Medicana

Irresponsible Advice About the Swine Flu Vaccine

2009-10-14T14:28:00.000-07:00

Bill Maher should stick to politics. He's been Twittering that people who get swine flu shots are idiots and also mouthed off on his "Real Time With Bill Maher" show about the vaccine, implying that getting the vaccine was the same thing as being injected with the disease, which it is not.

Now ordinarily this would not be a big deal. I mean, who would look to a talk show host for medical advice? Unfortunately, with this being a new vaccine, and a high level of suspicion about the government's ability to do anything whatsoever running rampant in the country, this just encourages those who are dubious about it to feel justified in skipping it. This would not be a good idea.

The H1N1 (swine) flu is a different strain of flu virus. Unlike the usual seasonal influenza that is more apt to be severe in the elderly, with the H1N1 virus, younger people are more vulnerable and become sicker than their elders.

This may be because the new H1N1 virus is related to the deadly 1918 Spanish flu, and since variants of the 1918 flu type were in circulation for several generations after it first appeared, people 65 and over tend to be less vulnerable to the new flu since they have had exposure to its cousin in the past.

In addition, those who were vaccinated against the swine flu strain that was prevalent in 1976 may also have a certain degree of cross-immunity to the new H1N1 virus.

This leaves younger people at most risk for severe illness in this new pandemic. In addition, pregnant women, whose immunity is lowered by their condition, and those with specific health problems, are also vulnerable.

There are two kinds of vaccine: One injectable, which is a killed virus that is incapable of causing illness, and a nasal spray version that is a weakened virus. It is recommended that those with impaired immunity only receive the injected vaccine.

It is the height of irresponsibility on Maher's part to be blathering about a medical subject about which he obviously knows very little, and contradicting Dr. Bill Frist, his guest on the show, who was trying to get across the importance of vaccination.

There are reasons some people shouldn't receive either vaccination. If they are allergic to eggs, as my mother is, they cannot receive any flu vaccines because the virus used to create them is incubated in eggs. In addition, there may be concerns about the preservative, thimerasol, which is used in the injectable vaccines for both H1N1 and regular seasonal flu.

And of course, it is always a personal decision whether one wants to have a shot or not. But to make that decision, a person needs to be armed with the facts, not a talk show host's personal aversions. If you want the facts, please go to this site and read up on them. Then you can make a truly informed decision about receiving the H1N1 vaccination.

(cross-posted at Mauigirl's Meanderings)

Alice in Wonderland Syndrome

2009-02-21T15:03:00.000-08:00

Well, I'm finally back here. The excitement of the election and the inauguration of Barack Obama has finally died down a bit and I'm able to tear my brain away from politics enough to concentrate on doing some medical research.

It also helps that I recently discovered a brand new condition that is fascinating to me and will be of interest, I'm sure, to all of you hypochondriacs out there.

I discovered it because a friend recently told me that when she was a child she experienced spells where everything around her - the door, the window, the furniture, whatever - seemed abnormally large and she felt abnormally small. This experience was accompanied by a distinctive odor. I immediately thought that if this was something neurological, which it appeared to be, it probably had a name like "Alice in Wonderland Syndrome," since it sounded so much like what happened in the story..."One pill makes you larger, one pill makes you smaller..."

So, being me, I had to go Google it. Imagine my surprise when I found there really is a syndrome called Alice in Wonderland Syndrome!

According to HealthCentral.com, Alice in Wonderland Syndrome was first described by C.W. Lippman in 1952, but J. Todd actually named the syndrome "Alice in Wonderland" syndrome in his 1955 article, "The Syndrome of Alice in Wonderland," in the Canadian Medical Association Journal. As a result, the syndrome is sometimes also called Todd's Syndrome.

What Are the Symptoms of Alice in Wonderland Syndrome?

According to the Migraine Aura Foundation, the syndrome refers to "a variety of self-experienced body image disturbances affecting the experience of the size, mass, shape of the body or its position in space."

Sometimes the affected person experiences a feeling of everything around them being much larger and they themselves feel smaller (macropsia) or vice versa - where they feel very large and everything around them seems very small (micropsia). These perceptions are also known as macro-somatognosia or micro-somatognosia.

These symptoms can appear along with other distortions, in time, vision, or other senses (including smell, which would explain the odor my friend experienced).

Sufferers may also see changes in the size of body parts such as their hands.

Following is a full list of possible additional symptoms:

"- feeling as if walking doesn't get them anywhere, as if they were walking on a treadmill
- the perception that only parts of their body are larger/smaller than normal
- - the feeling of walking on sponges
lingering touch sensation, i.e. after you've touched something, you continue to feel it after you've stopped touching it. Touch sensation hallucinations can also occur.
- lingering sound sensation, i.e. you continue hearing something after the noise has stopped
- anxiety
- loss of limb control and general discoordination, usually because of distorted perceptions of where one's body is in relation to surroundings
- agnosia / memory loss (though this is thought to be more of a side-effect: If you're having to think really hard about every movement, it's hard to pay attention to anything else and thus hard to remember things.)"

What Causes It?

Alice in Wonderland Syndrome can be caused by/associated with:

- Migraines (the symptoms of AIWS may be part of the "aura" that precedes a migraine; often no headache is actually experienced).
- Certain drugs (including cough syrups containing dextromethorphan)
- Viruses (Epstein-Barr, which causes Mononucleosis, or other viruses)
- Epilepsy
- Brain tumors
- Schizophrenia
- Delirium Tremens (from alcohol abuse)

What Are the Treatments?

Generally there is no specific treatment for AIWS; the root cause is what must be treated. For the most common cause, migraines, there are a number of remedies, as well as dietary restrictions that can help mitigate the symptoms. See this link to the Mayo Clinic for full information about migraine headaches.

For more information on treatment for epilepsy, see this link to Epilepsy.com.

Often the syndrome occurs in young children and eventually they may outgrow it. Others don't experience it until adulthood.

Will You Get It?

Probably not, unless you are a migraine sufferer. According to Pediatrics in Review:

"In the US it is estimated that 8.7 million females and 2.6 million males suffer from disabling migraine. The occurrence of migraine is greatest in adulthood, but this disorder is one of the most common causes of headache in children as well. In a 14-year longitudinal study of more than 9000 school children, Billie reported that 5% had had migraine attacks by 15 years of age.

A recent population-based study in Olmsted County, Minnesota, suggests an even greater incidence in this age range. For example, the highest incidence of newly diagnosed migraine headaches appearing in males, 246 per 100 000 person-years, occurred in those aged 10 to 14 years."

For an interesting article on the subject, see this article from WABC news.

Help for Hypochondriacs!

2008-04-12T10:39:00.001-07:00

A friend found a handy tool for us hypochondriacs on the "Real Simple" website. It's called the:

Hypochondriac's Handbook.

The "handbook," which is a 12-page web article, deals with such diverse subjects as chronic thirst (not necessarily diabetes), breast pain (not necessarily cancer) chronic headaches (not necessarily a brain tumor), and so on.

Time Magazine has also recently published articles about hypochndriacs. How to Heal a Hypochondriac talks about the tendency of medical students to become raging hypochondriacs as they gain more and more medical knowledge, truly illustrating Alexander Pope's contention that "a little knowledge is a dangerous thing."

The article goes on to talk about hypochondriacs in general:

"For doctors in training, nurses and medical journalists, hypochondria is an occupational hazard. The feeling usually passes after a while, leaving only a funny story to tell at a dinner party. But for the tens of thousands who suffer from true hypochondria, it's no joke. Hypochondriacs live in constant terror that they are dying of some awful disease, or even several awful diseases at once. Doctors can assure them that there's nothing wrong, but since the cough or the pain is real, the assurances fall on deaf ears. And because no physician or test can offer a 100% guarantee that one doesn't have cancer or multiple sclerosis or an ulcer, a hypochondriac always has fuel to feed his or her worst fears."

Sound like you? I know it sounds like me. Apparently we hypochondriacs are becoming a big wasteful clog in the medical system's pipes. And if you found this site by searching the Internet, you, like me, are part of the problem, and there is even a name for us - cyberchondriacs!

"According to one estimate, hypochondria racks up some $20 billion in wasted medical resources in the U.S. alone. And the problem may be getting worse, thanks to the proliferation of medical information on the Internet. 'They go on the Web,' says Dr. Arthur Barsky, a psychiatrist at Harvard Medical School and Brigham and Women's Hospital in Boston, 'and learn about new diseases and new presentations of old diseases that they never even knew about before.' Doctors have taken to calling this phenomenon cyberchondria.'"

Luckily for us, there are those who are taking our situation seriously.

"...a few clinicians, like Barsky and Columbia University neuropsychiatrist Dr. Brian Fallon, have begun to take the condition more seriously. 'It's not correct to say there's nothing wrong with a hypochondriac," Fallon asserts. "There is something wrong, but it's a disorder of thought, not of the body.' And, as he points out, disorders of thought are neither imaginary nor untreatable."

Dr. Fallon realized that hypochondriacs had a lot in common with those who suffer from Obsessive-Compulsive Disorder, or OCD.

"'Both disorders,' he says, 'involve intrusive, worrisome thoughts, the need for reassurance and a low tolerance for uncertainty.' Psychiatrists had lately come to think that OCD could be treated with Prozac and similar drugs, and Fallon decided the medications might work for hypochondria as well. With only 57 subjects, the study was too small to be definitive, but it was certainly promising: about 75% of those who got the drug showed significant improvement."

I can vouch for the fact that since I've been on a low dose of Prozac for the past several years, I am much less apt to go into panic mode and have an anxiety attack when I notice a new symptom, nor am I as apt to immediately assume I have some new disease the second I hear about it (it usually takes at least a few days now!).

Because some of the patients who responded were actually being given placebos, Dr. Fallon concluded there may be other causes of hypochondria, such as depression (stemming from guilt or loss) or a tendency to overanalyze and overreact to every bodily sensation, which is called "somatization."

Whatever the cause, hypochondria becomes a vicious cycle, and it is hard to break. To deal with this, Barsky recommends cognitive behavior therapy.

"'Just as focusing on a pain makes it seem more significant, ignoring it can make it seem much less,' says Barsky. Patients are also instructed to counter panicky thoughts with self-reassurance, reminding themselves, for example, that stomach pain almost never means stomach cancer. Both cognitive therapy and medication seem to work, and at this point it's hard to say whether one is better than the other."

Let's hope both doctors and patients become more aware of hypochondria and try to treat it. This way it will be a win-win for both!

Updates on Alzheimer's Disease

2008-03-29T13:56:00.000-07:00

Alzheimer's Disease is of particular interest to me, since my mother-in-law has it, and my father did too in his last years, although we never had a specific diagnosis.

Those of you who follow my other blog may be aware that in February we had a family crisis of sorts. My father-in-law, who is my mother-in-law's caretaker, was suddenly stricken ill (life-threatening bleeding in his intestines from diverticulosis) and hospitalized. Since we were unable to properly care for my mother-in-law, we needed to find respite care for her until my father-in-law recovered.

We were suddenly plunged head-first into the world of caregiving, and the financial and legal issues associated with it.

With the help of the hospital's social worker, we were able to find my mother-in-law a very nice nursing home for the time-being.

Through the magic of the internet, we found a local attorney who was able to draw up a Power of Durable Attorney document for my father-in-law to sign (up until then we did not have that document, which is very important for any children of elderly parents to obtain). Without it we couldn't access his bank account or other assets to pay for anything he or my mother-in-law needed.

Then we consulted with an eldercare attorney to get direction on the best way to handle the situation going forward.

Currently my father-in-law is back home while my mother-in-law is still in the nursing home while we figure out what the next step should be. Should she stay permanently in the nursing home? Or is she still well enough to live at home, albeit with help? My father-in-law now admits that her care is too much for him, especially after his recent health problem. But if she goes permanently into a nursing home, the financial implications become problematic.

As it is, we may have waited too long to address some of these eldercare issues, because it is uncertain whether we will be able to get Power of Attorney for my mother-in-law since she may not be deemed competent to sign the document; in that case it means going to court to obtain guardianship for her - which will involve about two more months of time and a $3000 legal bill.

We also learned that because both of my in-laws' names are on the deed to their house, both of their signatures would be required to sell the house if they need to sell. If my MIL is not competent, then my father-in-law or we need guardianship so we can sign in her stead.

The reason I'm sharing all this with you is for those who may have relatives in a similar situation. I hope you will heed my tale as a warning to go get the advice and legal documents you need before an emergency arises that forces you to do it. It would be a lot less stressful that way!

The Family Caregiver Alliance contains a wealth of information on all aspects of caregiving and eldercare issues if you would like more information about this important subject.

Now, on to the news:

Researchers at Rhode Island Hospital and Brown University learned that people with early Alzheimer's Disease were involved in more crashes and performed more poorly on road tests than those without the disease.

I'm sure this comes as no surprise for those of us who have had a parent with Alzheimer's Disease. My father, never a good driver, first got lost more easily and then started hitting things fairly frequently as he began to develop dementia. When he finally had a more serious accident as a result of running a red light, we asked him to stop driving, and he agreed. Luckily no one was hurt.

My husband's grandmother, who hadn't learned to drive until her husband died when she was 70, drove safely for about 10 years until she started to lose her grip. She drove a standard shift car, and one day suddenly couldn't remember how to change gears. That was when my in-laws realized she couldn't drive any more.

If you have a loved one with early dementia and are concerned about their driving, the Caregivers Alliance link above has more information on how best to address this problem.

According to Reuters, the NYU School of Medicine has discovered that PET scans can help diagnose Alzheimer's and other dementias. PET (Positron Emission Tomography) "correctly classified 94 percent of the normal subjects, 95 percent with Alzheimer's disease, 92 percent with dementia with Lewy bodies and 94 percent with frontotemporal dementia."

One of the problems with Alzheimer's Disease in the past has been the difficulty of accurately identifying it in the patient. Because Alzheimer's Disease and other forms of dementia may need different therapies, this is an important finding that should help doctors diagnose Alzheimer's earlier and with more accuracy.

According to the reasearcher, "'Because the incidence of these disorders is expected to increase dramatically as the baby-boom generation ages,' she added, 'accurate diagnosis becomes extremely important, particularly at the early and mild stages of dementia when life-style changes and therapeutic interventions are supposed to be most effective.'"

In other news, researchers at the University of California found that melatonin and light therapy can help Alzheimer's patients remain acclimated to the normal day and night sleep-wake cycle.

Many Alzheimer's patients tend to wake up at odd hours of the night and sleep during the day when they could be interacting with others and participating in activities.

The light therapy is similar to what is used for people with Seasonal Affective Disorder - patients are exposed to bright light for an hour or so in the morning.

For the study at the University of California, Alzheimer's patients were divided into three groups: One got only morning light therapy, one got both morning light therapy plus melatonin at bedtime, and the third group didn't have any special treatment.

It was found that only the group receiving both light therapy and melatonin improved in their daytime alertness.

Since light therapy alone did not show an effect, it is unclear whether it provided any benefit to the group that received melatonin, or whether melatonin alone was responsible for the improvement. Further research needs to be done to clarify this.

Many Alzheimer's patients are recalcitrant when it comes to taking pills and other medications. My mother-in-law is relatively good about this but sometimes she hides a pill in her mouth and spits it out when no one's looking, the same way my cat does when I give him a pill. The solution has been to crush pills in applesauce and have her consume them that way, which works as long as she's in the mood for applesauce.

Last summer, however, the FDA approved an Alzheimer's medication that is delivered in a patch. The medication, Exelon, is a drug for treating mild to moderate Alzheimer's Disease that has already been approved in the form of a capsule and an oral solution. It works similarly to Aricept, another commonly prescribed drug used for Alzheimer's Disease.

The patch, which can be applied to the back, chest or upper arm, delivers the drug in a steady dosage throughout 24 hours, after which it must be replaced with a new one.

A study showed patients using the patch had fewer side effects than with the capsule version of the drug.

Further research continues constantly, so if you have a loved one with this disease or are worried about getting it yourself, don't be discouraged. If you are interested in learning more, please check the National Institute of Neurologic Disorders website.

UPDATE: In doing some further research, I discovered that there have been studies that show Perispinal etanercept (Enbrel, Amgen), an anticytokine therapy that targets excess tumor necrosis factor - alpha (TNF-α) - in the brain, has been shown to produce almost immediate cognitive and behavioral improvement in a patient with moderate Alzheimer's Disease.

The therapy, which has already been approved for use in rheumatoid arthritis, reduces neurological inflammation. It is administered via a once-a-week injection into the cerebro-spinal system. Full research article is available at this site.

Further research must be done, but this seems to be a promising therapy.

Medical Sabbatical

2008-03-22T20:20:00.000-07:00

Hello fellow hypochondriacs! I just wanted to pop in and apologize for my long absence. I had been intending to write another information-laden post about, of all things, appendix cancer. (Yes, there is such a thing - and a friend of mine was recently diagnosed with it.) But I haven't had enough time and energy recently. (Do you think there's something wrong with me?)

I still want to write about that cancer, but was sidetracked for the entire month of February due to some family issues. Then I was on vacation for two and a half weeks, and have just gotten back into the swing of things. In addition, politics, my other obsession, has been taking up what time I have had for blogging, on my other site, Mauigirl's Meanderings.

I think to get back to my medical calling over here, I will write some shorter posts about recent medical developments before writing the long post. I hope to have something up in the next day or two!

In the meantime, no, that hacking cough you have is NOT lung cancer. It's from the dry heat in your house. Or the pollen that I hear is already blowing around out there despite the fact that every tree in my area is still starkly naked.

Of course, if the cough doesn't go away please do get it checked out...Just because you're a hypochondriac doesn't mean you don't have a fatal disease!

Colon Cancer

2008-01-05T20:03:00.000-08:00

Unfortunately, many of the subjects I choose to write about in Medicana are driven by the diagnosis of someone I know with the condition in question.

In the case of colon cancer, I am sorry to report that a friend of mine was just diagnosed with it. I don't yet know all the details, but her symptoms led to an initial diagnosis of some type of ovarian tumor, based on an ultrasound and an MRI. Once surgery was performed, it was discovered the tumor was actually colon cancer that had spread to the ovaries - not a good scenario.

I do not yet know the staging of her cancer since all the tests have not come back yet, but I thought I'd do the research on colon cancer now so there would be plenty of information available once she finds out more.

I am posting this information in hopes that my research may help discover new treatments or information that may help her and her family as they work with her doctors to find the right treatment for her cancer, and help anyone else who may have been diagnosed with this disease.

Colon Cancer - What is it?

Colon cancer, more generally known as colorectal cancer, is any cancer affecting the colon or rectum. The colon is the large intestine and the rectum the last six inches of the large intestine.

Colon cancer usually begins as small, noncancerous clump of cells called adenomatous polyps. Eventually these polyps can become colon cancers.

Because polyps usually cause few symptoms, or in many cases, no symptoms at all, it is important for people to get screened for colon cancer once they reach middle age; usually 50, unless there are risk factors in the family, in which case screening should start earlier.

There are three types of polyps:

- Adenomas: These are likely to turn into cancer.
- Hyperplastic polyps: These rarely turn into cancer.
- Inflammatory polyps: These can follow a flare-up of ulcerative colitis, and can turn cancerous, which is why ulcerative colitis is a risk factor for colon cancer.

Most colon cancers are adenocarcinomas (cancers that begin in cells that make and release mucus and other fluids).

What Are the Symptoms of Colon Cancer?

Often there are no symptoms that show up for colon cancer in its early stages. The symptoms to watch out for are:

- Any change in bowel habits, including diarrhea or constipation or a change in the consistency of your stool that lasts more than a week or two. Narrowing of the stool is another symptom.
- Rectal bleeding or blood in your stool
- Persistent abdominal discomfort, such as cramps, gas or pain
- Abdominal pain with a bowel movement
- A feeling that your bowel doesn't empty completely, or feeling full or bloated
- Unexplained anemia
- Weakness or fatigue
- Unexplained weight loss

According to Medicinenet.com (link below), colon cancer may be present for several years before symptoms develop. Symptoms vary according to where in the large bowel the tumor is located. The right colon has plenty of room, and cancers of the right colon can grow to large sizes before they cause any symptoms. Usually right-sided cancers cause anemia due to the slow loss of blood over a long period of time, which can lead to fatigue, weakness and shortness of breath. Because the left colon is narrower than the right colon, cancers of the left colon are more apt to cause partial or complete bowel obstruction.

What Are the Causes and Risk Factors for Colon Cancer?

There are a number of factors that put a person at higher risk for colon cancer:

Age: About 90 percent of people diagnosed with colon cancer are older than 50. Only about 10% of colon cancer cases occur in younger people.

A personal history of colorectal cancer or polyps: Naturally it makes sense that if a person has already had colon cancer they would have a risk of colon cancer again in the future. However, people who have had a history of adenomatous polyps also have a higher likelihood of getting colon cancer and will need regular screening.

Inflammatory bowel disease/conditions: Chronic conditions such as ulcerative colitis and Crohn's disease can increase the risk of colon cancer.

Genetics: Inherited syndromes passed through the family can increase the risk of colon cancer. Inherited conditions account for only about 5 percent of all colon cancers.

One such genetic condition is called familial adenomatous polyposis (FAP), which is a rare disorder that causes thousands of polyps to develop in the lining of the colon and rectum. People with untreated FAP have >90% chance of developing colon cancer by age 45.

Hereditary nonpolyposis colorectal cancer (HNPCC), which is also called Lynch syndrome, is more common than FAP. Sufferers of Lynch syndrome also tend to develop colon cancer at an early age. Both FAP and HNPCC can be detected through genetic testing.

Certain HNPCC patients are also at risk of developing uterine cancer, stomach cancer, ovarian cancer, and cancers of the ureters (the tubes that connect the kidneys to the bladder), and the biliary tract (the ducts that drain bile from the liver to the intestines).

MYH polyposis syndrome is another, recently discovered, hereditary colon cancer syndrome. Affected people tend to develop 10-100 polyps starting at around 40 years of age, and are at high risk of developing colon cancer.

According to Medicinenet.com, "Among first-degree relatives of colon cancer patients, the lifetime risk of developing colon cancer is 18% (a threefold increase over the general population in the United States).

Even though family history of colon cancer is an important risk factor, majority (80%) of colon cancers occur sporadically in patients with no family history of colon cancer. Approximately 20% of cancers are associated with a family history of colon cancer. And 5 % of colon cancers are due to hereditary colon cancer syndromes. Hereditary colon cancer syndromes are disorders where affected family members have inherited cancer-causing genetic defects from one or both of the parents."

Family history of colon cancer and colon polyps: If a person has a parent, brother or sister or a child with colon cancer, this too is a risk factor. This may be a hereditary connection or it might be due to mutual exposure to an environmental toxin, diet or lifestyle that leads to the condition.

Diet: Colon cancer and rectal cancer may be associated with a diet low in fiber and high in fat and calories. It is believed that the breakdown products of fat metabolism lead to the formation of cancer-causing chemicals. Some studies have found an increased risk of colon cancer in people who eat diets high in red meat and processed meats. Lack of fruits and vegetables may be part of the picture, since increased consumption of these foods seems to have a protective effect against colon cancer.

Lack of exercise: If a person is inactive, they are more likely to develop colon cancer, possibly by causing waste to stay in the colon longer.

Diabetes: People with diabetes and insulin resistance may have an increased risk of colon cancer. Just one more reason to try to avoid diabetes; it seems to be implicated in so many other diseases.

Obesity: People who are obese have an increased risk of colon cancer and an increased risk of dying of colon cancer when compared with people considered normal weight. Of course, obesity also may be associated with a high fat diet, sedentary lifestyle, and diabetes, so it may all be connected.

Smoking: People who smoke cigarettes may have an increased risk of getting colon cancer - and of dying of it.

Heavy Use of Alcohol: Heavy drinking may increase the risk of colon cancer.

Growth hormone disorder: Acromegaly, an uncommon disorder that causes an excess of growth hormone in the body, may increase the risk of colon polyps and colon cancer. (Sounds to me as if the use of human growth hormone by sports figures might not be a good idea).

Previous radiation therapy for cancer: Radiation therapy directed at the abdomen to treat previous cancers may increase the risk of colon cancer.

How Is It Diagnosed?

There are a number of screening methodologies available to find colon cancer before it is advanced enough to cause symptoms - and at a stage where it is most curable.

Unfortunately, none of them are very appealing to people, which is why many people avoid the whole subject. This is tragic, since when caught early, colon cancer is very curable. In fact, some of the screening methods actually prevent it from developing in the first place by removing polyps before they have a chance to go bad.

The following are the screening techniques currently used to detect colon cancer:

- Fecal occult blood test: This is a fancy way of saying it's a test to detect hidden (occult) blood in the stool. It can be done in the doctor's office, or by using a kit at home. If blood is detected, the doctor would then order more tests to find out the cause. Blood in the stool does not always mean cancer; it can be caused by a polyp that has not yet become cancerous, certain foods or medications (such as aspirin), or hemmorrhoids. A negative test for occult blood is not a guarantee of no cancer, either: Not all cancers bleed, and some only bleed occasionally, so they can be missed. This test, however, is least invasive and more apt to be performed willingly by the patient. A digital rectal exam may also be performed to check for growths or blood in the lower part of the rectum.

- Flexible Sigmoidoscopy: For this test, the lower colon must be cleaned out ahead of time, usually through an enema; the sigmoidoscopy is usually done in the doctor's office, where the doctor examines the last two feet (1/3) of the colon for polyps or other anomalies, using a slender, flexible lighted tube. The colon is inflated with air to enable the doctor to examine the colon. The drawback to this test is that since it only examines part of the colon, polyps or growths farther up will not be detected. I had one of these once after I'd noticed blood in my stool (it turned out to be hemmorrhoids).

- Barium Enema: In this test, barium is inserted into the cleaned colon, with or without air added. Barium is a contrast dye that enables the doctor to see irregularities along the colon walls through X-ray examination. Sometimes a flexible sigmoidoscopy is done as well. The barium enema is not able to identify small cancers and small polyps. A colonoscopy is usually recommended if suspicious lesions are sighted in the barium enema test, since no sampling is possible during this test.

- Colonoscopy: The gold standard of colon cancer screening, the colonoscopy enables the physician to examine the full length of the colon with a flexible lighted tube, similar to the one used in sigmoidoscopy, with a video camera and monitor attached. The colon must be thoroughly cleaned out ahead of time; the patient must consume a laxative solution the night before. The beauty of the colonoscopy is that the doctor is able to remove polyps or other suspicious growths with the colonoscope, and find out whether they are cancerous. As mentioned previously, removal of the polyps can actually prevent cancer since they will no longer have the opportunity to develop into cancer once they are removed. Patients are under sedation during this procedure so there is no discomfort; most people do not remember the experience due to new medications that are used. If nothing suspicious is found during the colonoscopy, patients are advised to have another one in 7-10 years.

I had a colonoscopy at age 47, since both of my parents have had polyps. I didn't feel a thing and felt fine afterwards. I am due for another this year and you can be sure I'm going to get it.

- Virtual Colonoscopy: Although many insurance companies do not yet cover this method, it is becoming more popular since it is not invasive. The patient cleans the colon ahead of time, similar to preparation for the standard colonoscopy, but instead the procedure is a simple computerized tomography (CT) scan. There is no sedation, no recovery needed; and no risk of perforating the colon. However, the colon does need to be filled with air, which is uncomfortable. Virtual colonoscopy is not as good as the real thing in finding very small polyps or flat lesions on the wall of the colon. In addition,if anything is seen on the scan, the patient would still need a standard colonoscopy to follow up, since there is no way to sample anything suspicious that is seen.

All of the invasive methods carry some risk of perforating the colon; however, the benefits of screening far outweigh the risks.

If a person presents to the doctor with actual symptoms, rather than just needing a routine screening, usually a colonoscopy would be ordered so as to enable the physician to take biopsies of anything that is found. When it is less clear that the symptoms are colon-related, MRIs, CT scans or ultrasounds may be ordered first.

If cancer is diagnosed, the next step is staging. The first step may be to have a CT scan of the abdomen and a chest X-ray to make sure nothing has spread yet.

How Is Colon Cancer Treated?

Surgery is the first line of treatment for colon cancer. It is important to remove as much of the cancer as possible, and also to remove lymph nodes in the abdomen to help stage the cancer and prevent it from spreading.

Depending on how much of the colon is affected, the patient may need to have more or less of it removed. In some cases the entire colon has to be removed; in others, just a section - and in some cases, only the cancerous polyp needs to be taken out.

During surgery, the tumor, a small piece of the surrounding healthy colon, and adjacent lymph nodes are removed. The surgeon then reconnects the healthy sections of the bowel. Recent studies have indicated that the more lymph nodes removed at the time of surgery, the better the prognosis.

If the cancer is in the right or left side of the colon but above the rectum, usually a resection of the colon will work. If the rectum or anal sphincter is involved, it may be necessary for the patient to have a colostomy bag; he or she can no longer defecate and stool goes into the bag instead.

According to EMedicineHealth.com, in the case of early cancers, sometimes there is no further treatment, just follow-up:

"Once your cancerous colon has been removed and you receive any other treatment recommended by your cancer care team, you will see your gastroenterologist or cancer specialist (oncologist) regularly for follow-up visits. These visits will allow your team to see if the cancer has spread and to detect newly formed cancers.

These follow-up visits should include, at minimum, the following:

Colonoscopy within 3 months after your surgery.
Colonoscopy 1 year after surgery and every 3 years after that.
Test for occult (hidden) blood in your stool every year, followed by colonoscopy if the test result is positive.

A screening tool—measurement of carcinoembryonic antigen (CEA) level—is available to test for cancer recurrence following cancer surgery.

CEA is a protein normally found in trace amounts in your bloodstream but is present in increased amounts in people with colon cancer. It is referred to as a tumor marker.

Blood CEA levels should be measured before colon cancer surgery and then at intervals of 2-3 months.

Increasing levels of serum CEA may indicate that colon cancer has come back and that you should seek further evaluation.

Once you have had several blood tests with negative results, you probably don't need to continue the tests indefinitely. However, no one is sure how long you should continue to have the tests."

Colon cancer, as mentioned before, is staged based on how much it has spread. If it is not caught early, further treatment is needed.

What Are the Stages of Colon Cancer?

There are a number of ways to stage colon cancer; there is a simple Stage I-IV method, but the more complex way to stage cancer is to divide up the various aspects of it into the tumor itself, the lymph node involvement, and whether or not it has spread (metastasized). From the Oncology Channel (link below), here is the breakout of these details:

"TNM Staging System (Tumor, Node, Metastasis)

Tumor
T1: Tumor invades submucosa.
T2: Tumor invades muscularis propria.
T3: Tumor invades through the muscularis propria into the subserosa, or into the pericolic or perirectal tissues.

(NOTE: these are all fancy words for the various layers of the intestinal wall).

T4: Tumor directly invades other organs or structures, and/or perforates.

Node

N0: No regional lymph node metastasis.
N1: Metastasis in 1 to 3 regional lymph nodes.
N2: Metastasis in 4 or more regional lymph nodes.

Metastasis

M0: No distant metastasis.
M1 Distant metastasis present.

Stage Groupings

Stage I: T1 N0 M0; T2 N0 M0
Cancer has begun to spread, but is still in the inner lining.

Stage II: T3 N0 M0; T4 N0 M0
Cancer has spread to other organs near the colon or rectum. It has not reached lymph nodes.

Stage III: any T, N1-2, M0
Cancer has spread to lymph nodes, but has not been carried to distant parts of the body.

Stage IV: any T, any N, M1
Cancer has been carried through the lymph system to distant parts of the body. This is known as metastasis. The most likely organs to experience metastasis from colorectal cancer are the lungs and liver."

Treatment may include chemotherapy, radiation, or both. According to Oncology Channel, the following regimens are frequently used:

"Chemotherapy is often used as a first-line treatment for metastatic colorectal cancer to destroy cancer cells that have metastasized (spread). It also may be used prior to surgery (called neoadjuvant therapy) to shrink the tumor, may be administered following surgery (called adjuvant therapy), and may be combined with biological therapy (also called immunotherapy) and radiation therapy.

Newer combinations of chemotherapy drugs, such as FOLFOX (5-fluorouracil [5-FU], leucovorin, and oxaliplatin [Eloxatin®]) and FOFIRI (5-fluorouracil [5-FU], leucovorin, and irinotecan [Camptosar®]) may be used to prevent recurrence following surgery or to shrink the tumor prior to surgery.

A combination of chemotherapy drugs (5-fluorouracil [5-FU], leucovorin, and irinotecan [CPT11]), administered intravenously, is standard treatment for metastatic colorectal cancer. Side effects include diarrhea, mouth irritation (mucositis), low white blood cell count (e.g., neutropenia), and hair loss (alopecia).

Colorectal cancer with liver metastasis also may be treated using floxuridine (FUDR®) administered intra-arterially (i.e., through an artery). Side effects include nausea, vomiting, diarrhea, and inflammation of the intestine (enteritis).

In addition to chemotherapy drugs, blocking agents (e.g., cetuximab [Erbitux®]) may also be used to treat metastatic colorectal cancer. These drugs prevent cancer cell receptors from receiving factors (e.g., epidermal growth factor) that cause cell growth, cell division, and additional metastasis. Blocking agents target specific cells so they usually do not cause systemic side effects. Side effects of these drugs include allergic reactions (e.g., difficulty breathing, hives, low blood pressure, rash).

Bevacizumab (Avastin®) may also be used to treat advanced colorectal cancer. This medication prevents new blood vessels, which are necessary for tumor growth, from forming. It does not affect normal tissues that already have an established blood supply. Side effects include blood clots and high blood pressure, which can be controlled with medication.

(NOTE: Avastin is one of a new class of drugs called angiogenesis inhibitors and they have shown to be quite effective against colon cancer.)

Panitumumab (Vectibix™) is the first entirely human monoclonal antibody approved by the Food and Drug Administration (FDA) to treat patients with metastatic colorectal cancer following chemotherapy. This medication is administered intravenously once every 2 weeks.

Immunotherapy

Immunotherapy, or biological therapy, attempts to stimulate the immune system to fight disease and protect the body from side effects of chemotherapy. Immunotherapy agents that may be used to treat colorectal cancer include bacilli Calmette-Guerin (BCG) and levamisole (Ergamisol®).

Immunotherapy may cause flu-like side effects such as the following:

Chills
Diarrhea
Fever
Loss of appetite
Muscle aches and weakness
Nausea and vomiting

Radiation Therapy

Radiation therapy uses high energy x-rays to destroy cancer cells and shrink tumors. External beam radiation (i.e., radiation from a machine outside the body) may be used in addition to surgery to treat colorectal cancer (called adjuvant therapy). It also may be used to relieve symptoms (called palliative treatment) in patients with metastatic colorectal cancer.

Side effects include fatigue, hair loss, reddened skin, and swelling (edema). Medicines and other treatments can reduce the intensity of the side effects. As with other cancer treatments, the incidence of side effects varies with patient health and the exact nature of the treatment.

Follow-up Treatment

Follow-up care is recommended for colorectal cancer patients to ensure that recurrent or metastatic disease is detected as soon as possible. Patients should undergo regular physical examinations, fecal occult blood tests, colonoscopies, CT scans, and chest x-rays.

Prognosis

Prognosis depends on the stage of the disease and the overall health of the patient. Overall, colorectal cancer patients have a 5-year survival rate of about 61%. The 5-year survival rate is about 92% when the disease is treated before it has spread (metastasized); 64% when the cancer has spread to nearby organs or lymph nodes; and 7% when it has spread to other parts of the body (e.g., liver, lungs)."

Depending on the severity of the disease, some patients may want to try to get into clinical trials. If you have been diagnosed with advanced colon cancer and you are located near a major cancer center, it is possible trials are being held of treatments that are not yet generally available to patients that may be more effective than current methods.

Clinical trials can be found on-line in a number of places. Please see below for some links.

http://bethesdatrials.cancer.gov/colorectal/index.aspx
http://www.mdanderson.org/patients_public/clinical_trials/?Referrer=Google&KW=Cancer_Research&gclid=CObv_IKH4ZACFShsGgodSzLZYA
http://www.fightcolorectalcancer.org/patients/clinicaltrials/index.htm
http://www.mskcc.org/mskcc/html/14075.cfm
http://www.ccalliance.org/patient/clinical/clinical.html
http://clinicaltrials.gov/ct/search?term=colon+cancer
http://www.mayoclinic.org/colon-cancer/clintrials.html
http://www.nlm.nih.gov/medlineplus/colorectalcancer.html#cat27

Be sure to check out the trials available before starting any treatment; always get a second opinion on your treatment before committing to something. For one thing, clinical trials don't always accept patients who have already had other treatments first.

Please note, although these trials are usually "double blind" trials (that is, patients and physicians don't know which patients are getting the experimental treatment), those who do not get the new treatment are given the current accepted treatment for the cancer, so no one gets a placebo.

Will You Get It?

You could, especially if you have any of the risk factors above. Colorectal cancer is the fourth most common cancer in the United States and the second leading cause of cancer death. A person at age 50 has about a 5 percent lifetime risk of being diagnosed with colorectal cancer and a 2.5 percent chance of dying from it.

Most people will not get it if they get screened at the recommended times. Unfortunately, people younger than 50 who have no other risk factors can get it too, and they are younger than the recommended age to start screening.

So any time you notice anything unusual about the way your body feels or how you feel overall, be sure to go to the doctor and get checked out.

And if you do find out you have cancer, always go to experts for your treatment. Get more than one opinion. Go to a major cancer center. I may sound like a broken record, but I'd rather be repetitive than not get the message across. Your life may depend upon it.

Sources:
http://www.medicinenet.com/colon_cancer/article.htm: Medicinenet.com
http://www.mayoclinic.com/health/colon-cancer/DS00035: The Mayo Clinic
http://www.cancer.gov/cancertopics/types/colon-and-rectal: Cancer.gov
http://www.emedicinehealth.com/colon_cancer/article_em.htm: EMedicineHealth.com
http://www.oncologychannel.com/coloncancer/staging.shtml: Oncology Channel
http://www.ahrq.gov/clinic/3rduspstf/colorectal/colorr.htm

For more information/treatments:
http://www.mdanderson.org/diseases/Colorectal/?gclid=CPKkh6fp4JACFRuhFQodBTLrXA: M.D. Anderson
http://www.mskcc.org/mskcc/html/5789.cfm: Memorial Sloan Kettering
http://www.nlm.nih.gov/medlineplus/ency/article/000262.htm: National Institutes of Health

Prostate Cancer

2007-12-13T23:00:00.000-08:00

I've known several people who have been diagnosed with prostate cancer, which is not surprising given that this is a common cancer among men, and I am now at that age that my male friends are in the likely age range to develop it.

Luckily, prostate cancer, when found early, is highly curable and in most cases not that aggressive. It is said more men die with prostate cancer than of it.

What is Prostate Cancer?

As it is described in nearly every website on the subject, the prostate is a "walnut-sized gland" located under the bladder and in front of the rectum.

Helpfully, the American Cancer Society also explains that only men have one, which, if you didn't already know this, is good information to have if you're a woman - this means if you are a female hypochondriac it's one cancer you don't have to worry about. (Don't worry, you have several other female-only cancers to choose from that men don't have to worry about, so don't get too smug).

According to the American Cancer Society, over 99% of prostate cancers develop from the "gland cells," which make the fluid that is added to the semen. The cancer arising from this type of cell is called "adenocarcinoma."

Other types of cancer that can start in the prostate gland include sarcomas, small cell carcinomas, and transitional cell carcinomas. Because these other types of prostate cancer are so rare, this post will just focus on adenocarcinoma.

Overall, prostate cancer tends to be slow-growing, and autopsy studies show that many older men who died of other diseases also had prostate cancer. The studies indicate that 70% to 90% of the men had cancer in their prostate by age 80, but in many cases neither they nor their doctors even knew they had it.

How Is It Diagnosed?

In the past, men frequently didn't receive a diagnosis until symptoms showed up, by which time it often was too late. Now there are methods available that can diagnose prostate cancer at a much earlier stage. From the Mayo Clinic website: the following screening tests are used today:

Digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape or size of your gland, you may need more tests.

Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein and analyzed for PSA, a substance that's naturally produced by your prostate gland to help liquefy semen. It's normal for a small amount of PSA to enter your bloodstream. However, if a higher than normal level is found, it may be an indication of prostate infection, inflammation, enlargement or cancer.

Memorial Sloan Kettering recommends the following criteria in interpreting PSA tests:

"To balance the influence of age on PSA levels, the following age-specific PSA level cut-offs should be considered:

Greater than or equal to 2.5 ng/mL for men up to age 49
Greater than or equal to 3.5 ng/mL for men aged 50 to 59
Greater than or equal to 4.0 ng/mL for men aged 60 and older.

Men with values outside their age-allowed targets should be considered as candidates for prostate biopsy.

For those men being screened for PSA velocity, a PSA velocity of greater than or equal to 0.75 ng/mL per year should necessitate a prostate biopsy -- even if the PSA level is in the normal range."

There are differences of opinion among experts about PSA testing. The American Cancer Society recommends that both the PSA and DRE should be offered annually, beginning at age 50, to men who have at least a 10-year life expectancy. However, men at high risk, which includes African American men and men with a strong family history of close relatives diagnosed at an early age, should begin testing at age 45.

Experts in favor of regular screening believe that finding and treating prostate cancer early offers men more treatment options with potentially fewer side effects. Those who recommend against regular screening feel that because most prostate cancers grow so slowly, the side effects of treatment would likely outweigh any benefit that might be derived from detecting the cancer at a stage when it is unlikely to cause problems. Although the jury is out on this one, given that two of my friends discovered their cancers solely through an abnormal PSA test, I tend to believe in testing.

The following tests are used to diagnose prostate cancer if the initial DRE and PSA tests raise a red flag. (From the Mayo Clinic site):

"Transrectal ultrasound. If other tests raise concerns, your doctor may use transrectal ultrasound to further evaluate your prostate. A small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to get a picture of your prostate gland.

Prostate biopsy. If initial test results suggest prostate cancer, your doctor may recommend a prostate biopsy. During a biopsy, small tissue samples are taken and analyzed to determine if cancer cells are present.

To do a biopsy, your doctor inserts an ultrasound probe into your rectum. Guided by images from the probe, your doctor identifies any suspicious areas. Then a fine, hollow needle is aimed at these areas of your prostate. A spring propels the needle into your prostate gland and retrieves a very thin section of tissue."

The biopsy could show either no cancer, precancerous or cancerous cells.

It is believed that prostate cancer begins with a pre-cancerous condition called "prostatic intraepithelial neoplasia" or PIN. Almost half of all men have this condition by the time they reach 50. Under a microscope, the gland cells with PIN appear changed, but not invasive. They can be low-grade (almost normal) or high-grade (more abnormal).

Doctors recommend that men with high-grade PIN be watched carefully and a repeat biopsy may be necessary.

Another type of precancerous condition that may be found is "atypical small acinar proliferation," or ASAP, sometimes known as "atypia." It just means there are some possibly cancerous cells showing up in the biopsy, but not enough to be sure. If ASAP is found, there's about a 40% to 50% chance that cancer is also present in the prostate, which means it's best to get a repeat biopsy within a few months. You might think of "ASAP" as meaning "get another biopsy ASAP!"

If the cells that are evaluated turn out to be cancer, then there may be more tests ordered to understand how advanced the cancer is, if there is a possibility cancer may have spread (from the Mayo Clinic website):

"Bone scan. A bone scan takes a picture of your skeleton in order to determine whether cancer has spread to the bone. Prostate cancer can spread to any bones in your body, not just those closest to your prostate, such as your pelvis or lower spine.

Ultrasound. Ultrasound not only can help indicate if cancer is present, but also may reveal whether the disease has spread to nearby tissues.

Computerized tomography (CT) scan. A CT scan produces cross-sectional images of your body. CT scans can identify enlarged lymph nodes or abnormalities in other organs, but they can't determine whether these problems are due to cancer. Therefore, CT scans are most useful when combined with other tests.

Magnetic resonance imaging (MRI). This type of imaging produces detailed, cross-sectional images of your body using magnets and radio waves. An MRI can help detect evidence of the possible spread of cancer to lymph nodes and bones.

Lymph node biopsy. If enlarged lymph nodes are found by a CT scan or an MRI, a lymph node biopsy can determine whether cancer has spread to nearby lymph nodes. During the procedure, some of the nodes near your prostate are removed and examined under a microscope to determine if cancerous cells are present."

Once a cancer is identified and necessary tests are done, Grading and Staging can be performed. These evaluations help you and the doctor decide on your treatment.

Grading

Grading is the process by which cancer cells are evaluated in terms of how aggressive they may be. The most common cancer grading scale runs from 1 to 5, with 1 being the least aggressive form of cancer.

The pathologist then assigns scores to the cancer, called Gleason scores. The Gleason score adds the grades of the two most aggressive types of cancer cells found in the tissue, so scoring may range from 2 (non-aggressive cancer) to 10 (very aggressive cancer).

Staging

The next step is called staging, which determines if or how far the cancer has spread:

Stage I. Signifies very early cancer that's confined to a microscopic area; it cannot be felt by the doctor.

Stage II. The cancer can be felt, but it remains confined to your prostate gland.

Stage III. Cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.

Stage IV. The cancer has spread to lymph nodes, bones, lungs or other organs.

What Symptoms Can Prostate Cancer Cause?

Although early prostate cancer doesn't cause any noticeable symptoms, eventually it can cause the following:

-Dull pain in your lower pelvic area
-Urgency of urination
-Difficulty starting urination
-Painful urination
-Weak or intermittent urine flow;dribbling
-A feeling that your bladder doesn't empty
-Frequent urination, especially at night
-Blood in the urine
-Painful ejaculation
-General pain in the lower back, hips or upper thighs
-Loss of appetite and weight
-Bone pain

Please don't panic if you do have some of these symptoms, as there are other conditions that can cause them. One of the most common is BPH, or benign prostatic hyperplasia. This is a harmless enlargement of the prostate caused by changes in the body's hormone levels. In older men, the inner part of the prostate around the urethra may continue to grow, and eventually cause problems leading to symptoms such as frequent urination, difficulty urinating, urination during the night, etc. Although this is a benign condition, it is important to get symptoms checked out and make sure that they aren't caused by cancer. BPH can be treated with medications, or if it is more severe, a surgical procedure called a TURP can solve the problem.

What are the Risk Factors for Prostate Cancer?

Age

Age is the strongest risk factor for prostate cancer; the chance of getting it rises quickly over the age of 50. Two-thirds of prostate cancers are found in men over 65.

Race/Ethnicity

Prostate cancer occurs more often in African-American men than in men of other races. African-American men are also more likely to be diagnosed at an advanced stage, and are more than twice as likely to die of prostate cancer as white men.

Conversely, prostate cancer occurs less often in Hispanic, American Indian, and Asian/Pacific Island men than in non-Hispanic whites. It is not known why these differences occur. (See chart below from the CDC for a comparison).

Prostate Cancer Death Rates by Race/Ethnicity in Men Aged 45 and Above

Nationality

Prostate cancer is most common in North America, northwestern Europe, Australia, and on Caribbean islands. It is less common in Asia, Africa, Central America, and South America. Intensive screening in the more developed countries may account for some of this difference, but other factors, such as lifestyle differences (diet, etc.) may be important as well.

Family History

Prostate cancer seems to run in some families, so there may be a genetic factor. Having a father or brother with prostate cancer more than doubles a man's risk of developing this disease. (The risk is higher for men with an affected brother than for those with an affected father.) The risk is much higher for men with several affected relatives, especially if their relatives were young at the time the cancer was found.

Scientists have found several genes that seem to raise prostate cancer risk, but they probably account for only a small number of cases overall. Genetic testing for these genes is not yet available.

(One of my friends, who was diagnosed with prostate cancer through a routine PSA test, immediately called his brothers and told them to be checked - and a good thing, too. One of his brothers was also diagnosed with prostate cancer as a result of his warning.)

Some inherited genes raise the risk for more than one type of cancer. For example, inherited mutations of the BRCA1 or BRCA2 genes, which lead to breast and ovarian cancers, may also increase prostate cancer risk in some men. So if there seems to be a pattern of women in a family with breast or ovarian cancer, the men in the family may be at a higher risk of prostate cancer and should be checked.

Diet

A number of dietary factors may raise risk of prostate cancer. Men who eat a lot of red meat or high-fat dairy products appear to have a slightly higher chance of getting prostate cancer. These men also tend to eat fewer fruits and vegetables, so it is not clear whether it is the presence of the red meat and dairy or the absence of fruits and vegetables that is to blame. A diet high in fat also seems to be a risk factor.

Some studies have suggested that men who consume a lot of calcium may also have a slightly higher risk; this may be why dairy products are associated with a higher risk as well.

Obesity

Although being obese does not seem to be linked with a higher risk of getting prostate cancer, several studies have found that obese men may be at greater risk for having more advanced prostate cancer and of dying from prostate cancer. The reasons for this are not clear, although it may be the connection with higher fat diets and higher fat levels in the body that does it.

Infection and Inflammation of the Prostate

Some studies have suggested that prostatitis (inflammation of the prostate gland) may be linked to an increased risk of prostate cancer. Inflammation is often seen in samples of prostate tissue that also contain cancer.

Can Prostate Cancer be prevented?

Eating more fruits and vegetables, particularly tomatoes, may confer some protection. Lycopene, a substance found in tomatoes, which is also available as a supplement, may help as well. One study has shown that pomegranate juice may be protective. Several other agents, including difluoromethylornithine (DFMO), isoflavonoids, selenium, and vitamins D and E have shown potential benefits in studies. Further studies are needed to confirm this.

A drug calle finasteride is being studied as a possible preventive agent, as it lowers testosterone levels, as this hormone is another factor in developing prostate cancer.

How is Prostate Cancer Treated?

Treatments options vary depending on the grade and stage of the cancer, the patient's age and overall life expectancy. Many factors must be taken into account, including the patient's own attitude toward the cancer. Some people just want to have the cancer removed, and are not as concernd with side effects, while others are more focused on their quality of life afterward. These concerns may result in different treatment choices even within the same stage of cancer. Following are some options recommended by the American Cancer Society.

Stage I

Since these prostate cancers are small and not aggressive, for elderly patients "watchful waiting" (by following PSA numbers) may be preferred. Other choices may be radiation therapy (either external beam therapy or the implantation of radioactive seeds (called brachytherapy).

Men who are younger and healthy may consider watchful waiting, radical prostatectomy (complete surgical removal of the prostate), or radiation therapy (external beam or brachytherapy).

Stage II

Stage II cancers that are not treated with surgery or radiation are more likely to eventually spread and cause symptoms. However, for elderly men who have other health problems, watchful waiting may still be the best option if the cancer isn't causing symptoms. These men are still more likely to die of something else rather than prostate cancer. However, surgery or radiation therapy may also be options for them.

For younger men who are healthy overall, radical prostatectomy (often with removal of the pelvic lymph nodes) may be the preferred choice. This may be followed by external beam radiation if the cancer is found to have spread beyond the prostate at the time of surgery, or if the PSA level is still detectable several weeks after surgery. This may be either external beam radiation, brachytherapy, or a combination of both. Participation in a clinical trial may be considered in order to take advantage of newer treatments. For aggressive cancers (as measured by Gleason score and PSA level), hormone therapy (to block the production of testosterone) may be added.

Stage III

Stage III cancers have spread beyond the prostate gland but have not reached the bladder, rectum, lymph nodes, or distant organs.

Treatment options at this stage may include:

-external beam radiation plus hormone therapy
-hormone therapy only
-radical prostatectomy in selected cases (often with removal of the pelvic lymph nodes). This may be followed by radiation therapy.
-watchful waiting for older men whose cancer is causing no symptoms or for those who have another more serious illness
-taking part in a clinical trial of newer treatments

Stage IV

Stage IV cancers have already spread to the bladder, rectum, lymph nodes, or distant organs such as the bones. These cancers are not considered to be curable, but treatment can be palliative and prolong life.

Treatment options may include:
-hormone therapy
-external beam radiation plus hormone therapy (in selected cases)
-surgery (TURP) to relieve symptoms such as bleeding or urinary obstruction
-watchful waiting for older men whose cancer is causing no symptoms or for those who have another serious illness
-taking part in a clinical trial of newer treatments

If symptoms are not relieved by standard treatments and the cancer continues to grow and spread, chemotherapy may be considered.

Treatment of stage IV prostate cancer may also include treatments for relief of symptoms such as pain.

One of the people I knew who had prostate cancer was a friend's father, who was diagnosed when he was nearly 80. Given his age and other health problems, and the stage of his cancer (which must have been III or IV), he was treated with hormones only. He lived about 18 months after his diagnosis.

For more details on all of the types of treatments, please see the Mayo Clinic website.

What Happens Next?

After prostatectomy, PSA levels are monitored to ensure the cancer is not returning. Since surgery removes the entire prostate, PSA levels should be undetectable afterward.

After radiation therapy, PSA is also monitored, but since the prostate has not been removed, the levels are not expected to be undetectable. A PSA that is rising on consecutive tests after treatment might indicate that cancer is still present.

For recurrent prostate cancer, the same treatments are available, depending on what has already been tried. If a patient has already had radiation treatment, for instance, then radiation treatment would not be an option if the cancer recurs. Surgery may still be an option, as is hormone therapy. For those whose cancer does not respond to hormone therapy, chemotherapy can extend life and reduce pain.

All treatments have side effects, varying from discomfort to impotence. It is important to understand the risks of these side effects before starting any treatment; be sure to discuss them with your doctor and make sure the doctor understands what your priorities are.

As with all cancers, when you are diagnosed, be sure to consult with various experts, including an oncologist and a radiation oncologist, as well as a surgeon, to truly understand your options. In addition be sure to consult with a major cancer center such as M.D. Anderson, Memorial Sloan Kettering, the Mayo Clinic, Johns Hopkins, or Dana Farber.

Will You Get It?

According to the American Cancer Society, about 1 man in 6 will be diagnosed with prostate cancer during his lifetime, but the good news is, only 1 man in 35 will die of it. If you have some of the risk factors mentioned above, then just make sure to get regular checkups and even if you do get it, you will likely catch it early and be cured.

Over 90% of these cancers are now found while they are still confined to the prostate gland, making them highly curable. Five-year survival rates are now at 99% for these men; for those whose cancer has spread to distant parts of their body, only 1/3 survive 5 years.

Sources used for this article:

http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=36 (American Cancer Society)http://www.mskcc.org/mskcc/html/403.cfm (Memorial Sloan Kettering)http://www.mayoclinic.com/health/prostate-cancer/DS00043 (Mayo Clinic)

Other excellent sources of detailed information, including the latest news and other resources on Prostate Cancer:

http://www.nlm.nih.gov/medlineplus/prostatecancer.html (Medline Plus)http://www.cancer.gov/cancertopics/types/prostate (National Cancer Institute)http://www.prostatecancerfoundation.org/ (Prostate Cancer Foundation)http://www.webmd.com/prostate-cancer/default.htm (Web MD)

Back Again

2007-12-01T19:49:00.000-08:00

After posting every day for the month of November on my regular blog, Mauigirl's Meanderings, as part of NaBloPoMo, it is finally over, and we can return to normal programming.

In other words, I should have time to post on this blog again and give you all some new medical information. Many apologies for the long silence.

I have not yet written the next post but have two topics pending that I intend to write about very soon. One will be on prostate cancer and the other on ovarian cancer. I've known several people with the former (one of whom was just diagnosed) and I know someone else with ovarian cancer, and would like to do research to understand more about what causes these cancers, learn how they are treated, and find out whether there are any new treatments being studied today.

So, hang in there, and I'll be posting a real post shortly!

Be Careful When Searching the Internet

2007-11-05T15:23:00.000-08:00

As a hypochondriac, I'm sure you have often searched the Internet for diseases and conditions that you fear you may have, or because you know someone who has something that you want to make sure you don't have.

And, in this blog, I have often urged you to do your own research on diseases so you'll be knowledgeable.

However, be careful. An article I came across on the Internet, while not recent, is still worth reading, even several years later. The point of the article is to be cautious when you search for medical information on the Internet.

The author refers to a study (whose link is now outdated, another problem with Internet research) that cited several problems with finding reliable health care information on the web:

"Two reasons have to do with the knowledge and skill of web users. Many consumers' ability to locate and evaluate health information online is hindered by access barriers for older, less well off, disabled, and non-English speaking Americans. Many people also lack critical thinking skills, having problems distinguishing credible health information from that which is not trustworthy.

The study also found problems with the web itself. Many web sites contain inaccurate, outdated or incomplete information. And of particular note, the study found that many consumers had a lack of knowledge about how search engines retrieve results, and didn't realize that paid placements listings can be featured prominently on search engine result pages without regard to quality."

In my experience with researching medical subjects on the Internet, I use the following "rules" when I search:

Never use information from a site that is also a source to purchase an herbal or pharmaceutical product.
Always look for mainstream sites such as the ones listed down the side of this blog in order to do your primary research on a disease or condition, e.g., The CDC, The Mayo Clinic, Memorial Sloan-Kettering, National Institutes of Health, etc.
Be sure to check the dates of the information you find. An article that may have been perfectly true several years ago may be hopelessly outdated now; some of these articles live forever on line.
Before believing any information you find, be sure that it is consistent with the preponderance of data you find on the major medical sites. If you see some miraculous cure for something that is not mentioned elsewhere, take it with a large grain of salt.
Whenever possible, if an article you find references a medical study, go to the original study to confirm the findings. Articles written for laypeople often "dumb down" the results of a study, or emphasize one aspect of it without covering the whole picture. Pub Med is a good source to look up medical studies, or you can search for the name of the study on Google. Even if you don't understand all of the technical language, you can at least double check to make sure the gist of the original article was correct.
Beware of quacks. If you find information on a doctor's site that you have no familiarity with, ignore information from that site unless it is backed up by the same data from a reliable source.
Never rely solely on the Internet for your diagnosis or treatment. It should only be a tool to help you talk to your doctor when you go for your appointment.

The Internet can be a very useful tool for those who use it wisely. You can learn what the latest treatment protocols are for your condition so you can ask your doctor about them, you can find clinical trials on line, you can learn to understand your disease or condition better, or you can look up your symptoms and find out what they may be caused by.

But be careful out there, as there is still a lot of uncharted territory.

The most important thing is to have a doctor you trust, who really listens to you when you tell them what is wrong.

MRSA: A Plague for the 21st Century?

2007-10-21T06:33:00.000-07:00

Recent reports of methicillin-resistant staphylococcus aureus (MRSA) spreading in schools have no doubt been panicking hypochondriacs everywhere, especially since these infections can look like an ordinary boil (or even a nasty zit). This is bad if you’re a teenager and don’t know whether you have it or not.

Before you hole up in your house and refuse to mingle with the general population, perhaps it would make sense to learn more about this “superbug” that is casting fear into the hearts of Americans everywhere.

First of all, you may ask, what is staphylococcus aureus?

Usually fondly referred to by its nickname, “Staph,” it is a bacterium that can cause a number of different illnesses, from superficial skin infections to systemic illness that can be fatal. The germ is found almost anywhere on the skin and is usually harmless. However, once in your body it can cause havoc.

I had a friend when I was young who got a staph infection from stepping on a tent stake, point-up (even now the mere idea of stepping on a tent stake gives me the horrors). She was hospitalized for over a week receiving intravenous antibiotics to quell the infection from staph germs that had gotten into her bloodstream. Luckily, being a strong, healthy 12-year-old, she recovered.

So, what is Methicillin?

Methicillin is a synthetic type of penicillin that was developed in 1959, when many drugs had already developed resistance to the original penicillin. By 1961, staph germs resistant to the drug had already been discovered, and subsequently additional drugs were introduced to fight the resistant strains. As time went on, the wily staph germ became resistant to a number of drugs, not just Methicillin, although these resistant bugs are still generically known as “Methicillin Resistant Staphylococcus Aureus.”

Currently the most resistant types of MRSA can only be attacked by what some call “the drug of last resort”: Vancomycin. When my father was hospitalized for depression in our local hospital a few years ago at age 88, he caught pneumonia while he was in the psychiatric ward. (It’s bad enough being depressed without getting pneumonia!). Because he caught it in the hospital, they immediately assumed the cause was a resistant bug and put him on I.V. Vancomycin. Thankfully, he recovered.

(By the way, here is a great term for you: A disease or condition that occurs as a result of hospitalization is called a “nosocomial” disease. It is kind of concerning to me that this happens so often that they have an official word for it. Just something to think about next time you’re hospitalized…)

MRSA is actually very common, and while it is concerning, there is something much scarier out there: Vancomycin Resistant Staphyloccocus Areus, or VRSA, which was first noted in the United States in a Michigan man in 2002. While still rare, and so far confined to people with chronic medical conditions (e.g., kidney failure) requiring catheterization or other invasive procedures, it is very concerning to know that MRSA is starting to become immune to Vancomycin. There are still a couple of other drugs that have been able to treat these very resistant bacteria, but unless science continues to develop new antibiotics, eventually these too will become ineffective.

MRSA can be acquired in two ways: through exposure through the healthcare system, or through the community without direct contact with the healthcare system. I’ll address both types here:

Healthcare-Associated MRSA:

According to the CDC:

“MRSA occurs most frequently among patients who undergo invasive medical procedures or who have weakened immune systems and are being treated in hospitals and healthcare facilities such as nursing homes and dialysis centers. MRSA in healthcare settings commonly causes serious and potentially life threatening infections, such as bloodstream infections, surgical site infections, or pneumonia.

In addition to healthcare associated infections, MRSA can also infect people in the community at large, generally as skin infections that may look like pimples or boils and can be swollen, painful and have draining pus. These skin infections often occur in otherwise healthy people.”

Hospitals have always been reservoirs of infection, even though healthcare providers have known for over a century that hand washing will cut down drastically on the spread of infection. However, CDC data show that the proportion of infections that are antimicrobial resistant has been growing. In 1974, MRSA infections accounted for two percent of the total number of staph infections; in 1995 it was 22%; in 2004 it was 63%.

The good news is that disinfection and stringent attention to hygiene can cut back on the spread of these infections in the hospital or at clinics and other medical settings. See the CDC website for more information on the precautions recommended to prevent the spread of drug-resistant staph in the medical community.

What about the Community-Associated MRSA?

This is the type that is getting all the bad press right now. The CDC definition of Community-Associated MRSA is:

“MRSA infections that are acquired by persons who have not been recently (within the past year) hospitalized or had a medical procedure (such as dialysis, surgery, catheters) are known as CA-MRSA infections. Staph or MRSA infections in the community are usually manifested as skin infections, such as pimples and boils, and occur in otherwise healthy people.”

What are the symptoms of MRSA?

According to Medicinenet.com,

“Most MRSA infections are skin infections that produce the following signs and symptoms:

Cellulitis (infection of the skin or the fat and tissues that lie immediately beneath the skin, usually starting as small red bumps in the skin),

Boils (pus-filled infections of hair follicles),

Abscesses (collections of pus in under the skin),

Sty (infection of eyelid gland),

Carbuncles (infections larger than an abscess, usually with several openings to the skin), and

Impetigo (a skin infection with pus-filled blisters).”

However, MRSA can spread from the skin to almost any organ in the body, resulting in a severe, even life-threatening illness, particularly among those with lowered immunity.

Symptoms to watch out for are:
-Fever
-Chills
-Low blood pressure
-Joint pain
-Severe headaches
-Rash over much of the body

How is MRSA transmitted?

It is usually spread in one of two ways:

One way is through physical contact with someone who is infected with, or a carrier of, MRSA. The second way is “for people to physically contact MRSA on any objects such as door handles, floors, sinks, or towels that have been touched by an MRSA-infected person or carrier.

Normal skin tissue in people usually does not allow MRSA infection to develop; however, if there are cuts, abrasions, or other skin flaws such as psoriasis (chronic skin disease with dry patches, redness, and scaly skin), MRSA may proliferate. Many otherwise healthy individuals, especially children and young adults, do not notice small skin imperfections or scrapes and may be lax in taking precautions about skin contacts. This is the likely reason MRSA outbreaks occur in diverse types of people such as school team players (like football players or wrestlers), dormitory residents, and armed-services personnel in constant close contact.”

How is it diagnosed?

MRSA is easily identified through taking a sample of the skin, pus, blood or urine of an affected person and sending it to a lab to be cultured to see whether S. aureus is present. If the bacteria grow in the Petri dish in the lab, then they are exposed to antibiotics, including methicillin, to find out whether they are resistant. If so, then the patient is diagnosed as MRSA-infected. If someone is suspected as being a carrier, the same procedure is done, but by swabbing the skin or mucous membranes, not through a biopsy.

How is it treated?

MRSA can still be treated with some antibiotics, including Vancomycin and others such as Linezolid. For MRSA carriers, mupirocin antibiotic cream can eliminate MRSA from mucous membrane colonization. The best way to proceed is to determine which antibiotic can kill the MRSA and use it alone or, more often, in combination with additional antibiotics. Since resistance can change quickly, antibiotic treatments may need to change also. It is extremely important for patients infected with MRSA to take the entire course of antibiotics that are prescribed, and not stop just because they feel better. This can lead to additional resistance.

Patients infected in the community usually fare well; hospitalized patients, not so much. Since they are usually ill in the first place, being in the hospital, they are more likely to develop the serious forms of the illness. As reported by the Kaiser Foundation, “As many as 1.2 million U.S. hospital patients are infected with methicillin-resistant staphylococcus aureus each year, nearly 10 times as many as previously estimated,” and the mortality rate is estimated to be between 4%-10%.

How can you avoid getting MRSA?

Avoiding direct contact with skin, clothing, and any items that come in contact with either MRSA patients or MRSA carriers, or anyone you think might be one, is the best way to avoid MRSA infection. However, unless you want to become a germophobic recluse like Howard Hughes, this may not work very well.

However, to minimize the possible spread of infection, people can treat and cover (for example, antiseptic cream and a Band-Aid) any skin breaks and use excellent hygiene practices (for example, hand washing with soap after personal contact or toilet use, washing clothes potentially in contact with MRSA patients or carriers, using disposable items when treating MRSA patients). Also, antiseptic solutions, such as Purell, and antiseptic wipes can be used to both clean hands and surfaces that may contact MRSA.

Personally, I never go anywhere without my Purell. Maybe I’m a little paranoid, but anytime I have touched surfaces that I know many other people have touched, whether browsing in a store or using a handrail in a public place, as soon as I have an opportunity, out comes the Purell. Better safe than sorry is always my motto.

In the hospitals, the CDC has found that use of alcohol gels can be more effective and result in more compliance than handwashing. See this link for a full analysis of improvements to hygiene and sanitation that can be made in the hospital setting.

Will you get it?

Not if you’re careful. But if you get any kind of unusual skin infection or have a flulike illness in combination with a skin infection, get to a doctor and get treatment. The earlier this type of infection is caught, the better. Cellulitis in and of itself, whether caused by MRSA or just regular bacteria, can be very serious.

The chart below shows the breakdown of who gets MRSA (more blacks than whites, higher rates of infection for the very young, teens and young adults, followed by a higher spike over age 50. About 58% of cases are associated with medical care within the past year; 27% start in the hospital, and just 13.8% are non-healthcare related.

The biggest concern is that new antibiotics are not being developed as frequently as in the past; once staph becomes resistant to Vancomycin and the other last resort drugs, we may have no defense against the next superbug. One way to forestall the rise of resistant bacteria is for doctors not to overprescribe antibiotics for every little ailment. Often patients go to the doctor with a sore throat or some other malady and literally expect to be prescribed an antibiotic and are disappointed or annoyed if the doctor sends them away without one. Doctors need to explain to patients that not all illnesses are caused by bacteria and that antibiotics do not work on viruses. The other danger is patients who do not finish their course of antibiotics, which means that if not all of the bacteria are killed, the ones that are left are more apt to be resistant and reproduce themselves.

Please see the links throughout this article for more detailed information on MRSA.

More on Misdiagnoses

2007-10-04T20:00:00.001-07:00

Not to belabor this subject, but CNN had another article about misdiagnoses that I thought I would share with you. This article was about several of the most common illnesses or conditions that tend to be misdiagnosed. Here, briefly, are the five they list:

1. Aortic dissection: This is when the aorta, the main artery leading from the heart to the rest of the body, actually tears. This is obviously catastrophic, since a complete tear results in massive blood loss. But sometimes this condition is hard to diagnose, as the pain or sensation the person feels can mimic other illnesses, or even something as simple as heartburn.

I had a friend whose father died of this; the pain he felt was in his back, and he thought he had injured his spine or had a slipped disk. He went to a chiropracter for treatment. The chiropracter immediately realized something much more serious was going on, and called an ambulance, but by the time my friend's father was on the operating table, sadly it was too late.

2. Cancer: In a Harvard study of malpractice claims in the U.S., cancer was the most misdiagnosed illness.

In my previous post on oral cancer, the young chef with tongue cancer was initially misdiagnosed by his dentist. And I had a friend whose doctor kept treating her for bladder infections when all along what she had was bladder cancer. Sadly, her initial surgery did not keep the cancer at bay and she died of the disease 2-1/2 years after her diagnosis.

3. Clogged arteries: Sometimes doctors tell patients they're short of breath because they're out of shape, when it's actually coronary artery disease. Chest pain can masquerade as heartburn or a pulled muscle.

4. Heart attack: Heart attacks don't always have the "classic" symptom of severe chest pain. Sometimes the only signs of a heart attack are a feeling of pressure or fullness in the chest, nausea, tiredness or malaise. Pain can also occur in the jaw or left arm. In women, in particular, heart attacks are often misdiagnosed as women tend to have less typical symptoms of heart attack than men do.

5. Infection: In the Harvard study, infection followed cancer as the most misdiagnosed condition.

An example of this is, a friend's mother, who is a lung cancer survivor, had problems breathing after a trip to Eastern Europe. The doctor she was going to at the time thought she was having symptoms of a recurrence of cancer. As it turned out, she had an infection with Mycobacterium avium, which is an unusual type of infection.

So how can you keep yourself from becoming a victim of misdiagnosis?

1. Ask for more tests (Do your research and find out what tests are commonly prescribed for symptoms such as yours).

2. Ask, "What else could my illness be?" (And of course, do your research so that you are aware of what other illnesses it could be, and can suggest them if your doctor does not).

3. Don't assume no news is good news. This is very important; my friend with the bladder cancer had been receiving CT scans regularly as follow-ups to her cancer surgery. Apparently, she did not hear any results from the last one she had had, and somehow did not find out until 3 months later that the scan had showed enlarged lymph nodes in her abdomen. Who knows whether her outcome might have been different had she found this out sooner?

This goes for all kinds of tests, including your yearly Pap test. If you had one and don't hear from your doctor, call him or her and ask if everything was OK. And ask for copies of your lab tests, and read them carefully. If something doesn't look right, call your doctor and ask about it.

4. Assume your doctors don't talk to one another. Always tell each doctor you go to about anything going on with the other doctor: Any tests, any blood results, any scans, any symptoms. If you feel your doctors should be working together as a team, schedule a conference call.

5. Be wary when your doctors work in shifts - be sure each one passes on information to the other. And whenever possible, try to always see the same doctor even in a practice that has a number of physicians.

Sometimes you only get one chance to get your diagnosis right. Make sure you do everything that is in your own power to accomplish that.

Oral Cancer

2007-09-30T09:01:00.000-07:00

I thought it was about time I wrote about this subject – since I am an oral cancer survivor. Two and a half years ago, I was diagnosed with, of all things, tongue cancer. I didn’t even really know there was such a thing until it happened to me.

As a hypochondriac, I feel I have always done a really good job of making sure to worry about all of the diseases and conditions with which I was likely – or not so likely - to be diagnosed.

I worried about breast cancer, cervical cancer, AIDS, Chronic Fatigue Syndrome (bingo, had that), brain tumors, aneurysms, and more. But never had I even remotely worried about tongue cancer.

And wouldn’t you know it, that was what I got? It just goes to show, you must constantly search for new, more obscure diseases to worry about, or else one will pop up that you hadn’t thought of. (I like to call it “preventive worrying.” If you worry about it, it won’t happen.)

So, here is my story.

In late January of 2005, I noticed a sore spot on the side of my tongue that was annoying me. At first glance I didn’t see anything, so I didn’t worry much. But it kept bothering me. Finally one day I carefully examined the side of my tongue with my glasses off (being highly nearsighted, this is as good as using a magnifying glass), and saw a tiny little indentation, like a canker sore when it first starts. Relieved, I started rinsing with Amosan, thinking it would be gone in a few days.

I had recently been under a lot of stress - my father had just died - and I figured that it wasn’t unusual to get a canker sore after that.

But about a week later it was still there, and it looked about the same, maybe a little whiter. I had a dentist appointment for a checkup and while I was there I asked him about it. He didn’t seem too worried, but said if it didn’t go away he’d send me to an oral surgeon.

I was back the next week for a filling and when I told him the tiny spot was still there, he gave me the name and phone number of a nearby oral surgeon.

The doctor was able to see me on March 4. When I went, the lesion was so tiny he couldn’t even see it until I pointed it out to him. A shot of Novocain, a quick cut, a few stitches, and it was gone.

In the meantime, I had done all kinds of Internet research on tongue cancer, and had discovered to my dismay that tongue cancer was not a laughing matter. It only had an overall survival rate of around 80% even in early stages, and did not respond all that well to chemotherapy. So I was glad to have gotten rid of this thing. I assumed I was being my usual hypochondriacal self and that it would turn out to be nothing.

Four days later I was supposed to go back to the surgeon to make sure the tongue was healing properly. It was snowing that afternoon, the tongue felt fine, and I figured maybe it wasn’t so important to go back. I called up and asked if I really had to go, given the weather. I was somewhat surprised when the nurse told me the doctor still wanted to see me.

When I arrived, the doctor invited me into his office rather than the examining room, and that’s when I realized something was amiss. He informed me the biopsy had come back as cancer.

To make a long story shorter, I didn’t mess around – I went to a surgeon at Memorial Sloan-Kettering who was recommended by my husband’s dentist, and on April 1 (no fooling), he took an additional chunk off the side of my tongue to make sure all of the cancer was gone.

By this time I had also consulted an oncologist at Hackensack University Medical Center’s Cancer Center, who had sent me for an MRI and a CT scan, and done blood work, to ensure that the cancer hadn’t spread anywhere. (The surgeon at Sloan-Kettering had not sent me to an oncologist for additional screening, but I figured better safe than sorry - I always hedge my bets. So I found my own).

I had also had the original biopsy sent to Sloan-Kettering at their request, where they did a more thorough examination that determined the depth of invasion by the lesion was less than a millimeter – barely a cancer at all. So by this time I was feeling better about my prognosis.

The results of the surgery showed that the original biopsy had actually gotten all of the cancer, and the surgeon told me I needed no further treatment; just needed follow-up examinations with him every 3 months.

Now it’s been 2-1/2 years and thankfully, no new cancers have popped up, nor have I had any spread of the original one. I am very lucky that I am a hypochondriac and didn’t wait too long to get the lesion taken off.

Sadly, that doesn’t always happen for everyone. There was recently a story in the Wall Street Journal about a young 33-year-old chef who was diagnosed with Stage IV tongue cancer. He had had a similar experience to mine, but his dentist just gave him a mouth guard to wear at night, saying he must be unconsciously biting on his tongue, and the young man ignored the continued pain until it got so bad a year or so later that he had lost 10 lbs. and could hardly eat. He is currently undergoing radiation and chemo in hopes of not losing his tongue – or his life.

So, with that introduction, I will now get into the details of what oral cancer is, what can cause it, what the treatments are, and whether you will get it.

What Is Oral Cancer?

Oral cancer is a group of cancers affecting the mouth. It is part of a larger group of cancers known as “Head and Neck Cancers.” This article will concentrate on cancers of the mouth, specifically, the palate, gums, tongue and lips. Locations where oral cancer is commonly found are:

- the lining inside the lips and cheeks (buccal mucosa)
- the floor of the mouth (under the tongue)
- the top of the mouth (hard palate)
- the small area behind the wisdom teeth

The most common type of oral cancer is the type I had – squamous cell carcinoma. Over 90% of oral cancers are of this type. It arises in the skin cells, and can also occur on other parts of the body.

According to the Merck Manual, about 40% of squamous cell carcinomas begin on the floor of the mouth or on the side or bottom of the tongue, like mine did, and another 40% occur on the lower lip. The rest of them start on the roof of the mouth or the tonsils.

Another type of cancer is called verrucous (warty) carcinoma, which appears as a white grooved surface on the lining of the mouth. This type of cancer rarely metastasizes (spreads to other parts of the body) and is considered to be of a low grade of malignancy. It makes up only about 5% of oral cancers.

Cancer can also arise in the salivary glands, but this is relatively rare. In addition, melanoma and Kaposi's sarcoma (an unusual cancer that is more common among AIDs patients) can also occur in the mouth.

What Are the Symptoms of Oral Cancer?

Oral cancer often starts as mine did, with a sore place or little ulcer that looks like a canker sore. However, not all of them cause pain, which explains why a lot of oral cancers may not be found until they have already progressed. An oral cancer can begin with any of the following symptoms:

Common symptoms or warnings of oral cancer can include:

- Patches inside your mouth or on your lips that are white, a mixture of red and white, or red
- White patches (leukoplakia) are the most common. White patches sometimes become malignant.
- Mixed red and white patches (erythroleukoplakia) are more likely than white patches to become malignant.
- Red patches (erythroplakia) are brightly colored, smooth areas that often become malignant.
- A sore on your lip or in your mouth that won't heal (which is what I had)
- Bleeding in your mouth
- Loose teeth
- Difficulty or pain when swallowing
- Difficulty wearing dentures
- A lump in your neck
- An earache

The earache is particularly of interest - it is called referred pain, when the pain that happens isn't where the problem lies. I had a pain like this toward the back of my jaw for ages before my cancer was diagnosed, and thought it was just a pain in my jaw from my mismatched bite. I also thought the very back of my tongue was rubbing on something. Turned out that it all came from the side of my tongue where the tiny ulcer eventually appeared, which was fairly close to the front of my tongue. Once it was removed, all pain left. So if you have some kind of pain in your mouth and can't put your finger on it - literally - explore different areas than you think it is; it may be referred pain.

So, say you get some weird symptom in your mouth. Before panicking, you may ask yourself "Could it be anything else besides a life-threatening cancer?" because otherwise you may go into a full-scale hypochondriacal panic attack. The answer is, yes, there are a lot of other types of growths that can occur in the mouth that are totally benign, such as:

Fibroma: a benign tumor consisting of fibrous connective tissues:

Keratoacanthoma : a flesh-colored, fast-growing bump on the skin with a keratin plug in the center (keratin, the main component of the external layer of skin, hair, and nails, is a tough substance);

Leiomyoma: a tumor of the smooth muscle, often found in the esophagus, small intestine, uterus, or stomach;

Lipoma : a tumor made up of mature fat cells;

Neurofibroma: a fibrous tumor consisting of nerve tissue;

Papilloma: a tumor that resembles a wart, growing on the epithelium (the cells that form the skin and mucous membranes);

Pyogenic granuloma: a small, round bump that often has an ulcerated surface;

Rhabdomyoma: a striated-muscle tumor that may appear on the tongue, pharynx, uterus, vagina, or heart;

Schwannoma: a single tumor that grows in the neurilemma (Schwann's sheath) of nerves; or

Verruca form xanthoma: wart-shaped tumors

If you see any kind of unusual symptom in your mouth that doesn't go away after a week or so, go to your dentist for an exam. If the symptom does not resolve within another week or so, even if your dentist does not seem concerned, don't ignore it. Make sure to get a biopsy or other definitive test to rule out cancer.

What Causes Oral Cancer?

Oral cancer has a number of risk factors. It is highly associated with smoking and is more common in older people – hence, when I told my regular doctor that I had tongue cancer, she said in surprise, “But you’re not an older man who smokes!”

Tobacco use (either smoking or chewing tobacco) is by far the biggest risk factor for oral cancer. However, alcohol use is another independent factor that can lead to oral cancer; naturally, more use is more risk. Combining alcohol with tobacco is even more risky.

Constant irritation from dentures or a sharp tooth can also be a factor, as can overexposure to sun (for lip cancer). In some cases poor oral hygiene can be a cause, although this isn't that common in our modern society.

Although as a precaution I stopped drinking alcohol after my diagnosis, I had also had a sharp tooth that may have been rubbing on my tongue. I've since had the dentist file it down. I will never know if that was the cause, or the alcohol consumption - or perhaps a combination of both.

I miss my wine - I had my last drink on St. Patrick’s Day 2005. A nice glass of Chardonnay. Kendall Jackson. I can still taste it. It’s ironic, too, because red wine was usually my wine of choice. And I loved Guinness, so I don’t really know why I had that Chardonnay on St. Patrick’s Day. But that was what it was. And I don't dare take it up again, given that people who have had one oral cancer are at high risk for another. There's no sense in doing something that is known to increase that risk.

Although oral cancer tends to be more common in men, in recent years women and younger people have been showing up with this cancer more frequently. Viruses such as the human papilloma virus (the same one that causes cervical cancer) may be a cause as well, which may account for more cases in younger non-smokers, according to the Oral Cancer Foundation.

At any rate, just because you may not fit into the typical oral cancer profile, don't assume you don't have it and make sure to get checked regularly for any abnormalities when you go to the dentist.

How Is Oral Cancer Diagnosed?

To diagnosis oral cancer, in addition to a complete medical history and physical examination, your dentist may send you for a biopsy, wherein tissue samples are removed (with a needle or during surgery) for examination under a microscope; this is the most definitive method, and the one that diagnosed my cancer.

There are some new methods of highlighting abnormal areas in the mouth that some dentists are now using as an overall screening method, wherein the patient rinses with a solution that causes unusual areas to show up under a special light.

Sometimes a brush can be used on a suspicious patch of tissue to obtain cells for further examination.

If cancer is diagnosed, the following methods may be used to ascertain whether it has spread, or how deep it may be:

Computed tomography (CT or CAT scan) - uses radiation to obtain a very detailed view of tissues that do not show up on an ordinary X-ray;

Ultrasonography - a diagnostic imaging technique which uses high-frequency sound waves to create an image;

Magnetic resonance imaging (MRI) - another non-invasive procedure that produces views of an internal organ or structure, and is especially useful to observe the brain and spinal cord.

Your doctor or dentist may also recommend fiberoptic examination of the throat and palate to ensure you don't have other lesions that are not visible through a regular oral exam.

There are a number of other methods to determine the stage of the cancer; see this link for more information: http://oralcancerfoundation.org/diagnosis/index.htm

There are four stages of oral cancer, as described on the Oral Cancer Foundation website:

Stage I

The cancer is less than 2 centimeters in size (about 1 inch), and has not spread to lymph nodes in the area (lymph nodes are small almond shaped structures that are found throughout the body which produce and store infection-fighting cells).

Stage II

The cancer is more than 2 centimeters in size, but less than 4 centimeters (less than 2 inches), and has not spread to lymph nodes in the area.

Stage III

Either of the following may be true: The cancer is more than 4 centimeters in size. The cancer is any size but has spread to only one lymph node on the same side of the neck as the cancer. The lymph node that contains cancer measures no more than 3 centimeters (just over one inch).

Stage IV

Any of the following may be true: The cancer has spread to tissues around the lip and oral cavity. The lymph nodes in the area may or may not contain cancer. The cancer is any size and has spread to more than one lymph node on the same side of the neck as the cancer, to lymph nodes on one or both sides of the neck, or to any lymph node that measures more than 6 centimeters (over 2 inches). The cancer has spread to other parts of the body.

Recurrent

Recurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the lip and oral cavity or in another part of the body.

There are also different "grades" of cancer, which mean differences in how aggressive the cancer may be. See the Oral Cancer Foundation site for more information on this.

Depending on what stage and grade the cancer is, there are a number of available treatments.

How Is Oral Cancer Treated?

For very early cancers, surgery is the first best choice for a full cure. However, for more advanced cancers, or those in a spot where surgery would cause a decrease in quality of life (affecting speech or taste), radiation can be a viable alternative. Here is a basic listing of the various treatments available, according to this source: http://www.healthsystem.virginia.edu/uvahealth/adult_oralhlth/cancer.cfm

Surgery

Different surgery techniques are used to remove specific types of oral tumors, including:

-Primary tumor resection - removal of the entire tumor and surrounding area of tissue

-Mandible resection -removal of all or part of the jawbone
maxillectomy - removal of the tumor, including part or all of the hard palate (roof of the mouth), if bone is involved

-Mohs' micrographic surgery - removal of the tumor in "slices" to minimize amount of normal tissue removed (may be considered when the cancer involves the lip)

-Laryngectomy - removal of a large tumor of the tongue or oropharynx, which may involve removing the larynx (voice box)

-Neck dissection - if cancer has spread to the lymph nodes in the neck, these lymph nodes may need to be removed as well.

Radiation therapy

This is a treatment that uses high-energy rays that damage cancer cells and halts the spread of cancer. Radiation therapy is very localized, aimed at only the area where the cancer is present. Radiation therapy may be administered externally with a machine, or internally with radioactive materials.

Chemotherapy

Chemotherapy uses medications that kill cancer cells. Chemotherapy has the ability to interfere with the cancer cell's replication. Chemotherapy may be used in combination with surgery and radiation therapy.

The following more detailed listing of treatments is exerpted from this link: http://www.oralcancerfoundation.org/cdc/cdc_chapter6.htm

Most centers advocate surgical excision for early-stage primary disease of the lip, floor of mouth, oral tongue, alveolar ridge, retromolar trigone, hard palate, or buccal mucosa. The CO laser may also be used as a cutting tool in removing oral cavity cancers. In addition, this laser may be useful in removing dysplastic lesions without scarring the area significantly. However, clinicians must still observe the patient closely after the lesions are removed, as there is a significant likelihood of recurrence.

Although radiotherapy [radiation] may work as well as surgery for early malignant lesions in several of these subsites, such as the floor of mouth, concern about complication rates has made surgery the choice for most of these lesions. However, more advanced primary tumors in any of these sites typically require a combination of surgery and radiotherapy. Advanced primary tumors adjacent to the mandible may require a rim mandibulectomy, and those tumors that frankly invade the mandible are treated with a segmental mandibulectomy. The plan for surgical resection must also include reconstructive options; reconstructive teams composed of head and neck surgeons, oral surgeons, and prosthodontists are most successful at achieving the best functional and cosmetic result.

Most radiotherapy for carcinoma of the oral cavity uses an interstitial implant either alone or combined with external beam. For carcinoma of the oral tongue and buccal mucosa, the results of an interstitial implant alone or combined with external beam radiotherapy are generally better than those achieved with external beam radiotherapy alone.

Recurrence rates vary by primary site and increase with increasing primary stage.

Because the effects of treatment may cause disfigurement and other difficult side effects, there is often a need for follow-up surgeries, prostheses to replace missing tissue, and other therapies. Support groups can be helpful for those trying to cope with these issues. When getting radiation treatment be sure to ask many questions ahead of time, as there are now drugs and other preventive measures that can be taken to minimize some of these effects (such as protecting the salivary glands from damage, which will help preserve the ability to produce saliva).

What Is The Prognosis?

(exerpted from above link, continued)

For lesions on the floor of the mouth, 5-year cause-specific survival rates by stage are as follows: I: 90%, II: 80%, III: 70%, favorable IV: 40-50%, and unfavorable IV: 20%.

Five-year cause-specific survival rates for oral tongue cancers by stage approximate the following: I and II: 70-80%, III: 40%, and IV: 15-20%.

These rates vary depending on where the patient is treated and how early the cancer was. My surgeon at Sloan-Kettering told me my chances of survival were above 90%.

If you are diagnosed with an oral cancer, be sure to get at least two opinions before embarking on your treatment. Some doctors prefer surgery, some recommend radiation, and you will need to understand the pros and cons of both.

I would also recommend, no matter where you live or end up actually having your treatment, be sure to at least have a consultation at a major cancer center such as Memorial Sloan-Kettering or M.D. Anderson (Texas). As Sloan-Kettering's motto goes, "Where you are treated first can make all the difference."

Will You Get It?

The odds are against it. Mouth cancer in general struck a little over 10,000 people in the United States in 2004, which are odds of about 1 in 26,000. Tongue cancer was even rarer, 1 in 37,000, or just over 7,000 cases in the U.S. that year. Other sources cite slightly different statistics, but they all confirm that oral cancer, particularly tongue cancer, is a relatively rare cancer. (I was one of the "lucky" ones I guess - why can't I hit those odds when I'm playing the lottery?)

While there are some experiments being done to identify preventive measures for oral cancer, so far the most important thing you can do to prevent this condition is to eat lots and lots of fruits and vegetables. And a recent study found avocados in particular may be helpful.

In conclusion, remember, just because the odds are against you having oral cancer, don't be complacent about it if you notice anything amiss in your mouth. Go to your dentist, and don't take any chances if something isn't going away, no matter what reassurances you may get. You only have one life to live and when early diagnosis is so important, time is of the essence.

The following links were sources for this information and can provide many more details than were included above.

http://www.cancer.gov/cancertopics/wyntk/ora
http://www.oralcancerfoundation.org/
http://www.nlm.nih.gov/medlineplus/oralcancer.html#cat11
http://www.medicinenet.com/oral_cancer/article.htm
http://www.healthsystem.virginia.edu/uvahealth/adult_oralhlth/cancer.cfm
http://www.merck.com/mmhe/sec08/ch113/ch113d.html#sec08-ch113-ch113d-136
http://www.wrongdiagnosis.com/o/oral_cancer/intro.htm

What If Your Doctor Is Wrong?

2007-09-24T10:09:00.000-07:00

CNN had an interesting, albeit concerning, article regarding misdiagnoses – which apparently happen all too often.

As a hypochondriac, you are probably used to being told “Don’t worry, there’s nothing seriously wrong with you.” But if you are really worried about symptoms you are having, don’t take no for an answer. Your doctor could be missing something. If the doctor you are currently going to doesn’t listen to your symptoms or take them seriously, go somewhere else.

By the same token, you may be all too ready to believe it if a doctor tells you that you have a serious illness. But if something tells you that it’s not likely that you have whatever it is he or she has diagnosed, then again, seek another opinion.

You are the best judge of how you feel; if there is something about your health that is making you uneasy, don’t rest until you figure it out.

This article has some alarming case studies. How would you like being told you had a rare form of lymphoma, but it turned out to be a benign fatty tumor?

http://www.cnn.com/2007/HEALTH/09/19/ep.misdiagnoses/index.html

The article has some good advice for all of us to follow when it comes to diagnoses, including the following recommendations (my comments in blue):

Here, from from medical experts, are some red flags -- five reasons for suspecting your doctor might have made the wrong diagnosis.

1. You don't get better with treatment

Sometimes doctors stick to a diagnosis even when multiple treatments aren't working.
As vice president for loss prevention and patient safety at Harvard's Risk Management Foundation, Bob Hanscom remembers one particular lawsuit against Harvard doctors.

A young woman complained of stomach and chest pain. Her doctor prescribed a medicine for gastric reflux. When it didn't work, a second doctor prescribed another drug for gastric reflux. It also didn't work. The woman ended up in the emergency room with acute pancreatitis, which eventually caused kidney failure.

She survived but will be on dialysis the rest of her life.

So, if your doctor has prescribed something for you that usually works on a condition within a certain amount of time, be sure to do some research on your symptoms and see if they could be caused by something else, and bring this to the doctor’s attention rather than blindly continuing to accept medications for the same condition as you continue farther down the wrong diagnostic path.

2. Your symptoms don't match your diagnosis

This is where the Internet comes in. You don't have to be a medical professional to Google your diagnosis.

For example, let's say a doctor diagnoses you with tendinitis. Looking it up, you can find out it usually lasts about six to 12 weeks, according to Dr. Saul Weingart, an internist and vice president for patient safety at Dana-Farber Cancer Institute in Boston, Massachusetts.

If you're still in pain beyond that time, the doctor may have made the wrong diagnosis.

By the same token, if you Google your symptoms and find they don’t really match what has been diagnosed, but are a closer match with something else, again, bring it to your doctor’s attention. If you have the right doctor, he or she will not be offended by your suggestions or your research. If they are, then find another doctor.

3. Your diagnosis is based purely on a lab test

The reality is that labs make mistakes. In Torrey's case, she says two labs made mistakes. When lab results are the sole criteria for a diagnosis, that can be a red flag, says Torrey, who works as a patient advocate. Another red flag is when a diagnosis of a rare disease comes from a lab that doesn't specialize in that disease, Weingart says.

Recently my husband and I had our annual blood tests, which required fasting beforehand. When we got our results back, we found that the lab had mislabeled our condition as being non-fasting, so all of the comparison ranges were for non-fasting values. This could have resulted in our cholesterol and blood sugar readings being incorrectly diagnosed as being normal when they may have been too high. (Luckily that was not the case when we checked into it).

Other tests can also be mixed up. I once had a misdiagnosis of severe heart failure based on a routine EKG that was run in my doctor’s office when I had complained of occasional palpitations. The doctor called me and told me he wanted me to take it easy over the weekend and not do anything strenuous, and that he’d want to put me in the hospital for tests on Monday. He later called back and apologized, saying my EKG had gotten mixed up with that of an elderly patient with an aortic aneurysm.

Again, this was an example of symptoms not matching the condition. Other than my minor palpitations (which turned out to be nothing to worry about), I had no symptoms of heart failure that would have matched the sobering diagnosis suggested by the EKG. Luckily my doctor was equally puzzled by this discrepancy, which made him double check the results – but not soon enough to avoid scaring the bejeesus out of me and my husband!

4. Your doctor attributes common complaints to an uncommon ailment

Torrey says her doctor said her night sweats and hot flashes were caused by the extremely rare lymphoma. Actually, they were signs of menopause.

Can you imagine? Quite a big mistake there!

Obviously this doctor did not remember the old adage that is told to medical students: “If you hear hoof beats, think horses, not zebras.”

5. Your diagnosis usually involves a test you never received

This is where the Internet comes in handy again. If you find out a specific test can determine the diagnosis you've been given, but you were never given that test, that's a reason to head back to the doctor's office armed with questions.

Another thing to be wary of is going by the results of just one test, if a disease or condition is more accurately diagnosed with more than one. Lyme disease is a good example; a simple antibody test might show up positive, but a more extensive type of test is needed to more definitively diagnose the disease. And even then there is potential for misdiagnosis.

So there you have it. While you shouldn't go by the motto of the old X-Files TV show, "Trust no one," at least follow the other old adage, "Trust, but verify."

Stress Linked to Alzheimer's Disease

2007-08-31T10:37:00.000-07:00

A recent article reported in Medical News Today confirms what I have suspected for some time: stress apparently is a co-factor for memory loss associated with Alzheimer's Disease.

A study being being published in the September 1st issue of Biological Psychiatry was designed to explore the relationship between mutations of the APOE gene (also called allele) and cortisol levels. It is known that the a4 variant of the APOE gene contributes to the risk for memory loss related to Alzheimer's Disease, as do high circulating levels of cortisol, associated with high stress levels.

The article is "The Effects of Prolonged Stress and APOE Genotype on Memory and Cortisol in Older Adults" by Guerry M. Peavy, Kelly L. Lange, David P. Salmon, Thomas L. Patterson, Sherry Goldman, Anthony C. Gamst, Paul J. Mills, Srikrishna Khandrika and Douglas Galasko. It appears in Biological Psychiatry, Volume 62, Issue 5 (September 1, 2007), published by Elsevier.

The study results showed that "low-stress subjects performed better than high-stress subjects on delayed recall of stories, word lists, and visual designs. APOE-epsilon4-negative subjects obtained better scores than epsilon4-positive subjects on immediate and delayed recall of visual designs."

The study also showed worse memory and higher cortisol concentrations in the high stress, epsilon4-positive group. The authors concluded that the findings indicate "prolonged exposure of older, nondemented individuals to stress in the presence of an epsilon4 allele leads to memory decline." They hope to do further studies to learn whether stress and this gene mutation interact to increase the risk of developing Alzheimer's disease in the first place.

I was not surprised to read about this, as I have been aware of several cases of Alzheimer's Disease that seemed to come on rather suddenly after a highly stressful situation. The mother-in-law of a friend of mine, who seemed totally normal not long before her husband died, became almost completely demented by the end of the following year. My husband's grandmother didn't show any overt memory loss or signs of Alzheimer's until not long after her only son accidentally (we think) shot himself in the head and was stricken blind as a result.

My father's mental state was pretty normal (other than his usual problems with depression) until a year or so after major heart surgery, which must have been stressful for both mind and body. I wonder to this day whether he would have been better off dying of heart failure at 86 rather than living to 92, with the last three years lived in an ever-increasing fog of memory loss, loss of skills, loss of comprehension, and loss of personality.

My mother-in-law now seems to be in the middle stages of Alzheimer's Disease; but her forgetfulness started not long after her own mother died in the nursing home of complications from Alzheimer's Disease. My mother-in-law had been under tremendous stress for a number of years before her mother's death, when her mother was still living in a senior citzen's apartment building. She went there every day, made sure her mother ate, bathed her, brought her over to her own home to entertain her, dealt with her mother's temper tantrums as she worsened and showed personality changes, etc. Her mother died not that long after entering the nursing home because she broke her hip, which tipped her over the edge into incoherence after the hip was operated on. This was still more stress for my mother-in-law, who developed shingles at this time, another indication of the body's reaction to stress, which lowers the immune system response.

While further studies are planned, it makes sense to me that if you have any Alzheimer's Disease in your family, that you should avoid stress as much as possible. While we don't know whether the development of AD can be prevented or delayed by reducing stress, it sure couldn't hurt.

Of course, as a hypochondriac, you will probably now get stressed out worrying whether your stress levels are leading to early Alzheimer's Disease. This will be self-defeating, so go meditate or something! And a little yoga might help too.

An Award for Medicana

2007-08-24T14:30:00.000-07:00

Ruth of Me, My Life, My Garden has awarded Medicana a "Creative Blogger" award, saying it is quite creative for someone to invent a blog for hypochondriacs! Thanks, Ruth!

In case, as a hypochondriac, this worries you, she did not award it to me for making things up! I do indeed try to get the facts straight!

I'll be passing this award on to other creative bloggers, but will do it from my other blog, Mauigirl's Meanderings.

A new medical post will be up soon!

When it Pays to be a Hypochondriac

2007-08-18T06:00:00.000-07:00

For all I poke fun of myself for being a hypochondriac, I believe hypochondria, in moderation, can actually be a very good thing, leading to a long and healthy life. Why? Because if you're the right type of hypochondriac, you go to the doctor when you have suspicious symptoms. And serious illnesses, caught early, are curable.

Naturally, this can be carried to extremes, and we all know people who run to the doctor for every sniffle or scratch, and drive people crazy with their constant obsessing over their health. This can be unhealthy, by driving up stress levels and actually causing stress-related illnesses.

So, as a hypochondriac, how do you know when you should worry, and when you should tell yourself to let it go?

Luckily for us, MSN.com has published an article from the Mayo Clinic about 10 Symptoms Not to Ignore. Following are their recommendations; I'll put my own comments in blue.

1. Unexplained weight loss
If you find you're losing excessive weight without intending to do so, see your doctor. Unintentional excessive weight loss is considered to be a loss of more than:

5 percent of your weight within one month
10 percent of your weight within six to 12 months

An unexplained drop in weight could be caused by a number of conditions, such as an overactive thyroid (hyperthyroidism), depression, liver disease, cancer or other noncancerous disorders, or disorders that interfere with how well your body absorbs nutrients (malabsorption disorders).

Heart disease is not mentioned as one of the causes of weight loss, but that is another reason people may lose weight for no reason. As my father progressed into heart failure in his mid-80's, he lost weight. He didn't seem to develop the edema (fluid retention/swelling) that some heart failure patients get, which can disguise the weight loss. His only issue was breathing difficulties at night.

Old age in general can result in weight loss, as people find it harder to chew, lose their appetite and sense of taste and smell, or live alone and don't feel like cooking. As mentioned in the previous post, it is important for the elderly to continue to keep up their nutrition, particularly protein. If they aren't willing or able to eat more, then nutritional substitutes such as Boost or Ensure can help keep up their caloric intake.

2. Persistent fever
If you have a normal immune system and you're not undergoing treatment, such as chemotherapy for cancer, a persistent low-grade fever — over 100.4 F — should be checked if it lasts for a week or more. If you have a fever with shaking chills, or a high fever — greater than 103 F — or if you're otherwise severely ill, see your doctor as soon as possible.

If you have an immune system problem or take immune-suppressing drugs, fever may not be a reliable warning sign and your primary doctor or oncologist can tell you what would signal a need for an evaluation.

Persistent fever can signal hidden infections, which could be anything from a urinary tract infection to tuberculosis. At other times, malignant conditions — such as lymphomas — cause prolonged or persistent fevers, as can some medications and conditions, and reactions to certain drugs.

Fever is common with treatable infections, such as urinary tract infections. But if a low-grade fever persists for more than two weeks, check with your doctor. Some underlying cancers can cause prolonged, persistent fever, as can tuberculosis and other disorders.

3. Shortness of breath
Feeling short of breath — beyond the typical stuffy nose or shortness of breath from exercise — could signal an underlying health problem. If you ever find that you're unable to get your breath or that you're gasping for air or wheezing, seek emergency medical care.

Feeling breathless with or without exertion or when reclining also is a symptom that needs to be medically evaluated without delay. (This was one of the key symptoms my father had with his congestive heart failure.)

Causes for breathlessness may include chronic obstructive pulmonary disease, chronic bronchitis, asthma, heart problems, anxiety, panic attacks, pneumonia, a blood clot in the lung (pulmonary embolism), pulmonary fibrosis and pulmonary hypertension.

4. Unexplained changes in bowel habits
See your doctor if you have any of the following:
-Severe diarrhea lasting more than two days
-Mild diarrhea lasting a week
-Constipation that lasts for more than two weeks
-Unexplained urges to have a bowel movement
-Bloody diarrhea
-Black or tarry-colored stools

Changes in bowel habits may signal a bacterial infection — such as campylobacter or salmonella — or a viral or parasitic infection. Among other possible causes are inflammatory bowel disease and colon cancer.

Of course, as a hypochondriac, you will want to know as many possible causes as you can, so you'll have more to worry about and so you can help your doctor by figuring out what is wrong with you ahead of time and informing him or her of your diagnosis.

Other reasons for diarrhea or changes in bowel habits include celiac disease (or milder forms of gluten intolerance, where the body is sensitive to wheat products) and irritable bowel syndrome (IBS).

Bloody or black diarrhea may not even be a problem related to the bowels; the cause could be a bleeding ulcer in the stomach. This happened to my father-in-law a few years ago. He began having black diarrhea and feeling very weak. After he was taken to the emergency room he was diagnosed with a bleeding ulcer; luckily it stopped of its own accord and medication and diet were able to cure him. He's had no problems since.

Bright red blood in the stool can be a symptom of something as simple as hemmorrhoids. But it is important to find out for sure by consulting your doctor.

5. Mental status changes
Immediate medical evaluation is warranted if any of the following occur:
-Sudden or gradual confused thinking
-Disorientation
-Sudden aggressive behavior
-Hallucinations in someone who has never had them

Changes in behavior or thinking may be due to infection, head injury, stroke, low blood sugar or even medications, especially ones you've recently started taking.

Other causes can include a brain tumor or other lesions on the brain, or dementia from Alzheimer's or other similar diseases. Please see my previous posts on Alzheimer's and Brain Tumors for more information to scare yourself with.

6. New or more severe headaches (especially if you're over age 50)
Seek prompt medical attention if you experience:
-A sudden and severe headache, often called a thunderclap headache, because it comes on suddenly like a clap of thunder.
-A headache accompanied by a fever, stiff neck, rash, mental confusion, seizures, vision changes, weakness, numbness, speaking difficulties, scalp tenderness or pain with chewing.
-A headache that begins or worsens after a head injury.

These headache symptoms may be caused by stroke, blood vessel inflammation (arteritis), meningitis, brain tumor, aneurysm or bleeding on the brain after head trauma.

I have known, or known of, several fairly young people who have been the victims of brain aneurysms, where a weakened blood vessel bulges and eventually bursts. One, a man that worked at my company, was only 40. Another, the sister of a friend of mine, was 47. Sometimes an aneurysm is so catastrophic that there is nothing that can be done, as sadly was the case with them. But it can also cause symptoms before it actually bursts, and if the person realizes something is wrong and seeks medical help, surgery may be able to repair the vessel before it bursts.

7. Short-term loss of vision, speaking or movement control
If you have these signs and symptoms, minutes count. These are signs and symptoms of a possible stroke or transient ischemic attack (TIA). Seek immediate emergency medical care if you have any of the following:
-Sudden weakness or numbness of the face, arm or leg on one side of your body
-Sudden dimness, blurring or loss of vision
-Loss of speech, or trouble talking or understanding speech
-A thunderclap headache
-Sudden dizziness, unsteadiness or a fall

If at all possible, try to get to a hospital that specializes in treating strokes. (For more information, see my post on stroke).

8. Flashes of light
The sudden sensation of flashing lights may signal the beginning of retinal detachment. Immediate medical care may be needed to save vision in the affected eye.

Other less serious causes can be a detachment of the vitreous humor in the eye (the gel-like substance that fills the interior of the eye), or an ocular migraine. Naturally I have experienced both of these phenomena.

The detachment of the vitreous humor caused me to see a ringlike light when I looked into bright lights. In and of itself, the detachment of the vitreous humor is not necessarily dangerous; it often happens in nearsighted people as they age. It can lead to a retinal detachment, however, so it is important to have an ophthalmologist keep an eye on it (so to speak). It can leave the person with a lot of "floaters" in the affected eye for awhile but this effect dies down after about 6 months.

The ocular migraine (which apparently is similar to the "aura" that some migraine headache sufferers get when they're getting a migraine, but with the ocular migraine the person never actually gets the headache), can be a bit scary when it happens for the first time. An affected person suddenly becomes aware of a distinctive curved pattern of jagged white light. It starts strongly and then gradually diminishes. These episodes usually only last 15-20 minutes. When I first had one, I thought of retinal detachment, but then remembered a friend of mine had had ocular migraines when she was pregnant. When my symptoms went away after 10 or 15 minutes, I decided it must have been an ocular migraine. (Like me, she gets concerned about health-related issues, so she described her symptoms in detail to me at the time.)

We were on vacation when I had this little episode, so I waited a few days until we returned home and went to the ophthalmologist just to be sure everything was fine. I told him what happened and that I thought it was an ocular migraine, he agreed, and said "You'll have another."

Sure enough, I had several more episodes over the next year or so, but since then I haven't had any others. It's been several years since the last one.

I'd like to add, unless you are an experienced hypochondriac like myself, I would highly recommend that if you have ANY kind of flashing lights, that you consult an ophthalmologist immediately. Don't try to figure out whether it's a vitreous humor detachment, ocular migraine, or detached retina. It's just nice to know that there are other reasons you may have flashing lights in your eye other than the detached retina, which would require laser surgery and could cause you to lose your vision if not treated promptly.

9. Feeling full after eating very little
Feeling full sooner than normal after eating and having persistent nausea and vomiting that last more than a week are warning signs that should be checked by your doctor. There are many possible causes, including pancreatic cancer, stomach cancer and ovarian cancer.

Um, of course, there is one other possibility - you could be pregnant. If this is possible, buy a pregnancy test and check it out!

10. Hot, red or swollen joint
These warning signs may occur with a joint infection, which requires emergency care to save the joint and keep bacteria from spreading elsewhere. Other causes may include gout or certain types of arthritis such as rheumatoid arthritis.

A friend of ours had these symptoms and found it hard to get a diagnosis. The doctor finally decided it was gout.

Be sure to differentiate between swollen ankles or swollen joints, as swollen ankles could be fluid retention, which of course has its own separate list of possible causes, such as heart failure, liver disease, or just eating too much salt on a hot day. (I had swollen ankles once after having been on a plane the previous day and panicked thinking I had heart failure.)

This list is not complete, since it doesn't mention the "7 Warning Signs of Cancer," which are:

-A change in bowel or bladder habits
-A sore that does not heal (including mouth sores - don't just assume it's a canker sore!)
-Unusual bleeding or discharge from any place
-A lump in the breast or other parts of the body
-Chronic indigestion or difficulty in swallowing
-Obvious changes in a wart or mole (or any mole that is irregular in shape or has various colors in it - see this link for more information: http://cancer.about.com/od/skincancermelanoma/p/abcdeskincancer.htm)
-Persistent coughing or hoarseness

The "7 Warning Signs of Cancer" link also has another good symptoms list - for prostate and bladder symptoms.

Now that you are thoroughly educated about symptoms that should be checked out, go forth and worry! Maybe you'd better make a doctor appointment right now just in case.

Keep Eating Protein as You Age

2007-08-10T16:05:00.000-07:00

A recent study by the University of Texas Medical Branch at Galveston indicates that elderly people are just as able to synthesize muscle from protein as younger people are.

The study compared the rate at which study participants built muscle protein after consuming a four-ounce serving of lean beef. Ten elderly volunteers were compared to ten younger volunteers, by analyzing blood and muscle samples during the five hours after the beef was consumed. Results showed that both groups increased muscle protein creation by +50%.

Since people lose muscle mass as they age, it is good news to learn there is no reason they cannot continue to build new muscle as long as they eat protein. However, elderly people often do not eat enough protein due to various reasons (loss of chewing ability, cost, decline in appetite, etc.). This study shows it is very important to continue to include sources of protein in one's diet on a regular basis.

This is particularly important for vegetarians, since their protein must come from other sources than meat, fish or poultry. Including soy, beans, and other protein sources in the diet is crucial.

Of course, lack of exercise is another factor leading to loss of muscle mass in the elderly. As a Baby Boomer (or "Aging Baby Boomer" as they keep calling us now) I was excited to find out that eating meat, one of my favorite foods, might help me stave off loss of muscle tone. However, I guess I still have to exercise. There's never an easy solution, it seems.

Macular Degeneration

2007-07-31T17:48:00.000-07:00

As the Baby Boomers age, more and more people will be diagnosed with the most common type of macular degeneration, age-related macular degeneration, or AMD.

Macular degeneration is a type of vision loss caused by a detrioration of the macula, which is the part of your retina that controls your central vision.

By the time I was old enough to really know my grandfather, he was already having problems with his sight. He was a lot older than my grandmother, so when I was 5 years old, he was 86. He could still see somewhat when I was that age, but by the time he died at age 94 he was virtually blind from a combination of macular degeneration and cataracts. He kept his wits about him till the end, and enjoyed listening to opera and the Mets on the radio. But I know he missed reading, which was a great love of his, and back then they had no books on tape.

I have an elderly neighbor who started developing macular degeneration quite a few years ago. She is now 97 and can see very little; however, she still lives at home by herself and enjoys listening to books on tape. Like my grandfather, she had been an avid reader, so she is grateful for the tapes and says they "saved her life."

Now both my mother and father-in-law have been diagnosed with this condition. They both have the less severe kind, the "dry" variety, and so far their daily activities have not been impacted. But I worry about the future. And of course, being both a hypochondriac and a realist (after all, it seems to run in my family, at least on my mother's side), I worry that I will get it as I age.

What is macular degeneration?

There are two types of macular degeneration: The wet form and the dry form.

Wet AMD is caused by the growth of abnormal blood vessels behind the retina, called choroidal neovasculization. They start to grow under the macula and, because they are poorly formed and fragile, often leak blood and fluid. This distorts the macula by lifting it from its normal position and quickly damages the structure, causing scarring. The wet type of AMD is considered advanced because the vision loss can happen quickly.

Dry AMD happens when the light-sensitive cells in the macula slowly break down, gradually causing blurred central vision in the affected eye(s). Eventually, as less of the macula functions, central vision can be gradually lost.

What are the symptoms?

For Wet AMD, symptoms develop rapidly, and can include:

-Visual distortions; straight lines may appear wavy or crooked, things may look smaller or farther away than they should
-A decrease in central vision or a central blurry spot

There is another type of Wet AMD where fluids leak behind the macula but there is no sign of abnormal blood vessel growth. This is called Retinal Pigment Epithelial Detachment. It progresses less rapidly than regular Wet AMD, but eventually does develop into the more severe form.

For Dry AMD, symptoms appear more gradually. They can include:

-Need for increasingly bright light when reading or doing close work
-Difficulty adapting to a darker place, such as when entering a restaurant after being outdoors in the brighter light.
-Increasing blurriness of printed words
-A decrease in the intensity or brightness of colors
-Difficulty recognizing faces
-Gradual increase in the haziness of your overall vision
-Blurred or blind spot in the center of your visual field

One of the most common early signs of Dry AMD is the appearance of little yellow spots called "drusen" in the retina.

Dry AMD has three stages, all of which may occur in one or both eyes:

Early AMD. People with early AMD may have several small drusen or a few medium-sized drusen, with no signs of vision loss yet.

Intermediate AMD. At this stage, there may be either many medium-sized drusen or one or more large drusen. At this point, there may be a blurred spot in the central vision and the patient may need brighter light for reading and other tasks.

Advanced Dry AMD. At this stage, in addition to drusen, there will be a breakdown of light-sensitive cells and supporting tissue in the central retinal area. This can cause a blurred spot in the center of the vision. Over time, the blurred spot may get bigger and darker, making it hard to read or recognize faces.

In either type of macular degeneration, the process may affect one or both eyes.

In addition, there may be visual hallucinations as the eyesight deteriorates; this phenomenon is called Charles Bonnet Syndrome, and may include seeing geometric patterns, strange-looking faces, animals, and more.

The dry form of AMD is much more common; among people with the early and intermediate stages of AMD, 85% have Dry AMD. However, all people who have the wet form started out with the dry form of the condition. Among those with advanced AMD, 2/3 have the wet form.

In both types of AMD, it is thought that a breakdown in the waste removal system in the eye may obstruct the nutrient flow and result in either the cellular deterioration seen in Dry AMD or the growth of the abnormal blood vessels in the wet form.

How is it diagnosed?

If you are having problems with your vision, consult an ophthalmologist. He (or she) will give you a thorough eye exam, in which he will look for the signs of drusen or mottled coloring in the retina. In addition, he may use an Amsler Grid to test your eyesight, to see whether lines look wavy or distorted.

You may need to have an angiography, where dye is injected into your veins so that the doctor can see the blood vessels and pigmentation in the back of your eyes that might not be visible in an ordinary examination. There are two different types of dye that may be used - fluorescein or indocyanine green (ICG).

Another test that may be conducted is Ocular Coherence Tomography, or OCT. This is a test that can indicate the thickness of the retina and identify the presence of abnormal fluid. It is non-invasive.

How is it treated?

Most of the treatments available are for treating Wet AMD. Since this is the most severe form, it is important to stop the damage as quickly as possible, as it is usually not reversible.

Treatments include:

Photocoagulation: This is a laser treatment which seals off the abnormal blood vessels and keeps them from leaking further. It is best for treating blood vessels that are not directly under the center of the macula (called the fovea).

Photodynamic Therapy: This treatment is mainly used for abnormal blood vessel growth under the fovea. It is a cold laser treatment that is used in conjunction with a light-sensitive drug (verteporfin, brand name Visudyne)which is injected into the bloodstream. It is concentrated in the abnormal blood vessels behind the fovea and when the laser hits them, the drug causes substances to be released that close off the blood vessels.

Macular Translocation Surgery: Another treatment used for the area under the fovea is this type of surgery, in which a skilled surgeon detaches the retina, moves the fovea away from the abnormal blood vessels, removes the blood vessels, and reattaches the fovea over unaffected tissue. This is not commonly used.

Another way to treat Wet AMD is through drugs called Anti-Vascular Endothelial Antivascular Growth Factor (Anti-VEGF) medications. They include:

-Macugen (pegaptanib). It is injected into the vitreous fluid in the eye and helps stop the development of new abnormal blood vessels and prevents leaking of fluids.

-Lucentis (ranibizumab) works in a similar way. In addition to preventing additional damage, Lucentis may also reverse existing damage.

-Avastin (bevacizumab)is related to Lucentis but is not currently approved for macular degeneration. Since it is approved for colon and rectal cancer, doctors can use it off-label for other purposes, and it is believed it will work similarly to Lucentis on Wet AMD. Therefore, some doctors are using it for this condition.

For Dry AMD, there are fewer treatments, but since it progresses so much more slowly, there is a good chance that those who are diagnosed with Dry AMD will continue to live normal lives for many years.

Photocoagulation is being explored as a treatment for Dry AMD who have drusen. It is hoped that low-level laser treatments of the retina may cause regressen of the drusen and prevent vision loss. This treatment is being studied in a clinical trial.

Other therapies being studied include the use of Kenalog, a steroid that reduces inflammation; and Rheophoresis, where the blood is removed from the body and filtered to take out harmful substances that may be impeding the flow of blood in the eye.

One therapy that has been proven to delay the progress of Dry AMD in those affected is the "AREDS" (for Age-Related Eye Disease Study) supplement formula. This combination of nutrients was tested in a national clinical trial and found to be effective in preventing the progress of AMD among those who were at high risk of developing Advanced AMD. The supplement consisted of a specific combination of vitamin C, E, zinc, copper and beta carotene. It is available in drug stores. Some versions include lutein as well, which has been shown to be beneficial.

If you are looking to prevent AMD, eating a lot of healthy foods full of antioxidants should be helpful. A recent study also indicated that increased consumption of fish high in Omega-3 fatty acids may also be protective.

Be sure to wear sunglasses, don't smoke, and keep your blood pressure under control as well.

If you have Dry AMD, you should have a comprehensive dilated eye exam at least once a year so that your eye doctor can monitor the condition. Because dry AMD can turn into wet AMD at any time, you should get an Amsler grid from your doctor and use it at home to evaluate your vision daily.

If you have Wet AMD and your doctor advises treatment, don't waste any time in getting it. After laser surgery or photodynamic therapy, you will need frequent eye exams to detect any recurrence of leaking blood vessels.

There are many aids for those who have vision loss, including magnifiers, automatic readers, large print books, books on tape, and various other ways to help those with vision loss to cope. And be sure to subscribe to a website newsletter that keeps you informed of new treatments.

Will you get it?

You may, if you live long enough. Macular Degeneration is the leading cause of vision loss in those over 55. Risk factors include:

The greatest risk factor is age. A large study found that people in middle-age have about a 2 percent risk of getting AMD, but this risk increases to nearly 30 percent in those over age 75.

Other risk factors include:

Smoking: Smoking may increase the risk of AMD.
Obesity: Research studies suggest a link between obesity and the progression of early and intermediate stage AMD to advanced AMD.
Race: Whites are much more likely to lose vision from AMD than African Americans.
Family history: Those with immediate family members who have AMD are at a higher risk of developing the disease.
Gender: Women appear to be at greater risk than men.

Information for this post came from the following websites:

http://www.mayoclinic.com/health/macular-degeneration/DS00284/DSECTION=1 http://www.nei.nih.gov/health/maculardegen/armd_facts.asp
http://www.macular.org/
http://www.macular-degeneration.org/home.htm

Please see these websites for further details on the disease.

Another resource that may be helpful is this site:
http://www.amd.org/site/PageServer?pagename=homepage

The picture of the eye at the beginning of the article came from this site:
http://images.google.com/imgres?imgurl=http://www.retinaaustralia.com.au/images/eye6.gif&imgrefurl=http://www.retinaaustralia.com.au/RP.htm&amp;amp;h=396&w=565&sz=16&hl=en&start=0&tbnid=kY7c9mTnGlIwzM:&amp;amp;tbnh=94&tbnw=134&prev=/images%3Fq%3Deye%26gbv%3D2%26svnum%3D10%26hl%3Den%26sa%3DG

Always read the fine print when it comes to medical studies

2007-07-12T09:31:00.000-07:00

I happened to notice a headline today that clearly stated "Meditation Won't Boost Health - Study." The article was one of those short, consumer-friendly health-related articles written for the layman, on Yahoo Health.

But if you read the whole article, it does not say meditation doesn't boost health. What it actually says is:

"Some of the studies suggested that certain types of meditation could help reduce blood pressure and stress and that yoga and other practices increased verbal creativity and reduced heart rate, blood pressure and cholesterol in healthy people.

However, the report authors said it isn't possible to draw any firm conclusions about the effects of meditation on health, because the existing studies are characterized by poor methodologies and other problems."

Anyone who just glanced at the headline would have said "Oh well, I can ditch those yoga classes I'm taking, they won't help me any." And they might be jettisoning a type of workout that truly has benefits for blood pressure or stress, all because of a poorly-written headline.

Whenever you see an article citing a study, always read the fine print of the article and draw your own conclusions. Better yet, find a copy of the actual study on the internet and read it yourself. This is the only way to truly understand the research results.

For the rest of the article, see this link:

http://news.yahoo.com/s/hsn/20070712/hl_hsn/meditationwontboosthealthstudy

A more complete article with a better headline appears in the Canadian press, here:

http://www.expressnews.ualberta.ca/article.cfm?id=8572

Just goes to show how the media can spin things with slight differences in words. This is something to keep in mind every time you read an article, and particularly on medical subjects.

Comments are welcome at Medicana

2007-07-01T08:25:00.001-07:00

In the course of checking my Sitemeter from time to time I notice a lot of people find this blog via Google. And often they are searching for symptoms that the blog doesn't address so I assume they move on to greener pastures.

But sometimes I wish they would comment and ask their question, as I may be able to provide information on what they're looking for.

Also, you readers may have more information about a subject than I have provided, or new treatments that I did not come across in my research. So please, feel free to comment and add to the knowledge!

Please note I've added a new search bar to the right of the posts - it is specific to medical subjects. You may be able to learn more there about whatever you're looking for, without having to wade through non-pertinent information.

Chronic Fatigue Syndrome or Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS)

2007-06-16T10:06:00.000-07:00

Believe it or not, this too has been an illness I have experienced personally. There is no end to them! (Are you really a hypochondriac if you actually have real diseases? I personally have always loved the story of the hypochondriac who died and had his headstone inscribed "I TOLD you I was sick!")

In April of 1987 I was under stress at work and had to give a presentation to a group of people, something I had never done before. I was so nervous the night before that I hardly slept! A few days later I started to feel odd -- my throat and ears felt clogged, and I started to get a kind of sore throat that ached rather than hurt when I swallowed.

Gradually I developed severe fatigue and a host of other symptoms, including sensitivity to smells and sounds, "brain fog," and pressure behind my eyes. When I say "fatigue" I mean the kind of fatigue that makes you so tired you want to cry. I'd come home from work and collapse in bed for a couple of hours before I could do a thing.

I had read about Chronic Fatigue Syndrome in an article in a magazine called "Hippocrates," which described a mysterious outbreak of the syndrome in a town called Incline Village, in Nevada, back in 1984. So at least I knew what it could be when the symptoms arose, and did not immediately assume I was dying.

Luckily, I went to a doctor who had also heard of Chronic Fatigue Syndrome, which was just becoming known at the the time, and he tested me for the Epstein-Barr virus. The test came back as positive, meaning the virus was showing signs of reactivation. Epstein-Barr is not the cause of this syndrome, but reactivation of the virus may be a marker for something going on in the body that affects the immune system. He also ruled out other possible causes like cancer and Lyme disease.

At that time there was little to do but rest a lot and hope the symptoms subsided on their own. The doctor tried me on tricyclic antidepressants, which were supposed to help with sleep patterns, and a couple of other things. I was lucky; the symptoms gradually became more intermittent - a few bad days, then a few good days, and after about three years the good outweighed the bad and I gradually returned to normal. I was also lucky in that I never had to miss work because of the symptoms, unlike some sufferers with this disease.

The history of Chronic Fatigue Syndrome is murky, because descriptions of these symptoms go back decades; even Florence Nightingale may have been a sufferer. It has masqueraded under various names and for many years doctors suspected it was psychological; possibly the result of depression.

This is no longer the case; the Centers for Disease Control now consider CFS (now known as CFIDS - Chronic Fagigue and Immune Dysfunction Syndrome) a real disease and research is being done on it to understand the causes and possible treatments. In Europe, it is often called Myalgic Encephalitis, to take into account the joint/muscle pain and mental effects of the disorder and make it sound more like a disease than just being tired all the time.

I am happy that I am now 100% back to my usual self and that being tired or achey nowadays is usually just because of my advancing middle-aged status! But for many people the nightmare never ended and they are still ill with a disease that many people still don't believe in. That alone is part of the frustration they go through. People are always saying "Are you sure you're sick? You look fine!"

CFIDS: What is it?

Chronic Fatigue Syndrome (or Chronic Fatigue and Immune Dysfunction Syndrome, which is now its preferred name in the U.S.) is a constellation of various symptoms, the most important of which is severe fatigue.

What Are the Symptoms?

The CDC defines Chronic Fatigue and Immune Dysfunction Syndrome as a combination of the following symptoms:

Clinically evaluated, unexplained, persistent or relapsing chronic fatigue that is of new or definite onset (has not been lifelong); is not the result of ongoing exertion; is not substantially alleviated by rest; and results in substantial reduction in previous levels of occupational, educational, social, or personal activities

The concurrent occurrence of four or more of the following symptoms, all of which must have persisted or recurred during 6 or more consecutive months of illness and must not have predated the fatigue:

-Self-reported impairment in short-term memory or concentration severe enough to cause substantial reduction in previous levels of occupational, educational, social, or personal activities
-Tender cervical or axillary lymph nodes (swollen or painful lymph nodes in the neck or under arms)
-Muscle pain, multijoint pain without joint swelling or redness
-Headaches of a new type, pattern, or severity
-Unrefreshing sleep - waking up just as tired as when you went to bed
-Postexertional malaise lasting more than 24 hours (feeling crummy after exercise)

The earlier, 1988, definition also included the following:

Exclusion of other clinical conditions that may produce similar symptoms (e.g., malignancy, autoimmune disease, chronic psychiatric disease, and chronic inflammatory disease, among others), which would still be an important thing to do.

Minor criteria:
-Mild fever
-Sore throat
-Unexplained generalized muscle weakness

Since I had the muscle weakness intermittently (I remember once I discovered the muscles in my hands felt overused and weak after typing!), and definitely the "sore" throat (which was really more of an ache, and unlike any sore throat I'd ever had before), I thought it worth including these symptoms, which are definitely common in many CFIDS sufferers, even though the current definition seems to be de-emphasizing them.

How Is It Diagnosed?

CFIDS, as mentioned, masquerades as various other illnesses. So many of the tests that are ordered are actually tests for other diseases or conditions, to rule them out. Naturally a full battery of blood tests will be ordered; in addition to a full blood chemistry to rule out liver or kidney problems or anemia, you would be tested for thyroid abnormalities, diabetes, multiple sclerosis, rheumatoid arthritis, lupus, HIV, leukemia, lymphoma, Lyme disease, or anything else that could cause similar symptoms as CFIDS. The doctor should also order tests such as an EKG and/or echocardiogram to check your heart, since heart problems can cause fatigue.

Many patients show abnormal levels of hormones such as cortisol (the stress hormone). Testing is still being done to further understand the relationship between these hormone levels and CFIDS.

Fibromyalgia is a similar illness to CFIDS, but its symptoms veer more toward pain in the muscles and joints, with 18 specific "trigger points" on the body that cause pain when pressed. Fibromyalgia sufferers share many similar symptoms to CFIDS and there may be underlying commonalities between the syndromes. There are a number of organizations that are researching both illnesses since they overlap in many cases.

Depression is another factor that must be considered. Although people who are depressed often complain of fatigue and even physical symptoms that are similar to CFIDS, CFIDS often strikes people who have been perfectly happy and active before their symptoms began. However, there may naturally be a relationship between CFIDS and depression, since people who are suddenly incapacitated by fatigue and other symptoms would naturally become depressed. There may even be some overlapping causes of both, so while depression, when present, should be treated, its diagnosis should not exclude the diagnosis of CFIDS.

The Epstein-Barr test that my doctor performed was based on a popular theory back in the 1980's that the syndrome was caused by the Epstein-Barr virus, which is the virus responsible for mononucleosis, since so many patients were complaining of symptoms that were so similar to those of mono. Later research has shown that those with CFIDS show higher than normal levels of antibodies to many viruses, not just Epstein-Barr, and it is hypothesized that the symptoms are actually caused by a highly oversensitive immune system that is responding too strongly to many different stimuli, causing the flu-like symptoms that people experience, not by any one viral agent. So the Epstein-Barr test is no longer used as a diagnostic for CFIDS.

Tests to positively confirm CFIDS are still being explored. It may be useful to test for immunological dysfunction (serum immunoglobulins, or IgC subclasses), since if these show up then treatment with immunoglobulin replacement could be helpful. There is also something known as the "Tilt Table Test" which tends to be positive for CFIDS patients. In this test, patients are put on a table that is then tilted so that they are lying down and then tilted upright. In a study that was done, CFIDS patients had abnormal responses to this test, unlike the control population (http://www.nfra.net/LowBld_1.htm), indicating they have a type of low blood pressure called "neurally mediated hypotension."

In severe cases of CFIDS, patients may show true signs of immunologic malfunctioning, such as yeast infections, shingles, and other opportunistic diseases.

How is it treated?

Naturally it will be important for anyone diagnosed with CFIDS to get a lot of rest and eat very nutritious food and perhaps even take vitamin supplements to ensure their bodies are getting what they need. It is also important to avoid stress, as may CFIDS patients exhibit abnormal levels of cortisol in their bodies, and stress can make symptoms of the illness worse. In addition, although mild exercise is encouraged, CFIDS patients should not overdo it or they will feel worse the next day.

Treatment mainly depends on the symptoms. Since sleep disturbances are common, many doctors prescribe a tricyclic antidepressant to help the patient achieve a good night's sleep, which often makes a big difference in how he or she feels on a day-to-day basis. More modern drugs such as Ambien may also be helpful but should be used with care. Over-the-counter products such as Tylenol PM or Benadryl may also help with restful sleep, as well as the hormone Melatonin (available in drug and health food stores).

Pain can be treated with over-the-counter remedies such as Tylenol or Advil (or their generic equivalents). More severe pain can be treated with narcotics but this is not encouraged due to the addictive nature of these drugs. Alternative treatments such as biofeedback techniques or acupuncture can also be helpful.

On top of everything else, some CFIDS patients have Irritible Bowel Syndrome, which can cause bloating, gas, and diarrhea/constipation. Therapy for this condition includes antispasmodics, antidiarrheal and anti-anxiety medications. A high fiber diet should help too.

Problems with the body's immune system can be treated with immune regulators. such as Gamma globulin or a drug called Ampligen. Both are still undergoing testing and have shown variable results.

"Brain fog" or cognitive dysfunction is one of the other key symptoms of the illness. Having problems with memory, finding words, and reasoning are just some of the neurological effects of the disease. The anticonvulsant, gabapentin (Neurontin) sometimes helps, although the exact way it works to help these symptoms is not fully understood.

Actual infections should be treated with the appropriate medications: antifungals for yeast infections, antibiotics for bacterial infections, antiviral medicines for viral infections such as Shingles, which is a reactivation of the chicken pox virus that shows up as painful blisters.

People with CFIDS often are unusually sensitive to medications so it's best to start with low doses and increase them gradually.

Will you get it?

You may. More than one million Americans have CFIDS (based on studies conducted by the Centers for Disease Control and Prevention and DePaul University) according to the CFIDS Association of America. Of these, as many as 90% of them are not even diagnosed and are therefore not getting treatment.

CFIDS can affect people of all age, racial, ethnic, and socioeconomic groups. It does seem to be more common in women, as research has shown it to be about four times as common in women (522/100,000) as men, similar to that of many autoimmune diseases, such as multiple sclerosis and lupus. Kids and teens can also get CFIDS.

For more information, be sure to check out these links, which is where a majority of this information came from. The CFIDS Association of America also has a lot of excellent links to scientific papers and other sources of information.

http://www.cfids.org/default.asp

http://findarticles.com/p/articles/mi_m3225/is_n3_v45/ai_12026536

http://www.cdc.gov/cfs/cfsdefinition.htm

Worry About the Right Diseases

2007-06-14T09:07:00.001-07:00

CNN had a good article today about the odds of people getting some of the more obscure diseases such as Mad Cow Disease, compared to more common ones like heart disease and osteoporosis.

Now, let's face it, as a hypochondriac, you probably spend a lot more time worrying about things like Mad Cow Disease than about osteoporosis. I admit it: I still worry about sausages I ate in Great Britain during the 1980's and wonder if eventually the Mad Cow prions are going to come home to roost! And I make a point of buying grass-fed beef at Whole Foods because I don't trust the USDA to inspect our meat properly.

But, as an overweight middle-aged woman with high blood pressure, I am much more likely to suffer from heart disease and diabetes in the future rather than Mad Cow Disease. But do I exercise? No. Do I lose the 25 lbs. I should lose? No. The two most useful things I could do to protect my health, I don't do. But do I go to the doctor any time I get a weird symptom that I'm afraid is some much less likely disease? Absolutely. Do I order new dietetic supplements that purport to prevent various diseases that I probably won't get anyway? Of course. It's so easy to take a pill.

The CNN article was a good wake-up call to remind us that we should focus on the proven things that we know can protect our health - exercising, achieving a healthy weight, and eating more fruits and vegetables - while of course still being vigilant about checking out new symptoms (did that mole really get bigger? Why am I so tired?) and getting our mammograms and colonoscopies regularly.

The challenge is that exercising, losing weight, and eating more fruits and vegetables require planning and effort, and the benefits are not seen immediately. Preventing these diseases requires a long-term commitment and change in lifestyle. But if your goal in being a hypochondriac is to have a longer and healthier life, these are the things you should be doing to achieve the goal!

Please see the link below for the full CNN article.
http://www.cnn.com/2007/HEALTH/06/14/healthmag.diseases/index.html

Stroke is often undertreated

2007-05-28T09:01:00.000-07:00

Hello friends,
I've been so busy recently that I haven't yet written my next major disease post, which will be on Chronic Fatigue Syndrome, or, as it is often known, Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS). Stay tuned...

In the meantime I was reading the New York Times today and there was a long article about strokes, and how so many patients are not treated with the drug, tPA, which could prevent much of the permanent damage that sadly often results from an ischemic (blockage type) stroke. First, strokes caused by bleeding must be ruled out before giving the drug, but many hospitals are not staffed or equipped to do this in a timely manner. Therefore the drug is often not given early enough or at all, to those who might have benefited from it.

Please see this link for the full article: http://www.nytimes.com/2007/05/28/health/28stroke.html?_r=1&hp&oref=slogin

Signs of a stroke include:

-Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
-Sudden confusion, trouble speaking or understanding
-Sudden trouble seeing in one or both eyes
-Sudden trouble walking, dizziness, loss of balance or coordination
-Sudden, severe headache with no known cause body

More information can be found here: http://www.americanheart.org/presenter.jhtml?identifier=4742

High blood pressure leads the list of risk factors for stroke. Other co-factors include a history of "transient ischemic attacks" (which cause temporary symptoms of stroke), high cholesterol, diabetes, cigarette smoking, artery disease (particularly the carotid artery, which is in the neck), heart disease or failure in general, atrial fibrillation (improper heart rhythm of the upper pumping chamber of the heart), sickle cell anemia, poor diet, obesity and inactivity. Alcohol and drug use are often associated with strokes as well. Most of these are under your control so you can take steps to prevent a stroke.

One of the points the article makes is to recognize the symptoms of a stroke and be sure to get treatment as quickly as possible. If there is a hospital that is accredited as a Primary Stroke Center, by all means try to go there, as they will have the equipment and expertise to treat you.

This handy website allows you to search within your area for the locations of Primary Stroke Centers. In addition, you can search for other specialties such as acute myocardial infarction (heart attack) and pneumonia, among others: http://www.jointcommission.org/certificationPrograms/disease-specificCare/DSCOrgs/

I was interested to learn that the two hospitals that are considered Primary Stroke Centers in my region were both fairly close, and yet not the hospitals I might have initially tried to go to in the case of an emergency. This is good information to know for future reference!

One thing that struck me was that the woman profiled in the NY Times article, who did have a stroke, but luckily was treated properly for it, had blood pressure of 200 over 120 for five years and yet decided not to go on medication because she was "too young" (53) and figured she'd worry about it later. There are so many medications out there now that can treat high blood pressure, no one should delay in getting treatment for it. The earlier it is treated the less long-term damage it can do and the less the likelihood of it causing a stroke. Please see my previous post about high blood pressure for more information.

Medical site for up-to-date medical articles

2007-05-19T11:31:00.001-07:00

I just discovered MDLinx, a website that provides scientific articles on many different diseases and conditions.

If you are a serious hypochondriac, as I am, I'm sure you will have sufficient medical understanding to find this site very useful. You can search on various types of illness and read either the abstract of the study or the full report, depending on the level of your interest. Sometimes the full report will require a subscription to a medical journal, but even knowing a study exists may be of use, since you can refer your doctor to the study if you think it might help them with your condition.

As a serious hypochondriac, I feel you, the patient, must be well-versed in your illness, or in the possible causes of your symptoms, before even going to the doctor. Doctors are so busy nowadays that many do not listen to their patients' symptoms carefully enough, and if you have one of those doctors, you want to be sure they test you for whatever you think you might have, because otherwise they might miss something!

I am very fortunate in that I have found doctors who are willing to listen to me, and will actually address my concerns, by either explaining why something isn't necessary, or else agreeing that the concern is valid. But many people are not so lucky, and if you may be dealing with something serious or life-threatening, you don't want to take a chance with your health.

Naturally there are some doctors that will not take kindly to your suggestions or questions. But I feel a good doctor would agree that "An educated consumer is their best customer" as the Syms ad goes.

Another website for you to dwell on

2007-05-10T14:01:00.000-07:00

I came across this new website and had to share it with my fellow hypochondriacs and anyone who is interested in medical subjects and basic gossip. It is called "Who is sick?"

The premise is that people can post their symptoms on this website, and they are then plotted on a map. So you can check out your own zip code area and find out whether there are a large number of people who are sick, and if so, what their symptoms are. So, if you see there are a huge number of people in your general area that are suffering from cough, fever and aches, you may think "Hmmm, lots of flu out there...maybe I should stay home!"

I feel this could be a very useful tool. Enjoy!

Alzheimer's Disease

2007-05-06T14:14:00.000-07:00

Alzheimer's Disease, unfortunately, is yet another disease with which I have first-hand experience. My husband's grandmother had it, and now his mother has it. My father developed dementia during the last several years of his long life, and it was probably Alzheimer's. A friend of ours in Australia has also, sadly, developed it as well.

It's an insidious disease because at first you don't realize the person is developing symptoms of Alzheimer's. Depending on what the first symptoms are, you may think they are just getting moody, or downright cantankerous. You might just think they are absent-minded. Or you may not notice a thing - because sometimes those in the early stages of the disease are great at "faking it" and acting as if nothing is wrong.

A friend gave me a book, Living in the Labyrinth, by Diana Mcgowin, the story of her own journey into Alzheimer's Disease. Diagnosed at an unusually young age (under 50), she retained her self-awareness and miraculously was able to write this book, which really helped me understand better what is going on inside my mother-in-law's head. I only wish I'd had it when my father first started developing symptoms. It's out of print now but you can buy it used on Amazon.com, along with other personal accounts of Alzheimer's Disease.

One of the first symptoms my father had was getting lost in familiar surroundings. This was one of Diana's first symptoms as well. In my father's case, we didn't realize the importance of the symptom, since he'd never had a great sense of direction to begin with, and he was, after all, 87 or so at the time.

One of the other early symptoms he showed was a sudden interest in winning the Publisher's Clearing House Prize. My father, who had never gambled in his life, became obsessed with winning this prize, and started ordering all kinds of things from Publisher's Clearing House, even though my mother and I told him that legally they have to give him the same chance to win even if he didn't order anything. He ordered a lot of other merchandise and books over the phone. Eventually the credit cards had to be taken away from him; it should have been done sooner.

Then the next thing that happened was he became hostile to my mother; started swearing at her and mocking her accomplishments. My theory is that he knew his own thinking processes were going downhill and was jealous of her continued mental sharpness. But treating my mother this way was very much out of character for him.

He also began having manic episodes, where he had grandiose ideas and talked nonstop, all his thoughts running together in a stream-of-consciousness river that would have made James Joyce proud.

As he deteriorated further, he became obsessive-compulsive, and started tearing things up. He would remove the covers of books, and then the first pages, and eventually tear up half the book. He would take the pieces and put them in his pocket. He had a lifelong love of books and I can only think that because he could no longer read them, this was his way of consuming them in another way.

Eventually he would sit for hours tearing any pieces of paper he could find into tiny pieces. I think he felt it was his job. My father always had to have a job; he didn't retire until he was 68 and then even in retirement he got a job proofreading, which he held until he was 88 and started being affected by the dementia.

He began getting up in the middle of the night, thinking it was morning and time to get up. Unfortunately this led to his ultimate decline. One night he got up in the dark and fell down the stairs and broke his leg. He had to go into a nursing home since my mother couldn't care for him with a broken leg. In the nursing home he gradually declined over the next year until he seldom spoke, then had problems eating and swallowing, and finally stopped eating altogether.

We chose not to have a feeding tube inserted, as I learned through research that it did not extend patients' lives, often caused complications, and after all, what would be the point anyway? He passed away peacefully at age 92 on January 20, 2005. One of the last things he still did was to play the piano, a lifelong hobby of his; he could still pick out a tune with one finger up until the last couple of months.

Naturally I am somewhat concerned that I might develop Alzheimer's Disease, but since my father didn't get it until very old age, I am not that worried about it, especially since my mother is now 88 and is mentally as good as ever.

I'm a little more concerned about my husband, since both his mother and grandmother have been affected, and at younger ages (his mother started showing symptoms in her early 70's). I hope by the time it may be his turn, that they will have discovered a cure, or at least something that will halt the disease in its tracks.

You too may be concerned about developing Alzheimer's Disease - and so you should, as it is estimated as many as half of people who live to be older than 85 will have it. Therefore, I have done all the research on it below so that you don't have to. And I hope you never need to.

What is Alzheimer's Disease?

Alzheimer’s Disease is the most common kind of dementia, a word that describes a number of conditions that all gradually destroy brain cells and lead to progressive decline in mental function. Alzheimer's Disease is named after Dr. Alois Alzheimer, a German doctor, who was the first to identify the condition, in 1906. He found abnormal clumps and tangles of fibers in the brain of a woman who had died of an unusual disease. The clumps are now called amyloid plaques and the tangles are called neurofibrillary tangles.

These plaques and tangles are considered the definitive signs of Alzheimer's disease. Although they can't be seen except on autopsy, other changes wrought in the brain as a result of these deposits in the brain can be identified through an MRI (Magnetic Resonance Imaging).

Alzheimer's disease is an irreversible, progressive condition, where brain cells deteriorate, causing loss of cognitive functions such as memory, judgment and reasoning. Because the plaques and tangles affect various parts of the brain, movement, coordination, and pattern recognition can also be affected.

The condition mainly affects the parts of the brain called the cerebral cortex and hippocampus, which lose mass and shrink as the disease worsens. This shrinkage can be seen in an MRI.

In addition to plaques and tangles in the brain, Alzheimer's patients also have greatly reduced amounts of acetylcholine. Acetylcholine acts as a transmitter between brain cells in the cerebral cortex and is needed for cognitive function.

A protein called beta amyloid makes up the center of the plaques found in Alzheimer's patients' brains. Surrounding this protein are fragments of deteriorating neurons (brain cells), especially those that produce acetylcholine.

The neurofibrillary tangles are pieces of a protein called tau, which is normally found inside brain cells and maintains proper cell structure and function. An abnormality in the tau protein disrupts normal cell activity.

Right now scientists are hard at work trying to identify the causes of Alzheimer's Disease in genetically susceptible people. Previous theories regarding the culpability of aluminum (in pots and pans or antiperspirants), flu shots and aspartame have been generally discounted as no definitive links have been found with these possible causes. In fact, being up to date on vaccinations and getting flu shots seems to be correlated with a decreased propensity to develop Alzheimer's.

There are other types of dementia besides Alzheimer's. A common one is called vascular dementia, caused by reduced blood flow to the brain from mini strokes. If this occurs along with Alzheimer's, the condition is known as "mixed dementia."

Parkinson's Disease and Creutzfeldt-Jakob Disease are two other neurological diseases that exhibit dementia as one of their symptoms.

There are also other types of primary dementia such as Dementia with Lewy Bodies, which comes on more quickly and has a swifter course than Alzheimer's Disease; and Pick's Disease, which generally affects people at a younger age.

This article will focus only on Alzheimer's Disease; however, please keep in mind that any symptoms of dementia must be investigated thoroughly to make sure you know which type you are dealing with.

There are also two patterns of Alzheimer's Disease: the kind that develops at an older age, and "early onset." Early onset Alzheimer's Disease is defined as Alzheimer's that begins before age 65. It can start as early as the 30's or 40's but this is very rare; usually early onset Alzheimer's Disease is diagnosed when the patient is in his or her 50's. This type of Alzheimer's Disease is more apt to have a strong genetic component and to run in families.

What are the symptoms?

Symptoms of Alzheimer's disease include the following:

Short-term memory loss
Inability to perform ordinary physical tasks such as dressing or eating, caused by a disorder of movement - apraxia.
Problems with getting meaning out of one or more of their senses (called agnosia)
Aphasia (loss of ability in comprehension of spoken or written language; tendency to use the wrong word)
Delusions (an example is thinking someone close to them is stealing things from them)
Person becomes easily lost and confused
Inability to learn new mental tasks - or, for that matter, to understand tasks that were previously easy for the person to perform
Loss of judgment, reason, and cognitive abilities
Loss of inhibitions
Belligerence (which my father developed)
Social withdrawal (someone previously gregarious, like my mother-in-law, gradually stops talking much in social situations; becomes anxious and confused in large gatherings)
Visual hallucinations (my father sometimes saw people who weren't there; "Isn't that odd, I thought I saw your aunt standing in the driveway," he said to me once. Later on in his decline he thought there was a tiger sitting on the bed in his nursing home room)

It is common for patients with Alzheimer's Disease to be worse the later in the day it gets. "Sundowning" is the term used to describe the increased confusion and agitation that often occurs later in the day and often into the night.

In end-stage Alzheimer's disease, patients may become bedridden and need help with eating and getting out of bed to use the bathroom. Often they are incontinent and need to wear diapers as my father did. Some have convulsions.

Depression is common in patients with Alzheimer's Disease, especially during the earlier stages when they may be aware of losing mental functions. My father had a history of depression throughout his life, so he was already on anti-depressants when his mental faculties began to decline.

According to the Alzheimer's Association website, there are a number of stages of Alzheimer's Disease:

Stage 1: No impairment (normal function) These people experience no memory problems and none are evident to a health care professional during a medical interview.

Stage 2: Very mild cognitive decline (may be normal age-related changes or earliest signs of Alzheimer's disease) The person may feel as if they have memory lapses, especially in forgetting familiar words or names or the location of keys, eyeglasses or other everyday objects. But these problems are not evident during a medical examination or apparent to friends, family or co-workers.

Stage 3: Mild cognitive decline. Early-stage Alzheimer's can be diagnosed in some, but not all, individuals with these symptoms. Friends, family or co-workers begin to notice deficiencies. Problems with memory or concentration may be measurable in clinical testing or discernible during a detailed medical interview. Common difficulties include:

Word- or name-finding problems
Decreased ability to remember names when introduced to new people
Performance issues in social or work settings noticeable to family, friends or co-workers
Reading a passage and retaining little material
Losing or misplacing valuable objects
Decline in ability to plan or organize

Stage 4: Moderate cognitive decline (Mild or early-stage Alzheimer's disease). At this stage, a careful medical interview detects clear-cut deficiencies in the following areas:

Decreased knowledge of recent occasions or current events
Impaired ability to perform challenging mental arithmetic-for example, to count backward from 75 by 7s
Decreased capacity to perform complex tasks, such as planning dinner for guests, paying bills and managing finances
Reduced memory of personal history
The affected individual may seem subdued and withdrawn, especially in socially or mentally challenging situations

Stage 5: Moderately severe cognitive decline (Moderate or mid-stage Alzheimer's disease).
Major gaps in memory and deficits in cognitive function emerge. Some assistance with day-to-day activities becomes essential. At this stage, individuals may:

Be unable during a medical interview to recall such important details as their current address, their telephone number or the name of the college or high school from which they graduated
Become confused about where they are or about the date, day of the week or season
Have trouble with less challenging mental arithmetic; for example, counting backward from 40 by 4s or from 20 by 2s
Need help choosing proper clothing for the season or the occasion
Usually retain substantial knowledge about themselves and know their own name and the names of their spouse or children
Usually require no assistance with eating or using the toilet

Stage 6: Severe cognitive decline (Moderately severe or mid-stage Alzheimer's disease).
Memory difficulties continue to worsen, significant personality changes may emerge and affected individuals need extensive help with customary daily activities. At this stage, individuals may:

Lose most awareness of recent experiences and events as well as of their surroundings
Recollect their personal history imperfectly, although they generally recall their own name
Occasionally forget the name of their spouse or primary caregiver but generally can distinguish familiar from unfamiliar faces
Need help getting dressed properly; may make such errors as putting pajamas over daytime clothes or shoes on wrong feet
Experience disruption of their normal sleep/waking cycle
Need help with handling details of going to the bathroom (flushing toilet, wiping and disposing of tissue properly)
Have increasing episodes of incontinence
Experience significant personality changes and behavioral symptoms, including suspiciousness and delusions; hallucinations; or compulsive, repetitive behaviors such as hand-wringing or tissue shredding (as my father did)
Tend to wander and become lost

Stage 7: Very severe cognitive decline (Severe or late-stage Alzheimer's disease) This is the final stage of the disease when individuals lose the ability to respond to their environment, the ability to speak and, ultimately, the ability to control movement. Frequently individuals lose their capacity for recognizable speech, although words or phrases may occasionally be uttered. They need help with eating and going to the bathroom, and there is general incontinence of urine; they lose the ability to walk without assistance, then the ability to sit without support, the ability to smile, and the ability to hold their head up. Reflexes become abnormal and muscles grow rigid. Swallowing is impaired. One of the things my father did was continue to eat and put more food into his mouth and to chew, but not swallow. Eventually he would have to spit out the food and start over.

Of course, not everyone who becomes forgetful is on the road to Alzheimer's. The saying is, if you lose your keys, don't worry; if you find them and can't remember what they're for, then you have a problem. I think this is true of many aspects of the disease; if you forget the details of a project, it means you're middle-aged and forgetful; if you forget you ever HAD the project in the first place, even after you're reminded, that's a bigger concern. But if you are truly worried, you should visit a neurologist and be evaluated.

How is it diagnosed?

You may ask, if Alzheimer's is so awful, why would anyone want to find out they have it any earlier than they have to? The answer is that early detection will give the person and his or her family the time to understand what to expect, get access to medications that can slow the progression of the disease or participate in a clinical trial; avail themselves of services that are provided to Alzheimer's patients; build a network of doctors and caregivers to depend on as the disease progresses; and plan for future needs.

No one type of doctor is needed to diagnosis Alzheimer's Disease. If you're concerned about yourself or a loved one, first consult the primary care physician and have a checkup. He or she can then send you to an appropriate physician who will do the evaluation. Often it is a neurologist or a psychiatrist, depending on the symptoms the person is experiencing.

There is no definitive test for Alzheimer's Disease. First, other conditions and diseases that can cause similar symptoms must be ruled out, so a full physical is in order. Medications should be evaluated to make sure they are not the cause of any symptoms, and other factors such as alcohol use and poor nutrition must be investigated.

Then the person's cognitive functions must be evaluated. The doctor will ask the history of the symptoms causing concern, and will conduct a cognitive test such as the mini-mental state exam or MMSE. In this test, the patient is asked a series of questions designed to test a range of everyday mental skills, such as:

Remember and repeat a few minutes later the names of three common objects
State the year, season, day of the week and date
Count backward from 100 by 7s or spell “world” backwards
Name two familiar objects present in the office as the examiner points to them
Identify the location of the examiner’s office (state, city, street address, floor)
Copy a picture of two interlocking shapes
Follow a three-part instruction, such as: take a piece of paper in your right hand, fold it in half, and place it on the floor.

The maximum MMSE score is 30 points, and the various point levels denote mild, moderate and severe dementia.

Another mental status test is the “mini-cog,” which involves two tasks: (1) remembering and a few minutes later repeating the names of three common objects, and (2) drawing a face of a clock showing all 12 numbers in the right places and a time specified by the examiner.

The neurologist that examined my father used a combination of these tests; my father did have to draw the clock and answer the various questions above. He also was asked who the president was (I was sad to realize my father didn't remember the name of the president, even though he'd always been politically involved). Last, he was asked to write a sentence. He wrote "Life is a long struggle."

The neurologist will also check reflexes, coordination, muscle tone, eye movement, and other functions that may be affected by Alzheimer's.

An MRI or a CT scan may also be done to rule out brain tumors or other causes of mental decline, as well as to assess the volume and shape of the brain structure. As Alzheimer's progresses, the brain shrinks. Functional imaging such as PET scans or functional MRIs are also used to assess brain activity.

Another area of research focuses on developing tracer compounds that will attach to key abnormal brain deposits. Preliminary data suggests that one such tracer may attach to beta-amyloid and “light up” in a PET scan.

My father had a CT scan but couldn't have an MRI because he had a pacemaker, which could be affected by the magnet in the MRI.

A good doctor will also evaluate the patient in terms of mental state, and treat them as appropriate for depression and other symptoms that may overlap with dementia.

Recent research has indicated that changes in the lens of the eye that are detectable by a brief, non-invasive laser pulse might reliably indicate the earliest stages of beta-amyloid buildup. This is still experimental.

Once the patient is diagnosed, the patient and family should learn all they can about what to expect, what resources are available to help both the patient and caregivers, and what to expect financially. There are eldercare attorneys available to counsel patients and their families on how to manage the difficulties of insurance coverage, Medicare, Medicaid, and how best to plan for the later stages of the disease.

There are also support groups for both patients and caregivers. It is important to seek these resources out and take advantage of them; many caregivers burn out or don't realize some of the symptoms the patient is showing are signs of the disease and not something they should take personally. Talking to others in the same boat can help family members and others involved with the patient deal with the situation. Similarly, the patient will feel better knowing he or she is not alone.

Patients may survive 8 to 10 years with Alzheimer's disease. Some have been known to live 25 years with the disease. Death usually occurs due to secondary infections, heart disease, or malnutrition. The late President Ronald Reagan, who was diagnosed with Alzheimer's Disease not long after he left office, lived many years after that and did not die until he was well into his 90's.

How is it treated?

Although there is no cure of Alzheimer's Disease, there are many medications available to slow the progression of the cognitive decline, and to treat specific symptoms.

For slowing the decline in mental function, there are a number of cholinesterase inhibitors, which act on the enzyme that breaks down acetylcholine, the neurotransmitter that is scarce in Alzheimer's patients. These drugs include:

Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (originally called Reminyl and now called Razadyne).

My father was on all three of these medications at various times.

The original cholinesterase inhibitor was Tacrine (Cognex), but it is seldom prescribed now as it tended to cause liver damage.

Another type of medication that was introduced in 2003 is Memantine (called Namenda). This drug is a new type of drug for Alzheimer's which works by regulating glutamate in the brain. Glutamate is a chemical that regulates the flow of calcium into nerve cells; too much of it can cause cell damage or death.

My mother-in-law is on both Aricept and Namenda, and the combination seems to help her.

Other drugs often prescribed for Alzheimer's patients include drugs to treat the symptoms of the disease, such as anxiety, violent behavior, and depression. These drugs include:

Antidepressant medications for depression and irritability

Citalopram (Celexa)
Fluoxetine (Prozac)
Paroxetine (Paxil)
Sertraline (Zoloft)
Trazodone (Desyrel)

(My father was on Desyrel and Celexa).

Anti-anxiety drugs for anxiety, restlessness, verbally disruptive behavior and resistance, such as:

Lorazepam (Ativan)
Oxazepam (Serax)

Antipsychotic medications for hallucinations, delusions, aggression, hostility and uncooperativeness. These include:

Aripiprazole (Abilify)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Risperidone (Risperdal)
Ziprasidone (Geodon)
Drugs such as haloperidol (Haldol)

My father was on both Seroquel and Risperdal at different times.

Use of an antipsychotic drug needs to be done with care, as studies have shown that they may lead to an increased risk of death in older adults with dementia.

Prescription sleeping pills are usually not prescribed for these patients as they can increase difficulties with balance and incontinence. However, antianxiety medications or Desyrel can sometimes help a patient sleep. Over-the-counter sleep aids should be avoided as their main ingredients can worsen cognitive symptoms.

There are also ways to help Alzheimer's patients deal better with their situations and avoid triggering a bad reaction. These include:

Redirecting the person's attention, rather than arguing, disagreeing, or being confrontational
Simplifying the environment
Simplifying tasks and routines
Making sure the person rests between stimulating events
Labeling items to remind the person what they do
Putting safety locks on doors and gates; put gates by stairs
Put up extra smoke alarms and control access to the stove
Use lighting to reduce confusion and restlessness at night

Naturally, if you have a gun in the house, get rid of it.

My mother-in-law reacts poorly to crowds and noise. She does much better in a more intimate, quiet environment, with just a few people she knows very well. Interestingly, this did not seem to be a problem for my father. He was also different from her in that he did not become that withdrawn or quiet until after he went into the nursing home; his manic symptoms made him talk more, rather than less, in his early stages.

Keeping the mind active is one way to stave off the disease for as long as possible.

Research is continuing on Alzheimer's Disease and new discoveries and treatments are happening constantly. A company called Neurochem has developed a drug, Tramiprosate, called Alzhemed, which seems to reduce the formation of the amyloid plaques that are seen in the disease and also protect cells from damage and death. The drug has just completed Phase III trials and results should be announced shortly.

Other therapies are still being investigated. Vitamin E is being researched as something that may help prevent Alzheimer's. Another possible candidate is folate, found in green leafy vegetables. Estrogen replacement therapy may help prevent Alzheimer's Disease if women take it before age 65; after 65 it appears to increase the risk.

Even marijuana is being considered for Alzheimer's prevention.

Scientists as Purdue University have designed a new molecule that may actually prevent the cascade of events that leads to the formation of the amyloid plaques in the brain of Alzheimer's patients. This exciting discovery could lead to a drug that could actually prevent Alzheimer's from progressing, not just mask the symptoms of the progression as most other drugs do.

You can keep up with the latest new discoveries by checking the following websites and signing up for their newsletters:

http://www.alzheimersnews.com/

http://www.seniorjournal.com/Alzheimers.htm

http://www.medicalnewstoday.com/sections/alzheimers/

http://www.alzheimersupport.com/

http://alznews.org/Library/InfoManage/Guide.asp?FolderID=53

Will you get it?

You have a good chance of it. About 4.5 million Americans have it now. It is estimated that by 2050 that number of people with Alzheimer's could be as high as 16 million. Approximately 10% of all people over the age of 65 and as many as 50% of those over the age of 85 are diagnosed with the condition.

Risk factors for Alzheimer's Disease include:

Age: Alzheimer's Disease increases with each decade of life as an adult. At 65 to 70 years your risk is about 1.5%; At 70 to 74 years your risk is about 3.5%; At 75 to 79 years your risk is about 6.8%; Your risk of Alzheimer's nearly doubles every 5 years so by the age of 95 nearly one half will have Alzheimer's disease.
Genetic Tendency: People with a family history of Alzheimer's have a higher risk, implying that a genetic factor is involved. A clear inherited pattern of AD exists in less than 10% of cases. Some involve a mutation of the gene for the protein APP, found on chromosome 21. It is known that a protein called Apolipoprotein E, of which we all have a copy of one of three types, affects the chances of getting Alzheimer’s disease. If you have two copies of the E4 version you have an increased risk of Alzheimer’s; the E2 version seems to give protection against it.
Down's Syndrome: Nearly all people with Down's syndrome (trisomy 21) who live into their 40s develop the disease.
Other genetic defects: Some cases involve a defect on chromosome 14. The gene for the protein Apo E, found on chromosome 19, is a risk factor that may be involved in modifying the age of onset.
Untreated high blood pressure: High blood pressure is a risk factor for loss of mental function in older people. Treatment reduces the risk.
Head injuries: People who have had head injuries are three times more apt to develop Alzheimer's Disease.
Diabetes: Recent research indicates a connection between diabetes (particularly if it is poorly controlled) and Alzheimer's Disease.

Will you get it?

If you live long enough, you have a 50-50 chance overall, since almost half of those over 85 do get with the disease. Those with a family history are even more likely to get it, and at an earlier age.

To try to prevent Alzheimer's Disease, eat right, exercise, keep your mind active, make sure to keep your diabetes or high blood pressure under control, take a vitamin pill, and keep your fingers crossed.

Information for this article was obtained from links referenced above, and:

http://www.neurologychannel.com/alzheimers/index.shtml

http://alzheimers.about.com/cs/diagnosisissues/a/what_alzheimers.htm

http://www.alz.org/

A Museum for the Morbid

2007-04-29T21:25:00.000-07:00

I'm in the process of writing a post on the next major disease - Alzheimer's - but in the meantime I thought I'd introduce you to a fascinating museum in Philadelphia, the Mutter Museum. That's Mutter with those little dots over the "u" (umlaut I believe it's called!).

I hadn't heard of the Mutter Museum until my Dear Husband gave me a marvelous book about it for Christmas one year.

The museum is a part of the College of Physicians of Philadelphia, and was founded in 1858 as a repository for medical oddities to help educate the budding physicians at the college and enlighten them about human anatomy and anomalies.

As described on the College's website, the museum was founded by Thomas Dent Mütter, retired Professor of Surgery at Jefferson Medical College. He donated his own collection of specimens to The College of Physicians of Philadelphia.

The collection comprises over 20,000 objects, including fluid-preserved anatomical and pathological specimens; skeletal and dried specimens, medical instruments, memorabilia of famous scientists and physicians; medical illustrations, photographs, prints, and portraits.

The objects displayed include:

The plaster cast of the torso of world-famous Siamese Twins, Chang & Eng, and their conjoined livers (yes, their ACTUAL livers);
Joseph Hyrtl's collection of skulls;
Preserved body of the "Soap Lady";
Collection of 2,000 objects extracted from people's throats;
Cancerous growth removed from President Grover Cleveland;
and the tallest skeleton on display in North America (7' 6").

You may think I might not have appreciated my husband for having chosen a book about this museum as a gift for me. You would be wrong. Being the hypochondriac and medical junkie I have always been, I loved it. It was my favorite Christmas present out of the past decade!

As a child I used to find medical books in my parents' bookcases since they were both medical writers. I reveled in paging through these tomes, which came with photographs of people with bizarre diseases and deformities. The pictures considerately had black bars across the eyes on the faces of the unfortunate sufferers so no one would guess their identities. The Mutter Museum photography book was right up my alley.

The book includes photographs of many of the most grotesque exhibits from the museum, including the liver of Chang and Eng, mentioned above. There is a woman with a horn sticking out of her head. (Yes, people really do develop these things). And there are even photos by the famous photographer William Wegman, known for his trademark photographs of Weimaraners.

I have not yet visited the Mutter Museum but intend to do so at some point, sooner rather than later!

Medical Knowledge - Practice Makes Perfect

2007-04-19T21:42:00.000-07:00

Since I am between major articles I decided to post another useful site for you. Instead of letting you go searching for symptoms, this site will let you test your medical knowledge and make sure you are up to date on your medical terminology.

It is a listing of quizzes pertaining to medical subjects. Some are easy, others are more difficult.

Test your knowledge - see if you can qualify to be a professional hypochondriac or whether you are strictly amateur!

http://www.funtrivia.com/quizzes/sci__tech/miscellaneous_health/medical_lingo__abbreviations.html

Elephantiasis

2007-04-15T10:01:00.000-07:00

Distribution of Lymphatic Filiaris in the world
(source: http://www.bg-sentinel.com/en/filariasis.html

So far I have tended to write about diseases or conditions that have affected either me or someone I know. And this topic is no exception. Well, the condition of Elephantiasis itself did not affect anyone I know, but a friend of mine has a daughter who saw something about the disease on Discovery channel last year and started to worry that she might have it! (My friend and I joke that her daughter is really my blood relative since she has my same tendency to be a hypochondriac!)

Her daughter, who was about 9 or 10 at the time, started focusing on her hands and imagining they were growing. Luckily her mother was finally able to convince her there was nothing wrong with her, and she hasn't had any other health-related panics in recent months! I can so identify with this because it is exactly the kind of thing I used to do...fixate on some symptom and keep checking to see if it was still there.

So, Elephantiasis. It's actually NOT what the famous "Elephant Man" (Joseph Merrick) had. He apparently suffered from something called Proteus Syndrome, not elephantiasis as experts had thought during his lifetime, and not neurofibromatosis, as was postulated in the 1970's.

What is it?

The main type of Elephantiasis, also called Lymphatic Filariasis, is a parasitic disease that is endemic in 80 countries throughout the world, and about 120 million people are directly affected. The disease flourishes in tropical and subtropical areas, including India, Africa, South Asia, the Pacific and the Americas.

Caused by tiny threadlike worms called Wuchereria bancrofti and Brugia malayi that invade the human lymphatic system (the system of lymph nodes and fluid that are the main system for the body to defend itself against disease), Elephantiasis causes enlargement of the leg, arm, genitals, vulva and breasts. The worms live for 4-6 years and produce millions of larvae that are released into the blood. Mosquitoes that bite an infected person pick up the larvae from the blood and are then able to transmit them to another person after the larvae continue to incubate for 1-3 weeks within the mosquito.

The disease has been increasing in prevalence in recent years due to the unplanned growth of cities in the developing world. The cities provide even more places for the mosquitoes to breed and multiply.

Men are more likely to be affected than women; 10-50% of men in affected populations can be symptomatic, and up to 10% of women.

The parasitic form of the disease is not the only type. Since the enlargement of certain body parts is because of swelling due to a build-up of fluid from a blocked lymphatic system, there can be other causes as well.

Nonfilarial elephantiasis, the second type of elephantiasis, is more common in Africa’s central mountains. It is caused by contact with volcanic ash in the soil; since the population mainly goes barefoot, the chemicals from the soil leach into their feet and eventually irritate and block the lymphatic vessels.

Hereditary lymphedema is a disorder caused by a genetic defect, which causes an accumulation of fluid to collect in the affected parts of the body. Underdevelopment of the lymph vessels is thought to be the cause.

What are the symptoms?

The obstruction of the lymphatic vessels results in extreme swelling of the skin and tissues, typically in the lower trunk and body. It primarily affects the legs and genitals, resulting in baggy, thickened and ulcerated skin, along with fever and chills. One serious complication of elephantiasis can also be obstructed blood vessels, which limit blood supply and cause the skin to become infected and can even lead to gangrene.

In the parasitic form of the disease, symptoms of elephantiasis may not appear until years after infection. As the parasites build up in the blood vessels, they restrict circulation and cause fluid to accumulate in surrounding tissues.

Symptoms of infection with elephantiasis are:

Fever
Pain in/above testicles (for men only of course)
Enlarged groin lymph nodes
Massively swollen legs, genitalia and breasts
White urinary discharge
Swollen liver
Swollen spleen

How is it diagnosed?

Until recently it was hard to definitively diagnose the parasitic form of the disease. The worms' active period is at night so blood samples taken during the day did not always show any activity. Now, however, there is a simple test that looks for the antigens to the parasites in the blood rather than the parasites themselves, and it is able to be diagnosed with a finger-prick blood test.

How is it treated?

There are medications that remove the parasites from the blood, which helps prevent transmission of the disease. DEC (diethylcarbamazine) reduces the number of parasites from the blood of an infected person for a year; a single dose of two drugs given together (albendazole with DEC or ivermectin) is 99% effective in removing the parasites from the blood for one full year.

Both albendazole and DEC have been shown to be effective in killing the adult-stage filarial parasites (which would accomplish a complete cure of infection), but an ideal treatment protocol has not yet been defined. Eliminating the parasites can help improve the symptoms, especially if the patient is still in the early stages.

Other medications include Suramin, Metrifonate, Mebendazole and Levamisole. Recent studies of use of the antibiotic doxycycline show promise. Medicines must be taken early after the primary infection. The problem with treatment of elephantiasis is that it is difficult to diagnose it early enough for the treatment to prevent the disabling effects of the disease.

Many of the most bothersome symptoms come from secondary bacterial and fungal infections caused by the original infection with the worms. Keeping the affected areas of the body very clean and taking care to minimize infection and encourage lymph flow are important in reducing the frequency of fevers and symptoms of elephantiasis.

Surgery is sometimes used to remove the excess tissue and fluid if possible.

The World Health Organization is working to stop the spread of Elephantiasis by treating the affected populations for the infection and disseminating table salt with DEC in it to keep the level of parasites down.

Control of mosquitoes in the areas where the disease is endemic would also be an important component in eradicating the disease.

Will you get it?

You might if you travel to an area where it is endemic, and newcomers develop symptoms more quickly than populations that have lived with the disease for many years. There is no vaccine currently available. To prevent infection, be sure to wear mosquito repellent and stay covered up wherever mosquitoes are prevalent. If you are in a tropical location sleep with mosquito netting around your bed.

Other sources for this post:

http://www.mamashealth.com/parinfect/elep.asp
http://www.wisegeek.com/what-causes-elephantiasis.htm
http://www.who.int/mediacentre/factsheets/fs102/en/

Lung Cancer

2007-04-08T18:21:00.000-07:00

I've known three people with lung cancer. Although lung cancer usually has a poor prognosis, two of the three people survived it. The third is still alive, although her long-term outlook is poor.

One of the three was diagnosed early on with an operable cancer and it was surgically removed. Luckily because it was caught early and he was treated at Memorial Sloan Kettering, he recovered. A cigarette smoker, he quit after his diagnosis, although I believe he eventually went back to smoking cigars or pipes.

The other is the mother of a friend of mine. She was diagnosed with Stage IIIb (more on staging later, but just know this is not good) lung cancer at age 69, after having quit smoking five years earlier. My friend was diligent in researching her mother's condition and combined state of the art medical treatment with alternative medicine for her mother, who has now been cancer free for over eight years.

The third person, the sister of a good friend of mine, has not been so fortunate. She waited too long to go to the doctor, despite knowing she had concerning symptoms, and by the time she was diagnosed, the cancer had spread to her brain and bones, and the tumor in her lung was inoperable. However, with chemotherapy and radiation, she has already lived longer than the expected 18 months and has been able to enjoy time with her daughter and other family members.

So, although lung cancer is often fatal, it doesn't have to be. And early diagnosis can make a difference. Because they are typically diagnosed at a later stage of disease, 6 in 10 lung cancer patients will die within the first year following diagnosis. Five-year survival is just 14 percent, and an estimated 170,000 Americans die each year from the disease. As a result, lung cancer is the leading cause of death due to cancer in both men and women in the United States.

What is lung cancer?

There are two major varieties of lung cancer: primary and metastatic. The metastatic kind is actually other types of cancer that have spread to the lungs. So although it is in the lungs, it is actually cells from the other type of cancer. This article is going to focus on the primary type, that originates in the lungs.

There are different types of primary lung cancer. The two major classes of lung cancer are: Small cell lung cancer and non-small cell lung cancer. (Strangely, they don't call the non-small cell lung cancer, "large cell lung cancer" - that's because a specific type of non-small cell lung cancer is called "large cell lung cancer.")

Small cell lung cancer only makes up 20% of all lung cancers, and it is the cancer most closely tied to smoking. This type, also known as "oat cell cancer," spreads rapidly to other sites in the body and is quite aggressive.

Non-small cell lung cancer grows more slowly and does not spread as aggressively as non-small cell lung cancer.

Non-small cell lung cancer (NSCLC) comes in three main varieties:

Adenocarcinomas are the most common type of NSCLC in the U.S. and account for up to 50% of NSCLC . Although these tumors are still associated with smoking, this type is the one most seen in non-smokers who develop lung cancer.

Squamous cell carcinomas presently account for about 30% of NSCLC. Also known as epidermoid carcinomas, they arise most frequently in the central chest area in the bronchi. This is really just like having skin cancer in your lung.

Large cell carcinomas, sometimes referred to as "undifferentiated carcinomas," are the least common type of NSCLC.

Mixtures of different types of NSCLC are also seen.

There are other miscellaneous types of lung cancer than NSCLC and SCLC, and together they account for about 5-10% of lung cancers:

Bronchial carcinoids are the main remaining type, and account for up to 5% of lung cancers. These tumors are usually small when diagnosed and occur most commonly in people under 40. This type is not related to cigarette smoking. They can metastasize, and a small proportion of these tumors secrete hormone-like substances. Carcinoids generally grow and spread more slowly and are detected early enough to be operable.

What causes lung cancer?

Smoking is the main co-factor causing lung cancer in most people who get it; in fact, approximately 87% of all lung cancers are caused by smoking. And, although if you are a smoker and you quit, the risk of lung cancer declines each year, it never returns to pre-smoking levels. There tends to be a 20-year lag time from the time smoking began to the time cancer develops.

(Chart copyright © 2005 BIOTECH100.COM. All rights reserved)

Secondhand cigarette smoke can also cause lung cancer in non-smokers, as can inhaling radon gas. Exposure to asbestos causes a specific type of lung cancer called mesothelioma. There are other inhaled carcinogens that can cause lung cancer as well. It is theorized that viruses can even be involved in some cases.

We all know plenty of people who have smoked like chimneys all their lives and have no sign of lung cancer; my mother, for instance. She is now 88 years old and has been smoking a pack of cigarettes a day for 60 years and is doing fine. Then there are others who didn't even smoke that long, or never smoked at all, and nevertheless get lung cancer. So, most people who get lung cancer are smokers, but not all smokers get lung cancer. Why is this?

Recent research indicates that those who get lung cancer are more apt to have a variation in a gene that produces an enzyme that protects against lung cancer, resulting in lower levels of the enzyme, making them more susceptible to cancer. An Israeli study also identified an enzyme that may be lacking in lung cancer victims, so there may be several co-factors involved. As more is understood about these co-factors, new drugs may become available. There are even studies that indicate ACE inhibitors, a type of blood pressure drug, may help protect against lung cancer.

In the past, men were more apt to get lung cancer than women, but in recent years the rate of lung cancer in men has been dropping, but it is still rising in women. This may reflect the differences in prevalence of smoking in men vs. women over the years.

If you want to prevent lung cancer, don't smoke. If you do smoke, quit. You don't know whether you're one of the people who have the genetic tendency to get lung cancer or not; why take a chance?

Avoid exposure to toxins and carcinogens; have your home tested for radon and stay away from places that expose you to second-hand smoke. Now that so many states have passed laws against smoking in the workplace and in other public places, this should be less of a problem than in the past.

There is now evidence that eating cruciferous vegetables such as cauliflower and broccoli may help prevent or inhibit lung cancer: http://www.sciencedaily.com/releases/2005/09/050915003652.htm

What are the symptoms?

OK, so say you're a smoker or an ex-smoker and are worried about lung cancer. What symptoms should you be on the lookout for? What can you do to make sure you catch it early if you do get it?

Symptoms:

Chronic cough
Coughing up blood
Hoarseness
Weight loss and loss of appetite
Shortness of breath
Fever without any reason to have one
Wheezing
Repeated episodes of bronchitis or pneumonia
Chest pain

In about a quarter of lung cancer cases, the cancer is discovered early, through an X-ray or CT scan, and the patient has not had any symptoms whatsoever.

Once symptoms start, this indicates the cancer is large enough to interfere with the esophagus, the vocal chords, the lungs, or even the nerves (causing shoulder pain for some).

Further symptoms can develop due to metastasis of the original tumor, as happened to my friend's sister. Lung cancer that has spread to the bones can cause pain at the sites of bone involvement, e.g., pain in the ribs, if the ribs are affected. Cancer that has spread to the brain may cause blurred vision, headaches, seizures, or weakness or loss of sensation in parts of the body.

Lung cancers are often accompanied by "paraneoplastic syndromes," symptoms that are caused by production of hormone-like substances by the tumor cells. This occurs most often with SCLC but may be seen with any tumor type. Sometimes this syndrome causes too much of the hormone cortisol to be produced by the adrenal glands (Cushing’s Syndrome). The most frequent paraneoplastic syndrome seen with NSCLC is the production of a substance that causes elevated levels of calcium in the bloodstream.

Other less specific symptoms can also be apparent: weakness, tiredness, depression.

How is it diagnosed?

First, the doctor will take a full history of your symptoms, smoking habits, and anything else that might be pertinent. Physical examination may reveal sounds in the lungs or other symptoms ("clubbing" of the fingernails can indicate lung disease; pallor or a bluish tinge to the skin can show lack of oxygen).

A chest X-Ray will often be taken. Some doctors may do a "spiral CT" scan which is more sensitive than an X-Ray; unfortunately it also often shows nodules that turn out to be benign but require further testing to make sure.

An MRI (magnetic resonance imaging) can provide more detailed information about a tumor's location in the body.

Positron emission tomography (PET) scanning is a specialized imaging technique that uses short-lived radioactive substances to produce three-dimensional colored images of those substances functioning within the body. PET scans measure metabolic activity and functioning of tissue and can tell whether a tumor is actively growing and can help identify the type of cells within a particular tumor.

Bone scans using radioadtive material are done to determine whether the cancer has spread to the bones as part of the staging process.

Even if one of the scans shows a possible tumor, unless cancer cells are observed under a microscope, no one can be sure whether it is cancer or not.

Often just examining the patient's sputum under a microscope can enable a pathologist to make a diagnosis, as the cancer cells can often be seen in the sputum.

A more direct method to obtain cells is to biopsy the affected area of the lungs with an instrument called a bronchoscope, a thin tube that is put down into the patient's lungs to look at and sample the suspected tumor. This is done with the patient under sedation, in an outpatient procedure.

For tumors not reachable through a brochoscopy, fine needle aspiration of nodules that have been identified through a scan can be done, by inserting a very thin needle through the chest wall into the lungs.

If fluid has accumulated in the lining of the lungs, as can happen with certain types of lung cancer, then this fluid can be aspirated with a needle and examined for cancer cells as well.

Blood tests are also done to see if any abnormalities show up that could be caused by the cancer.

Once all these tests are complete and lung cancer has been definitively diagnosed, the physician can then stage the cancer, which identifies how far the cancer has spread and helps guide treatment options and prognosis.

Staging involves both evaluation of a tumor’s size as well as the presence or absence of metastases in the lymph nodes or in other organs.

Non-small cell lung cancers are assigned a stage from I to IV in order of severity:

Stage I: The cancer is confined to the lung.
Stages II and III, the cancer is confined to the chest (with larger and more invasive tumors classified as stage III).
Stage IV: Cancer has spread to other parts of the body.

Small cell lung cancers are staged using a simpler system:

Limited stage (LS) SCLC: Cancer that is confined to its area of origin in the chest.
Extensive-stage (ES) SCLC: Cancer has spread beyond the chest to other parts of the body.

There are also more complex ways that doctors use to stage lung cancer, described in this link: http://www.health-alliance.com/Cancer/Lung/staging.html. As you'll see, my friend's mother's Stage IIIb cancer meant some lymph node involvement, but thankfully, no distant metastases.

How is it treated?

Depending on the stage and location of the tumor, it may be treated by surgery, radiation, chemotherapy, or all three.

Surgery - Surgical removal of the tumor is the treatment of choice for cancer that has not spread beyond the lung. Unfortunately, only about 10-35% of lung cancers can be removed surgically, and even then removal does not always result in a cure, since the tumors may already have spread and can come back later on.

Among people who have an isolated, slow-growing lung cancer removed, 25 to 40% are alive 5 years after diagnosis.

Surgery may not be possible if the cancer is too close to the windpipe or there are health problems that would endanger the patient if an operation were performed. Surgery is less often performed with SCLC because these tumors are less likely to be localized to one area.

It is a nasty operation. Surgeons have to cut open the chest wall and may have to remove a portion of one lobe of the lung, perform a full lobectomy (removal of the whole lobe), or a pneumonectomy (removal of an entire lung). Sometimes lymph nodes in the region of the lungs are also removed. The risks of surgery include complications due to bleeding, infection, and complications of general anesthesia, and the patient must be carefully followed afterward as he or she recovers from the surgery.

Radiation - Radiation therapy may be used as a treatment for both NSCLC and SCLC. Radiation therapy may be given as curative therapy, palliative therapy (just to help reduce symptoms, by using lower doses of radiation than with curative regimens) or as an accompaniment to surgery or chemotherapy. The radiation is either delivered by using a machine that directs radiation toward the cancer, or internally through placement of radioactive substances in the area of the tumor.

Radiation therapy can be given without surgery if a tumor is inoperable, or if a person has other conditions that make them too ill to undergo major surgery. Radiation therapy generally only shrinks a tumor or limits its growth when given as a sole therapy, yet in 10-15% of persons it leads to long-term remission and palliation of the cancer. Combining radiation therapy with chemotherapy can further increase the chances of survival. External radiation therapy can generally be carried out on an outpatient basis while internal radiation therapy requires a brief hospitalization.

Radiation therapy can cause tiredness, lack of energy, reduced white cell count and low blood platelet levels. It may also cause nausea, vomiting, or diarrhea.

For patients with inoperable tumors, radiofrequency ablation can be very effective.

Chemotherapy - Both NSCLC and SCLC may be treated with chemotherapy. The platinum-based drugs have been the most effective in treatment of lung cancers.

Chemotherapy is the best treatment for most small cell lung cancers, since these tumors are generally widespread in the body when they are diagnosed. Only half of people who have SCLC survive for four months without chemotherapy. With it, their survival time is increased up to four or five times that long.

Chemotherapy alone is not particularly effective in treating NSCLC, but when NSCLC have metastasized it can prolong survival.

Chemotherapy may be given as pills, as an intravenous infusion, or as a combination of the two, and are usually done on an outpatient basis. A combination of drugs is given in a series of treatments, called cycles, over a period of weeks to months, with breaks in between cycles. The blood must be checked for levels of platelets and white blood cells; when they get too long, a cycle may have to be missed.

There is a new drug, Tarceva, which has been shown to prolong life in lung cancer patients.

Side effects to most chemotherapy include increased susceptibility to infections and difficulties with blood clotting (bleeding or bruising easily), fatigue, weight loss, hair loss, nausea, vomiting, diarrhea, and mouth sores. Medications have been developed that can treat or prevent many of the side effects of chemotherapy, so it is not as unpleasant as it was in the past.

Sometimes people with SCLC that is responding well to treatment are treated with radiation therapy to the head to treat very early spread to the brain (called micrometastasis) that is not yet detectable with CT or MRI scans and has not yet produced symptoms.

Lung cancer that has returned following treatment with surgery, chemotherapy, and/or radiation therapy is called recurrent or relapsed. If a recurrent cancer is confined to one site in the lung, it may be treated with surgery. Relapsed tumors are usually resistant to the original type of chemotherapy that was used. So, a second-line chemotherapy is used to treat recurrent cancers, and some of these agents have been proved effective at prolonging survival.

New drugs or new combinations of drugs are tested in clinical trials, studies that evaluate the effectiveness of new medications in comparison with those treatments already in widespread use. If you have a lung tumor with a poor prognosis, you may want to check some of these out ahead of time before starting treatment. Depending on the protocol of the clinical trial, some may require that you have not undergone previous treatment before participating in a trial. Refer to the National Cancer Institute's website to find a clinical trial: http://www.cancer.gov/clinicaltrials

Treatments known as immunotherapies are being tested. These may involve the use of vaccine-related therapies or other therapies that attempt to utilize the body’s immune system to fight cancer cells.

One kind of experimental therapy used for recurrent SCLC is photodynamic therapy, in which a photosynthesizing agent (such as a porphyrin, a naturally-occurring substance in the body) is injected into the bloodstream a few hours prior to surgery. During this time, the agent deposits itself selectively in rapidly growing cells such as cancer cells. A surgical procedure then follows in which the physician applies a certain wavelength of light through a hand held wand directly to the site of the cancer and surrounding tissues. The energy from the light activates the photosensitizing agent, causing the production of a toxin that destroys the tumor cells.

Small cell lung cancer is the most aggressive; it has a median survival time of only 2-4 months after diagnosis when untreated. But, there is some hope: SCLC is also the most responsive to radiation therapy and chemotherapy. Nevertheless, of all patients with SCLC, only 5-10% are alive 5 years after diagnosis.

As for non-small cell lung cancer (NSCLC), in Stage I cancers that can be completely removed, the 5-year survival rate is nearly 75%. Radiation therapy can produce a cure in a small minority of patients with NSCLC and relief of symptoms in most patients. In advanced-stage disease, chemotherapy can improve survival time; however, overall survival rates are still poor.

Survival rates for lung cancer are generally lower than those for most cancers, with an overall 5-year survival rate for lung cancer of about 15%.

Sounds bad. What about alternative therapies?

There are a number of alternative therapies out there that many people swear have helped them or a loved one. This website offers a good summary of a number of promising alternative therapies, as well as information on which therapies may interfere with other treatments: http://www.lungcanceronline.org/treatment-cam/topics.html

The National Cancer Institute also offers a comprehensive overview of alternative therapies and how they are testing them: http://www.cancer.gov/cancertopics/factsheet/therapy/CAM.

There are some controversial alternative therapies out there. My friend's mother took a substance called hydrazine sulfate. This National Cancer Institute link explains the history of its use and the tests that have been done: http://www.cancerlinksusa.com/alternative/hydrazine.htm. The controversy arises because, according to Dr. Joseph Gold, the main proponent of the use of hydrazine sulfate, the clinical trials that were done did not follow his recommended protocol and therefore he felt that the trials were invalid. Studies in Russia and elsewhere seem to show a benefit. I have no idea whether my friend's mother would have lived anyway without the hydrazine sulfate. But I do know that WITH it, she did live. And it's also an antidepressant, which can't hurt when you have cancer.

My recommendation is, if you are diagnosed with lung cancer, do your research. Go on line, read legitimate medical sites, learn about new clinical trials, question your doctors. Always get a second opinion in the beginning and make sure you go to a major cancer center for all of your treatments, including the initial diagnosis and operation, if any. If you do decide to take alternative medicines, be sure to keep your doctors informed of everything you are taking.

Will you get lung cancer?

If you don't smoke, and haven't been exposed to carcinogenic chemicals or substances, probably not.

Men are still more likely to get it (78.5 per 100,000 men vs. 51 per 100,000 women), but as previously mentioned, their rates are declining while women's are increasing.

Sources for this information in addition to links noted above, were:

http://www.medicinenet.com/lung_cancer/article.htm

http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=38494

http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=669263

Website Link for you - to search for your symptoms

2007-03-31T10:57:00.000-07:00

Hello fellow hypochondriacs,
I am in the process of writing the next post - on lung cancer. But to keep you occupied in the meantime I thought I'd post a link to WebMD's Symptom Checker. It's a handy tool - you can enter your symptoms and where they are, and it tells you what diseases you might have. I knew you all would enjoy it as much as I did. I just learned about a new (to me) disease called Floppy Eyelid Syndrome. Luckily it seems I don't have that.

WebMD Symptom Checker

Diphtheria

2007-03-19T19:37:00.000-07:00

I happened to be watching a biographical show about Eleanor Roosevelt on public television and it mentioned that her mother, Anna Hall Roosevelt, died at the tender age of 29, of diphtheria, when Eleanor was a child.

This made me think about diphtheria, one of the dread diseases of the past that in the United States has been rendered rare because of widespread vaccination. However, there are still cases of it from time to time here, and in other parts of the world it is still common, particularly in parts of the former Soviet Union, where there was a serious epidemic between 1990 and 1998 (over 150,000 cases).

My father had diphtheria when he was about six years old and, obviously, recovered. However, I wondered whether his lifelong tendency to a nervous cough may have been a leftover effect of the traumatic feeling of his throat closing off from the swelling and membranous material that diphtheria causes in the throat.

I also recall reading about diphtheria in my favorite Cherry Ames nurse books when I was young; this series was written originally in the 1940's so diphtheria was not as uncommon then as it is now (19,000 cases in 1945) so Nurse Cherry did run into it in some of her cases. The description of the symptoms left a lasting impression on me. (For those not familiar with Cherry Ames, you can read more about her here).

Diphtheria is a nasty disease, and if you aren't sure when you had your last booster shot for it, I'd recommend having one, especially if you travel to other parts of the world. It is given in conjunction with the tetanus vaccine, and it is recommended you get a booster every 10 years.

What is it?

Diphtheria is a highly contagious infectious disease that is caused by a bacterium. Unfortunately, unlike your ordinary run-of-the-mill bacterium, this one creates a toxin (similar to what happens with botulism or tetanus).

Diphtheria is quite contagious and easy to spread. People get diphtheria by breathing in diphtheria bacteria after an infected person has coughed or sneezed. People can also catch it from coming in contact with discharges from an infected person's mouth, nose, throat, or skin.

There are several kinds of diphtheria; the milder type is called Anterior Nasal Diphtheria and it mainly affects the back of the nose and doesn't tend to expose the person to a lot of the toxin.

Another common type is pharyngeal and tonsillar diphtheria. If a patient gets this type of diphtheria, a good amount of toxin is usually absorbed, which can cause serious consequences.

Laryngeal Diphtheria affects the larynx (voicebox); it is sometimes an extension of the pharyngeal type or can occur on its own.

Diptheria can also occur in the skin, called Cutaneous Diphtheria; this usually shows up as some type of ulceration or rash.

What are the symptoms?

Anterior Nasal: The symptoms mimic a common cold, but with a nasty nasal discharage and a whitish membrane that forms in between the nostrils on the "septum" that separates the insides of your nose. This sounds pretty nasty but it's not as bad as what happens with the other kinds. This type of diphtheria is pretty easily cured by administration of antibiotics and anti-toxin.

Pharyngeal/Tonsillar: This starts with a feeling of general crumminess (malaise), sore throat, lack of appetite and low grade fever. After a couple of days, a bluish grey membrane starts to form in the back of the throat. Eventually it can appear blackish if bleeding occurs. It sticks to the tissues of the throat and can't be removed without causing bleeding. It can result in obstruction of the throat and interfere with breathing. This is the criical point; at this time a patient may recover, or else develop further complications. If a large amount of toxin is absorbed,the patient can become weak, with a rapid pulse and pale skin; and can even fall into a coma. The neck can become markedly swollen due to swollen lymph nodes. Death can occur within 6-10 days if treatment is ineffective.

Laryngeal: Symptoms of this type of diphtheria can include hoarseness, a "barking" cough, and a fever. The membrane can also obstruct the airway. This type can also lead to death due to these complications.

Cutaneous: More common in the tropics or among the homeless population in the United States. This type causes a rash or clearly outlined ulcers with a membrane. But the skin type of diphtheria is less dangerous since most infections do not cause the toxin to be released which results in fewer symptoms and complications. Even if the bacterium involved does produce the toxin, the cutaneous type is less severe.

Symptoms usually appear 2-5 days after exposure but the range can be from 1 to 10 days in different cases.

Complications:

Most of the most serious complications of diphtheria, beyond the airway obstruction from the membrane, are the results of the toxin. They include:

Inflammation of the heart (myocarditis): Can include heart arrhythmia; if it happens early in the course of the disease it is often fatal.

Inflammation of the nerves (neuritis): Between the third and fifth week of the disease, paralysis of the soft palate (back of the throat), eye muscles, limbs and diaphram can occur. If the diaphram is affected it can cause pneumonia, breathing problems or even death.

Inflammation of the kidneys (nephritis): Can result in kidney damage.

Infection of the middle ear can also be a complication.

If you are interested in looking at some of the symptoms in living color, this website, http://www.vaccineinformation.org/diphther/photos.asp, has a number of graphic images of the membrane in the throat and other manifestations of diphtheria. Not for the weak of stomach, but as true hypochondriacs I'm sure you may want to take a look and make sure you don't have any of these symptoms.

Of course, the most severe "complication" is death. Even today, the overall death rate for this disease is 5-10%, and up to 20% among young children under 5 or people over 40.

How is it diagnosed?

Initial presentation of symptoms indicative of diphtheria are enough to motivate a physician to start treatment even before the definitive diagnosis, given the time-sensitive nature of catching the disease before too much toxin is produced.

A throat culture is also taken to identify the presence of Corynebacterium diphtheriae , the diphtheria bacterium. Sometimes more complex tests are needed to definitively diagnose the disease, including staining of the material in the membrane of the throat or testing of antibodies in the blood.

How is treated?

If initial examination indicates diphtheria, treatment should be started immediately, even before test results are available.

Diphtheria anti-toxin is given as a shot into a muscle or through an IV (intravenous line). The anti-toxin is strictly controlled by the Centers for Disease Control. It is produced in horses and dates back to its development in the late 1800's. People can be allergic to it, so a patient should be tested for sensitivity before using the anti-toxin. Anti-toxin does not neutralize the toxin if it is already in the body's tissues, but it will bind with circulating toxin and will prevent further progression of the disease.

The infection is then treated with antibiotics, such as penicillin or erythromycin. They may be administrated orally or by injection. After 48 hours the disease will no longer be contagious.

People with diphtheria may need to stay in the hospital while the anti-toxin is being received, and should be isolated until no longer contagious.

Depending on symptoms, other treatment may include:

-Fluids by IV
-Oxygen
-Bed rest
-Heart monitoring
-Insertion of a breathing tube
-Correction of airway blockages

Anyone who has come into contact with the infected person should be receive immunization or booster shots against diphtheria. Protective immunity lasts only 10 years from the time of vaccination, so it is important for adults to get a booster of tetanus-diphtheria (Td) vaccine every 10 years.

Those without symptoms but who carry diphtheria should be treated with antibiotics.

Of course, the best thing to do is not to get diphtheria in the first place. In the developed world, most people are vaccinated as children. The diphtheria vaccine is usually given in a combination shot with tetanus and pertussis vaccines, known as DTP vaccine. A child should have received four DTP shots by 18 months of age, with a booster shot at age 4 years to 6 years. After that, diphtheria and tetanus boosters should be given every 10 years to provide continued protection. The diphtheria toxoid (inactivated toxin that causes the body to produce protective antibodies) vaccine was developed in the 1920's but was not widely used until the 1930's and 40's when it was combined with the pertussis (whooping cough) and tetanus vaccines and began to be used routinely.

Will you get it?

If you live in the United States or western Europe, it isn't likely at all. From 1980 to 2004, only 57 cases of diphtheria have been reported in the United States; only 5 since 2000. Most occurred in adults, with over 40% of them in adults over 40, in people who were unimmunized or had let their immunity lapse.

This chart shows the dramatic decrease in diphtheria deaths after the vaccine became widely used.

However, other parts of the world still have a problem with diphtheria due to undervaccination and poor living conditions. As mentioned previously, the newly independent countries that were formerly part of the Soviet Union had a severe outbreak in the 1990's. If you are traveling to other parts of the world, make sure your vaccinations are up to date.

Information on this topic was taken from the following sources:

http://www.cdc.gov/nip/publications/pink/dip.pdf

http://www.nlm.nih.gov/medlineplus/diphtheria.html

http://www.astdhpphe.org/infect/dip.html

http://www.healthsentinel.com/pictures/graphs/Picture/US-UK-Diphtheria-1901-1965.gif

Eating Disorders

2007-03-10T08:45:00.000-08:00

This entry is actually by request...a friend of mine has two daughters who have struggled with eating disorders. Since one of her daughters is still bulimic, my friend is still looking for answers as to how to best deal with this difficult affliction.

I have had past experience with someone with an eating disorder as well. My roommate in college freshman year became anorexic soon after we started living together. Her parents were divorced, she lived with her mother and stepfather; she did have a good relationship with her biological father but he lived far away, in California, as he was in the film industry. Her mother had gone to private school in New York City when she was growing up and had been quite the social butterfly. But her daughter, my roommate (we'll call her Cindy), was not the same type. She was serious and studious; her forte was to study hard and get good grades. A little bit on the chunky side, she was not beautiful but not homely either. But no matter how good her grades were, her mother always asked about her social life, which was nonexistent.

When we first met, we got along fine, as I too was not a social phenomenon. I was glad to have been paired with someone on my own level socially. So we went to a couple of mixers together, had some good times, and studied in our rooms together. But shortly after the beginning of the school year, Cindy decided to go on a diet and really change her life. She was still trying to live up to what her mother wanted her to accomplish - being popular.

Cindy started out dieting in a fairly normal way: eating salads, tuna, fruit, etc. But gradually it became more and more pathological. Eventually she was eating nothing but iceberg lettuce. No tuna. No chicken. No fruit. After awhile she had lost enough weight that she could put on her old jeans and button them and pull them down without unbuttoning them.

She lost all interest in anything; she didn't have the energy to go out and go to mixers anymore. She would come back from class, do her homework, and lie on her bed staring at the ceiling. It didn't help that the college we attended was all women and the only way to meet anyone of the opposite sex was to actually make an effort; there were no men in our classes. So her social life did not flourish despite her weight loss, and she continued to want to lose more.

Luckily for Cindy, after freshman year when she went home, her family must have realized there was a problem. She did not return to school in the fall; instead she transferred to the University of South Florida, where her beloved older brother was already a student. The last I heard of her, she had done well there, apparently was eating in a healthier way, and by senior year was engaged to be married.

Not all people with eating disorders have such happy endings. There were two other girls I was acquainted with in college who were seriously anorexic, to the point of needing hospitalization to prevent them from starving themselves to death. Cindy, although she qualified for the definition of anorexia, never got to that point.

Many people know someone who they suspect suffers from some kind of eating disorder; you may have someone in your family who has one. Others may have told you that you have one. This article will help you understand what constitutes an eating disorder, what types there are, why people develop them, and what can be done to help those who suffer from this illness.

Eating Disorders: What are they?

Eating disorders are serious, but treatable, medical illnesses. People suffering from eating disorders typically become obsessed with food and their body weight. Eating disorders afflict several million people at any given time, most often girls/women between the ages of 12 and 35. In fact, over 90% occur in an even narrower age range of girls/women 12-25, according to the National Alliance of the Mentally Ill. However, these disorders can occur in boys and men as well, and in people of any age. Eating disorders are often associated with other forms of psychiatric illness such as depression, obsessive-compulsive disorder, bi-polar disorder, and others.

These illnesses come in three main types:

Anorexia Nervosa, which is the type of disorder Cindy had: Self starvation and excessive weight loss. The person with anorexia can be rail-thin and still think they are fat.

Another form of disorder is Bulimia, also called Bulimia Nervosa, where the person binges on food and then forces themselves to vomit. Sometimes they use laxatives to purge as well. Often these people have a normal appearance in terms of body weight. The word "bulimia" comes from a Greek word meaning "extreme hunger."

There are also Binge Eaters, who are compulsive overeaters, who eat beyond the point of feeling comfortably full. While there is no purging, there may be fasts or repetitive diets and often feelings of shame or self-hatred after a binge.

There are other combinations of eating disorders, with aspects of more than one. Someone who is anorexic can become bulimic and vice-versa. All eating disorders involve an unhealthy relationship with food and try to use food and weight as a way to deal with emotional problems and issues of control.

What are the symptoms?
Anorexia:

Deliberate self-starvation with weight loss to 15% or more below normal body weight
Fear of gaining weight
Refusal to eat
Denial of hunger
Constant exercising
Sensitivity to cold temperatures
Absent or irregular periods
Loss of scalp hair, eyebrows
A self-perception of being fat when the person is really too thin
Anxious or ritualistic behavior at mealtimes
Fatigue
Depression
Irregular heart rate
Baby-fine hair covering the body (a condition known as lanugo)
Mild anemia
Brittle nails and hair
Low blood pressure

Bulimia Nervosa:

Although they may frequently diet and vigorously exercise, individuals with bulimia nervosa are often of normal weight, although some can be slightly underweight, others overweight or even obese. But they are never as underweight as anorexia nervosa sufferers. Those with bulimia nervosa binge eat frequently, often consuming thousands of calories by eating foods that are high in carbohydrates and fat. They can eat very rapidly, sometimes gulping down food without even tasting it.

After a binge, feelings of loss of control, stomach pains and the fear of weight gain are common reasons that those with bulimia nervosa purge by throwing up or using a laxative or diuretic (which removes water from their system). This cycle is usually repeated at least several times a week or, in serious cases, several times a day.

The signs and symptoms of bulimia include:

Recurrent episodes of binge eating
Feeling a lack of control over eating behavior
Eating much more food in a binge episode than in a normal meal or snack
Following a binge with efforts to prevent weight gain — such as self-induced vomiting, using laxatives or other medications, fasting or excessive exercise
Unhealthy focus on body shape and weight
Dehydration
Fatigue
Depression
Constipation
Damaged teeth and gums from gastric acid contained in vomit
Swollen cheeks from regular vomiting
Irregular heartbeat

Binge Eating:

Binge eaters lack control over their eating habits, and binge at least twice a week for at least six months in order to be diagnosed as a binge eater. Binge eating is one form of eating disorder that males and females are equally likely to develop, according to the Mayo Clinic.

The signs and symptoms of binge-eating disorder include:

Recurrent episodes of compulsive overeating not followed by purging
No control over eating behavior
Feelings of shame or guilt
Fatigue
Joint pain
Gallbladder disease
Increased blood pressure and cholesterol levels

Many kids and teens who develop eating disorders often manage to hide them from their parents. Warning signs to watch out for are if the child avoids eating with the family, excessive preoccupation with weight and body appearance, wearing baggy clothes, and long visits to the bathroom shortly after eating.

What causes eating disorders?

There are a number of theories about the cause of eating disorders. There may be a genetic component. Research has shown that in some cases the areas of the brain governing appetite and digestion aren't functioning properly. Family behavior, culture and the effect of the media's preoccupation with thin celebrities and models have all been identified as possible causes. Certainly our culture's focus on the importance of being thin has resulted in many young girls growing up with a distorted view of what is normal and desirable in society.

Risk factors for developing an eating disorder include:

Gender (more women than men)
Age (younger, as mentioned above)
Family influence (feelings of insecurity within the family, stemming from overcritical parents or siblings, or teasing about appearance)
Heredity (more common if another family member also has had an eating disorder)
Other emotional disorders (depression, obsessive-compulsive disorder, etc.)
Participation in highly competitive athletic activities

Beyond genetic and cultural co-factors, there tends to be a pattern in the families of those suffering from eating disorders. Eating disorders can be related to problems during upbringing, resulting in low self-esteem; there may be over controlling parents (particularly mothers and distant fathers), and sometimes sexual abuse. Those with eating disorders often fear sexual maturation, have trouble coping with stress, and tend to behave in a non-assertive manner. They try to avoid conflict and seldom resolve conflicts with others in a mature way.

These families are often over protective, and there may be alliances of the anorexic daughter with one parent or another (called triangulation). The family overall tends to have difficulty coping with stress; the parents may have an unacknowledged problem in their relationship, and enlist the daughter to balance an otherwise unhealthy situation. Parents are often affectionate and intrusive, but may be neglectful and controlling.

Anorexics usually are perfectionists. They set very high standards for themselves and feel they always have to prove their competence. A person with anorexia may also feel the only control they have in their lives is in the area of food and weight. If they can't control what is happening around them, they can control their weight.

Sometimes focusing on calories and losing weight is their way of blocking out feelings and emotions. Because of their low self-esteem they sometimes feel they don't deserve to eat. The anorexics usually deny that anything is wrong.

Bulimics also do not feel secure about their own self worth. They usually strive for the approval of others and hide their own feelings. Food becomes their source of comfort. Bulimia also serves as a function for blocking or letting out feelings. they tend to be impulsive rather than perfectionists. Unlike anorexics, bulimics do realize they have a problem and are more likely to seek help.

Binge eaters use food as a way to cope with or block out feelings and emotions they do not want to feel. IThey may use food as a way to numb themselves, to cope with daily life stressors, to provide comfort to themselves or fill a void.

Complications

People with anorexia have a greater variety of health complications and a greater risk of death (either from weight loss complications or suicide) than do people with bulimia. However, both eating disorders can result in serious health problems.

Anorexia can cause heart problems, particularly due to irregular heart rhythms and reduced size of the heart muscles. (Karen Carpenter, the singer, died of heart problems related to her history of anorexia.) In addition, changes in reproductive hormones and in thyroid hormones can cause absence of menstruation, infertility, bone loss and retarded growth. Disruption of the body's levels of fluids and minerals can create an electrolyte imbalance. Unless restored, this imbalance can be life-threatening. Anorexia may cause brain and nerve damage, seizures and loss of feeling.

Bulimia does not cause as severe health problems as anorexia, since bulimics tend to maintain a more normal weight. Complications may include: Teeth and gum problems, low potassium levels (which can lead to weakness and heart arrhythmias), irritation of the walls of the esophagus and rectum.

Binge eaters may develop high blood pressure, high cholesterol, heart disease, gallbladder disease or type 2 diabetes.

How are eating disorders diagnosed?

Often a family will bring in the afflicted family member to the doctor when they realize there is a problem. Or, the person may realize themselves that they have a problem and go to the doctor.

In addition to finding out whether the person qualifies as being the victim of an eating disorder based on their eating behaviors and symptoms, the physician will also perform a complete physical examination to ascertain whether the person is experiencing any of the side effects of the particular eating disorder. He or she will record the patient's weight and then run a number of tests. These tests should include:

Complete blood count (to check for anemia and other health problems)
Blood chemistry (to check for performance of various organs)
Electrocardiogram (to identify heart damage or irregular rhythms)
Chest X-Ray (to see whether the heart size has changed)
CT scan of brain, digestive tract
Bone density test

If any of the tests show effects from the eating disorder, these problems need to be addressed along with the underlying cause, which is the eating disorder itself.

How are eating disorders treated?

For severe anorexia nervosa, hospitalization is sometimes required to rehydrate the body, balance the electrolytes and begin bringing nutrition back into the body.

If the situation is not as dire, the patient can be treated at home, and a nutritional program prescribed to lead to a gradual weight gain.

For all types of eating disorders, a combination of various therapies is needed, including nutritional education, psychotherapy and family counseling. Medications may be prescribed to reduce vomiting, anxiety and associated depression.

Psychological counseling must address both the eating disordered symptoms and the underlying psychological, interpersonal, and cultural forces that contribute to, or maintain, the eating disorder. The person needs to change their relationship with food.

Some feel that cognitive behavioral therapy is particularly helpful in eating disorders. Cognitive-behavior therapy directly targets the binge cycle. The therapist and patient work together to change eating behaviors, to stop purging, and re-establish natural and healthy eating patterns. Adoption of more flexible eating patterns and learning coping skills are central to preventing binges. Education about meal-planning, nutrition and the ineffectiveness of purging techniques are often a part of treatment. Treatment also targets thoughts and feelings that can trigger binge-eating, including perfectionism and “all-or-nothing” thinking.

Nutritional counseling is also necessary and should incorporate education about nutritional needs and planning for and monitoring rational choices of the individual patient.

Many people with eating disorders respond to outpatient therapy, including individual, group, or family therapy and medical management by their primary care provider. Support groups, nutritional counseling, and psychiatric medications under careful medical supervision have also proven helpful for some individuals.

These disorders often respond to antidepressant medications in conjunction with therapy. Doctors often prescribe selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro) and fluvoxamine. Other antidepressant medications may include venlafaxine (Effexor) and tricyclic antidepressants such as imipramine (Tofranil) and desipramine (Norpramin). These drugs also help with anxiety.

Researchers are still trying to find the treatment that is the most helpful in controlling binge eating disorder. Other therapies that may be tried include dialectical behavior therapy, which helps people regulate their emotions; drug therapy with the anti-seizure medication topiramate; weight loss surgery; exercise used alone or in combination with cognitive-behavioral therapy; and self-help.

The Bulimia Nervosa Resource Guide has a wealth of information on Bulimia specifically. http://www.bulimiaguide.org/index/category.aspx?lid=465

Will you get an eating disorder?

It depends. If you have some of the risk factors, and are still young, you could become one of the 10 million girls or women, or the million or so boys/men in the U.S. who suffer from an eating disorder such as anorexia or bulimia. However, if you've reached a relatively mature age without any significant issues with food, you will probably not develop one of these illnesses later on.

Perhaps the more important question would be, do you HAVE an eating disorder? Think about your own eating habits and behaviors. Anorexics are often in denial that they have a problem. Be sure that you aren't one of them.

One thing is certain, when there is a person with an eating disorder within a family, it is not just about that person. It is about the family. Not only can family dynamics be a co-factor in the development of the disorder, but once a family member has the disorder, their affliction affects everyone else in the family as well. So it can perpetuate or worsen the family dynamics, and in order to address these issues, the family must all be involved.

For more information please see the links below - there are a myriad of information sources about this subject and this article has only skimmed the surface.

Information taken from the following sites:
http://www.nlm.nih.gov/medlineplus/eatingdisorders.html http://www.minddisorders.com/Br-Del/Bulimia-nervosa.html
http://www.mayoclinic.com/print/eating-disorders/DS00294/DSECTION=all&METHOD=print
http://mentalhealth.samhsa.gov/publications/allpubs/ken98-0047/default.asp
http://www.edap.org/p.asp?WebPage_ID=337

http://atdpweb.soe.berkeley.edu/quest/Mind&Body/Carpenter.html
http://familydoctor.org/063.xml

http://www.hec.ohio-state.edu/bitf/etiology.htm

http://www.bulimiaguide.org/index/category.aspx?lid=465

http://www.mirror-mirror.org/anorexia.htm

http://www.cognitivetherapynyc.com/problems.asp?sid=251

http://www.anorexiasurvivalguide.com/anorexia_familysupport.htm

http://www.mayoclinic.com/health/eating-disorders/DS00294

Depression

2007-03-04T15:07:00.000-08:00

Depression runs in my family; in fact, "it practically gallops," with apologies to Joseph Kesselring, author of the play "Arsenic and Old Lace," who first used the phrase.

My father had major depression at least three times in his lifetime; once in college, back when they just called it a "nervous breakdown;" and two specific times after he retired, with long periods of continuous low spirits in between crises.

His mother also was prone to depression, and was hospitalized in the 40's and given electroshock therapy. And we found out well after he died that my father's father had also suffered from depression and had committed suicide.

Luckily for me and my half-sister, we seem to have dodged the family tendency; perhaps the genes on our respective mothers' sides were dilutive. Neither of us has had a major depression although we do have our periods of the blues from time to time. However, one of her daughters is bi-polar.

Why am I writing about depression here? Is it a condition that hypochondriacs tend to fear? No, but hypochondria can be related to depression. Two-thirds of hypochondriacs also have another psychiatric illness such as depression or obsessive-compulsive disorder. http://www.medicalnewstoday.com/medicalnews.php?newsid=9983

Some people, like my father, battle depression off and on for their entire lives; others have a mild and transient bout of it during a stressful period of their lives or during menopause.

On a personal basis, I have had a tendency to worry about things all my life, particularly when it came to my health, despite the fact that I was really relatively healthy. The older I got the more obsessed I became with my health and it got to the point that I could just read about a symptom that I had and if there was a possibility of it being something fatal, I'd actually get a panic attack thinking about it.

Then two years ago I actually got something wrong with me - oral cancer, of the tongue - and the hypochondria "paid off." I had gotten so neurotic over this tiny little sore on my tongue and was so sure it was cancer that I ran to the oral surgeon within a couple of weeks and had it taken off. As it turned out, it actually was cancer, but so early that it was not likely to have spread and I didn't need further treatment after additional surgery was performed to make sure the biopsy had taken it all off. (I'll write a future article on oral cancer). In a way, it was lucky I worried so much about things or I might have waited too long to do something about it.

After this incident, however, I was even more paranoid about my health and was feeling down all the time. Two of my friends had been on Prozac, one during menopause on a temporary basis, and another on an ongoing basis. I knew none of us was in the throes of a major depression as my father had been; my friends were able to work and function, they were just down, as I was. And I finally decided to ask my doctor about going on Prozac since it worked for my friends. She was willing to prescribe it for me and I started taking it and it was the best decision I ever made.

I feel as if I have a new lease on life. It's not as if I couldn't enjoy myself before, but everything was so extreme. All I'd have to do is hear a song on the radio that was sentimental or sad or reminded me of something, and the next thing I'd know I'd be crying all the way to work and have to fix my makeup before I went in! I couldn't even go to a folk music concert without bawling over some song. I had to take kleenex with me everywhere!

Now, although I can still get sad over something worthy of sadness, I am in control of my emotions and feel much more able to cope with whatever comes along. And, I've stopped being obsessed over my health. It's a very subtle effect; I still feel totally normal and like myself, and I actually feel as if I've just changed my attitude about things. But I'd be willing to bet if I went off the drug my new attitude would change and go back to the way it was.

My father was always a proponent of "better living through chemistry" - he was taking Miltown and Librium in the 60's and 70's, and went on antidrepressants in the 80's when he had his depressive crises. I never thought about whether I needed to be on any drugs until it finally dawned on me that you don't have to be catatonically depressed to need a little help. So now I take the lowest dose of Prozac (10 mg.) and an occasional Xanax for anxiety (also the lowest dose) and I am a lot happier with my life. It may not be for everyone, but if you feel you may need some help, don't deny yourself. It is nothing to be ashamed of.

And, if you are in a much worse place, and are deeply depressed, it can be a life-threatening illness. Please don't hesitate to consult your family physician and ask for a recommendation for a psychiatrist who can prescribe medicine. A combination of therapy and medicine is usually the best solution for a severe depression.

So, without further preamble, following are the details about depression.

What is depression?

Depression is an illness that causes a person to lose interest in life, can affect their eating and sleeping habits, and affects both the mind and the body.

There are various types and levels of depression, as follows:

Major Depression: This is what my father had during his worst periods. It is disabling. A person with major depression finds it impossible to function; they can't concentrate on work or on pleasurable activities; they often just sit and stare into space. They often feel so hopeless that they think life is not worth living and can see no way out besides ending it all. This is a life-threatening type of depression and sometimes can require hospitalization (my father was hospitalized several times). This is not a mood that a person can pull themselves out of by taking up a hobby or volunteering at a soup kitchen. When a person is affected by depression, he or she cannot remember ever feeling good and therefore can't imagine they will ever feel good again.

Dysthymia: This is probably what I have a tendency to have. Unlike major depression, dysthymia involves long-term, chronic symptoms that do not disable a person but prevent them from ever feeling really good or truly happy. Some people who suffer from this syndrome also have major depression at some time in their lives.

Bi-polar Disorder: People with bi-polar disorder have also been known as "manic-depressive." This disorder is a type of depression wherein the patient has cyclic episodes; at some periods they will experience "mania" (where they are extremely energized and excited, can go without sleep, and feel invincible), while during other periods they may have all the symptoms of a major depression. Manic episodes can lead to a psychotic break where the patient loses touch with reality. This has happened to my half-sister's daughter, my niece, who suffers from bi-polar disorder. Thankfully, she has found medications that are stabilizing her.

My father had a manic period later on in his life; looking back, I often wonder whether his moodiness during the time I was growing up were mild symptoms of bi-polar disorder.

What are the symptoms?

Depression:

Persistent sad, anxious, or "empty" mood
Feelings of hopelessness and pessimism
Feelings of guilt, worthlessness or helplessness
Loss of interest or pleasure in hobbies and activities that were once enjoyed (including sex)
Decreased energy, fatigue; feeling "slowed down."
Difficulty concentrating, remembering, making decisions
Insomnia, early-morning awakening, or oversleeping
Loss of appetite and/or weight loss or overeating and weight gain
Thoughts of death or suicide; suicide attempts
Restlessness, irritability
Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Mania:

Abnormal or excessive elation
Unusual irritability
Decreased need for sleep
Grandiose notions
Increased talking (often skipping from one thought to another)
Racing thoughts
Increased sexual desire
Markedly increased energy
Poor judgment
Inappropriate social behavior

Some people who are depressed have thoughts of hurting themselves, or actually do hurt themselves, to try to take away the pain of the depression by distracting themselves from it with physican pain. It can also be to punish oneself, or to divert anger. In fact, depression is sometimes decribed as "anger turned inward."

Recently there has been media attention on teens who cut themselves, which may be a manifestation of depression or obsessive-compulsive disorder. More information can be found here:
http://www.kidshealth.org/teen/your_mind/mental_health/cutting.html

What causes depression?

Major depression is caused by a chemical imbalance in the brain or changes in brain structure. However, there may be a number of reasons why the brain chemicals get out of balance.

Some types of depression may be inherited; there is a particular tendency for bi-polar disorder to run in families, and a genetic component has been identified. However, not everyone with the genes that predispose them to get bi-polar disorder actually develop it, so other co-factors may be involved, such as stress or illness.

Certain illnesses such as Parkinson's Disease, Alzheimer's Disease, strokes, heart attacks, cancers, and more - can be factors in developing depression. In fact, anyone who exhibits signs of depression without having any previous tendencies to the illness should be carefully checked for other illnesses that may be the actual cause.

People who are overwhelmed by stress, have low self-esteem or have pessimistic viewpoints tend to develop major depression. However, it is hard to know whether their issues are symptoms of incipient major depression or the cause of it.

Hormones can play a part in depression. In particular, disorders of the thyroid can be a factor. People who are hyper-thyroid (too much thyroid hormone) may seem manic, with irritability, anxiety, and nervousness; while those with an underative thyroid (hypo-thyroid) may seem depressed, lethargic, and apathetic. It is very important that anyone with manic or depressive symptoms have tests of their thyroid function. Please see this link for more information. http://www.tsh.org/disorders/related/depression.html

Women, with all the hormonal fluctuations they are prone to, are more likely to develop depression than men. Their multiple responsibilities for the household, children and job may contribute to their stress and trigger depression as well.

Men are less apt to be depressed, but when they are they are less likely to admit it, less likely to seek help, and doctors are less likely to identify it. Men are four times more likely to successfully commit suicide than women, although more women attempt it.

Depression can play a role in coronary heart disease, and men who are depressed have a higher death rate from heart disease than women.

People with undiagnosed depression may "self-medicate" with alcohol or drugs to make themselves feel better. This is particularly likely with men. Men may also work obsessively long hours or exhibit their depression as anger and irritability.

Depression is often under-diagnosed in elderly people. It is not normal for the elderly to feel depressed, and if they are, family members or caretakers should make sure the elderly person is checked for diseases, overmedication with prescription drugs, or other factors, and if there is no other cause of their condition, then they should be treated appropriately for depression.

Children can also be clinically depressed, and new research is being done to further understand the best ways to treat them.

How is it diagnosed?

The first step is for the patient to consult his or her family physician and get a full check-up. As mentioned above, there are a number of diseases and conditions that can cause or mimic depression, and certain viral infections or medications can also cause the same symptoms. The physician should rule out these possibilities through examination, interview, and lab tests. In cases where a neurological cause such as Alzheimer's is suspected, a visit to a neurologist would be in order. If a physical cause for the depression is ruled out, a psychological evaluation should be done, preferably by referral to a psychiatrist or psychologist.

How is it treated?

There are two major components of treatment: psychotherapy and medication. If nothing else works, electro-convulsive therapy (ECT, formerly known as electro-shock therapy) or other less common therapies may be tried.

There are various types of psychotherapy, from Freudian analysis to cognitive therapy. Overall it is therapy where the patient and his/her psychiatrist or psychologist work in partnership to talk through the patient's thoughts and issues. Here is a helpful link about psychotherapy: http://helping.apa.org/articles/article.php?id=52

Cognitive-Behavioral Therapy is a particularly useful type of therapy for people with depression. My father found it helpful. Instead of focusing on the past and what made the person depressed, it focuses on specific tools and methods to defeat the depression and change the thought patterns. Here is a link to more information about this useful therapy: http://www.nami.org/Template.cfm?Section=About_Treatments_and_Supports&template=/ContentManagement/ContentDisplay.cfm&ContentID=7952

Therapy in conjunction with medication is the best way to treat major depression. There are a myriad of medications out there now, and if one doesn't work, another one, or a combination of several, should.

There are several major classes of antidepressants, which all work somewhat differently.

Older types include the tricyclic antidepressants such as Elavil, or the MAOIs (Monoamine Oxidase Inhibitors) such as Nardil and Parnate. My father was on Parnate for a fairly long while and it worked quite well for him. One of the disadvantages of MAOIs is that there are dietary restrictions for those who take this type of drug, as the drug interacts with foods such as aged cheese, red wine, sausage, and certain other substances to cause a dangerous rise in blood pressure.

The more recently developed drugs include the SSRIs, or Selective Serotonin Re-uptake Inhibitors. Prozac and Celexa are popular brands of this type of drug. Effexor is a drug which is part of another similar class of drug called Selective Serotonin-Norepinephrine Reuptake Inhibitors. All of these medications work to modulate Serotonin and other brain chemicals which control mood.

Lithium has been used for many years for bi-polar disorder and is also useful for other types of mood disorder. Not everyone can take it as it has to be carefully monitored and can cause complications if the patient has thyroid or other specific problems. Other drugs that are useful either alone or in combination with lithium include anti-convulsives such as Depakote or Neurontin. Many people with bi-polar disorder also take anti-anxiety medications.

For more information about all the different types of drugs used for depression and related disorders, please see this link. http://web4health.info/en/answers/depr-treat-links.htm

Almost all medications for depression take some time to be effective, often several weeks, so the person must be patient and wait for the results. In addition, some medications may be harmful if stopped abruptly, so the patient should never go off medication without telling the doctor. Often patients feel better after taking the medication and decide they don't need it anymore. This is dangerous, as often after medication is stopped, the person can sink back into depression. Just as they can't ever imagine feeling better while they're depressed, depressed people often forget how bad they once felt once the medication has taken effect. My father made this mistake after he'd been on Parnate and went off it once he was feeling well, and his depression returned.

All of these medications can have side effects, including dry mouth, insomnia, drowsiness, dizziness and headaches. If you are taking drugs that give you undesirable effects, be sure to tell your doctor so he or she can modify the dosage or change medications until something is found that is tolerable. Overdoses can be dangerous so always take the medication as it is prescribed.

Some people have tried herbal remedies such as St. John's Wort for depression. It seems to work for mild depression, and has been used extensively in Germany for treatment of depression. My husband became depressed after being in New York on 9/11/2001 and has found St. John's Wort to be helpful and continues to take it on a regular basis. It is very important NOT to take St. John's Wort if you are already taking some other type of prescription medication for depression, as they both work similarly and can cause a dangerous interaction. In addition, St. John's Wort can interfere with other medications for other illnesses so always tell your doctor if you are taking an herbal remedy.

As mentioned, for people with intractable depression, or for those who are unable to take medications, there is electro-convulsive therapy, or ECT. This is no longer the scary thing it was back in the mid-20th century. ECT is the next generation of this type of treatment and is much safer and less traumatic for the patient than in the past. A muscle relaxant is given before treatment. The patient is anesthetized for the process and just a small shock is administered to the brain in a more focused way than in the old days, using electrodes at specific locations on the head, which cause a short seizure. The patient wakes up and doesn't remember the experience. Treatments are usually given three times a week for a period of time in order to be effective. Some transient memory loss can occur but usually patients get their memories back. My father was treated with ECT several times when nothing else would work and it successfully pulled him back from his blackest hours. For more information, please see this link: http://familydoctor.org/058.xml

Will you get it?

Possibly. In any given 1-year period, 9.5 percent of the population, or about 20.9 million American adults, suffer from a depressive illness.

If you think you or someone you know is depressed, please do not hesitate. Go for help. No one should have to suffer from depression, with all of the remedies available today. And no one should be embarrassed or ashamed to admit they are depressed. It's no different than being a diabetic - there is a chemical imbalance and it must be treated.

Much of the above information was taken from the National Institutes of Mental Health website, http://www.nimh.nih.gov/publicat/depression.cfm#intro. Additional useful information can be found on Medline Plus: http://www.nlm.nih.gov/medlineplus/depression.html#fromthenationalinstitutesofhealth

Myasthenia Gravis

2007-02-11T17:26:00.000-08:00

Originally my main association with this condition was that I remembered Jackie Kennedy's second husband, Aristotle Onassis, had it. I had a vague recollection of reading that he had to have his eyes taped open so that he could see, so I knew it had something to do with your eyelids drooping, but I had never really studied it.

About three years ago I started to notice that in pictures my right eye seemed smaller than my left eye. And I started to realize that my right eyelid had started to droop. Now I always had rather heavy eyelids - "bedroom eyes" as my mother used to tell me they were called, when she was trying to make me feel better about them. But this was something new. I looked at old pictures, trying to decide if it had always been that way. I didn't see evidence of it going back to my younger days.

I knew it was an actual problem when a friend of mine at work pointed it out, asking if I realized my eyelid was drooping. This was serious; not only was it drooping, and I didn't know why, but it was also - horrors - a cosmetic issue! People could notice it! It wasn't just me being paranoid!

I started Googling myasthenia gravis. Naturally I found it could be a serious illness; it wasn't necessarily just droopy eyelids. It could lead to generalized weakness and could even be fatal. Ah, a perfect disease for a hypochondriac. Hypochondriacs need to not only fear that they have a disease, but that that disease is serious, and preferably life-threatening. (Actually, nowadays treatments are very effective, so MG is not all that dangerous anymore).

Some people would have gone to the eye doctor first. Not me. I called up the neurologist that we'd taken my father to when he started to develop dementia. I made an appointment and went to see him. He agreed my right eyelid was kind of droopy and scheduled me for a special test that they do in the hospital (on an outpatient basis). Basically MG is caused by a lack of a certain chemical, and the way the test works, they give you an infusion of something else that increases the level of this chemical and see if your eyelid springs open suddenly. I sat there waiting as they injected the IV. I felt a slight twitch of my eyelid but no change was seen. Apparently I didn't have Myasthenia Gravis.

So then I went to the eye doctor, who told me that many times as people age (I hate that, why is it everything going wrong with me is from "aging"?) the muscles holding up the eyelids often loosen up and need to be tightened up surgically. Since it wasn't bothering me that much I didn't pursue it, but now three years later I'm noticing that it's harder to see out of the right eye and I think I may address the problem this year.

In the meantime, I will share with you all the knowledge I have learned about myasthenia gravis in the course of my experience with the possibility of having it.

What is Myasthenia Gravis?

Literally, taken from both Greek and Latin, it means "grave muscle weakness" - a pretty descriptive title.

Myasthenia gravis is a "chronic autoimmune neuromuscular disease characterized by varying degrees of weakness of the skeletal (voluntary) muscles of the body." (taken from this website:
http://www.ninds.nih.gov/disorders/myasthenia_gravis/detail_myasthenia_gravis.htm

What this means in plain English is, the body actually starts attacking its own cells and causes muscle weakness. This weakness increases during activity and improves after rest. The muscles that control eye and eyelid movement, facial expression, chewing, talking, and swallowing are often affected. The muscles that control breathing and neck and movements of the arms and legs can also be involved.

The way the muscles usually work is, nerve impulses stimulate the muscles by releasing a chemical called acetylcholine, a "neurotransmitter." Acetylcholine then binds to receptors that then cause the muscle to contract. In myasthenia gravis, the body's own immune system starts making antibodies that attack the receptor cells and disrupt the signal from the nerves to the muscles. As a result, the muscles aren't able to contract as they usually would.

It is believed that the thymus gland plays a role in myasthenia gravis. This gland, which is found in the upper chest area, is part of the body's immune system. The gland is larger when you are a baby; it shrinks when you become an adult. But, in some adults with myasthenia gravis, the thymus is abnormally large and has an overgrowth of certain cells. Some people also have tumors of the thymus, called "thymomas." Usually, thymus gland tumors are noncancerous. Scientists are still unsure of the exact role that the thymus plays in the condition.

Some factors can make myasthenia gravis worse, including fatigue, illness, stress, extreme heat, and some medications, such as beta blockers, calcium channel blockers, quinine and some antibiotics.

What are the symptoms?

In many cases, the first sign of the disease is, as I correctly remembered, weakness of the eyelids, making them droop (called "ptosis"). In some cases, the condition is limited to the eyelids alone, which is called "ocular myasthenia gravis." However, in other cases, MG causes a general effect over the body, and other symptoms can include:

-Facial muscle weakness causing change in facial expression;
-Double vision;
-Difficulty in breathing, talking, chewing or swallowing;
-Muscle weakness in your arms or legs;
-Fatigue brought on by repetitive motions (the more times you use a muscle the weaker it gets).

Not all days will be the same; some days a myasthenia gravis patient will feel better, other days he or she will feel worse. Temporary remissions may occur.

How is it diagnosed?

There are a number of ways to find out whether or not you have myasthenia gravis. The first would be a simple neurological examination, where the doctor tests your reflexes, muscle strength, ability to walk, your balance and coordination.

Another test is a blood test that looks for special antibodies that are the culprits attacking the acetylcholine receptors. However, not all cases can be diagnosed this way since these antibodies don't alway show up in the ocular type of myasthenia gravis.

Another test is called the "edrophonium test." Although I had also had the neurological exam and the blood test, this was the test that my doctor decided ruled out MG in my case. As I mentioned above, the doctor gives an intravenous dose of a chemical called edrophonium chloride or Tensilon(r), which temporarily increases the levels of acetylcholine at the junction between the nerves and the muscles. If the person has myasthenia gravis affecting the eye muscles, the Tensilon(r) will briefly relieve weakness and cause the eyelids to raise.

Doctors also do a study which tests for specific muscle "fatigue" by repetitive nerve stimulation.

Another common test for myasthenia gravis is single fiber electromyography (called EMG), in which single muscle fibers are stimulated by electrical impulses. Muscle fibers in myasthenia gravis do not respond as well to repeated electrical stimulation compared to muscles of normal individuals.

The doctor may also do a CT scan to see whether the patient has an abnormal thymus gland or a tumor of the thymus.

Pulmonary function testing may also be used to test the breathing strength.

How is it treated?

The good news is, there are a number of effective treatments for myasthenia gravis.

Medications include the cholinesterase inhibitors, such as pyridostigmine (Mestinon) and neostigmine (Prostigmin. These drugs help communication between the nerves and muscles, improving muscle contraction and strength.

Drugs such as prednisone, cyclosporine, and azathioprine, which suppress the immune system, can also help. These medications improve muscle strength by suppressing the production of abnormal antibodies. They may cause major side effects such as bone thinning, weight gain, diabetes, increased risk of some infections and a redistribution of body fat. Anyone who has ever temporarily taken prednisone for a bad case of poison ivy or some more serious ailment knows the "moon face" look that they get from these drugs. Longer term, fat can be deposited in other places as well.

In some cases, the doctor may surgically remove the thymus gland. Removal of the gland reduces symptoms in many cases and can be curative. This treatment is usually recommended for younger patients under 60.

Some patients who are severely affected by MG are given a treatment called plasmapheresis, where the blood is filtered and the antibodies affecting the acetylcholine receptors are removed. This is not a permanent cure since antibodies re-form, but it can help temporarily.

Intravenous immune globulin, which temporarily provides the body with normal antibodies from donated blood, is sometimes given during periods of weakness.

Sometimes a life-threatening situation, called a myasthenic crisis, occurs when the muscles that control breathing weaken severely, requiring a respirator for assisted breathing. These crises may be triggered by infection, fever, or a reaction to medication.

Generally the prognosis is good for myasthenia gravis sufferers. With all of the treatments available, they can expect to live a normal lifespan with good quality of life.

Research continues and it is likely that more new treatments will be developed as understanding of this condition continues to increase.

Will you get it?

Probably not; lifetime risk is 500 in a million, or about 0.1%, if my math serves me. Annually, between 2.5 and 20 people per million get this disease.

Myasthenia gravis more commonly affects young adult women (under 40) and older men (over 60), but it can occur at any age. Any ethnic group can get it.

In neonatal myasthenia, the fetus may acquire antibodies from a mother affected with myasthenia gravis. Generally, cases of neonatal myasthenia gravis are temporary, and the child's symptoms usually disappear within 2-3 months after birth. Other children develop myasthenia gravis indistinguishable from adults.

Myasthenia gravis is not directly inherited and is not contagious, so you don't have to worry about catching it from anybody. However, the disease may occasionally occur in more than one member of the same family.

This post is based on information from the website posted above, plus the following links:
http://www.neuro.wustl.edu/neuromuscular/mtime/mghxpe.html
http://www.mayoclinic.com/health/myasthenia-gravis/DS00375/DSECTION=3

High Blood Pressure

2007-02-02T11:51:00.000-08:00

High blood pressure is often called "the silent killer" because most people have no symptoms of this condition. But untreated, it can cause a myriad of conditions that can lead to an earlier death than would have otherwise been scheduled! High blood pressure is implicated in all kinds of heart disease, stroke, and kidney failure.

Both my husband and I have high blood pressure. In his case, he found out he had it over ten years ago when he was only about 42. He hadn't been to the doctor for a checkup since he went off to college, and after incessant nagging on my part, he finally went for a checkup. (My theory as to why married men live longer than single men is that they have wives nagging them to go to the doctor).

We sat in the waiting room, him sulking and giving me smoldering looks because I had dragged him there. When the nurse checked his blood pressure, it was sky-high - about 180 over 110. (More on what is normal vs. high to follow). Even after he'd sat there for awhile and gotten over his annoyance at being there, it was still well above normal.

Of course he didn't want to go on medication - who does? So the doctor gave him three months to lose weight and exercise, and see if it would go down to normal.

So, he began carrying a salad with plain tunafish and a yogurt to work for lunch every day, walking to and from the train, and cutting back on fattening foods in the evening. When he went back to the doctor, he had lost 25 pounds and his blood pressure was down to just under the high-normal range. He was able to keep it that way for about three years.

Unfortunately, over time it crept back up again, and finally he had to go on medication. He now takes three different types of blood pressure medicine. In his case, it was probably inevitable - his father has high blood pressure, and so did his father's mother.

In my case, it seemed to be directly caused by stress. It doesn't really run in my family (my father didn't have it until he was about 80 and my mother still has no high blood pressure despite smoking a pack of cigarettes a day her entire adult life - she is now 88). And I never had particularly high blood pressure either, even as I gained weight in mid-life. But in 2005 I had a bad year...my father passed away in a nursing home at age 92, then I was diagnosed with oral cancer (a posting to follow on that) and then in July of the same year, our dog died unexpectedly.

That was the last straw - I happened to go to the doctor not long after that and my blood pressure was up. It kept being up, and my doctor put me on a simple diuretic. That didn't seem to do the trick so she added another drug, which was eventually replaced with a different drug due to side effects. Now my blood pressure is normal--as long as I am medicated. However, I know if I lost weight and exercised, I probably could bring it down naturally. Some day...

So, after this rather lengthy story, here is the scoop on high blood pressure.

What is high blood pressure?

High blood pressure is measured by two numbers: the systolic and diastolic pressures. The systolic is the pressure in your arteries that exists when the heart pumps; the diastolic is the pressure when your heart is at rest. At one time they used to think only the diastolic number was significant; experts now know both numbers are important.

High blood pressure (also called hypertension) is officially defined as blood pressure that is at or above 140 (systolic) "over" 90 (diastolic), commonly shown as 140/90.

High normal (or "pre-hypertension) is 120-139 over 80-89, and anything under 120/80 is normal. Lower is even better.

Similar to other conditions, the experts keep moving the goal posts. A generation ago, a blood pressure of 140/90 was seen as only "borderline" and not a big concern. Now it is considered time for medication.

There are two major types of high blood pressure: primary (or "essential") hypertension and secondary. Secondary hypertension is called that because it is not the primary problem you have; it is caused by something else. In this case, it is usually caused by the narrowing of an artery, a defect in the aorta (the main artery bringing fresh blood out of the heart), or certain kidney conditions. If the original problem can be fixed, then the high blood pressure goes away.

Most high blood pressure is the "essential" kind - there is no good reason for it. In fact, 85-90% of high blood pressure is this type.

The way blood pressure changes is due to the widening or narrowing of your arteries; nerve impulses play a part in this process, causing the arteries to dilate or contract. When the vessels are open enough, the blood gets through easily. If not, then the blood pressure increases as the heart works harder to get the blood through so it can carry oxygen to your cells.

When this happens, your heart becomes strained and blood vessels become damaged. Changes in the vessels that supply blood to your kidneys and brain then may cause these organs to be affected. You can have a heart attack, a stroke, develop kidney failure (since the kidneys are also very dependent on the blood vessels to function) or even go blind. This is why it is so important to control high blood pressure as soon as it is diagnosed. There are various factors that can cause the arteries to narrow or become less elastic, all of which can lead to hypertension.

You may wonder whether there is such a thing as blood pressure that is TOO low. In general, the lower the better. However, there are a few underlying conditions that may cause unusually low blood pressure, such as nerve disorders, endocrine diseases (such as thyroid problems), or even internal bleeding. Therefore if you discover your blood pressure has dropped unexpectedly, further investigation is warranted.

How is it diagnosed?

It is often discovered at a routine doctor visit or at screenings that are held at work places or other locations. You can even check it yourself on one of those machines in the drug store. If you do this a few times and your blood pressure is above normal consistently, then a trip to the doctor is in order.

The way both the machines and the doctor (or nurse or other technician) measure blood pressure is by attaching a cuff around your upper arm. When the cuff is inflated, it compresses a large artery in your arm, momentarily stopping the blood flow. As the air in the cuff is released, the doctor listens with a stethoscope. When the blood starts to pulse through the artery, it makes a sound. Sounds continue to be heard until pressure in the artery exceeds the pressure in the cuff.

The doctor listens and watches the gauge, then records the pressure when the heart beats (the systolic pressure, when the first sound is heard). He or she then records the pressure when the last sound is heard -the diastolic pressure. The measurements are in millimeters of mercury, which is abbreviated mm Hg. Of course, there are now new digital machines, even machines you can have at home, that still use the same measuring system but record the readings digitally rather than by measuring a column of mercury.

The 120/80 criterion is based on the "resting" blood pressure. So a person should sit quietly for a few minutes before having the pressure checked. It is also important to check more than once. The key thing to find out is whether the blood pressure is consistently high.

Often a person has high blood pressure from being at the doctor's office in the first place - this is called "white coat hypertension." If you think this is what happens to you, you can buy a blood pressure monitor at your local drug store and test your blood pressure at home. The best thing to do is test it periodically and take an average over several readings. If you see it is still elevated, then tell your doctor.

Are you sure there are no symptoms?

High blood pressure itself has no symptoms; however, because prolonged high blood pressure can lead to heart problems and other issues, symptoms of those conditions could be a warning sign of high blood pressure as well (such as arrhythmias, palpitations or chest pain). Naturally if you are having any of these symptoms, you should see a doctor right away. Sometimes a headache develops if an individual has particularly high blood pressure or it has gone up suddenly.

Severe or long-standing high blood pressure that is untreated (especially malignant hypertension,which is a very severe kind of high blood pressure where the pressure is over 210/120) can produce symptoms because it can damage the brain, eyes, heart, and kidneys. Symptoms include headache, fatigue, nausea, vomiting, shortness of breath, restlessness, and blurred vision. It can even cause the brain to swell, and cause a patient to fall into a coma. This would be a medical emergency.

How is it treated?

The first step is lifestyle changes - diet and exercise. Studies have been done that show that eating a certain diet, known as the "DASH" diet (Dietary Approaches to Stop Hypertension), can lower blood pressure. When that diet also is lower in salt, it works even better. Salt works in your body to regulate the amount of water that is retained; less salt results in less water, and lower blood pressure.

The DASH diet calls for more whole grains, low fat dairy, fruits and vegetables, and healthy oils like olive oil, and less saturated fat, red meat, and all the other usual culprits. Here is a useful site that explains it all: http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/how_make_dash.html

If you are going to start exercising for the first time in years, please do consult your doctor first and work up to it slowly.

Practicing meditation and yoga may also help reduce stress and help your general frame of mind which can help your blood pressure - or at least help you accept your condition!

If you are overweight, lose weight until you get back to the proper weight range for your height. Being on the DASH diet should help you accomplish this. If you still struggle with your weight, join a group such as Weight Watchers that helps keep you on track by group support and weight loss tips. If you're not into the group thing, some people's insurance will cover visits to a nutritionist who can help you tame your weight problems.

If you smoke, quit - smoking is another strain on the heart and blood vessels. Excessive alcohol consumption can also affect the flexibility of the blood vessel walls over time, so keep your drinking to the "moderate" level - one drink a day for a woman, or two for a man.

Say you try all that - faithfully - and it doesn't do the job. The next step is medication.

There are literally dozens of medications out there with various effects on blood pressure. Never despair - if you try several and they still don't work, your doctor can try a lot of different combinations until he/she finds one that does. If you have side effects from a drug even if it's working beautifully, don't keep it to yourself. Let your doctor know and you can try something different. There is no reason you should have to put up with any discomfort.

One of the oldest, and still one of the most effective type of drug, is the group of drugs known as diuretics (or as some people call them, "water pills"). These are just pills that help take water and salt out of your body and lower the amount of blood volume, which lowers the pressure. They also cause the blood vessels to dilate, another helpful effect. If your doctor tries to start you on something else first, ask to try a diuretic. They have the fewest side effects and the least hit on your medical insurance.

The one thing to be cautious about is that some diuretics cause potassium to be excreted in the urine, so potassium supplements sometimes must be taken with a thiazide diuretic.

Thiazide diuretics go under names like "Aquatensin," "Diucardin," "Diuril," "Naqua," and others. Many people just get the generic form of these drugs. The one my husband and I take is just called hydrochlorothiazide.

Another common class of diuretics include drugs such as "Lasix" (furosemide), which increase the kidneys' output of urine. There are also potassium-sparing kinds of diuretics, which include "Aldactone" (spironolactone), "Dyrenium" (triamterene) or "Midamor" (amiloride).

Another common type of blood pressure medication is the "adrenergic blockers," which block the effects of the sympathetic division, the part of the nervous system that can rapidly respond to stress by increasing blood pressure. They include beta-blockers, such as "Tenormin" (atenolol), "Lopressor" or "Toprol XL" (metoprolol) and others. Beta-Blockers are very effective for people who have had a previous heart attack and are also helpful for certain arrhythmias. They work by blocking adrenalin and thus slowing down the heart rate. (They can also make a person feel "slowed down" as well, which bothers some people). Another type, Alpha-blockers, affect the artery walls by reducing nerve impulses that cause constriction. A common medication of this type is "Cardura" (doxazosin).

Alpha-agonists are centrally-acting drugs that keep the arteries from constricting, similar to alpha-blockers. "Catapres" (clonidine) is an example of this type of drug.

ACE inhibitors (angiotensin-converting enzyme inhibitors) work by preventing the formation of an enzyme that constricts the smaller arterial blood vessels. "Lotensin" (benazapril) and "Vasotec" (enalapril) are two examples. (My husband is on enalapril as one of his medications). ACE inhibitors work very well but a very common side effect is an annoying dry cough. My husband never got this but I tried the same drug and after several months of being driven crazy by the cough, switched to another drug. The cough sneaks up on you...at first you just think it's an allergy or an irritation. But it just won't go away. Within a few days of switching drugs it disappeared completely for me.

Angiotensin II receptor blockers (ARBs) are similar to ACE inhibitors but instead of preventing an enzyme from forming that eventually results in the creation of Angiotensin II, the substance that actually causes constriction of arteries, this drug blocks the receptors for the Angiotensin II. Because they work in a different way from ACE inhibitors, they have fewer side effects. I am now taking one of these drugs, "Diovan" (valsartan), and have no problems with it. Other brands include "Avapro" (irbesartan) and "Benicar" (olmesartan).

Calcium-channel blockers are another blood pressure medication type. As the name suggests, they regulate calcium uptake into your cells, which prevents the walls of your arteries from constricting. "Norvasc" (amlodipine), "Cardizem" (diltiazem) and "Procardia" (nifedipine) are common brand names. My husband takes Norvasc as part of his regimen. If you use one of these drugs, be sure it is the "long-acting" version - recent studies have shown a slightly higher risk of sudden death with the short-acting varieties of this type of drug.

One other type of drug used to treat high blood pressure is the group known as direct vasodilators. This type of drug is only used in conjunction with other drugs, not alone. Examples are "Lonitin" (minoxidil) and "Apresoline" (hydralazine).

All drugs have side effects for some people. The drugs mentioned here can cause anything from dizziness to weakness or fatigue, or various other symptoms. When your doctor prescribes the medication be sure to ask him or her to explain what the common side effects may be. If you read the literature you get with the drug, you may never want to take it at all, because the drug companies are required to list every possible side effect ever reported. Please remember that the most important thing is to get your blood pressure down; you have to remind yourself that most people do not get these side effects, and have a positive attitude toward the drug. Don't expect the worst!

Also ask your doctor about drug interactions. Be sure to mention if you are taking any herbal supplements as well, since these too can interfere with blood pressure medications. Grapefruit juice (or grapefruit) also can affect how certain drugs are absorbed in your body; be sure to find out whether the one your doctor is prescribing is one of them. If you don't know, then avoid grapefruit juice or fruit until you find out.

Will you get it?

Very possibly. About 1 in 4 people in the United States has high blood pressure. It is even more prevalent among African-Americans (about 40%). For more information, see this link: http://www.cdc.gov/MMWR/preview/mmwrhtml/mm5401a3.htm

If you're over 65, even if you have normal blood pressure, your overall risk of developing hypertension before the end of your life is 90%. See article:

http://www.medscape.com/viewarticle/457696_1

For more information on blood pressure medication, please see this website: http://familydoctor.org/797.xml

For a fuller explanation of high blood pressure, please see the following links, where this information was obtained:

http://www.merck.com/mmhe/sec03/ch022/ch022a.html

http://www.americanheart.org/presenter.jhtml?identifier=2114

http://www.nhlbi.nih.gov/hbp/

Brain Tumors

2007-01-20T13:40:00.000-08:00

A lot of the medical topics I know the most about are those that have affected someone close to me, or myself. Naturally I tended to do the most research on these subjects as I was trying to find helpful information for the person affected.

In the case of brain tumors, the person I knew was a good friend of mine from work. Sadly, the information I found was not helpful because the type of brain tumor my friend had was nearly always fatal.

I had known her for about two years. She joined our department as a new hire from another company. She immediately fit right into our group and she and I developed one of those work friendships where you stop into each other's cubes and talk, both about business and personal lives, go out to lunch occasionally, and enjoy each other's company during the day. We had often said we should really get together outside of work but hadn't gotten around to it. Little did I know that we would never have that opportunity. I wish we had acted on our plans.

One day at the beginning of the year 2000, January 7th, to be exact, we were both attending a goodbye party after work for a colleague and my friend mentioned she had a terrible headache. She left relatively early. It was a Friday, and I didn't think anything more about it over the weekend, as she had been prone to headaches before.

That Monday she called her manager and left a message - over the weekend her headache had become unbearable and she had gone to the emergency department of her local hospital. A CT scan revealed the bad news: she had a brain tumor.

She and her husband went for the best possible care; she had an operation at Sloan Kettering to remove the majority of the tumor. A few tendrils were not able to be removed but they hoped the radiation afterward would eliminate them.

She chose not to have chemotherapy and tried natural remedies instead, using a new juicing machine she bought. She consumed her antioxidants faithfully, grinding up vegetables and fruits in the juicer to ensure as much consumption as possible of the valuable ingredients.

Sadly, it did not help. The tumor came back that summer. By September 6th she was gone. Her tumor was a glioblastoma, the most aggressive type of brain tumor. Few people survive it more than a year.

This entry is for you, Vicki.

What types of brain tumors are there?

There are two major kinds of brain tumor: primary and metastatic. Metastatic brain tumors have spread from another part of the body and are actually made up of cells from the other cancer. Primary tumors originate in the brain. This essay will focus only on primary brain tumors. There are also brain tumors that specifically develop in children. This will just focus on those that are common in adults.

Tumors can be either benign (non-cancerous) or malignant (cancerous). However, unlike other tumors, even benign brain tumors can be dangerous.

Tumors can harm the brain in various ways: they can destroy brain cells, cause damage by producting inflammation of the brain, or cause swelling that compresses other areas of the brain and increases pressure within the skull.

Primary brain tumors can grow from within brain cells, the meninges (membranes around the brain), nerves, or glands.

The cause of primary brain tumors is unknown, although there are theories that everything from cell phone use to radiation or microwaves can cause them. There are a few inherited conditions that seem to increase the risk of brain tumors. Otherwise, the following risk factors are associated with an increased chance of developing a primary brain tumor:

Being male (except for meningiomas)
Being white (they are less common in other races)
Being older (most brain tumors are in people 70 years of age or older). My friend was only 36.
Exposure to radiation or certain chemicals at work (formaldehyde, vinyl chloride, or acrylonitrile).

In adults, gliomas and meningiomas are the most common types of tumors. Gliomas are derived from glial cells such as astrocytes, oligodendrocytes, and ependymal cells. Together they account for half of all primary brain tumors, and 90% of adult primary brain tumors. The gliomas are subdivided into 3 major types:

Astrocytic tumors - these include astrocytomas (less malignant), anaplastic astrocytomas, and glioblastomas (most malignant). Although astrocytomas are less malignant, unfortunately they can change over time to more malignant forms.
Oligodendroglial tumors - can also vary from low grade to very malignant. Some brain tumors are a combination of both astrocytic and oligodendrocytic tumors. These are called mixed gliomas.
Glioblastomas - the most aggressive type of primary brain tumor. These may or may not arise from a prior lower grade primary brain tumor. This was the tumor that afflicted my friend.

Another relatively common type of brain tumor is the meningioma. This tumor arises in the meninges, the tissue surrounding the brain. You're more apt to get this type of tumor if you're a woman between 40 and 70 years old. Meningiomas are usually benign (90%) but depending on their location in the brain, can still produce devastating consequences.

There are a number of other brain tumors that are much less common than these types and I won't go into them for the purposes of this entry.

What are the symptoms?

In my friend's case, headache was her first, primary symptom. Later on when the tumor returned after surgery, she developed difficulties in thinking and speaking.The most common symptoms of a brain tumor are:

Headaches - usually worse in the morning
Nausea/vomiting
Changes in speech, vision or hearing
Problems balancing or walking
Changes in mood, personality, or ability to concentrate
Problems with memory
Muscle jerking or twitching, including seizures or convulsions
Numbness or tingling in the arms or legs

Unfortunately, many of us get headaches, including some that cause nausea or vomiting (such as those who suffer from migraines). So if you are a hypochondriac who gets migraines, you have probably been to the hospital a few times thinking you had a brain tumor.

A stroke can also cause very similar symptoms. It is very important to go to the hospital immediately if you start having any of these symptoms.

How are brain tumors diagnosed?

The following tests may be used to confirm the presence of a brain tumor and/or identify its location and type:

CT scan or MRI of the head
Electroencephalogram (EEG) - a test that shows the brain waves
CT-guided biopsy (to determine the type of tumor)
Biopsy during surgery to remove the tumor
Examination of the cerebral spinal fluid, which may show cancerous cells

What treatments are available for brain tumors?

Treatment depends on the size and type of tumor. In some cases, the goal may only be to relieve symptoms, improve quality of life and the comfort of the patient. Other tumors may be curable.

If a tumor is accessible, surgery is usually done to either try to remove the whole tumor or at least "debulk" it. Afterward radiation and/or chemotherapy may be used to try to eliminate the rest of the tumor.

Corticosteroids may be used to reduce swelling and inflammation. Other medications may be provided to relieve specific symptoms such as seizures.

There are various methods of operating on brain tumors that are used at hospitals specializing in the treatment of brain tumors. The Gamma Knife is a non-invasive way to eliminate tumors. This link will explain more details: http://pennhealth.com/neuro/gammaknife/.

Another type of non-invasive surgery is the Cyber-Knife, described in the following link: http://www.phillycyberknife.com/cyberKnifeTechnology.html

There are also newer medications, chemotherapy and other promising treatments. Two new methods have been developed to more effectively target the brain tumor:

Gliadel Wafers: These wafers are implanted directly at the site of the tumor during the brain surgery. They then slowly release potent chemotherapy agents (BCNU or carmustine) at the site where the tumor was removed to kill any remaining tumor cells that may still be present.
Gliasite Radiation Therapy System: The Gliasite Radiation Therapy System is an implanted radiation delivery device consisting of a tube with a balloon and a port. The balloon is placed into the location of the tumor at the time of surgery. The balloon is filled with a liquid radiation solution by the radiation physician for a specific period of time, thus directly treating the area. More information is available on the website listed below for the Wallace Kettering Institute.

The following link has a wealth of information about brain tumors, clinical trials, and new medications that are available: http://www.virtualtrials.com/

There is also a section on survivor stories that should be inspirational to anyone who has been diagnosed with a brain tumor. Some glioblastoma patients have beaten this terrible tumor and lived many years. This site also has detailed information on treatments that are available.

One important drug, Temodar, is often used for glioblastoma patients. My friend started on it right before she passed away, when it was newly approved. Unfortunately it was too late for her, but has been found to prolong the lives of many patients.

Will you get a brain tumor?

Probably not, although they are becoming more common among adults in the past 25 years, probably due to the aging of the population.

Lifetime risk of a brain tumor:
Males have a 0.66% lifetime risk of being diagnosed with a primary malignant brain tumor and a 0.50% chance of dying from a brain tumor. Females have a 0.54% lifetime risk of being diagnosed with a primary malignant brain tumor and a 0.41% chance of dying from a brain tumor. (Data taken from the Brain Tumor Society website: http://www.tbts.org/itemDetail.asp?categoryID=383&itemID=16635)

General information for this article was taken from the MedlinePlus website, the National Cancer Institute website, and the Wallace Kettering Institute of Neuroscience website, http://www.wkni.org/index.cfm, as well as other websites specifically cited above.

The Guinea Worm

2007-01-16T18:26:00.000-08:00

This is a picture of a Guinea Worm emerging from the skin of an unfortunate sufferer.

I decided for my second post to talk about something you're not likely to get here in the Western Hemisphere, so I chose Guinea Worm Disease, also known as Dracunculiasis, since it was one of the first diseases I read about simply out of curiosity rather than trying to figure out what my own symptoms were.

I had read about the Guinea Worm in my old Merck Manual and thought it sounded hideous. Having just looked it up on the Internet to find out if any new treatments had been developed since my original reading, I was sorry to learn that the treatment has remained the same: slow extraction of the worm by gradual traction. This is a picture of the process.

What is Guinea Worm Disease?

It is an infection caused by the parasite Dracunculus medinensis. It is spread through unclean drinking water, and as such, is totally preventable.

The way it works is, the worms emerge from the skin of an infected person when they (the worms, that is) are mature. If the person is entering a pond or stream that is a source of drinking water, the worm can then release larvae into the water, which are then eaten by "water fleas;" there they develop into the next, infective, stage, within 10-14 days.

People become infected by drinking water with the fleas in it, thus starting the whole process over again in a vicious cycle.

Once a person ingests the fleas, the Guinea Worm larvae are released from the fleas as the fleas are digested, and these larvae cleverly find their way to the small intestine, where they are able to go through the wall and into the inside of the body cavity.

Once there, they happily ensconce themselves for the next year or so. The female worm grows to a size of two to three feet in length, about the width of a strand of spaghetti.

Once she is fully mature, the female worm migrates to a site where she can bore her way out of the body, usually the legs. A blister then develops where she is trying to get out, and after 2-3 days it will rupture. At any point after that if the worm is exposed to water, she will release larvae.

What are the symptoms?

There are usually no symptoms until about a year after a person becomes infected. A few days to a few hours before the worm emerges, the person may develop a fever, swelling and pain in the area. Although the worm mostly affects the legs, it can appear anywhere else on the body.

Patients often develop secondary bacterial infections from the worm, and this can cause disabling complications, which can seriously disrupt their lives.

How is it treated?

There is only one treatment for Guinea Worm. Once the worm emerges from the wound, it must be pulled out a little at a time each day and wrapped around a small stick. This can take weeks or even months.

The only other way to get rid of this worm is to remove it surgically before the ulcer forms.

Aspirin or ibuprofen can ease the pain and antibiotic ointment can prevent infection.

Will you get it?

Probably not. This disease is endemic in Africa, mostly in the Sudan, where civil war is making eradication difficult. Asia is now free of the disease, as are several African countries.

Since 1986, a number of health organizations have been working to eradicate the disease. The annual number of cases has declined in that time from 3.2 million to about 32,000 in 2003, which is very good news indeed.

The disease is only common in remote rural villages and in areas visited by nomadic groups. Anyone who drinks standing pond water contaminated by people with Guinea Worm Disease is at risk for infection.

Preventing it is a matter of educating the people to drink only water from underground sources that are free from contamination, to prevent people with Guinea Worm Disease from entering ponds and other bodies of water used for drinking water, and to filter any unsafe drinking water with a cloth, to remove the fleas, before drinking. Unsafe water can also be treated with an approved larvicide.

The source of this information was the Center for Disease Control's (CDC)website.

Appendicitis

2007-01-14T20:59:00.000-08:00

I consider myself somewhat of an expert on appendicitis. Not only have I had it myself, but my husband (boyfriend at the time) had it, and I diagnosed it immediately when I heard his symptoms. In my own case, I knew I had appendicitis several days before the doctors figured it out, to my detriment.

It all goes back to my childhood when even then I was fascinated by medical subjects. I was a huge fan of Cherry Ames, Student Nurse, and all of the sequels. I also got caught up in another nurse series about a nurse called Sue Barton. In one of the Sue Barton books, Nurse Sue herself becomes sick with appendicitis. Although the books were for kids, they did describe the symptoms quite accurately. And when I got those same symptoms when I was about 23 years old, I knew I had appendicitis.

In my case, the symptoms had happened more than once. One day I had noticed a kind of gnawing pain in the pit of my stomach that didn't go away for several days. I popped Tums periodically and assumed it was indigestion. It did go away and I forgot about it - until a month or so later it came back, and got worse. The pain persisted until it finally moved downward. I got myself driven to the local hospital emergency room and they checked me out, decided I had gastritis, and sent me home with a shot of Demerol! I asked, "Aren't you even going to do a white blood count?" (as even then, my hypochondriacal knowledge included the fact that appendicitis causes the white cell count in the patient's blood to become very high due to the infection in the appendix). The resident in charge of the ER said "No, you don't have appendicitis, don't worry, go home." Later on the pain persisted so I called them again and they said to put a hot water bottle on my stomach! (Do not do this if you have symptoms of appendicitis. It makes it worse).

To make a long story shorter, 5 days later I ended up in the hospital with a burst appendix and was in for 10 days recovering from a nasty operation and getting IV antibiotics until I was well enough to go home.

So, in order to prevent this from happening to you, I will let you know more information about appendicitis than you ever thought you would need or want to know:

Appendicitis:
What is it?

The appendix is a small organ that is what is called "vestigial," meaning it is no longer a useful part of your body and basically exists to cause you problems, similar to your wisdom teeth. It is attached to your large intestine, usually on the right lower side of the abdomen. However, there are some people whose intestines are twisted or otherwise misaligned and the appendix can be elsewhere. This just makes life more difficult for these people. If you think I had trouble getting a diagnosis as it was, you can imagine what would have happened if my appendix had been on the other side.

Sometimes the appendix can become blocked, either by feces, infection or even swollen lymph nodes. In some cases, an injury can cause this. Some people have a genetic predisposition to develop appendicitis. Once the appendix is blocked, pressure builds up and it becomes inflamed. At this point the person is considered to be suffering from appendicitis and unless the offending organ is removed quickly, it can become a serious or life-threatening condition. The appendix can become gangrenous and burst, scattering nasty microbes all over the unlucky person's insides. This is called peritonitis and it is a Very Bad Thing.

What are the symptoms?

The symptoms of acute appendicitis may include:

Pain, starting near the belly button, moving gradually downward and to the right
Loss of appetitite, nausea, or vomiting
Constipation or diarrhea
Low fever
Abdominal swelling

Some people may feel as if they have to make a bowel movement; however, if they have these symptoms they should NOT take a laxative.

One key symptom that often occurs is what is called "rebound tenderness." To find out if you have rebound tenderness, lie on a flat surface such as a bed, press into the abdomen around the area of the pain, and let go suddenly. If it hurts a lot more when you let go than when you first pressed in, you have rebound tenderness. Go to the hospital.

Another symptom that I have not seen listed anywhere, but certainly happened in both my case and my husband's, is profound nervousness. You develop a feeling of panic and feel you can't calm down. It may be a result of the infection causing adrenalin to be released in the system. Of course, if you are a hypochondriac as I am, you may get this feeling any time you think you are about to die of some strange disease. So this is not as definitive as the rebound tenderness! However, since it happened to my husband as well, and he does not tend to panic easily, I felt it was worth mentioning.

How is it diagnosed?

Back in the day, they didn't have all the fancy diagnostics they have nowadays, which is why I was not diagnosed easily. Now, if you arrive at the emergency room with your list of symptoms, they will do all the usual things like check your heart, your blood pressure, and other vital signs. They should do a blood test to see if you have a high white blood cell count from infection or any other signs of disease. Unlike in 1978, they also have ultrasounds and CT scans that can more accurately identify the source of the pain and diagnose the problem much more easily.

How is it treated?

Once appendicitis is clearly the cause of the pain, the patient is operated on and the appendix removed. This can be done through a small incision or else with laparascopic surgery, where there is a thin tube with a camera used to guide the surgeon as he uses several small incisions to access the area. This method results in a shorter recovery time and less scarring.

Will you get it?

You might, but it isn't that common. Lifetime risk of getting acute appendicitis is 8.6% for males, 6.7% for females (Rothrock et al, 2000).

If you suspect you have appendicitis, call your doctor immediately and go to the hospital. It is best to have your own physician overseeing your care, particularly if you have a good relationship with your doctor. But whether it is your own doctor or the doctor in the emergency room, you know when there is something wrong with you. Don't let them send you home without doing the proper tests to make sure they have diagnosed you correctly. Believe me, I know this from experience!

Source of this information was the National Digestive Diseases Information Clearinghouse website.

This is a blog for hypochondriacs

2007-01-14T14:53:00.000-08:00

As a hypochondriac, I know that most of my kind are already fascinated with diseases and conditions that most people have never heard of. I for one have read the entire 1982 Merck Manual from cover to cover (since at the time there was no Internet to look things up on). I know more about river blindness, guinea worms, thyroid dysfunction and ebola virus, among other things, than most normal people.

I am also totally hypnotized by the Discovery Health channel's "Medical Mysteries," "Medical Incredible," and various other medically-related shows, to say nothing of "House" with that wonderful Hugh Laurie. Any show that has a mysterious illness every week that no one can figure out, is always a challenge to any good hypochondriac. Tell me your symptoms, I'll tell you your disease -- and then develop the symptoms myself and become convinced I have it.

Both of my parents were medical writers; my mom wrote abstracts for Hoffman-LaRoche's medical magazine back in the 40's and then worked in medical advertising, where she met my dad, who was a medical copywriter. I missed my calling - I probably should have followed in their footsteps. But, as George Eliot said, "It's never too late to be who you might have been." So I thought I'd start a blog to write about medical subjects.