Prostate Cancer

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

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

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?

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

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

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?

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

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

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

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.