Archive for May, 2012

Nutritional supplements and cancer prevention-what’s the hype and what’s the science?

May 29, 2012

Millions of American men and women are taking nutritional supplements with the attention of preventing cancer and other serious health conditions.  Does this work and is it worth the risk?

The US food and drug administration categorized as nutritional supplements under the general a brown of foods rather than drugs.  The supplements had not undergone clinical trials and a rigorous approval process and cannot be removed from the market and less they are proven to be dangerous or have false labile information.  It is of interest that FDA Manufacturing guidelines do not have to prove supplements safe or affective.

The risks

A little is good but a lot can’t be harmful.  Most American study had on and off vitamins in their normal diet.  By taking extra vitamins can cause an overdose.  In 2008 a more than 69,000 cases of toxicity 228 vitamin overdose were reported.

Another risk of using supplements is that some supplements can interact with medications in a way that will harm the patient.  If you are taking prescription medications you should inform your physician about any nutritional supplements you may be using.

Nutrients in foods

It is true: An apple at they may really keep the doctor away.  Fruits and vegetables contain important nutrients and fiber, which helps protect against colon cancer.  By eating fresh fruits and vegetables you can reduce both the risk and recurrence of breast cancer.  The American institute for cancer research estimated that one third of the cancers that occur every year in the United States could be prevented by lifestyle changes, including bleeding or whole foods.

The reason whole foods are more beneficial than and vitamin supplements is probably that whole foods contain any nutrients that worked in combination to protect against cancers.  For example, fresh salmon is superior to salmon oil supplements because although both provide fatty acids, Fresh salmon provides nutrients not found in oil, such as vitamin D and B,amino acids, calcium and selenium.

Foods known to help prevent cancer include: berries, grapes, tomatoes, mushrooms, green tea, salmon, squash, broccoli, cauliflower, cabbage, Brussels sprouts, linseed, and flaxseed.

Bottom line: For most people a diet that includes healthful foods can eliminate the needs for supplements.

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Your Morning Cup of Jo Won’t Make You Go (Urinate)

May 28, 2012
Morning Coffee

Go ahead and have a sip, it won’t affect your bladder

For years the standard advice doctors gave patients was that coffee\caffeine contributed to urinary incontinence. Now we know that women with urinary incontinence who also enjoy their regular cup of coffee or tea don’t have to worry about the extra caffeine making their condition worse.
The new research stands in contrast to the common recommendation that women with incontinence avoid caffeinated foods and beverages.

A recent study from Harvard showed that women with moderate incontinence shouldn’t be concerned about their caffeine consumption. All women, even those without incontinence, need to know that caffeine increases the production of urine and may give some the urge to urinate.

The researchers looked at data on roughly 21,500 women enrolled in two large studies, each of which tracked the long-term health of U.S. nurses through surveys starting in the 1970s or 1980s. The study included women with moderate incontinence — defined as leaking urine one to three times per month — from participants who were asked about incontinence and caffeine consumption in 2002 or 2003.

The women were questioned about how much caffeine they consumed in the form of coffee, tea, soda or chocolate. Two years later, when they were again surveyed about incontinence, about 20% said their symptoms had gotten worse and they now leaked urine at least once per week.
The percentage of women with urinary incontinence progression was similar across categories of baseline level of caffeine intake. Similarly, they were unable to find a link between increased caffeine consumption and worsening urinary symptoms — either for general incontinence or for overactive bladder in particular.

Bottom Line: If you are a woman with mild to moderate urinary incontinence, caffeine in moderation will probably not worsen your urinary symptoms
SOURCE: http://bit.ly/IJ1RzF (April 23, 2012 in Journal of Obstetrics & Gynecology)

The Sterilization Decision-Vasectomy vs. Tubal Ligation

May 25, 2012

You have had all the children you would like and you like to ensure that you won’t have another pregnancy then you need to make the sterilization decision.

So who is going to become sterilized? This him-or-her question should be decided with great care. For couples weighing whether they’re ready to permanently prevent pregnancy, here are some important questions to ask.

At this time men have just one option when they want to permanently turn off the possibility of sperm getting to an egg– and women can choose from several. For men, the option is a vasectomy. A doctor cuts and seals off the two tubes that allow sperm to travel from the testicles to the outside world.

The vasectomy can be done without a scalpel and without a needle to inject the local anesthetic so it is nearly painless. The procedure takes about 10-12 minutes but the man is not sterile right away. He needs to ejaculate approximately 15 times to purge sperm from the vas above the area where the occlusion of vas takes place. (See Figure)

After 15 ejaculations, a specimen must be examined under a microscopic to be absolutely certain that there is no sperm in the ejaculate and then the man is sterile.
Women can have a tubal ligation, also called a “tubal” or “getting your tubes tied.” Her fallopian tubes are sealed off, keeping her eggs from meeting any sperm. Or a doctor can do an in-office procedure in which he inserts tiny devices into the tubes through the uterus, blocking them permanently.
Women become sterilized nearly three times as often as men. About 16% of reproductive-age women had opted for tubal sterilization in 2002, compared to 6% of the male member of the relationship who submits to a vasectomy.

What Could Go Wrong?
Women were 20 times more likely to have a serious problem related to a tubal than men face from a vasectomy. In addition, men tend to recover more quickly from a vasectomy than women do from a tubal ligation. A tubal ligation requires anesthesia and deep incisions into her abdomen both of which are concerns.
The most common problems related to vasectomy include bruising, infection, and inflammation in the epididymis, a sperm-holding structure near the testicle. But each of these seems to occur in less than 5% of cases.

How Much Does It Cost?
In terms of cost, a vasectomy is definitely more cost-effective. In general, a tubal costs about three times as much as vasectomy.
If you have health insurance, check on whether it will cover the procedure and what costs may still be your responsibility. Talk with your health care provider to see what your costs are for other birth control options, since other forms of birth control may be more cost-effective.
Bottom Line: There are effective methods of sterilization. A discussion with your doctor will help you decide which one is right for you, vasectomy or tubal ligation.

The New Equation: Stress = Excessive Eating = Obesity

May 25, 2012

Stress can impact your eating habits and lead to obesity, the national epidemic affecting millions of Americans. Doctors have now unraveled the relationship between stress and obesity. With chronic stress, the hypothalamus, located in the brain and where stress starts, sends a signal to the pituitary gland to release ACTH or adrenocorticotrophic hormone, which travels via the blood stream to the adrenal gland and stimulates the release of cortisol. Chronic stress leads to far more cortisol than is necessary which in turn stimulates the appetite as the cortisol secretion is turned on and off with excess stress resulting in excess ACTH to fuel the reaction. Cortisol has now been shown to activate lipoprotein lipase, the enzyme that facilitates the deposition of fat. Finally chronic stress is associated with increase anxiety, apathy, and depression, which by themselves may lead to excessive eating and obesity.

That’s the bad news. The good news is that exercise can help relieve chronic stress, reduce your appetite, and promote weight loss. Physical activity can protect against feelings of distress, defend against symptoms of anxiety, guard against depressive symptoms and the development of major depressive disorder and enhance psychological well-being.

Studies have documented that 30 minutes of exercise a day appear to have stress-reducing benefits. The type of exercise does not seem to make a difference. However, the intensity of the exercise does have an impact on stress reduction. The research shows that moderate to vigorous physical activity reduces stress better than low-intensity activity.

Bottom Line: Stress can be a killer just like heart disease. Want to make yourself heart healthy? Then reduce your stress by exercising. Your heart and so many other organ systems in your body will thank you.

For more information go to my website, http://www.neilbaum.com

WWYDD-What Would Your Doctor Do….Regarding His PSA?

May 22, 2012

I’m sure you have all heard about the current controversy around prostate cancer screening using the PSA (prostate specific antigen) test.  A recent panel, U.S. Preventive Services Task Force, consisting of physicians, including a pediatrician who certainly does not diagnose or treat men with prostate cancer just came out against screening for prostate cancer.  The American Urological Association, which I am a member, is outraged at the task force’s recommendation. 

What are the facts?

Prostate cancer is the second most common cause of cancer death in men following lung cancer.   There are 32,000 men who die each year from prostate cancer.  If many of these men were screened with a PSA test and a digital rectal exam, they would likely have had their cancer detected at an early stage, i.e., localized to the prostate gland and, therefore, curable.  Failure to screen means that men will likely present with prostate cancer that has moved outside of the prostate gland and spread to bones and other tissues and organs.  Disease that has spread to bones can be very painful and lead to a very slow and agonizing demise.

So what did your doctor do?

I get a PSA every year and recommend it to all of my patients who are over the age of 50.  I recommend that younger men who are at a higher risk for prostate cancer such as African American men and men who have a close relative such as father, brother or uncle, start testing in their 40s.  I stop testing men over age 75 as prostate cancer in this age group is less to cause death and the older man is likely to die of some other cause such as heart disease.

Bottom Line:  I recommend you speak to your doctor and discuss the pros and cons of screening and then make the decision whether screening is right for you. It may also be of interest to ask your physician if they obtain a PSA or if their significant other does. 

WWYDD-What Would Your Doctor Do….Regarding His PSA?

May 22, 2012

I’m sure you have all heard about the current controversy around prostate cancer screening using the PSA (prostate specific antigen) test.  A recent panel, U.S. Preventive Services Task Force, consisting of physicians, including a pediatrician who certainly does not diagnose or treat men with prostate cancer just came out against screening for prostate cancer.  The American Urological Association, which I am a member, is outraged at the task force’s recommendation. 

What are the facts?

Prostate cancer is the second most common cause of cancer death in men following lung cancer.   There are 32,000 men who die each year from prostate cancer.  If many of these men were screened with a PSA test and a digital rectal exam, they would likely have had their cancer detected at an early stage, i.e., localized to the prostate gland and, therefore, curable.  Failure to screen means that men will likely present with prostate cancer that has moved outside of the prostate gland and spread to bones and other tissues and organs.  Disease that has spread to bones can be very painful and lead to a very slow and agonizing demise.

So what did your doctor do?

I get a PSA every year and recommend it to all of my patients who are over the age of 50.  I recommend that younger men who are at a higher risk for prostate cancer such as African American men and men who have a close relative such as father, brother or uncle, start testing in their 40s.  I stop testing men over age 75 as prostate cancer in this age group is less to cause death and the older man is likely to die of some other cause such as heart disease.

Bottom Line:  I recommend you speak to your doctor and discuss the pros and cons of screening and then make the decision whether screening is right for you. It may also be of interest to ask your physician if they obtain a PSA or if their significant other does. 

WWYDD-What Would Your Doctor Do….Regarding His PSA?

May 22, 2012

I’m sure you have all heard about the current controversy around prostate cancer screening using the PSA (prostate specific antigen) test.  A recent panel, U.S. Preventive Services Task Force, consisting of physicians, including a pediatrician who certainly does not diagnose or treat men with prostate cancer just came out against screening for prostate cancer.  The American Urological Association, which I am a member, is outraged at the task force’s recommendation. 

What are the facts?

Prostate cancer is the second most common cause of cancer death in men following lung cancer.   There are 32,000 men who die each year from prostate cancer.  If many of these men were screened with a PSA test and a digital rectal exam, they would likely have had their cancer detected at an early stage, i.e., localized to the prostate gland and, therefore, curable.  Failure to screen means that men will likely present with prostate cancer that has moved outside of the prostate gland and spread to bones and other tissues and organs.  Disease that has spread to bones can be very painful and lead to a very slow and agonizing demise.

So what did your doctor do?

I get a PSA every year and recommend it to all of my patients who are over the age of 50.  I recommend that younger men who are at a higher risk for prostate cancer such as African American men and men who have a close relative such as father, brother or uncle, start testing in their 40s.  I stop testing men over age 75 as prostate cancer in this age group is less to cause death and the older man is likely to die of some other cause such as heart disease.

Bottom Line:  I recommend you speak to your doctor and discuss the pros and cons of screening and then make the decision whether screening is right for you. It may also be of interest to ask your physician if they obtain a PSA or if their significant other does. 

Treatment of Prostate Cancer in Older Men-Warren Buffet’s Experience

May 15, 2012

No one knows the right answer for the management of prostate cancer in older men. I would like to share an article that appeared in a blog by my friend, Dr. Kevin Pho

A version of this column was published on April 24, 2012 in USA Today.

There has been a recent uptick of elderly men in my primary care clinic asking about prostate cancer, perhaps because they heard of Warren Buffett’s recent prostate cancer diagnosis and his proposed treatment.

Patients are wondering if they should also be screened. Other patients who already have been diagnosed are wondering if they should receive radiation treatment for their prostate cancer, as Buffett is planning to do. It is very important to remember that what’s right for Buffett may not be right for everyone else.

According to Buffett’s letter to shareholders, his prostate-specific antigen (PSA) had been “regularly checked for many years.” A sudden jump in his PSA level led to a prostate biopsy and cancer diagnosis. But should an 81-year-old man even be screened for prostate cancer?

The evidence says no. The U.S. Preventive Services Task Force, an independent panel of non-government clinicians providing data-based practice guidelines, recommends against prostate cancer screening for healthy men. Studies over the years, which have included participation of more than 300,000 men of various ages, have failed to show prostate cancer screening saves lives.

“If there is significant benefit, it should have been apparent by now, and it is not,” said Virginia Moyer, chair of the task force.

The guidelines of other organizations, which are not as stringent as those suggested by the task force, also question Buffett’s routine prostate cancer screening. For instance, the American Cancer Society and American Urological Association both recommend that doctors discuss the pros and cons of prostate cancer screening with men whose additional life expectancy exceeds 10 years. Even by that measure, screening Buffett — who can expect to live another eight years, based on actuarial data from the Social Security Administration — is questionable.

According to his letter, Buffett was diagnosed with Stage 1 prostate cancer, meaning the cancer had not spread beyond the prostate. The prognosis is generally excellent for this early-stage cancer, and for many men, just monitoring the cancer to ensure it doesn’t spread is proper. More aggressive treatments are available, including surgery and radiation therapy, which Buffett plans to undergo. The problem with these options is that the treatment may be worse than the disease.

The fact is, 75% of men over the age of 80 have cancer cells in their prostate, but in elderly men cancer grows so slowly that the men are much more likely to die of something else.

Moreover, for all men, prostate tests are not sophisticated enough to determine which of these cancers are dangerous and which are not. Without knowing, most men opt for treatment. But for every 1,000 men treated for prostate cancer, five will die of complications from surgery. Side effects of both SURGERY and radiation can include impotence, incontinence and frequent urination — all for a disease that, at Stage 1, has less than a 1% chance of causing death in the next 10 years.

The annual cost of PSA testing contributes $3 billion annually to health care spending, much of it paid for by Medicare and the Veterans Administration, without significant health benefits. In fact, Richard J. Ablin, the scientist who discovered PSA, calls its widespread use a “public health disaster.” Buffett’s high profile cancer coverage should have been an opportunity to educate the country that, for many, more conservative options would not only save them from harmful, unnecessary treatments, but also potentially reduce health costs.

Instead, some may view Buffett’s decision to screen for prostate cancer and aggressively treat it as the right thing to do. I’m not second-guessing the approach taken by Buffett and his medical team. And I also understand that some men would rather know their prostate cancer status and accept the risks of too much testing. but we should realize that Buffett’s prostate cancer path isn’t necessarily the right road for every man.

Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today. He is founder and editor of KevinMD.com, also on Facebook, Twitter, Google+, and LinkedIn.

When It Hurts Down There In the Prostate Gland-New Treatment for Chronic Pelvic Pain

May 13, 2012

Chronic pelvic pain is a disabling condition with multiple treatment options. However, in men with chronic prostatitis, which is not due to bacterial infection, have difficulty finding relief.
The symptoms of chronic pelvic pain are pain with urination, pain under the scrotum, and urinary frequency and urgency. Now there is a new treatment using trigger point therapy that has been helpful in some men with chronic pelvic pain.
In a study published in The Journal of Urology (Volume 185, page 1294), researchers evaluated the protocol, known as myofascial trigger point therapy and paradoxical relaxation training (PRT), in 116 men who had pelvic pain for several years.
Trigger point therapy, which involves applying pressure on a trigger point in a tight muscle until it “releases,” was performed by a physical therapist for 30 to 60 minutes daily for five consecutive days. A psychologist provided daily instruction in PRT for three to five hours. The goal of PRT is to reduce nervous system arousal in the presence of perceived pain and catastrophic thinking. The men were instructed to use the techniques at home.
At six months, their quality of life had improved significantly, and 82 percent of the men reported improvement in pain and urinary dysfunction. The improvement was described as major or moderate by 59 percent and as slight by 23 percent.
Bottom Line: If you have chronic pelvic pain with pelvic muscle tenderness that has not improved with standard medical therapies, consider asking your doctor for a referral to physical and behavioral therapists with experience treating this condition.

Breast Cancer-Not Just A Problem for Women

May 8, 2012

Breast cancer is one of the most common cancers in women. However, men are not immune to this problem although it is far more common in women. Many people do not realize that men have breast tissue and that they can develop breast cancer. Breast cancer is about 100 times less common among men than among women.
The prognosis (outlook) for men with breast cancer was once thought to be worse than that for women, but recent studies have not found this to be true. In fact, men and women with the same stage of breast cancer have a fairly similar outlook for survival.

The most obvious difference between the male and female breast is size. Because men have very little breast tissue, it is easier for men and their health care professionals to feel small masses (tumors). On the other hand, because men have so little breast tissue, cancers do not need to grow very far to reach the nipple, the skin covering the breast, or the muscles underneath the breast. So even though breast cancers in men tend to be slightly smaller than in women when they are first found, they have more often already spread to nearby tissues or lymph nodes. The extent of spread is one of the most important factors in the prognosis (outlook) of a breast cancer.

Another difference is that breast cancer is common among women and rare among men. Women tend to be aware of this disease and its possible warning signs. Women perform self exams on a regular basis and also obtain mammograms every year. However, most men do not realize they have even a small risk of being affected. Some men ignore breast lumps or think they are caused by an infection or some other reason, and they do not get medical treatment until the mass has had a chance to grow. Because breast cancer is so uncommon in men, there is unlikely to be any benefit in screening men in the general population for breast cancer.

Men need to know that breast cancer is not limited to only women. Possible signs of breast cancer to watch for include: A lump or swelling, which is usually (but not always) painless, skin dimpling or puckering, nipple retraction (turning inward), redness or scaling of the nipple or breast skin, or discharge from the nipple
These changes aren’t always caused by cancer. For example, most breast lumps in men are due to gynecomastia (a harmless enlargement of breast tissue). Still, if you notice any breast changes, you should see your health care professional as soon as possible.
Treatment

Most of the information about treating male breast cancer comes from doctors’ experience with treating female breast cancer. Because so few men have breast cancer, it is hard for doctors to study the treatment of male breast cancer patients separately in clinical trials.
Local therapy is intended to treat a tumor at the site without affecting the rest of the body. Surgery and radiation therapy are examples of local therapies. Systemic therapy refers to drugs, which can be given by mouth or directly into the bloodstream to reach cancer cells anywhere in the body. Chemotherapy, hormone therapy, and targeted therapy are systemic therapies.

The prognosis (outlook) for men with breast cancer was once thought to be worse than that for women, but recent studies have not found this to be true. In fact, men and women with the same stage of breast cancer have a fairly similar outlook for survival.

Bottom Line: Breast cancer can occur in men as well as women. While not as common in men as in women, men need to know that any lumps, swelling or discharge from the nipple should be examined by a physician.