What a Pain in the Butt!

"...my problems are all behind me"
Hall-of-Fame baseball player George Brett, after hemorrhoid surgery during 1980 World Series

I've heard the term "piles" but had no clue that it meant hemorrhoids; nor did I really have a clear idea of what hemorrhoids are. So I've done some reading on this pain in the butt topic.

The MayoClinic says, Hemorrhoids (HEM-uh-roids), are swollen and inflamed veins in your anus and lower rectum that may result from straining during bowel movements or from the increased pressure on these veins during pregnancy [or from being overweight]. ... By age 50, about half of adults have had to deal with the itching, discomfort and bleeding that can signal the presence of hemorrhoids.

WebMD says, normally, tissue inside the anus fills with blood to help control bowel movements. If you strain to move stool, the increased pressure causes the veins in this tissue to swell and stretch.

Symptoms include

• Bleeding during bowel movements with streaks of bright red blood on toilet paper
• Anal Itching
• Rectal pain when sitting or wiping your bottom

If you are younger than 50 your doctor may just examine your rectum with a gloved finger or use a short, lighted scope to look inside. If older than 50 or there's not an obvious hemorrhoid the doctor may recommend a colonoscopy because bleeding can also indicate colon-rectum cancer.

Bottom Line

For most hemorrhoids, home treatment is sufficient - eat more fiber, drink more water, and use over-the-counter ointments for a limited time to stop itching. Get more exercise, especially walking to reduce constipation. You might also use stool softeners to reduce straining.

For painful internal hemorrhoids a doctor may tie off the hemorrhoids with rubber bands or scar the tissue around the hemorrhoids to reduce the blood supply and make them shrink or go away.

Resolve to get your Mammogram

I have to admit, like so many women, I always knew there was a chance. But like so many women, I never thought it would be me. I never thought I'd hear those devastating words: 'You have breast cancer.'
-Debbie Wasserman Schultz

I have two friends that have been diagnosed with breast cancer in the past month or two. Both were caught early and the prognosis is excellent. I decided to do some research on the topic and was surprised to learn that the American Cancer Society (ACS) is a bit skeptical about BSE (Breast Self Exams).

"Breast cancers that are found because they can be felt tend to be larger and are more likely to have already spread beyond the breast. In contrast, breast cancers found during screening exams are more likely to be small and still confined to the breast."

Here are the ACS recommendations:

• Women age 40 and older should have a screening mammogram every year and should continue to do so for as long as they are in good health.
• Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a periodic (regular) health exam by a health professional, at least every 3 years. After age 40, women should have a breast exam by a health professional every year.
• Breast self exam (BSE) is an option for women starting in their 20s.  ... Doing BSE regularly is one way for women to know how their breasts normally look and feel and to notice any changes. The goal, with or without BSE, is to report any breast changes to a doctor or nurse right away.
• Women at high risk (greater than 20% lifetime risk) should get an MRI and a mammogram every year. Women at moderately increased risk (15% to 20% lifetime risk) should talk with their doctors about the benefits and limitations of adding MRI screening to their yearly mammogram. Yearly MRI screening is not recommended for women whose lifetime risk of breast cancer is less than 15%.
  
  High risk includes

• Have a known BRCA1 or BRCA2 gene mutation
• Have a first-degree relative (parent, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation
• A family history with high risk

The ACS seems of two minds on Breast Self Exam technique. It notes that sometimes, women are so concerned about "doing it right" that they become stressed over the technique. And yet the ACS also recommends that women who choose to do BSE should have their BSE technique reviewed during their physical exam by a health professional. So ask your doctor about the right way to do it but don't get stressed out over it.

The ACS addresses concerns over mammogram radiation.

To put dose into perspective, if a woman with breast cancer is treated with radiation, she will receive around 5,000 rads. If she had yearly mammograms beginning at age 40 and continuing until she was 90, she will have received 20 to 40 rads [total].

How much is 20-40 rads? It's equivalent to eating a banana (.0036 rads) or two every month from age 40 to 90.

Bottom Line

Read the entire article at http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-detection
It might save your life.

Cancer Self-Exams

"But when I first got cancer, after the initial shock and the fear and paranoia and crying and all that goes with cancer - that word means to most people ultimate death - I decided to see what I could do to take that negative and use it in a positive way."
-Herbie Mann, Jazz muscian who died at age 73 after a long battle with prostate cancer.

The second highest cause of death in America is Cancer which is often treatable IF detected early. At Stage 1 a cancer is located in just one part of the body. In Stages 2 & 3 it spreads locally and by Stage 4 it has spread throughout the body.

My wife was fortunate to have a cancer discovered by chance in Stage 1 and it was removed with surgery. My mother had the same experience but what happened afterwards made a difference. A year after the surgery the doctor said Mom was "cured" and there were no further follow-ups. Seven years later she felt bumps on her neck and another doctor diagnosed it as stage 4 cancer. The original cancer had come back and spread everywhere. Mom has lived four years with chemo and other agressive treatments but these just slow down a cancer in stage 4; there is no cure. The family gathered last week for her 70th birthday that none expected she would live to see.

In my wife's case she has a excellent doctor who insists on a check-up every six months and she has been cancer free for five years.

Cancer inspection is very imporant and one reason that every adult should have an annual physical. I've seen two Dermitologists for minor items and each made me strip to my shorts as they examined all my skin for signs of cancer. This seems to be standard for a first time visit. The first one didn't like a spot on my back and cut out a dime-sized "biopsy" which turned out to be fine. Skin cancer is something that everyone can and should do self-exams for. See http://www.skincancer.org/Self-Examination/ for details. Also check out http://www.aad.org/skin-conditions/skin-cancer-detection/about-skin-self-exams/how-to-examine-your-skin for photos of suspicious "moles."

Look for:

• A skin growth that increases in size and appears pearly, translucent, tan, brown, black, or multicolored
• A mole, birthmark, beauty mark, or any brown spot that:
  • changes color
  • increases in size or thickness
  • changes in texture
  • is irregular in outline
  • is bigger than 6mm or 1/4”, the size of a pencil eraser
  • appears after age 21
• A spot or sore that continues to itch, hurt, crust, scab, erode, or bleed
• An open sore that does not heal within three weeks

Women are encouraged to do a breast self-exam monthly. Nearly 70% of all breast cancers are found through self-exams and with early detection the 5-year survival rate is 98%.
http://www.nationalbreastcancer.org/about-breast-cancer/breast-self-exam.aspx

New to me is the idea of monthly Testicular self-exam:.
http://www.cancer.org/cancer/testicularcancer/moreinformation/doihavetesticularcancer/do-i-have-testicular-cancer-self-exam

Smokers and tobacco chewers should perform Oral self-exams: http://www.oralcancerselfexam.com/?module=cms&modmethod=view&args=selfexam.  Though the site does point out that regular vistits to a dentist should catch oral cancer.

Bottom Line

Cancer won't be detected early if no one is looking for it.

Tanning Salons

“To be successful, keep looking tanned, live in an elegant building (even if you're in the cellar), be seen in smart restaurants (even if you nurse one drink) and if you borrow, borrow big.” -
Aristotle, Ancient Greek Philosopher

A brief note today based upon the Consumerist story Indoor Tanning Quadruples Risk Of Skin Cancer. A new study from the American Association for Cancer Research has determined that frequent use of tanning beds can quadruple your risk of skin cancer. An estimated 30 million Americans visit tanning salons each year and unknowingly(?) endanger the future health of their skin.

A (student?) paper published by Vanderbilt University compares the claims of the Tanning industry vs health professionals. The Tanning Salons say they are safer than sun by using mostly UV-A rays which cause tanning and much less UV-B rays which cause sun burns. UV-A is safe they say. Doctors disagree. UV-B damages just the top of the skin but UV-A goes down deep and can cause damage that will last for a lifetime. Including cell injury that causes wrinkles, tumors and cancer.
And despite Industry safety claims, a study of teenagers in Sweden found that 44% of the participants reported a sunburn from a visit to the tanning bed. 23% of the sunbed users reported skin diseases such as eczema, psoriasis, or acne compared to only 16% of the students who did not use sunbeds.

According to the Consumerist, the FDA is considering banning teens from tanning beds; teenage girls and young women are the largest users of tanning salons.

Bottom Line - Warning Signs of Skin Cancer

Early detection offers your best chance of surviving skin cancer. Here are some signs to look for:

•A skin abnormality that increases in size and appears multicolored, pink, red, black, brown, tan, pearly, translucent, or tan.

•A mole that changes color, textures, grows, becomes irregular in shape, or that is bigger than a pencil eraser.

•A spot or growth that continually itches, hurts, becomes crusty, scabs, or bleeds.

•An open sore that does not heal after 4 weeks or one that heals and reopens.

Regular skin self-exams could save an estimated 4,500 lives annually. Anytime you are concerned about a growth or spot on your skin, it is best to seek the advice of your physician.

Barrett’s esophagus

"I would like to find a stew that will give me heartburn immediately, instead of at three o clock in the morning." - John Barrymore, actor

Barrett’s esophagus is a condition in which the tissue lining the esophagus, the tube connecting the mouth to the stomach, is replaced by tissue similar to the lining of the intestine due to frequent exposure to stomach acids from Acid Reflux (see GERD). Barrett’s esophagus affects about 1% of adults in America; most commonly older, white, males. A small number of people with Barrett’s esophagus develop a rare but deadly type of cancer.

Barrett’s esophagus can only be diagnosed using an upper gastrointestinal (GI) endoscopy to obtain biopsies. After the patient is sedated, a doctor inserts a flexible tube (an endoscope) with a light and miniature camera down the throat. If esophagus tissue looks suspicious, several small pieces are removed using the endoscope. A pathologist examines the tissue with a microscope to determine the diagnosis.

If you’re told you have Barrett’s esophagus, here are some questions from the Mayo Clinic to ask your doctor

■Does my pathology report show dysplasia (i.e. cell change)? If so, what is the grade of my dysplasia? High-grade dysplasia is thought to be the final step before cells change into esophageal cancer.
■Were my biopsy samples examined by a gastroenterological pathologist? Did two or more pathologists agree on the diagnosis?
■How much of my esophagus is affected by Barrett's dysplasia?
■Will I need to undergo another endoscopy exam to confirm my diagnosis?
■What is my risk of esophageal cancer?
■What are my options for reducing my risk of esophageal cancer?
■What are my treatment options for Barrett's esophagus?
(Removing damages cells via endoscope or surgery, using heat or light to kill bad cells)
■What are the benefits and risks of each treatment option?
■Do I have to have Barrett's esophagus treatment? What happens if I choose not to have treatment?
■Should I see a specialist? What will that cost, and will my insurance cover it?
■Are there any brochures or other printed material that I can take with me? What Web sites do you recommend?

Bottom Line

Fortunately the odds of cancer from Barrett’s esophagus is less than 1% per year. However it’s not uncommon for esophagus cancer to show no new symptoms not already experienced with GERD. By the time it’s detected through symptoms alone, the cancer is advanced and untreatable and leads to death. Late stage symptoms include difficulty swallowing, vomiting red blood or blood that looks like coffee grounds, passing black, tarry or bloody stools.

Persons with a history of GERD over many years should be examined via GI endoscopy. And if Barrett’s esophagus is diagnosed, schedule an annual GI endoscopy to look for cancer. Also change your lifestyle to minimize the occurrences to GERD to avoid damaging more of the esophagus. See my post on GERD for more details.

Resources

http://digestive.niddk.nih.gov/ddiseases/pubs/barretts/
http://www.mayoclinic.com/health/barretts-esophagus/hq00312
http://www.gicare.com/diseases/barrett-esophagus.aspx
http://en.wikipedia.org/wiki/Barrett