After my last chemotherapy treatment, I was scheduled for surgery. My surgeon explained to me that the cancer had shrunk to the point that it was hardly detectable by mammography. My surgeon performed a lumpectomy to remove what was left of the cancer. Lymph nodes were also removed and tested. Thankfully the lymph nodes were negative for cancer. After healing from surgery, I began six weeks of radiation therapy. Radiation was administered five days a week for a full six weeks. I finished my treatments midSeptember 2001. I experienced the expected side effects from my treatments including hair loss, energy loss and fatigue and some unanticipated side effects, including mouth sores where it hurt to smile or eat. For me, the most challenging part was to not be able to smile at my sweet baby girl. Seeing her, holding her and being there for
her every day was my motivation to push forward with the treatments.
Looking back on this experience, there are moments that stand out in my memories: the outpouring of love and assistance from family and friends, their encouragement to keep a sense of humor and laugh in keeping my spirits up, the strength I received from looking at my infant child knowing that I wanted to be there to watch her grow up, the importance of faith in God and new experience of praying for myself, my health and my survivorship, and also the confidence I had in the medical professionals who treated me both clinically and personally. It was a highly charged emotional ride of shock, grief, anger, guilt, love, gratitude and hope. The milestones along the way, five years,10 years and now 20 years have become true moments of celebration for me and my family. With this 20 year anniversary, I am more thankful than ever for the love I received from family and friends. It was the blessing of their support and encouragement, their kindness and insistence that I laugh and enjoy the life I had that boosted my persistence. It is my wish that my survivorship provides hope for the women who have been stunned by receiving a diagnosis of breast cancer, just as the women who came before me and shared their stories provided me with hope 20 years ago.”
–Deb Stone, Old Forge
Little by little, researchers around the world are working to find better ways to prevent, detect and treat breast cancer, and to improve the quality of life of patients and survivors. Studies continue to uncover lifestyle factors and habits, as well as inherited genes, that affect breast cancer risk.
But more work remains. H
–Christine Fanning
Wayne Memorial Welcomes Nephrologist
aima Choudhry,
ZMD, brings an
array of muchneeded services to the Wayne Memorial Health
System community. She is board-eligible in Nephrology, a subspecialty of Internal Medicine that focuses on diseases of the kidney. Dr. Choudhry is board-certified in Internal Medicine and is a Certified Hypertension Specialist (CHS), a skill she hopes will help save many lives.
Dr. Choudhry comes to Wayne Memorial from Temple University in Philadelphia, where she just completed a Fellowship in Nephrology. A native of Pakistan, Dr. Choudhry attended the Shifa College of Medicine in her home country, then completed an internship and residency in Internal Medicine at St. Mary’s Mercy Hospital in Livonia, Michigan.
Wayne Memorial CEO David L. Hoff noted that Dr. Choudhry will oversee inpatient dialysis at the hospital, a service in high demand. “Often a patient will come to the Emergency Department for something unrelated to his or her kidney function, but because they are on routine dialysis, we have to transfer them to another facility because we could not offer it here. Now we can.” Dialysis is a procedure to remove waste products and excess fluid from the blood when the kidneys stop working properly. Hoff said that Dr. Choudhry will also be working in conjunction with the DaVita outpatient dialysis clinic at the Stourbridge Complex in Honesdale.
Dr. Choudhry anticipates taking her Nephrology board certification exam this coming October. “I’m very excited to treat patients in the Wayne Memorial service area offering them important services close to home,” she stated.
Her practice at Wayne Memorial will be at the Physician Specialty Clinic inside the hospital at 601 Park Street, Honesdale. Dr. Choudhry’s office can be reached at 570-2538346. Visit www.wmh.org. H
Photo: Zaima Choudhry, MD
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COMPLIMENTARY CONSULTATIONS
201 Smallacombe Drive • Scranton, Pennsylvania
A Physician’s Transcontinental Medical Tour
By Christine Fanning
Gary Neale, M.D. was born in Miami to Arthur Neale, a physician and Andrea Neale, an ultrasound technician who grew up in Ireland. Gary, along with his two brothers all became physicians inspired by the life and work of their father who traveled extensively in interest of his medical career.
Arthur Neale was initially a primary care doctor in Australia who, in the 1950s, delivered babies and performed appendectomies. Arthur worked his way through England and Scotland to eventually end up in Philadelphia at Temple University Hospital, where he completed a residency in radiology in an era before computed tomography (CT) and magnetic resonance imaging (MRI). Arthur and Andrea met in London, moved to New York and started their family. “My father was a big proponent of his sons being educated at private schools which resulted in me completing junior high and high school in England. With that accomplished I was able to attend medical school in England at the age of 18, which saved me four years, compared to the American system.” Dr. Neale is a bariatric surgeon with Surgical Specialists of Wyoming Valley and an emergency room surgeon at WilkesBarre General Hospital, Regional Hospital of Scranton and Moses Taylor Hospital. He is also a preceptor for the Physician Assistant program at Kings College and the medical director at Post Acute Medical, Wilkes-Barre. He completed a general surgery residency for five years and then a minimal invasive fellowship for one year. “I wanted additional training to gain more hands-on surgical experience prior to starting as an attending surgeon. I chose a relatively new program in Oakland, California. During this year I was exposed to bariatric surgery -- a surgery that helps reduce food consumption and helps with weight loss by removing a part of the stomach thereby reducing its size -- which is a challenging operation to perform through five small holes in morbidly obese patients. I enjoyed the challenge of sewing bowel back together using what are effectively twofoot long instruments while looking at a monitor. Obesity is a pandemic in its own right. The field and my techniques have progressed over the years where I used to take three to four hours to do a gastric bypass through five holes and sew the bowel closed with a regular suture, to robotic-assisted surgery through four holes in two hours using a barbed-like suture that does not unravel and requires no knotting.” Dr. Neale explained that bariatric surgery is very successful for many patients, but there are those who want to doubt it. “There are examples out there of people eating through it and defeating the operation. Morbid obesity can be viewed as cancer in one way. As there are percentages after a cancer surgery that a cancer could recur, so too for bariatric surgery where the weight could be regained and a subsequent operation may become necessary.” When patients are 300 lbs. with comorbid conditions of diabetes, hypertension and obstructive sleep apnea, there is no way for these patients to diet and exercise their way out of obesity. “As the reality TV show ‘The Biggest Loser’ has shown, contestants have to spend all day in the gym after the show ends just to maintain their weight loss. How is a mother of two, with a job, supposed to be in a gym all day? With no other alternatives, bariatric surgery is essential to improving these patients' lives, their quality of life, and reducing their illnesses/ prescriptions and need to visit multiple doctors. Many of my patients have tried dieting, but as many know through personal experience, it is boring, frustrating, and the benefits are little and short lived. Interestingly, Dr. Neale’s other career considerations included becoming an engineer or commercial airline pilot. “Having crossed the Atlantic twice a year for more than eight years, I had a large experience of airlines. Perhaps until my childhood flight log book was full, I always visited the cockpit on every flight to meet
the crew and see the view. As becoming a pilot was a close second for a career choice, I got on with learning to fly with an instructor out of Forty Fort Airport. I logged over 100 hours and have landed at Selinsgrove, Bloomsburg, Lancaster, Elmira, Scranton and enjoyed views of the Finger Lakes. It may still be a second career for me at a later time.” After he completed medical school, Dr. Neale worked for a time in England, Scotland and Australia, which was made somewhat easier by having passports for the United States, Ireland and Australia. He somewhat traced his father’s footsteps in reverse, all the while taking exams so he could return to the United States where he knew surgical training was shorter. “In America surgical training is five years, whereas in England you could be training for 12 to 13 years. In England there are only so many attending positions as it is a socialized health care system. There are only as many surgeons as the country is willing to employ, you are effectively waiting for the surgeon to die or retire so you can have their job. I enjoyed my time working in Great Britain, no need for insurance approval, or coding and billing for your visits with patients, but then the system there resulted in waiting lists where 10 percent of patients might pass away waiting upwards of a year before undergoing cardiac bypass operations. The health system in the United States is too expensive, secondary to defensive medicine (malpractice insurance), he said. Doctors order more tests than necessary to protect themselves against a lawsuit. Malpractice insurance is obscenely expensive such that doctors can not stay in private practice but must become employed by larger institutions, and the money to pay malpractice insurance effectively comes from charging patients. Patients in America can not afford the health insurance or the bills or copays. Being sick in America is a sure way to become bankrupt. I appreciated the socialized health care system of Britain, that through paying taxes, all citizens were covered for minor and major care. Waiting lists were an expected thing there, not something that I suppose Americans would tolerate. The United States ranks pretty low when you factor in cost, equity ( fairness) and access to care.” He has been married to Nancy for more than 14 years. They met in an operating room where the doctor was having a tough day as a resident assisting a surgeon for a 10hour vascular surgery and she was the circulating nurse. They have a son, Oliver. Dr. Neale speaks monthly at the Thomas Saxton Pavilion in Edwardsville on bariatric surgery. For the Scranton population, he does Google meets to continue to socially distance. H
–Christine Fanning
Safe, Specialized Breast Cancer Treatment at NROC
reast cancer is the
Bmost common type
of cancer in American women other than skin can-
cer. This year, 281,550 women will learn they have breast cancer. Another 49,290 women will learn they have noninvasive (also called DCIS, Ductal carcinoma in situ) breast cancer. (Data supplied by the American Society of Clinical Oncology.) The good news, however is that breast cancer can often be cured, and our treatments continue to improve. Such is the case at Northeast Radiation Oncology Centers, where the most clinically appropriate and technically competent radiation therapy is administered to breast cancer patients, including heart blocking, (cardiac protection) prone position (lying on stomach), partial breast irradiation, and hypo fractionation (fewer treatments). In addition to this technological precision, NROC’s staff, including an oncology-certified nutritionist, helps patients and families adjust to what can be a new and overwhelming routine. This is accomplished with ongoing communication and integrative oncology: bringing together medical disciplines and support services so the patient receives the proper care they need and deserve.
NROC remains the only practice of its kind in Northeastern Pennsylvania with APEx® accreditation, and the first to offer many advanced services by a highly knowledgeable team. Readers of The Scranton TimesTribune voted NROC Best Cancer Center for ten years in a row and Best Patient Care for the third time. Visit nrocdoctors.com or call 570-504-7200. H
What to Know About Cervical Health
When it comes to women’s
health, cervical cancer may not always receive the attention it deserves. Christine Kim, MD, a board-certified and fellowshiptrained gynecologic oncologist with LVPG Gynecologic Oncology, part of Lehigh Valley Cancer Institute answered important questions on cervical health. Kim provides care at Lehigh Valley Hospital (LVH)–Pocono and LVH–Muhlenberg.
When should women begin having obstetrician gynecologist (OB-GYN) exams?
In the U.S., we recommend women start Pap test screening at age 21 and repeat it every three years if results are normal. Starting at age 30, women have the option of having both a Pap and human papillomavirus (HPV) test. If both are normal, this screening can be spaced out to every five years. If a patient has had at least three previous normal Pap and HPV tests, then most women can stop further screening at age 65. Again, this depends on a patient testing regularly prior to that age and having sufficient normal screenings.
Why are regular cervical cancer screenings important?
Sometimes there are issues that could be going on that may not be detected until a gynecologic check-up. With respect to cervical cancer screening, it is not the Pap tests themselves, but the frequency of them that has improved the ability to pick up precancerous changes. We now have HPV testing that also helps guide which Pap tests are potentially more concerning than others. An OB-GYN checkup is also a good time for women to discuss private issues that they don’t wish to discuss with their friends or family members. For example, an OB-GYN provider will not balk at being asked about various types of contraception, vaginal dryness, vaginal discharge, vulvar itching, menstrual irregularities, pelvic pain or menopausal symptoms. It’s a great time to ask about the HPV vaccination or other aspects of female health, such as how much calcium to take.
What symptoms might a woman experience that indicate she should see her OB-GYN or primary care provider?
A woman should contact her provider if she is experiencing any abnormal bleeding, such as between menstrual periods, during intercourse or after menopause. Very heavy bleeding or prolonged bleeding, pelvic pain, vulvar itching, abnormal vaginal discharge, feeling a vaginal bulge, history of diethylstilbestrol (DES) exposure or any other pelvic issues are signs you should seek gynecologic care immediately. Ultimately, it’s important for patients to discuss how frequently they need gynecologic exams with their provider. There may be other reasons that OB-GYN checkups need to be performed more regularly.
If a woman needs GYN cancer care, how can a gynecologic oncologist help?
As a gynecologic oncologist, I can help distinguish what is potentially cancerous and what is not. I also will work with your gynecologist to determine the best treatment for conditions like complex ovarian masses, abnormal Pap tests or persistent abnormal bleeding. A woman should see a gynecologic oncologist for further counseling if she has a strong family history of cancers, specifically ovarian, breast, endometrial or colon cancers. A gynecologic oncologist can assess a woman’s risks and discuss whether she’s a candidate for genetic testing, risk-reducing surgery or if she should be followed more closely. Your doctor may recommend a visit to a gynecologic oncologist based on your condition, particularly if you have been diagnosed with a cancer or a premalignant condition. You also may request an appointment on your own.
Why should women visit LVHN for their GYN care?
Our GYN providers are really knowledgeable, and they’re a great team of people who work well together. We can provide in depth evaluations of the cervix with colposcopies, and some offices offer outpatient loop electrosurgical excision procedures (LEEP), if needed. Additionally, LVH–Pocono has received accreditation as a Center of Excellence in Minimally Invasive Gynecology (COEMIG). The COEMIG designation is a professional recognition and distinction of surgeons. My colleagues, Radhika Ailawadi, MD, Shadi Kayed, MD, Vladimir Nikiforouk, MD, and Daying Zhang, MD, are all certified as COEMIG surgeons at LVH–Pocono. The hospital and physician accreditation is a testament to the exceptional work provided by these physicians and their supporting medical teams to patients in the Pocono community. Learn more about Christine Kim, MD, at LVHN.org/Kim H
Satya Upadhyayula, D.M.D.
Peering into a dental
patient’s mouth, Satya Upadhyayula, D.M.D., can see the future.
More precisely, he can envision the way the treatment of a complex case will unfold, eventually resulting in better teeth and overall oral health, and more often than not a brighter outlook and a bigger smile. “I actually visualize how it will finally look and then I work my way toward the goal,” says Dr. Upadhyayula, known to many patients as “Dr. U.” “If you don’t have vision and instead try to do one tooth at a time, without a whole picture of it, it’s just doomed to fail.” “Dr. U”, 29, joined The Wright Center for Community Health this summer, bringing his dental and surgical skills, plus a passion for research and a flair for cooking savory Hyderabadi biryani (a traditional Indian rice dish) – to Northeast Pennsylvania. He is accepting new patients of all ages, including children. Demand for high-quality, affordable dental care is steep in our region, where public policies (such as unfluoridated water supplies) and personal behaviors (high rates of cigarette smoking) too often conspire against good oral health. “Dr. U” admittedly was drawn to The Wright Center because of its commitment, as a Federally Qualified Health Center LookAlike, to take on many of the area’s most significant health challenges and to serve all patients regardless of income. The Wright Center has in recent years established state-of-the-art dental offices at its primary care practices in Scranton and Jermyn and has conducted periodic “pop-up dental clinics” at other sites. Today the organization continues to recruit more dental professionals and increase the services offered, including individuals with minimal or no insurance. The newly arrived “Dr. U”, using skills he fine-tuned during an Oral and Maxillofacial Surgery Internship at the University of Maryland Medical Center, will perform extractions and soon begin to offer dental implant services. Existing dental services at The Wright Center’s clinics include exams, cleanings, fillings, X-rays, oral cancer screenings, denture care and certain emergency services. In conversations with his younger patients, “Dr. U” emphasizes that routine brushing and flossing, and early treatment of minor issues, can stave off potentially painful problems down the road. That’s often true for pre-teens and teenagers who are developing teeth or jaw irregularities; if referred earlier to
an orthodontist, the issue might be corrected with less treatment time and expense required. He advises brushing twice a day (and after candy consumption, kids!) and staying hydrated throughout the day with water, not continual sips of acidic soft drinks. In his professional assessment, “mouthwash is not a substitute for anything.” A native of southern India, “Dr. U” says his pursuit of a medical career wasn’t predestined; it wasn’t until after high school that he decided to enter dentistry, partly at the urging of his grandfather, a veterinarian. “Dr. U” studied and trained for five years in India, briefly entering private practice. The allure of ample research opportunities –and the assurance of having a brother already living in the United States – brought him to this country, where he excelled academically. He attained a master’s degree in oral biology at the University of Louisville School of Dentistry, then earned his Doctor of Dental Medicine at the University of Pittsburgh School of Dental Medicine. His multiple, ongoing research initiatives largely involve the study of periodontitis, or severe gum disease. Dr. U, who is a member of the dental honor society Omicron Kappa Upsilon, intends on soon receiving his credentials to teach for NYU Langone, which offers an Advanced Education in General Dentistry (AEGD) postdoctoral residency program at partner sites across the nation, including at The Wright Center. The AEGD partnership is yet another way that the Wright Center is trying to increase the number of dental providers in the region. “Dr. U” is already impressed by his colleagues, saying, “I think we have a really motivated team here; everybody wants to make a difference.” As he adjusts to his new surroundings and life in NEPA, the Old Forge resident is on the lookout for some pleasurable hiking trails and a place to play competitive badminton. Oh, and this budding inventor could use a few spare hours to devote to his latest concept (a tool to help first-year dental students in the simulation lab as they practice on plastic teeth). The invention might be stalled at the moment in the pre-patent stage. But “Dr. U” can practically look into the future and see it materializing. Visit TheWrightCenter.org or call 570-230-0019. H
Domestic Violence is a national problem of epidemic proportions. Consider the following statistics: • In the United States, more than 10 million adults experience domestic violence annually. • According to the (CDC), one in four women and one in seven men have experienced severe physical violence from an intimate partner in their lifetime. • In Luzerne County, police respond to 24 family violence calls per day - more than 8,500 domestic violence incidents each year. • Luzerne County is currently ranked 5th among the 67 counties in Pennsylvania with the most domestic violence fatalities. • In 2020, 109 women, men and children in Pennsylvania lost their lives because of domestic violence. • A study of intimate partner homicides found 20% of victims were family members or friends of the abused partner, neighbors, persons who intervened, law enforcement responders or bystanders. One in two female murder victims and one in 13 male murder victims are killed by intimate partners. • Use intimidation to make you do what they want? • Make you feel there is “no way out” of the relationship? • Make you perform sexual acts that you don’t enjoy? • Threaten you with force, words or weapons? • Use alcohol or drugs as an excuse for saying hurtful things or abusing you? • Get very angry frequently and you don’t understand why? • Not believe they have hurt you or blame you for what they have done? • Physically force you to do what you do not want to do? If you answer yes to one or more of these questions, Domestic Violence Service Center’s expertise, experience and established networks can assist you as we have supported more than 2,900 individuals each year. Among numerous other services, DVSC offers supportive options counseling, safety planning or just someone to talk with confidentially and obtain information. A counselor/advocate is available to speak with you 24 hours a day/seven days a week at 1-800-424-5600. H
Domestic Violence.
Ignore it... it will just go away... One life at a time.
October is recognized nationally as Domestic Violence Awareness Month. A time to mourn those who have died as a result of abuse; honor those who have survived; raise public consciousness about violence in the home; and unite to help end this deadly and devastating crime. Society’s lack of understanding about domestic violence often is the greatest obstacle battered victims face in their effort to end the violence in their lives. Domestic violence is a silent, insidious destroyer. In its most virulent form, abuse can destroy a life as effectively as any physical disease. Each year we are reminded yet again how important community commitment, awareness and understanding are to the lives of those impacted by domestic violence.
The following questions may help identify the signs of an abusive relationship:
Does your partner: • Isolate you from people you care about or from friends you had before you dated them? • Frequently embarrass you or make fun of you in front of other people?
Three Days to a New Financial Future
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Discuss the difference between a home equity loan and a home equity line of credit:
A home equity loan has a fixed interest rate and a set monthly payment. It is a great option for a borrower who has a specific project to tackle. A home equity line of credit has a variable interest rate (based on National Prime) and a variable monthly payment during the draw period. This is a better option for a borrower who wants to have access to cash should they ever need it.
Who is a good candidate for a home equity loan?
A good candidate is: • Someone who has built equity in their home. A
homeowner has equity when a home’s value is higher than the amount owed on the mortgage • A homeowner with good credit, typically a score of 710 or greater
Discuss the benefits of taking out a home equity loan:
With a home equity loan, the borrower never has to worry about fluctuations in the interest rate, as it will stay the same for the life of the loan. Borrowers have the benefit of set monthly payments, so budgeting is easier each month. It’s typically a low-cost option to get access to the funds you need.
What should be considered before applying for a home equity loan?
The bank will run a credit check, confirm employment of the borrowers, and look at their debt-toincome or the amount of money they owe versus their income. If all of those factors are within an acceptable range, the borrowers still must consider their ability to repay the loan during the loan period, which can range from 5 years to 15 or 20 years.
What information will borrowers need to apply or consult with their banker?
Items they may need include: • Estimated insurance • Tax amounts • Home value • Estimated income verification
Describe the application process.
Fidelity Bank makes applying online fast and convenient with the Fidelity Bank Mortgage app. It’s available 24 hours a day, seven days a week and allows clients to upload documents to a portal, sign up for automatic notifications and complete almost the entire mortgage process from a smart phone or tablet. They can request as much or as little assistance from a Fidelity Banker as they like. H
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1.800.388.4380
APPROVAL GUARANTEED IN 3 BUSINESS DAYS•
*Annual Percentage Rate (APR) effective as of September 3, 2021 and is based on loan amount of $75,000.00 or greater for a term of up NMLS# 440404 to sixty (60) months. Maximum loan to value is 80.00% and a minimum credit score of 740 and maximum debt to income of 43%. One (1) to MEMBER FDIC four (4) family owner-occupied homes, primary and secondary residences, and a first (1st) or second (2nd) lien only. Promotional rate requires automatic deduction of payments from a Fidelity Bank checking account. 60 monthly payments of $17.74 per $1,000 borrowed. Payments do not include taxes or mortgage insurance premiums; actual obligation will be higher. Homeowner’s insurance with Fidelity Bank listed as mortgagee is required, flood insurance is required if applicable, and title insurance is required on loans greater than $250,000.00. Subject to credit approval. Other rates are available, but fees may apply. Please consult a tax advisor regarding the deductibility of interest. Offer may change or discontinue at any time. Offer cannot be combined with any other offer. Not a commitment to lend. •Guarantee of loan decision is within three (3) business days pending receipt of complete loan application including signatures of all borrowers, signed disclosures, and all necessary financial information. Restrictions apply on loans greater than $500,000.00. Not a guarantee for an extension of credit. Please see a Fidelity Banker for more details.
