A recent study presented at the 2008 American Society of Clinical Oncologists (ASCO) Breast Cancer Symposium questioned the need for breast MRI on patients recently diagnosed with breast cancer. The abstract “the influence of routine pretreatment MRI on time to treatment, mastectomy rate, and positive margins” was headed by Dr. Richard J. Bleicher, a breast cancer surgeon at Fox Chase Cancer Center, and tried to determine if having an MRI would be helpful for breast cancer patients. Increasingly more women seem to be getting them after the diagnosis.
Basically, is using the latest imaging technology helpful? Already, the American Cancer Society recommends that women at high risk of developing breast cancer, those with a family history or personal history of breast biopsy for example, get screening MRI in addition to mammography. Whether MRI can and should be used as a tool before breast surgery was the reason for the research. The study looked at 577 women, who were referred to the breast cancer clinic between July 2004 and December 2006. The average age of a woman in the group was 57 years old. Nearly 23% of the women had MRI. Women who received MRI were younger (52 years old) than those who did not (59 years old).
Researchers found that having a MRI appeared to delay treatment by nearly 25 days after the initial doctor evaluation. Patients who had a MRI were two times more likely to have a mastectomy rather than breast conserving therapy (BCT). Interestingly, the women who received MRI were not considered at high risk for breast cancer (family history of breast cancer or ovarian cancer) or for recurrence based on tumor size, staging, or pathology. It wasn’t clear to researchers why some women received MRI and why others didn’t.
Perhaps MRI was ordered to help surgeons prepare their plan for surgery. An ideal pre-surgical tool would help the surgeons and patients make better decisions prior any surgery so that an operation is only done one time. So, how did MRI do for breast cancer surgery? Having a MRI before breast cancer surgery made no difference in the likelihood another excision would be needed because the biopsy margins weren’t free of tumor and it didn’t decrease the chance that a lumpectomy would be needed to be converted to a mastectomy. In other words, MRI made no difference, even though intuitively you would think it would. After all, isn’t more information better?
The study concludes that, “our findings suggest that MRI should not be a routine part of patient evaluation for BCT. Greater efforts to define the limitations and appropriate use of breast MRI are needed.”
What does this mean for you? MRI for breast cancer surgery planning is not the standard of care, there is currently no evidence that it makes surgical outcomes better than without it, trying to obtain one can delay treatment by 25 days, and it can also increase your chances of having a mastectomy. Understand that the findings should be limited to those patients in their fifties and probably older. It is difficult to say whether the findings are applicable to younger women in their twenties and thirties as MRI has been found to be somewhat helpful in breast cancer screening and could possibly have a role in pre-surgical planning.
As has been demonstrated many times in medicine, don’t fall into the trap of always assuming the latest technology or test is any better than traditional therapies. As this study suggests, newer methods may actually delay care and result in more surgery (mastectomy) than initially intended. Always try to demand treatments and therapies that are evidence-based.
Read more from the abstract.
Friday, September 12, 2008
Sunday, September 7, 2008
Fountain of Youth - Exercise
Fascinating article from Men's Health, not talking about the fountain of youth per se, but about the feeling among researchers that people were born to run. Titled, "Yes, You Were Born to Run" it speaks about the evolutionary adaptations that people have that provides proof we were meant to be running - a strong nuchal ligament to keep our head straight and focused when hunting prey (evidently pigs can't do that), a large number of long leg tendons which provide bounce so we can run (chimpanzees have short and few leg tendons which are fine for climbing trees), and the ability to perspire when running continuously (which provides the advantage of hunting speedy prey like a kudu which although faster than a human is unable to sweat and therefore needs to stop and therefore can be run down). More from the article:
- According to a controversial body of research, is that our passion for running is natural. A small group of biologists, doctors, and anthropologists say our bodies look and function as they do because our survival once depended on endurance running, whether for long-distance hunts like the one Liebenberg witnessed or for racing the competition across the African savanna to scavenge a kill.
- In his book Why We Run, the biologist and runner Bernd Heinrich, Ph.D., argues that something exists in all of us that still needs to be out chasing antelopes, or at least dreaming of antelopes. Without that instinct, "we become what a lapdog is to a wolf. And we are inherently more like wolves than lapdogs, because the communal chase is part of our biological makeup."
- Anyone who has put in some miles knows how good running can feel, once it stops feeling bad. But beyond the way it feels, medical evidence also suggests that humans are built for endurance exercise. In response to a good training program, for instance, the left ventricular chamber of the heart can increase as much as 20 percent in volume. The chamber walls thicken, too. So the heart fills up faster and pumps more blood to the rest of the body. The coronary arteries also change, dilating more rapidly to meet the body's demand for oxygen. Endurance exercise won't make anyone live forever. But it seems to make the cardiovascular system function the way the owner's manual intended.
- In the skeletal muscles, increased blood pressure causes new capillaries to emerge. The mitochondrial engines of the cells ramp up to consume energy more efficiently, helped along by an increase in the production of various antioxidants. These changes in the heart and extremities together typically boost the maximum amount of oxygen the body can consume each minute by 10 to 20 percent. For men who used to become short of breath slouching to the fridge for a beer, VO2 max can increase even more. Lapdogs start to function like wolves.
- More surprisingly, the brain responds as if it was built for endurance exercise, too. researchers have discovered lately that exercise affects the function of 33 different genes in the hippocampus, which plays a key role in mood, memory, and learning. By stimulating growth factors, exercise also produces new brain cells, new and enhanced connections between existing cells, new blood vessels for energy supply, and increased production of enzymes for putting glucose and other nutrients to work.
- People who exercise regularly perform better on some cognitive tests: Run more, think better, hunt smarter, eat better. Exercise also seems to buffer the brain against neurological damage, reducing the effects of stress and delaying the onset of Alzheimer's and other diseases. Most significant, exercise helps prevent and alleviate depression, which afflicts one in six Americans and costs $83 billion a year.
Not advocating everyone start running, you might need to check with your doctor first before doing any vigorous exercise, but what is clear is that people were built to move. In our American 21st century society where everything is built on convenience and relatively little work -- cars allow us to travel distances without walking / running, grocery stores and restaurants provide us food without us actually laboring in the fields to grow, harvest, and then prepare food, entertainment is becoming more sedentary with internet, video games, television, movies, instead of us actually participating in activity, and finally that for many of us work isn't as laborious as the past -- perhaps it isn't surprising as a nation we are getting fatter and less healthy than a generation before even though we understand more about health and illness.
It appears we were born to run or be active. Our society makes our bodies more like lapdogs rather than the wolves that our anecestors evolved to be to survive. The fountain of youth is very much staying active whether dancing, swimming, walking, running, biking, or whatever. It affects our bodies and our minds. Unlike any machine that exists, our body is dynamic and adapts to the challenges ahead, regardless of your age or whatever happened (or didn't happen) in the past. So even lapdogs have the potential to slowly become wolves again with increased activity. So start getting active!
Sunday, August 31, 2008
Book Review - Medical Myths That Can Kill You: And the 101 Truths That Will Save, Extend, and Improve Your Life
As a practicing family doctor and author of Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America's Healthcare System, I am a strong believer in empowering and educating patients so that they can make the right decisions to get the most out of life. As the only doctor in my family I don't think it is fair that only the people I know or care for are privy to the truth about staying healthy, so I looked forward to reading Medical Myths That Can Kill You: And the 101 Truths That Will Save, Extend, and Improve Your Life, by Dr. Nancy Snyderman, chief medical correspondent for NBC News, which has a similar same perspective.
Overall, the book was a mixed blessing. It has interesting factoids, ideas we should all take to heart, but at times is misleading. As a consumer and a patient, I thought the truths and news you can use pieces were interesting. As a primary care doctor and patient advocate, however, I felt that many parts of the book were misleading. Perhaps one of the faults is it tries to be too ambitious and attempts to cover too many topics, which often are not in depth enough to be of much value.
Dr. Snyderman points out correctly multiple times that the path to good health is through prevention by adopting healthy habits, staying physically active, and maintaining a sensible weight. The structure of the book reflects this preventive focus and chooses to debunk many myths with these clever chapter titles - Annual Checkups Are Obsolete, Vaccinations Are Just For Kids, Doctor's Don't Play Favorites, Only Old People Get Heart Disease and Stroke, We're Losing the War on Cancer, Natural Means "Safe", and You Can Just Snap Out of Mental Illness. She tackles the truth about herbal and dietary supplements, the unproven value of full body scans, as well as the importance of vaccinations and preventive screening tests for cancer, heart disease, and diabetes.
Throughout the book there are plenty of truth tidbits including, "you cannot catch sexually transmitted diseases from toilet seats; you do not need to drink eight glasses of water every day", among many others and news you can use segments that will make some readers hopefully more aware of what is myth and what is fact. These small sidebars were very interesting. I think patients and consumers will find these factoids topics of conversation.
As a practicing doctor, however, there are many areas which are misleading and others that provide information too superficial to be of value. Dr. Snyderman is correct in one of her chapters that heart disease and stroke are the leading causes of death in this country. However, she uses two individuals, a twenty-six year old former beauty pageant winner, who suffered from a stroke, and a forty year old woman, who died suddenly from swimming, as reasons why we should be concerned. The problem is that these type of occurrences are extremely unlikely and rare for these age groups and gender. The typical cause of these problems, atherosclerosis, or hardening of the arteries didn't cause these cases. The former was most likely due to a heart wall septal defect or a blood clotting disorder, known as a hypercoagulable state. The latter was probably due to sudden cardiac death from a fatal arrhythmia, like ventricular fibrillation.
In the area of stroke, she talks about atrial fibrillation, a heart arrhythmia, as the leading cause of stroke. It is a cause, but this heart condition is typically found in patients over age 60 and far more common in people over 80 years old. She doesn't say that and one would naturally and wrongly assume based on the prior patient stories that it can happen at younger ages, which again is extremely unlikely.
Other areas that are covered superficially include when Dr. Snyderman discusses cancer and mental illness. She pushes for prevention as well as clarifies myths that still exist among the public. Unfortunately in the chapter on cancer, she also talks about various cancer treatments which isn't thorough enough and doesn't seem to fit in a book with this preventive theme. For the mental illness, one of the best written sections because of her personal experience, again the book is rather too ambitious and tries to cover anxiety, depression, and bipolar disorder and the various treatment options even as she admits that "it is impossible to go into as much detail as I would like to". Though she gives a website reference, perhaps it may have been better only to cover depression as she and her husband both had experienced it, and acknowledge the other conditions.
Overall, I wanted to like this book as I believe the intent of giving the public the facts about what they can do to stay healthy and well is vital. I think as a practicing doctor and insider, however, the book at times it is misleading, in some areas is too light in content and in others the information deviates from the book's intent of wellness and health promotion.
Overall, the book was a mixed blessing. It has interesting factoids, ideas we should all take to heart, but at times is misleading. As a consumer and a patient, I thought the truths and news you can use pieces were interesting. As a primary care doctor and patient advocate, however, I felt that many parts of the book were misleading. Perhaps one of the faults is it tries to be too ambitious and attempts to cover too many topics, which often are not in depth enough to be of much value.
Dr. Snyderman points out correctly multiple times that the path to good health is through prevention by adopting healthy habits, staying physically active, and maintaining a sensible weight. The structure of the book reflects this preventive focus and chooses to debunk many myths with these clever chapter titles - Annual Checkups Are Obsolete, Vaccinations Are Just For Kids, Doctor's Don't Play Favorites, Only Old People Get Heart Disease and Stroke, We're Losing the War on Cancer, Natural Means "Safe", and You Can Just Snap Out of Mental Illness. She tackles the truth about herbal and dietary supplements, the unproven value of full body scans, as well as the importance of vaccinations and preventive screening tests for cancer, heart disease, and diabetes.
Throughout the book there are plenty of truth tidbits including, "you cannot catch sexually transmitted diseases from toilet seats; you do not need to drink eight glasses of water every day", among many others and news you can use segments that will make some readers hopefully more aware of what is myth and what is fact. These small sidebars were very interesting. I think patients and consumers will find these factoids topics of conversation.
As a practicing doctor, however, there are many areas which are misleading and others that provide information too superficial to be of value. Dr. Snyderman is correct in one of her chapters that heart disease and stroke are the leading causes of death in this country. However, she uses two individuals, a twenty-six year old former beauty pageant winner, who suffered from a stroke, and a forty year old woman, who died suddenly from swimming, as reasons why we should be concerned. The problem is that these type of occurrences are extremely unlikely and rare for these age groups and gender. The typical cause of these problems, atherosclerosis, or hardening of the arteries didn't cause these cases. The former was most likely due to a heart wall septal defect or a blood clotting disorder, known as a hypercoagulable state. The latter was probably due to sudden cardiac death from a fatal arrhythmia, like ventricular fibrillation.
In the area of stroke, she talks about atrial fibrillation, a heart arrhythmia, as the leading cause of stroke. It is a cause, but this heart condition is typically found in patients over age 60 and far more common in people over 80 years old. She doesn't say that and one would naturally and wrongly assume based on the prior patient stories that it can happen at younger ages, which again is extremely unlikely.
Other areas that are covered superficially include when Dr. Snyderman discusses cancer and mental illness. She pushes for prevention as well as clarifies myths that still exist among the public. Unfortunately in the chapter on cancer, she also talks about various cancer treatments which isn't thorough enough and doesn't seem to fit in a book with this preventive theme. For the mental illness, one of the best written sections because of her personal experience, again the book is rather too ambitious and tries to cover anxiety, depression, and bipolar disorder and the various treatment options even as she admits that "it is impossible to go into as much detail as I would like to". Though she gives a website reference, perhaps it may have been better only to cover depression as she and her husband both had experienced it, and acknowledge the other conditions.
Overall, I wanted to like this book as I believe the intent of giving the public the facts about what they can do to stay healthy and well is vital. I think as a practicing doctor and insider, however, the book at times it is misleading, in some areas is too light in content and in others the information deviates from the book's intent of wellness and health promotion.
Monday, August 25, 2008
Wishing For Natural Therapies Can Kill or Injure
A couple of news reports reminds us about how as a society we have very short memories - one involves measles and the other involves raw cow milk.
The CDC reported a large increase in the number of measles cases. An outbreak in Illinois occurred in home-schooled children and none were vaccinated. Already in 2008, 131 cases were reported, which is three times that of 2007.
The other story was about raw cow milk and how 15 people became ill and one woman became partially paralyzed! This frankly is unbelievable and sad. Louis Pasteur, the famous French scientist, who figured out that organisms invisible to the naked eye caused diseases, was also the one to understand and learn how to kill them and make things like milk safer for consumption. This is where the word- pasteurized - came from.
In a high-tech world where many of us wish for simpler times, we must not forget that these more natural methods had major problems as well. The leading cause of death about a hundred years ago was due to infectious diseases. Like the example of measles, just because we don't witness illness or problems ourselves doesn't mean that the problems still don't exist. Many of the reasons we live longer than generations ago is because of high immunization rates and more sterile and hygenic food processing techniques. Are some of the foods perhaps less natural and less safe than the past because of pesticides and hormones? Hard to say, but in that case, purchase organically grown products. Don't ignore basic common sense.
Here's the other question. If people became ill because of an accident or food poisoning, then I don't think anyone would argue we should take care of them. However, what if a person out of ignorance gets ill from a very preventable infection, should we as a society pay of their healthcare? If the woman, who is partially paralyzed doesn't regain full use of her body and requires resources from the community, is that fair for the rest of us?
The CDC reported a large increase in the number of measles cases. An outbreak in Illinois occurred in home-schooled children and none were vaccinated. Already in 2008, 131 cases were reported, which is three times that of 2007.
- "Before the measles vaccine in this country, there were 400 deaths of U.S. children each year caused by measles," says Dr. William Schaffner, department of preventive medicine chairman at the Vanderbilt University School of Medicine. "Measles carries serious complications, including pneumonia and encephalitis, which is a life-threatening inflammation of the brain tissue that can be caused by viral infections such as measles. Measles is a serious illness. To be cavalier and not vaccinate shocks someone like me, who has seen the devastating effects of this disease."
- So far this year, 15 patients have been hospitalized as a result of measles. They suffered symptoms such as high fever, dehydration and pneumonia. Four of those who were hospitalized for measles were infants.
The other story was about raw cow milk and how 15 people became ill and one woman became partially paralyzed! This frankly is unbelievable and sad. Louis Pasteur, the famous French scientist, who figured out that organisms invisible to the naked eye caused diseases, was also the one to understand and learn how to kill them and make things like milk safer for consumption. This is where the word- pasteurized - came from.
- The raw milk came from Alexandre Family EcoDairy Farms, which supplied the product to 115 customers.
- The county's Department of Public Health suspects at least 15 people were sickened by Campylobacter, a common bacteria found in domesticated animals. The department has confirmed three cases, and are awaiting test results for the other 12.
- Alexandre EcoDairy voluntary stopped its raw milk program June 15 after learning one of its customers was hospitalized. That woman later became partially paralyzed by a rare disorder often associated with Campylobacter infection.
In a high-tech world where many of us wish for simpler times, we must not forget that these more natural methods had major problems as well. The leading cause of death about a hundred years ago was due to infectious diseases. Like the example of measles, just because we don't witness illness or problems ourselves doesn't mean that the problems still don't exist. Many of the reasons we live longer than generations ago is because of high immunization rates and more sterile and hygenic food processing techniques. Are some of the foods perhaps less natural and less safe than the past because of pesticides and hormones? Hard to say, but in that case, purchase organically grown products. Don't ignore basic common sense.
Here's the other question. If people became ill because of an accident or food poisoning, then I don't think anyone would argue we should take care of them. However, what if a person out of ignorance gets ill from a very preventable infection, should we as a society pay of their healthcare? If the woman, who is partially paralyzed doesn't regain full use of her body and requires resources from the community, is that fair for the rest of us?
Monday, August 18, 2008
Michael Phelps' Diet - Don't Try This at Home
Like everyone else, I've been in awe of Michael Phelps' accomplishments at the Beijing Olympics with his unprecedented eight gold medals at a single olympic game. Certainly, it doesn't hurt that he appears to be a team player, grounded, as well as being hypercompetitive.
What is more fascinating is the amount of calories he ingests daily to keep up with his training regimen. If anyone of us tried to eat the same amount he does, we would gain about 3 pounds per day and definitely would not have his sculpted physique!
He has 12,000 calories per day. A typical American is supposed to have 2,000 calories per day. Given the increasing numbers of obese children and adults it would be safe to assume many of us are exceeding that suggestion.
For breakfast he has:
As a quick reminder, it takes about 3500 calories to equal a pound. So for those of us who are inspired to lose weight, a brisk 30 minute walk uses about 200 calories. Therefore, if one walks this amount three times a week for a total of 600 calories, it would take six weeks to lose one pound! It's no wonder weight loss is so difficult.
Of course, you could do what Michael Phelps does and swim his intense training schedule where he burns 4,000 calories per day!
What is more fascinating is the amount of calories he ingests daily to keep up with his training regimen. If anyone of us tried to eat the same amount he does, we would gain about 3 pounds per day and definitely would not have his sculpted physique!
He has 12,000 calories per day. A typical American is supposed to have 2,000 calories per day. Given the increasing numbers of obese children and adults it would be safe to assume many of us are exceeding that suggestion.
For breakfast he has:
- three fried-egg sandwiches loaded with cheese, lettuce, tomatoes, fried onions and mayonnaise.
- two cups of coffee
- a five-egg omelet
- a bowl of grits
- three slices of French toast topped with powdered sugar
- three chocolate-chip pancakes
As a quick reminder, it takes about 3500 calories to equal a pound. So for those of us who are inspired to lose weight, a brisk 30 minute walk uses about 200 calories. Therefore, if one walks this amount three times a week for a total of 600 calories, it would take six weeks to lose one pound! It's no wonder weight loss is so difficult.
Of course, you could do what Michael Phelps does and swim his intense training schedule where he burns 4,000 calories per day!
Monday, August 11, 2008
Learnings from Private-Label Groceries - Generic Drugs
Reports surfaced recently that growth from private-label (i.e. store brand) versions of groceries has risen dramatically as the economy has worsened and gas prices have increased. Even though thought to be inferior in quality or perhaps more importantly taste, these days the products are as good or perhaps better than brand names.
"Store brands have come a long way," said Tod Marks, a senior editor at Consumer Reports, which has tested store brands against national brands for quality and customer response. "Over the years, retailers realized that store brands were not just something to be floated out during hard times."
With consumers very price conscious these days, they should have no hesitation in asking their doctor for generic medications. These are medications that are proven but no longer have patent protection so the price is affordable. The public should not be fooled in thinking that newer is better. Most of the latest drugs are "me too" cholesterol, blood pressure, allergy, diabetes, and heartburn medications. Pharmaceutical companies spend millions of dollars equal or exceeding marketing budgets of alcoholic and soda companies to influence you to prefer their brand.
Evidently the makers of Ambien CR is acutely aware of this as in a television ad they note that Ambien CR is not available as a generic, even though there are plenty of helpful generic sleep aids that can provide sleep at a price that people can feel good about.
"Store brands have come a long way," said Tod Marks, a senior editor at Consumer Reports, which has tested store brands against national brands for quality and customer response. "Over the years, retailers realized that store brands were not just something to be floated out during hard times."
With consumers very price conscious these days, they should have no hesitation in asking their doctor for generic medications. These are medications that are proven but no longer have patent protection so the price is affordable. The public should not be fooled in thinking that newer is better. Most of the latest drugs are "me too" cholesterol, blood pressure, allergy, diabetes, and heartburn medications. Pharmaceutical companies spend millions of dollars equal or exceeding marketing budgets of alcoholic and soda companies to influence you to prefer their brand.
Evidently the makers of Ambien CR is acutely aware of this as in a television ad they note that Ambien CR is not available as a generic, even though there are plenty of helpful generic sleep aids that can provide sleep at a price that people can feel good about.
Monday, August 4, 2008
The Myth of Moderate Exercise
A recent article in Time magazine titled "The Myth of Moderate Exercise" I hope catches the attention of the public. It shows why moderate exercise, that is 30 minutes of activity most days of the week, is NOT enough to lose weight. It is no wonder why so many people feel frustrated they aren't losing weight fast enough. With the obesity problem now prominent among children as well as adults, it is important we all learn the following.
Although it is clear that more physical activity not only helps lose weight, but also it is important that the increased activity is sustained lifelong to maintain the weight. Calorie restriction also helps immensely as well. The trick also is that is too must be lifelong.
Find out how much activity you must do if you eat certain foods by reviewing the fun, interactive, and eye-opening experience Portion Distortion Quiz.
If we as a country are going to be healthier, then we all need to realize that the way to lose weight and keep it off is simply and as hard as eat less and move more.
Although it is clear that more physical activity not only helps lose weight, but also it is important that the increased activity is sustained lifelong to maintain the weight. Calorie restriction also helps immensely as well. The trick also is that is too must be lifelong.
Find out how much activity you must do if you eat certain foods by reviewing the fun, interactive, and eye-opening experience Portion Distortion Quiz.
If we as a country are going to be healthier, then we all need to realize that the way to lose weight and keep it off is simply and as hard as eat less and move more.
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