Breast cancer is the most common malignancy diagnosed in women. Survival rates have increased. The number of deaths is declining due to earlier detection and prompt treatment.

Five to ten percent of breast cancers are due to genetic mutations passed through family generations. Inherited mutated genes increase cancer likelihood. The most common are cancer gene 1 (BRCA1) and 2 (BRCA2). Both of these increase risk for breast and ovarian cancer.

Presence of genetic risk doesn't mean that cancer will occur. However, risk is higher with increasing age. Cancer in one breast increases risk for cancer in the opposite breast. A family member with breast cancer at a young age increases risk. The majority of those have known family history. Risk factors include obesity, onset of early menstruation, and menopause at older age. Women who gave birth to their first child after age thirty and those who haven’t been pregnant but took hormone (estrogen) have elevated risk. However, risk decreases when the medicines are stopped.

Presence of a lump requires a mammogram. If there is a lump, a diagnostic mammogram is more specific. Ultrasound is reasonable to distinguish a solid mass or cyst.

Biopsy should be ordered to determine if tissue and cells are cancerous. An MRI with contrast is reasonable. Biopsy or surgery could determine the stage or type of cancer.

Further workup includes a blood count, bone scan, CT (computerized tomography), breast MRI, and PET (positron emission tomography) scan.

Stage four cancer indicates that the cancer that has spread. Simple mastectomy or modified radical mastectomy is considered. Chemotherapy, hormone therapy, or radiation treatment is initiated

If surgery is considered, a second opinion from a breast specialist is appropriate. Surgery includes lumpectomy, breast sparing surgery, and removing the tumor with a small margin of surrounding healthy tissue. Simple mastectomy involves removing all breast tissue, including the lobules, ducts, fatty tissue and skin, including the nipple and areola.

Removing a limited number of lymph nodes (sentinel node biopsy) could determine whether cancer has spread to the lymph nodes. If the nodes are cancer free, probability of finding cancer in remaining nodes is minimal. Should there be cancer in the sentinel node, additional nodes are removed. Those with cancer in one breast could decide to have their other (healthy) breast removed if there is a strong family history. However, most women with cancer in one breast won’t develop cancer in the other.

 Plastic surgery reconstruction involves a breast implant (silicone or water-filled) or reconstruction using one’s own breast. Radiation therapy is considered to obliterate remaining cancer cells.

External beam radiation, or brachytherapy, involves placing radioactive material inside the tumor area. It’s performed after lumpectomy for early-stage breast cancer. Radiation to the chest wall after mastectomy could be considered if cancer has spread to the lymph nodes.

Radiation side effects include fatigue and red, sunburn-like rash where radiation is applied. The tissue could appear swollen or firm. Rarely, damage to the heart or lungs could occur in the treated area.

If cancer has spread outside the breast, chemotherapy is given to mitigate the cancer and decrease symptoms. Effects include hair loss, nausea, vomiting, fatigue, and infection. Rare effects include premature menopause, infertility (if premenopausal), injury to the heart and kidneys, nerve damage, and blood cell cancer.

Hormone-blocking therapy treats breast cancers sensitive to hormones. It might be considered after surgery to decrease recurrence. (SERM) selective estrogen receptors, block estrogen from attaching to the estrogen receptors, slowing tumor growth, and obliterating cancer cells.

There are no alternative medicine treatments that have been found to cure breast cancer. However, complementary and alternative medicine (CAM) may help. Survivors have fatigue during and after treatment that could continue for years. When combined with a doctor's care, CAM could relieve fatigue and improve sleep. Exercising three to four times a week, journaling, walking, yoga, Tai Chi, and swimming decrease depression and improve mood.

A breast cancer diagnosis is overwhelming. Local groups, such as the American Cancer Society, give support. .

 Women who eat a Mediterranean Diet supplemented with extra-virgin olive oil and mixed nuts reduced cancer risk. The diet focuses on plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts. Those who follow this diet choose healthy fats, like olive oil, over butter and fish, instead of red meat. Estrogen-blocking medications reduce cancer risk. These include Tamoxifen and Raloxifene (Evista). Removal of the ovaries further reduces risk.

 Signs and symptoms include a breast lump or thickening different from the surrounding tissue, bloody discharge from the nipple, and change in breast size, shape, and appearance. Nipple scaling with redness or pitting are suspicious findings.

Make an appointment with your treating doctor to review your current medical history and medications. An annual checkup is crucial.

http://www.mayoclinic.org/diseases-conditions/breast-cancer/basics/definition/con-20029275

The American military experience in World War I and the influenza pandemic in 1918 were closely intertwined. The war fostered influenza in the crowded conditions on the Western Front. The flu virus traveled with military personnel from camp to camp and across the Atlantic. At the height of American military involvement in WWI, September through November 1918, influenza and pneumonia sickened twenty to forty percent of Navy and Army personnel and rendered hundreds of thousands of military personnel non-effective.

During the American Expeditionary Forces’ campaign at Meuse-Argonne, the flu epidemic diverted urgently needed resources from combat support to transporting and caring for the sick and the dead. Influenza and pneumonia killed more American soldiers and sailors during WWI than did enemy weapons.

Autumn is coming; the CDC (Centers for Disease Control) recommends everyone six months and older be immunized against the flu, except for rare contraindications. The flu season begins in early October till May.  Those who receive the vaccine have protection two weeks after receiving it.

The vaccine is sixty to seventy percent effective in preventing the flu. The vaccine can be given by either injection or inhalation. Most people have no significant side effects. Both children and adults might prefer the inhaled spray instead of the injection.

 Babies less than two years of age should not take the inhaled spray. Kids two to eight years of age may have better immunity with the spray. FluMist is simple to administer. Those who choose the spray could have mild runny nose, headache, cough, and sore throat. These symptoms are temporary and milder than getting the flu. Patients receiving the injection might have low-grade fever and soreness at the injection site. Fever and muscle aches could occur for for one to two days.  It's not necessary or helpful to get receive both.  

High priority for receiving the vaccine includes children and young adults between six months and eighteen years; children with pulmonary (lung) disease, such as asthma; diabetes; those with heart, kidney, and liver disease; and anyone with a weakened immune system, such as HIV infection, should be immunized.

Women who plan to be pregnant should get vaccinated. Children and adults who have heart disease, diabetes, kidney disease, and Guillan-Barre Syndrome should be vaccinated. Adults fifty years or older, residents of nursing homes or care facilities, as well as those who live with someone at high risk of flu complications; and caregivers; should all get the vaccine.

Those with a history of severe allergic reaction to eggs or complications from a previous flue vaccination, pregnant women, and those who have a weakened immune system due to a stem cell transplant or organ transplant should not get the vaccine.

Other means of preventing flu include washing hands with soap and water, using alcohol based sanitizer on the hands, avoid touching the eyes, nose or mouth whenever possible, and avoiding crowds when the flu is prevalent. 

Questions or comments?  Contact Dr. Clem at  clement.hanson@blogspot.com

Source: http://www.riversideonline.com/health_reference/Infectious-Disease/ID00017.cfm

  

Women who will be pregnant during flu season; adults fifty and older; children with pulmonary (lung) disease, such as asthma; those with heart, kidney, and liver disease; and adults and children with weakened immune systems (i.e., HIV infection) should be immunized.

People who live in nursing homes or care facilities, those who live with someone at high risk of flu complications, caregivers, children under six months of age, and health care workers should all get the vaccine.

FluMist spray is recommended for healthy children two through eight years of age.

Those who shouldn't get the spray vaccine include children less than two years of age; adults; children or adults who have heart disease, diabetes, kidney disease; and Guillan-Barre Syndrome, a condition that includes a weakened immune system.

Anyone with a history of severe allergic reaction to eggs or complications from prior a previous flu vaccination, pregnant women, and those who have a weakened immune system due to a stem cell transplant should not get the vaccine. The vaccine is safe for those who have a suppressed immune system, such as those with diabetes or HIV.

FluMist, the nasal spray, is easy to administer. Children and adults might prefer it to the injection. Children ages two to eight have better immunity with FluMist than the injection.

The highest priority for flu vaccine includes children between six months and eighteen years old, children on long-term aspirin therapy, women who will be pregnant during flu season, adults fifty and older, and children with diseases of the lungs, such as asthma.

The injectable vaccine can cause muscle aches and fever for one to two days. Possible side effects of the inhaled vaccine include runny nose, headache, and sore throat. It takes two weeks for the flu vaccine to take effect. Lowering flu risk includes washing hands with soap and water, using alcohol based sanitizer on the hands, avoid touching eyes, nose or mouth whenever possible, and avoiding crowds when the flu is prevalent.

The American military experience in World War I and the influenza pandemic in 1918 were closely intertwined. The war fostered influenza in the crowded conditions on the Western Front The flu virus

traveled with military personnel from camp to camp and across the Atlantic. At the height of American military involvement in WW2, September through November 1918, influenza and pneumonia sickened twenty to forty percent of Navy and Army personnel and rendered hundreds of thousands of military personnel non-effective.

During the American Expeditionary Forces' campaign at Meuse-Argonne, the flu epidemic diverted urgently needed resources from combat support to transporting and caring for the sick and the dead. Influenza and pneumonia killed more American soldiers and sailors during the war than did enemy weapons.

Autumn is coming. The CDC (Centers for Disease Control) recommends everyone six months and older be immunized against the flu, unless there is a medical reason not to. Those who are two to forty nine years of age need the annual flu vaccine.

Flu season begins early October and lasts through May. Those who receive the vaccine have protection two weeks after receiving it. The vaccine can be given by either injection or inhalation.

 Most people have no side significant effects. Low grade fever and soreness at the injection site could occur. The inhaled nasal spray might cause runny nose, headache, fatigue, and mild fever. These symptoms resolve in a few days. The vaccine is sixty to seventy percent effective in preventing the flu.

The U.S. Centers for Disease Control (CDC) recommends the nasal spray instead of the injection for children between two and eight. The spray might cause mild runny nose, headache, cough, and sore throat. These symptoms are temporary and are milder than the flu. Those who choose the inhaled vaccine, FluMist, could have similar symptoms which are not caused by the flu.  Those who receive the injection don't need the inhaled spray.

Children and adults might prefer the inhaled spray instead of the injection. Kids two to eight years of age have a better response with the spray.  

High priority for receiving the vaccine include children and young adults between six months and eighteen years, and children on long-term aspirin for Reye’s Syndrome, a rare condition that causes swelling in the liver and brain after getting the flu.

 Women who will be pregnant during flu season; adults fifty and older; children with pulmonary (lung) disease, such as asthma; those with heart, kidney, and liver disease; and adults and children with weakened immune systems (i.e., HIV infection) should all be immunized.

 People who live in nursing homes or care facilities, those who live with someone at high risk of flu complications, caregivers, children under six months of age, and health care workers should get the vaccine.

FluMist spray is recommended for healthy children two through eight years of age.

Those who shouldn't get the spray vaccine include children less than two years of age, adults, children or adults who have heart disease, diabetes and kidney disease, and Guillan-Barre Syndrome, a condition of weakened immunity.  

Anyone with a history of severe allergic reaction to eggs or complications from prior a previous flu vaccination, pregnant women, and those who have a weakened immune system due to a stem cell transplant should not get the vaccine. The vaccine is safe for those who have a suppressed immune system, such as those with diabetes or HIV.

FluMist, the nasal spray, is easy to administer. Children and adults might prefer it to the injection. Children ages two to eight have better immunity with FluMist than the injection.

The highest priority for flu vaccine includes children between six months and eighteen years old, children on long-term aspirin therapy, women who will be pregnant during flu season, adults fifty and older, and children with diseases of the lungs, such as asthma.

The injectable vaccine can cause muscle aches and fever for one to two days. Possible side effects of the inhaled vaccine include runny nose, headache, and sore throat. It takes two weeks for the vaccine to take effect. Lowering flu risk includes washing hands with soap and water, using alcohol based sanitizer on the hands, avoid touching eyes, nose or mouth whenever possible, and avoiding crowds when the flu is prevalent.

The American military experience in World War I and the influenza pandemic in 1918 were closely intertwined. The war fostered influenza in the crowded conditions on the Western Front The flu virus

traveled with military personnel from camp to camp and across the Atlantic. At the height of American military involvement in WW2, September through November 1918, influenza and pneumonia sickened twenty to forty percent of Navy and Army personnel and rendered hundreds of thousands of military personnel non-effective.

During the American Expeditionary Forces' campaign at Meuse-Argonne, the flu epidemic diverted urgently needed resources from combat support to transporting and caring for the sick and the dead. Influenza and pneumonia killed more American soldiers and sailors during the war than did enemy weapons.

Paralysis Agitans

     I finished an examination on a seventy-year old retired sergeant. I was about to reassure him with a clean bill of health. I handed him his refill prescription. His hand tremored. The slip of paper fluttered to the floor.  

      One million people in the US and seven to ten million people worldwide live with Parkinson’s disease (PD). An estimated four percent are diagnosed before age fifty. If a person’s parent has PD, his or her chance of developing it is higher than those in the general population. Those with an affected first-degree relative have a four to nine percent higher chance of developing PD. Men are more likely to have it than women. The cause is unknown.

            

       PD is a chronic and progressive movement disorder. Symptoms such as tremor of the hands, arms, legs, jaw, and face increase over time. Slow movement (bradykinesia), muscle rigidity, stiffness, and impaired balance are characteristic. Activities such as getting out of bed unaided and driving can become challenging. Those affected might stop working due to symptom progression. Though FD is not considered fatal, in some cases, people could die due to complications, such as pneumonia.

        Brain neurons produce dopamine, a neurotransmitter that sends messages to the brain. Dopamine facilitates movement and coordination. Protein alpha-synuclein (Lewy Bodies) are present in the mid-brain stem and Olfactory Bulb. These regions correlate with impaired motor functions, such as disrupted smell and sleep disturbance. As PD progresses, dopamine decreases. There is no accurate diagnostic test. The diagnoses should be made by an experienced neurologist. Physicians rely on a neurological examination and the patient’s descriptions of symptoms to verify the diagnosis.

    

     Though there is no specific treatment, Levodopa is the most prescribed medication. Medication costs for one person with PD average $2,500 per year. Surgical options, such as deep brain stimulation, could alleviate symptoms. Surgery is effective for a small group of those affected and must meet specific criteria. Therapeutic surgery could cost up to $100,000 but is still in experimental stages. Over the last decade, the National Institutes of Health devoted significant resources to clinical trials. 

     Those who are affected who want to participate in clinical trials should log on to http://www.webmd.com/parkinsons-disease/guide/clinical-trials-parkinsons. The website provides a listing of trials that are open for enrollment.

       Those who have PD suffer anger and guilt. However,those affected may have a sense of relief that symptoms were unexplained or misdiagnosed for years. According to one patient, “the worst day of this was the day I was diagnosed. The best was when I understood that I could do something about it. It gave me control.”

       

      A crisis may be looming as the population ages. Combined direct and indirect cost of PD, including treatment, social security payments and lost income from inability to work are estimated at twenty five billion dollars per year.

                

Quote: “involuntary tremulous motion, with lessened muscular power, in parts not in action and even when supported, with a propensity to bend the trunk forward, and to pass from a walking to a running pace, the senses and intellects being uninjured.” James Parkinson 1817

 Questions or comments? Contact Dr. Clem at clement.hanson@gmail.com

Filters: Viewing stats by location

3-13-14

 

I was re-organizing my files today when I came across a Wall Street Journal article describing a woman’s predicament following a diagnosis of Alzheimer’s disease. The story, “Curse of a Diagnosis,” detailed her perilous journey through brain imaging, spinal fluid analysis, and imaging tests. Her husband commented, “There’s no way this diagnosis benefits people who have it”, and allowing his wife to be tested “was the biggest mistake of my life … a bomb has gone off ….”  He acknowledged that his wife “sometimes gets confused and repeats herself. But why not me; I eat right, exercise, and no one else in my family has this.” The couple owns an import saddle business in California. To add to the couple’s misfortune, she had to relinquish her driver’s license by California regulation.

This story, though not uncommon, touches my soul. The most compelling dimension of the article is what it doesn’t cover.

Let's put aside this woman’s unhappy situation for a few moments and look at the subject matter from another dimension. A healthy lifestyle that includes exercise, strong family and social connections, and dietary changes can delay and may prevent most chronic disease, including Alzheimer’s. A through medical evaluation is mandatory before we label someone with the “A-word.” Health conditions that act like Alzheimer’s are lengthy -- chronic heart disease, endocrine problems, Vitamin B12 deficiency, heart disease, uncontrolled diabetes, multiple sclerosis, depression, stroke, mini-stroke (transient ischemic attack), Lyme Disease, pesticide exposure, traumatic brain Injury, and medication side effects. 

Now consider a healthy lifestyle approach. Anti-oxidants, such as pomegranates, avocado, fish, turmeric, cinnamon, and alcohol/caffeine in moderation can improve memory and long term brain function. Regular exercise, such as walking, dancing, Tai Chi, and golf relieve stress, improve concentration and balance, sharpen the mind, and enhance blood flow to the brain. In other words, what’s good for the brain is good for the heart.

Neurocognitive rehabilitation can help with mental focus, memory recall, name recognition, and abstract reasoning. Two excellent references on healthy brain strategies include The Alzheimer’s Prevention Program, Keep your Brain Health for the Rest of Your Life (Small and Vorgan, Workman Publishing), and Neuropsychological Rehabilitation, Theory, Models, Therapy,and Outcome (Wilson, Gracey, Evans, and Bateman).     

There are numerous peripheral issues regarding treatment and evaluation of memory impairment, including insurance coverage and Social Security Disability.  Finally the medical term, “dementia,” evokes images of insanity, derangement, idiocy, and lunacy. In my opinion, we should avoid the “dementia” when referring to memory impairment and use, “mild cognitive impairment,” and “organic brain dysfunction of the Alzheimer’s’ type.”

It’s time to show optimism regarding Alzheimer’s evaluation and treatment. More diagnostic and  treatment strategies are on the horizon. Alzheimer’s is not a death sentence.

                                                                                                                                                                               Clement Hanson D.O. MPH

cataracts

Insomnia is a condition of fragmented sleep. Those affected have early morning awakening that leads to poor concentration and irritability. It hampers job performance and slows reaction time.
Your doctor might have you complete a questionnaire to determine your sleep-wake pattern and daytime sleepiness. You may be asked to keep a sleep diary.
• How often do you have insomnia and when did it begin?
• How long does it take you to fall asleep?
• How many hours do you sleep?
• Do you snore or wake up choking for breath?
• How often do you awaken at night? How long does it take you to fall back to sleep?
• Are you refreshed when you wake up?
• Are you tired during the day?
• Do you doze off or have trouble staying awake while sitting or driving?
• Where do you sleep? What's the noise level, temperature and amount of lighting?
• Stressful life events?
• Alcohol and tobacco use?
• Family history of sleep issues?
• Recent travel and time changes?
• Long work hours, shift changes, and night shift?
Keep a current list of medications, vitamins, and herbal supplements, including doses. Have your sleep partner come along for your next doctor’s visit. The partner could provide observations that verify information. Your doctor could suggest an overnight sleep study. A blood test might be appropriate to rule out hypo or hyperthyroidism. .
Parkinson’s Disease and Alzheimer’s aggravate symptoms. Ritalin, prescribed for Attention Deficit Syndrome, inhibits sleep. Coffee, tea, and “energy drinks” are detrimental. Other sleep-related disorders include Sleep Apnea and Restless Legs Syndrome. Other disorders include depression, anxiety disorder, post traumatic stress disorder, and substance abuse.
If the cause isn't clear, or you have symptoms and signs of another sleep disorder, such as sleep apnea or restless legs syndrome, referral to an overnight sleep center is recommended. This study monitors brain waves, breathing, heartbeat, brain waves, eye movement, and body movement.
Behavior therapies are recommended as the first line of treatment for those with insomnia. They are equally or more effective than sleep medicines. Cognitive behavioral therapy helps or eliminates negative thoughts and worries that inhibit sleep, such as the concept, “a bad sleep night will make me sick.”.Muscle relaxation, biofeedback and deep breathing reduce anxiety. These modalities bolster breathing, heart function, muscle tension and mood.
“Stimulus control” is a technique that limits time spent awake in bed. The bed and bedroom should only be associated with sex and sleep. Sleep restriction decreases time spend in bed, causing partial sleep deprivation. This strategy creates fatigue the next night. When sleep quality has improved, time in bed is decreased. Other treatments include remaining awake. Also called “paradoxical intention,” this method reduces worry and anxiety about being able to sleep by getting in bed and trying to stay awake, rather than expecting to fall asleep.
If you fall asleep too early and awaken too early, you can use light to push back your internal clock. Go outside during times of the year when it's light outside in the evenings. Consider purchasing a medical-grade light box kept in your bedroom.
Prescription sleeping medicines, such as zolpidem (Ambien), zopiclone (Lunesta), zaleplon (Sonata) or ramelteon (Rozerem) can induce sleep. Physicians might not recommend “prescription sleeping pills” for more than a few weeks.
Over the counter nonprescription sleeping medicines contain antihistamines that cause drowsiness. These reduce sleep quality. Side effects include daytime sleepiness, urinary retention, dry mouth and confusion.
Antihistamines worsen urinary problems, causing urinary urgency during the night. Additional options include Melatonin. This over-the-counter (OTC) supplement could reduce insomnia.
Valerian is a dietary supplement sold as a sleep aid. It has a sedating effect, but hasn't been well studied. It is released into the bloodstream at dusk and tapers off in the morning. You might want to discuss it with your doctor. Those who take it at high doses or long term may develop liver inflammation (hepatitis). When it's time to stop, it should be tapered to prevent withdrawal symptoms.
Stick to a sleep schedule. Keep your bedtime and wake time consistent, including weekends.
Avoid large meals before bed. A light snack is fine. Drink less before bedtime so that you won't have to urinate as often.

Don’t work or eat in bed. Avoid TV, computers, video games, smart phones or other gadgets before bedtime.

The TV and an i-Pad may interfere with your sleep cycle.

Close the bedroom door or create a subtle background noise, such as a fan, to dampen noise sources. You might want to silence your cell phone and bedroom clocks.

A warm bath or massage can prepare you for sleep. Create a relaxing bedtime ritual, such as reading, soft music, breathing exercises, yoga or prayer. Avoid trying hard to sleep. The more you try, the more awake you’ll become.

Read in another room till you’re drowsy, then go to bed to sleep. If you can't sleep after twenty minutes, do something relaxing, such as reading. Try again.

Yoga and Tai-Chi help with sleep quality. Start slow and work with a coach or instructor who listens to your needs and limitations.
“Mindful Meditation” along with conventional treatment can improve sleep. Research suggests that regularly practicing meditation reduces stress and lowers blood pressure.

Source: MayoClinic.org
―
Famous quote: “The best cure for insomnia is to get a lot of sleep.” W.C. Fields