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August 11, 2008

Self Breast Exams “Do They Work?”

There's a lot of controversy these days over the importance of self-breast exams. In this week’s Wellness Report we talk to a local specialist who breaks down the "how to" and the "why should I?"

Every three minutes a woman in the U.S. is diagnosed with breast cancer. We all know regular check-ups are important, but the game plan gets confusing when it comes to checking ourselves.

“The breast exam is just one part of a woman's breast health program,” says Dr. Patricia Dawson, who is a breast surgeon and program director at the Swedish Breast Center.

“The self breast exam is something they can do to understand their bodies.”

There have been several recent studies on whether self-breast exams help. Just this summer: an international group called the Cochrane Collaboration found in their study no solid evidence that self-breast exams do any good. In fact, it said they often lead to unnecessary biopsies.

wellness_breast_1.jpg

But in another 2006 study right here by a doctor at Swedish Medical Center, more than 80% of the women under 40 diagnosed with breast cancer found the lump or symptoms themselves.

“It doesn't have to be an elaborate exam,” says Dawson. She recommends self-exams as part of her program, but recognizes there are some issues that need to be addressed.

“Women are uncertain about them and they feel insecure,” she says, “They don't know what they are feeling and they are worried they will find something.”

Her best advice:
1. Check yourself at the same time every month-and about a week after your period starts.

“That’s because we tend to be lumpier before our periods start and less lumpy after they have been going on for about week,” she advises.

If you’re menopausal just make sure to check it on the same day so you can compare notes and tell your doctor about any changes.

2. Do 2 exams: one in the shower when your hands are slippery so you can feel things more easily, and one lying down.

“That allows the breast tissue to flatten out against the chest wall,” says Dawson.

Also, use different pressures: First a somewhat firm touch, then a lighter touch.

wellness_breast_2.jpg

Remember: younger women's breasts are naturally lumpier because the breast tissue is denser.

Also, nipple discharge usually does NOT indicate cancer.

And that lump you're feeling could just be a cyst.

“You can get a lot of lumps that you can feel and they feel like grapes. If you were to put a needle into this and take the fluid out, it would go away. Just remember, when you feel new ones keep telling your doctor about it.”

Dawson says the goal is not to know or catch everything, but to simply get familiar with what your breast usually feels like and never hesitate to tell your doctor.

“Mostly we are responsible for saying something feels different and we need to get it checked out.”

The American Cancer Society still recommends a 3-part screening: a clinical breast exam, a self breast exam, and a mammography.

Web Extra: Recommendations & Links on Self Breast Exams & Breast Cancer Awareness

Swedish Medical Center: Breast Cancer Information

Dr. Susan Love’s Breast Book http://books.google.com/books?

The Cochrane Collaboration Report: Should Women Stop Breast Self-Exams?

The American Cancer Society: So what should women do?

ACS Cancer.org: Breast Cancer Resource Page

ACS Electronic Mammogram Reminder

Recommendations by the American Cancer Society:

1. MAMMORGRAM:
Women age 40 and older should have a mammogram every year and should continue to do so for as long as they are in good health. While mammograms can miss some cancers, they are still a very good way to find breast cancer.

2. CLINICAL BREAST EXAM (CBE):
Women in their 20s and 30s should have a clinical breast exam (CBE) as part of a regular exam by a health expert, preferably every 3 years. After age 40, women should have a breast exam by a health expert every year. It might be a good idea to have the CBE shortly before the mammogram. You can use the exam to learn what your own breasts feel like.

3. BREAST SELF-EXAM (BSE):
BSE is an option for women starting in their 20s. Women should be told about the benefits and limitations of BSE. Women should report any changes in how their breasts look or feel to their health professional right away. If you decide to do BSE, you should have your doctor or nurse check your method to make sure you are doing it right. If you do BSE on a regular basis, you get to know how your breasts normally look and feel. Then you can more easily notice changes, but it's ok not to do BSE or not to do it on a fixed schedule. The most important thing is to see your doctor right away if you notice any of these changes: a lump or swelling, skin irritation or dimpling, nipple pain or the nipple turning inward, redness or scaliness of the nipple or breast skin, or a discharge other than breast milk, but remember that most of the time these breast changes are not cancer.

August 4, 2008

Glioblastoma: The Unfaltering Fight for a Cure

Glioblastoma is the most common form of brain cancer and it often strikes without a warning.

Senator Ted Kennedy has it. It took the lives of composer George Gershwin and Movie Critic Gene Siskel.

Scott Patrick is finding a web of support as he braces for the fight of his life.

“It's just pure and sincere,” says Scott.

In the pages of a Caring Bridge, a site that connects people through serious illness, Scott and his family have found a find a team of care brought together by a man playing his toughest game.

“We've seen a huge connection of friends and family that may not have happened had Scott not had this challenge,” says Scott’s wife Ronda Patrick. “Those connections are really energizing. So for me, having the feedback from people that are really sincere and wanting to know and care about Scott, it's really made me feel the human spirit is alive and well.”

“My childhood friend growing up, Kevin Bergstrom,” says Scott, “he reached out, and few days later he was at my doorstep here as a result of Caring Bridge. That’s a pretty powerful connection.”

Scott has been the Vice-President of Corporate Sales for the Seahawks for 11 years. He was also with the Sonics for 11 years and helped open two stadiums here in Washington.

But at the height of his career, life threw him a big curveball.

Two years ago, sitting in a hot tub after a workout, Scott had a seizure.

“But just by luck a maintenance man was nearby and he pulled me out of the tub and called 911,” he says.

“That was the first miracle, “says Ronda, “We figured he was meant to be here a little bit longer.”

A blur of surgery and tests concluded: Scott has Glioblastoma, which is an aggressive and incurable form of brain cancer.

“So now I’m trying to fight hard to stay in this game,” says Scott.

“You look up words that are really big that you've never heard before,” says Ronda, “but I had a need to know what we were dealing with.”

20,000 people will be diagnosed with Glioblastoma this year--500 in the state of Washington.

And it’s a tough one: Glioblastoma is highly aggressive and resistant to treatment.

Dellan Elliott’s husband Chris died of Glioblastoma 6 years ago. She’s been fighting for better research, treatment and education ever since. This summer has brought exciting news:

So, for now, the fight for Scott and his family, the fight goes on…

“Just put one foot down and put another foot down in front of it,” says Scott, “and here we go.”

…for a family that knows, this, is worth fighting for.

“There are a lot of great people with big hearts out there working on it and I believe we are going to find the way.”

Web Extra: An Interview with Ground-Breaking Advocate Dellann Elliott



Founder of the Chris Elliott Fund Dellann Elliott talks about Glioblastoma

August 27, 2000, we were up at Crystal Mountain and my husband said let's go home. When we left my husband kept thinking I was drifting on the road. He worked on the yard, I went to the store and when I came back my husband was sitting with my children and he said I feel really weird. I'm smelling all kinds of smells like rotten tennis shoes. I thought he had the flu, I had no idea that was a symptom of a brain tumor. Later he said call 911. They thought he had meningitis. He said the man in the ambulance had a seizure.

The neurosurgeon came and got me and showed me that he had a primary brain tumor, and I remember being told if you have it this is the right place to have it in the right temporal lobe.

I as pacing and his neurosurgeon came out and he said to me, this is the type of tumor that will end his life sooner than later. So that was really tough. That was really tough

At that point in time I never knew anyone with brain tumor let alone brain cancer. So friends did some research, and it wasn't good. In fact it was really scary. At that time standard protocol was radiation and then intravenous chemo. Now standard protocol for this type of disease has advanced. Now you have radiation and a drug called Temador so we are seeing some advancement. You also don't have to wait for the drug to reoccur to get that drug. 8 years ago you had to wait until you had a second brain tumor until you had the drug Temodar.

You've had a quick education. Yes I have. So, I like to share that with people because I know how important it is because I would have loved to had someone there sharing that with me. What were some of the last things Chris told me? We sat down together. We made a list of the things that he wanted to do. Besides spending time with his family and traveling, but he also said please do something about this disease so that's where I built my strength. I also know we've made a difference here and world wide. Chris left a beautiful legacy in that fact, as well as a beautiful legacy for his kids.

What are you doing to change what's happening with brain cancer? I know you're traveling a lot... I've been going to Washington D.C. We also educate, advocate and spread awareness. I advocate for increasing our national health institute of health budget for cancer, also to eliminate the 2 year waiting period for medicare for people with life-threatening diseases. People with brain cancer often don't last that long. It's happening all over including here. There will be 500 new cases here in Washington this year. So people need to know what. Work with the experts. Swedish has a brand new center for advanced brain tumor treatment. Everyone's brain tumor is different so it doesn't make sense to have a standard protocol. You want to have the genetic markers tested so you can find the drug that will respond to that. Why has it been more difficult to get the funding? Part of the problem the life span is short for people with brain cancer. But also because we've been treating with a protocol that only works for 30 percent. That has stunted our research that way.

What I would want people to know for sure is that we are there for them. It is not an easy disease. I would like people to see us as a resource to help them on their journey. The more we can get the word out about brain cancer and that it is an individual approach is beneficial the more we can do that the more we will be having success with brain cancer.

The Chris Elliott Fund supports research at the Dana-Farber Institute. Years ago we sent them the seed money to get enough to do more research. We have actually identified the genes that cause glioblastoma.

With are now with the National Institute of Health to prioritize those genes. 13 exciting and wonderful and fabulous. So go to our website to find more information at www.chriselliottfund.org and you will see on there many ways to get involved.

Web Extra: An Interview with Ambassador Tamara DePorter

Mrs. Seattle and Ambassador Chris Elliott Fund Tamara DePorter talks about Glioblastoma

I had a good friend and colleague who died of brain cancer. 10 years ago I couldn't do anything but now I feel like I can thanks to the Chris Elliott Fund and Dellann Elliott. Cancer touches everyone. I know so many people and it is personal for me to. So, it's just awesome to be a part of it. So what impressed you? The people. We can see the impact we are making especially because of my title but also be cause of my work with the Chris Elliott Fund.

What do you hope to do? I hope to get the name Glioblastoma out there so people don't say 'what is that?' I keep running across people that have Glioblastoma. What have you learned about brain cancer? It's scary. But everything helps. I just want people to know that we are here and we can help. It's so overwhelming sometimes we are happy to help. So let's try and make it better because this is not going to go away. Not yet.

MORE LINKS & INFORMATION:

Caring Bridge: Visit Scott Patrick

Caring Bridge

The Chris Elliott Fund

The Chris Elliott Fund: Fundraisers!

Dana-Farber Cancer Institute

July 28, 2008

Debt Stress

There's a lot of financial anxiety going around these days. In fact it's causing a lot of headaches, stomach problems and even depression. Even though you can't control the price of food or gasoline, you can protect yourself from debt stress--which can take a real toll on your body.

With prices climbing, people all over the country are on edge. Ernest Gordon, an engineer, says lately his family has gone from living an "upper middle class" life, to wondering how they're going to pay the bills.

"I have many, many friends who have lost their homes, that normally I could help. I can't help them now. I'm trying to, my wife and I are too busy trying to maintain and it's sad."

Psychiatrists say it's normal to feel stressed - when you're facing a major financial loss, like being laid off or losing your home, but there's a distinct difference between stress and depression.

"So, I think it's helpful for people to recognize that if really bad things are happening, they should be on the look both inside themselves and inside their loved ones that these are the sorts of things that can leave them depressed," says Dr. Charles Raison.

“Depression is more of feelings of sadness that just won't go away--no matter how well your life is going so it’s helpful to be proactive by taking small steps to try to control what you can of your situation.”

1. Start by getting a clear picture of your financial situation, so you know what you're facing.
2. Once you have that, get professional help to come up with a plan to start paying off your debts. Even if it involves difficult choices, we know if you feel that you are ahead of the game in making these choices rather than that the choices are being forced on you, then that protective against getting depressed.
3. Regular exercise, eating healthy and avoiding too much alcohol will help you better cope with stress.
4. Reach out to someone you can trust.
5. And be honest about what you're going through.

“Everyone has to face difficult circumstances, but I can tell you there is overwhelming data that people who have just one or two people they can really be open with, drop the pretenses, and really lay it on the line, are much less likely to die, are much less likely to have heart disease, much less likely to get depression.”

Links & Helpful Information

WebMD: Stress Management

WebMD: Managing Marriage and Money Problems

Psychology Today: The Depression Test

Psychology Today: The Burn Out Test

July 21, 2008

Cancer Treatment Alternatives

More than 1,500 people die of cancer every day, but there are more than 10 million walking around right now living with it. These days alternative treatments are playing an even bigger role.
With the growing popularity of naturopathic alternatives more doctors are incorporating it into their treatment plans, but it's also growing in popularity online.

We introduce you to a leading expert in Seattle who's combining the old and the new while fighting the fakes.

“I don't look back. I've learned to look forward,” says Therese Billings.

She is a survivor several times over. In 13 years: Therese Billings has been diagnosed with breast cancer 7 times.

“Anytime you hear the word cancer that's scary!” she says.

The first few years she did surgery, chemotherapy and radiation, but each time it came back. That’s when she started to look at less conventional answers and she says it opened up a new world of hope.

“It may have been someone who told me about it, a friend, and so I decided to look into it,” she says.

4 years ago she found Dr. Dan Labriola who runs Northwest Natural Health in Ballard and is the Medical Director of Naturopathic Services at the Swedish Cancer Institute.

“There is a tremendous increase in interest. Many very large institutions are looking increasingly at naturopathic treatments,” says Labriola.

At Swedish, Labriola recommends conventional treatments with natural ones, but there is a new concern: claims to cure cancer online that are unapproved and often dangerous.

“And there's just so much information on the Internet that's just bogus,” says Labriola.

Therese says she avoids the risky stuff, but her best friend did not.

“She tried a whole bunch of crazy things and that scared me, but she was desperate, afraid and desperate, and I completely understand that.”

This summer the FDA sent out dozens of warning letters to companies marketing those so-called “all-natural” cancer cures. It’s a trend Dr. Labriola is trying to crack.

“A significant part of what I do in practice is protecting patients from self-treatments that could either interfere with conventional treatment or create new harm on their own and in some cases make some cancer worse.”

Labriola says his supplements are thoroughly checked and FDA approved. His focus is getting cancer survivors strong and as healthy, treating other problems, and sharing every bit of information, every step of the way to make sure his natural treatments don’t interfere with western ones.

Therese now works as a navigation manager for chronic disease at the YMCA for Greater Seattle. So, she is helping others while learning there is still so much life for her to live.

“If nothing else, for what ever time I have left, I want to have the best possible life that I can live.”

Web Extra: Cancer Alternatives: The Good & The Bad

Dr. Dan Labriola says for some people it can help, but for breast cancer patients for example, where tumors are sensitive to estrogen:

“There is actually increasingly good evidence to support the fact that they can accelerate the disease,” he says.

Then there's anti-oxidants that are helpful in suppressing cancer, but potentially harmful by interfering with radiation and some chemotherapy treatments.

“These are good things, and we should really consider them in the overall cancer plan because they have great potential benefit, but timing is everything.”

Also, specific anti-oxidants can be a bad idea before surgery.

“The use of specific anti-oxidants like vitamin E, using plant substances like garlic they all thin your blood.”

Saint John's Wart and ginger in a lesser way, also can thin the blood. So, Dr. Labriola's best advice:

“Almost every study that's been done shows that patients do not fess up about the natural medicine things that they are doing. Make certain that everyone knows what everyone else is doing. No secrets.”

Links & Helpful Information

Swedish Medical Center: Natural Health
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Northwest Natural Health Clinic:
http://www.nwnaturalhealth.com

Bastyr University: Natural Health
http://www.bastyr.edu/

July 14, 2008

Wellness Report: Growing Local

With food prices going up and up it's getting harder to feed a family these days with healthy, affordable meals. That's why the idea of "growing local" is getting bigger and easier. A new website out of Tacoma is showing us how to do it and why, now more than ever, it's worth it.

Claire Kjeld is a dietitian at MultiCare in Tacoma, but today she is more of a proud mom--sort of.

"That's our baby!" She's talking about a tiny pepper.

Kjeld says she is so excited, but a bit humbled too. This is the first time she and her husband are growing their own produce in their Tacoma backyard. It's a work in progress she says, and an important lesson--with great rewards.

"I appreciate farmers so much more. There's a lot of care in preparing these foods and bringing them to us," she says. "But my veggies are really growing so fast! I put the little seeds in there and within a month I had spinach that I could be eating."

Now she's blogging about it on a new site called "Grow Local Tacoma." Joining her are experts and other beginners.

"This is something started in partnership with the city," says Whitney Rhodes who is deeply involved in the project. "It started as a way to promote Tacoma and it is becoming a big hit. People just want to know the food they are feeding they're families is safe and affordable."

Seattle's P-Patch program is already a big player in the community garden world. Tacoma's crew is a bit different--with a pretty diverse background and some growing concerns.

"A lot of the community gardens in Tacoma are heavily done by immigrant populations," says Rhodes, "so you really end up with interesting things growing in community gardens!"

"But with what's happening to the economy," adds Kjeld, "all those things I've been encouraging people to do for so long they're starting to do it out of having to do it."

According to the U.S. Department of Labor, from May 2007 to May 2008 flour is up 55%, eggs are up 28%, bread 16% and milk up 15%.

The stuff in Kjeld's garden are all up in grocery store cost too including beans up a whopping 23%.

With gas prices up more than 60% compared to a year ago, this might hit home says Kjeld:

"Most food, the average distance that it travels is 15-hundred miles to get to us."

1,500 miles that's reflected in our grocery store prices and weighing on the minds of Kjeld and company.

"We don't give a second thought to eating something grown in Chile or China," says Rhodes, "We have no concept of where that tomato came from."

The idea now is to inspire and to educate...

"A lot of people are not going to eat local unless they can do it just as easily as going to the grocery store," admits Rhodes.

And, to make what was once a trend easy, in an economy where every effort is now becoming priceless.

"I love it!" says Kjeld. "I think they taste even better, because I knew I grew it myself!"


Web Extra: How To Grow Local or Eat Local

July 7, 2008

Esophageal Cancer

Up to 80 million people suffer from acid reflux or heartburn every day--and the esophagus can suffer. The esophagus is that tube connecting the throat to the stomach. Smoking makes it worse, but so does poor eating habits and stress--making a potentially dangerous problem a common problem.

Cyndy Hayward is in her early 50's, in shape, and on the move.

“I’ve moved to the beach and just opened a bookstore and a coffee shop,” she says.

When you see Cyndy she doesn’t look like someone who’s just overcome esophageal cancer.

“When I was diagnosed with cancer, it came out of the blue for me. I've had acid reflux and heartburn for years, and years and years and years,” she says.

For quite a while Cyndy says over the counter and heartburn and acid reflux drugs did help, but 5 years ago, she started having problems swallowing.

“With french fries, or chicken or certain foods I realized I needed a lot of water to get down.”

Dr. Donald Low is a thoracic surgeon at Virginia Mason Medical Center and a leading expert in esophageal cancer.

In a procedure to treat esophageal cancer, Low and a team of experts remove the entire esophagus and create a new one by pulling part of the stomach, up through the body, and attaching it to the throat.

“Cyndy is the classic example,” says Low, “she thought for 15 years that she was just someone who had standard heartburn disease.”

But doctors believe a small percentage of those who have chronic acid reflux or heartburn... will develop what's called Barrett's esophagus where the cells in the lining of the esophagus change, and that, for some people, can eventually turn into cancer.

“This cancer is one of the fastest growing cancers in the United States at the present time,” says Low, “and historically it is very difficult to treat.”

Up to 20% of those diagnosed with esophageal cancer will die, though at Virginia Mason, the odds are much better, thanks to a specialized, well-practiced team.

“We put together a plan that is specifically tailored to that individual patient,” says Low.

“What saved my life is we got it early,” says Cyndy.

Still: the numbers of those at risk are growing and Cyndy admits not only good doctors, but a bit of luck saved her life.

”The gift of the illness was to give me an opportunity to look at my life, what's left in my life and what I want to do with my life and that's a big gift.”

Web Extra: Symptoms and Resources for Esophageal Cancer and Barrett’s Esophagus

Esophageal Cancer: Virginia Mason

Dr. Donald Low: Virginia Mason

Esophageal Cancer: Mayo Clinic

Definition of Barrett’s Esophagus:
Barrett's esophagus is a condition in which the color and composition of the cells lining your lower esophagus change because of repeated exposure to stomach acid. This exposure to stomach acid is most often a result of long-term gastroesophageal reflux disease (GERD) - a chronic regurgitation of acid from your stomach into your lower esophagus.
Barrett's esophagus is uncommon. Only a small percentage of people with GERD develop Barrett's esophagus. But once Barrett's esophagus is diagnosed, there's a greater risk of developing esophageal cancer. Although increased, the absolute risk of esophageal cancer for someone with Barrett's esophagus is small - less than 1 percent a year.
You can eliminate or reduce the frequency of stomach acids flowing up into the lower end of your esophagus - and your chance of developing Barrett's esophagus - by making lifestyle changes.

Symptoms:
Barrett's esophagus itself isn't associated with specific symptoms. But, heartburn and acid reflux - the sensation of bad-tasting liquid that may enter your mouth from your throat - are common indicators of GERD. And having GERD can lead to Barrett's esophagus.

A telltale sign of Barrett's esophagus - which your doctor can notice using a lighted instrument -occurs when the color of the tissue lining the lower esophagus changes from its normal pink to a salmon color. This cellular change, called metaplasia, is caused by repeated and long-term exposure to stomach acid.

Other signs and symptoms that may suggest a complication of GERD or Barrett's esophagus, including the development of esophageal cancer, include:

Trouble swallowing. Often, a narrowing of the esophagus (esophageal stricture) leads to difficulty swallowing (dysphagia).
Bleeding. You may vomit red blood or blood that looks like coffee grounds, or your stools may be black, tarry or bloody.
Weight loss and loss of appetite. You may experience an unexpected drop in weight.

Causes:
The exact cause of Barrett's esophagus is not known, but the condition usually develops in people who have GERD. Heartburn and acid reflux are the most common symptoms of GERD and result from stomach contents washing back into the esophagus.

The ring of muscle at the junction of the esophagus and stomach (sphincter) normally keeps acid in your stomach by closing tight. GERD usually results from a weakened sphincter, and it can be aggravated by a protrusion of the upper stomach through the diaphragm (hiatal hernia).

Left untreated, GERD can lead to more-serious complications. Severe heartburn with inflamed esophageal tissue (esophagitis) can cause chest pain intense enough to resemble a heart attack. Other complications of GERD may include esophageal stricture - in which scarring causes narrowing of the esophagus - bleeding, Barrett's esophagus and esophageal cancer.

Risk factors:
Risk factors for Barrett's esophagus include:
Chronic heartburn and acid reflux or GERD. These put you at risk of Barrett's esophagus because the esophagus is designed to carry food and liquid only one way - from your mouth to your stomach. The esophageal lining is sensitive to acid and unable to handle it.
Your stomach, however, has a lining designed to withstand acid-containing stomach (gastric) contents.

Stomach acid is damaging to esophageal tissue. Repeated and long-term exposure to stomach acid can lead to the transformation of esophageal tissue into the salmon-colored tissue characteristic of Barrett's esophagus, which is actually an acid-resistant lining of cells similar to the cells lining your small intestine.

Being a man. Men are two to threes times more likely to develop Barrett's esophagus.
Being white or Hispanic. White and Hispanic people are at greater risk of the disease than are blacks and Asians.
Being an older adult. Although Barrett's esophagus can affect people of all ages, the condition is more common in older adults.

When to seek medical advice:
See your doctor if you've had long-term trouble with heartburn and acid reflux. Talk to your doctor as soon as possible if you:

*Have difficulty swallowing
*Are vomiting red blood or blood that looks like coffee grounds
*Are passing black, tarry or bloody stools
*Experience an unexpected weight loss

Tests & Diagnosis:
Diagnosing Barrett's esophagus is difficult because it often doesn't exhibit specific symptoms. Experiencing the frequent and severe acid reflux of GERD may be the best indication that you either have Barrett's esophagus or may be at risk of the disease.

If you have severe acid reflux or have had acid reflux for many years, your doctor may discover Barrett's esophagus by examining your esophagus through endoscopy. Endoscopy involves inserting a lighted, flexible tube (endoscope) with a camera on its tip through your mouth and into your esophagus and stomach. Usually, you'll receive a local anesthetic, and you may be sedated for this procedure.

What your doctor looks for
The procedure allows your doctor to search for abnormalities such as precancerous cell changes (dysplasia) or an abnormal junction between your stomach and esophagus. In a healthy esophagus, the stomach-esophagus mucosal junction is at the lower end of the esophagus. In Barrett's esophagus, this junction is displaced upward. If Barrett's esophagus is suspected, your doctor also looks for evidence of cancer or precancerous changes.

During endoscopy, your doctor may remove tissue samples (biopsies) of potentially abnormal areas to be examined under a microscope. If specimens reveal intestinal goblet-shaped cells not usually seen in the esophagus, your doctor may make a diagnosis of Barrett's esophagus.

Following your diagnosis, your doctor may recommend endoscopies at regular intervals to screen for cell changes that could indicate progression to cancer. This usually means a repeat endoscopy one year after your diagnosis, followed by endoscopies every three years if no dysplasia is present. If a tissue sample shows dysplasia, you may need screenings at shorter intervals — at least annually and in some cases, as often as every three months.

Treatments & Drugs:The primary goal of Barrett's esophagus treatment is to prevent the development of esophageal cancer. It's not too late to treat dysplasia in Barrett's esophagus if it hasn't yet advanced to cancer.

Treatment for Barrett's esophagus may start with controlling GERD by making a number of lifestyle changes and taking self-care steps. These actions include losing weight, avoiding foods that aggravate heartburn, stopping smoking if you smoke, taking antacids or stronger acid-blocking medications, and elevating the head of your bed to prevent reflux during sleep.

People with severe GERD and Barrett's esophagus usually need aggressive treatment, which may include medications, other nonsurgical medical procedures or even surgery.

Medications
Medications to treat GERD and Barrett's esophagus include:

Proton pump inhibitors (PPIs). These medications — such as omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), pantoprazole (Protonix) and esomeprazole (Nexium) — block production of acid and relieve irritated tissue.
H-2-receptor blockers. Doctors sometimes prescribe this class of drugs to treat GERD and Barrett's esophagus. They're less expensive, although weaker than PPIs. Prescription H-2-receptor blockers such as famotidine (Pepcid AC), cimetidine (Tagamet), nizatidine (Axid AR) and ranitidine (Zantac 75) are also available over-the-counter in doses less than prescription strength.
Although these medications often are quite effective for GERD, once Barrett's metaplasia is present these drugs won't reliably reverse the condition, and the risk of cancer remains even if your GERD symptoms go away with treatment.

Surgery
Anti-reflux surgery (laparoscopic Nissen fundoplication) offers an alternative to long-term use of medication for GERD. The procedure tightens the sphincter by wrapping part of the stomach around the lower esophagus to prevent acid reflux. Laparoscopic surgery involves inserting special instruments through small incisions — less than an inch. The procedure leaves only tiny scars. You can expect to stay in the hospital for one or two days after this surgery. Although surgery can be effective for GERD, once Barrett's metaplasia is present surgery won't reliably reverse the condition, and the risk of cancer remains.

If you have esophageal cancer, or if you have Barrett's esophagus and high-grade dysplasia, your doctor may recommend you undergo a major surgical procedure in which the esophagus is removed completely and the stomach is pulled into the chest (esophagectomy). You may need to spend about two weeks recovering in the hospital after surgery. Although this treatment is effective, it is associated with significant health risks. Up to 50 percent of people who undergo esophagectomy experience at least one serious complication, including pneumonia, heart attack and infections at the surgical site.

The surgical treatment of people with high-grade dysplasia is controversial. Some experts believe that esophagectomy should be used as a measure to protect against cancer. Other experts believe that it's sufficient to schedule screening endoscopies every three to six months and perform an esophagectomy only if cancer develops. Doctors generally don't recommend surgery for people with declining health or for those who are too weak to withstand this major procedure.

Alternatives to medications and surgery
Removal (ablation) of dysplasia makes possible the reversal of Barrett's esophagus, and it may prevent esophageal cancer. Combined with PPIs, ablation may be appropriate especially if you're not a good candidate for an esophagectomy. Ablation procedures include:

Photodynamic therapy (PDT). First, you'll be injected with a drug called porfimer sodium (Photofrin) that makes the Barrett's cells sensitive to light. Then, your doctor inserts a specialized light source into your esophagus. The light causes a reaction with the Photofrin that destroys Barrett's cells.
Electrocautery. Your doctor inserts an electric wire into your esophagus to burn away dysplasia.
Laser therapy. Your doctor uses a hot beam of light (laser) inserted into your esophagus to burn away Barrett's cells.
Argon plasma coagulation. Your doctor releases a jet of argon gas into your esophagus along with an electric current to burn away dysplasia.
Endoscopic mucosal resection. Using an endoscope, your doctor injects a saline solution under the area of your esophagus that contains dysplasia. A blister forms under these abnormal cells, allowing your doctor to cut or suction the abnormal area away from the underlying tissue without damaging the rest of your esophagus. Your doctor may recommend following this procedure with photodynamic therapy.
Radiofrequency ablation. During this procedure, your doctor guides a tiny camera and a small balloon down your esophagus. The balloon and camera help your doctor measure the size of your esophagus and the length of the area that needs treatment. Then, your doctor inserts a second balloon, specifically sized to fit the area requiring treatment. The second balloon delivers a short burst of energy that burns out (ablates) the dysplasia.

Radiofrequency ablation is a fairly new procedure that is still being studied. However, research shows that more than 70 percent of those treated are free of dysplasia up to 12 months after treatment. Complications can include esophageal perforation (rupture) and strictures (narrowing).

The long-term effectiveness of ablation procedures in preventing cancer is still being studied.

Lifestyle & Home Remedies:
You may eliminate or reduce the frequency of stomach acids flowing up into the lower end of your esophagus by making the following lifestyle changes:

Control your weight. Being overweight is one of the strongest risk factors for heartburn. Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus.

Eat smaller, more frequent meals. Three meals a day, with small snacks in between, will help you stop overeating. Continual overeating leads to excess weight, which aggravates heartburn.
Loosen your belt. Clothes that fit tightly around your waist put pressure on your abdomen, aggravating reflux.

Eliminate heartburn triggers. Everyone has specific triggers. Common triggers such as fatty or fried foods, alcohol, chocolate, peppermint, garlic, onion, caffeine and nicotine may make heartburn worse.

Avoid stooping or bending. Tying your shoes is OK. Bending over for a long time to weed your garden may not be, especially soon after eating.

Don't lie down after eating. Wait at least three to four hours after eating to lie down or go to bed.
Raise the head of your bed. An elevation of six to nine inches puts gravity to work for you. Or you can insert a wedge between your mattress and box spring to elevate your body from the waist up. Wedges are available at drugstores and medical supply stores. Raising your head by using only pillows isn't a good alternative.

Don't smoke. Smoking may increase stomach acid. The swallowing of air during smoking also may aggravate belching and acid reflux. In addition, smoking and alcohol increase your risk of esophageal cancer.

June 30, 2008

Celiac Disease

It's one of the most common genetic conditions in the world. Still: 97% of those who have what's called Celiac Disease--are misdiagnosed. It affects children and adults, men and women and it's a disease that has everything to do with what you eat and can take a serious toll on your health-and your lifestyle.

Desperation is what Brandy Trafman felt ever since she was 13, but as a beauty pageant contestant winning over the judges became harder and harder as she feared she was losing her life.

"There's something wrong with me, and I'm slowly dying and nobody's figuring it out," says Trafman.

Then during her first year of college Brandy got the scare of her life.

"My stomach was in such excruciating pain that I woke up in the middle of the night screaming... and my friends in the dorms had to rush me to the hospital."

Misdiagnosed for most of her childhood, Brandy learned she suffers from Celiac Disease which is an autoimmune disorder where the body reacts abnormally to gluten-a protein found in wheat, rye, and barley. Gastroenterologist Michael Goldberg of Evanston Northwestern Healthcare confirmed Brandy's condition after conducting a number of tests.

"Basically, nobody could find out what was wrong with her, but when I talked to her it seemed like she did have something going on. It's just that it wasn't found with all the tests that she had," says Evanston.

The problem with Celiac Disease is it effects about 1 in 133 people yet more than two million Americans don't even know they have it. Symptoms include diarrhea, bloating, weight loss, anemia, mouth sores, joint pain, tooth enamel defects, and an itchy rash.

"But more of the patients today that we see just have non-specific symptoms,” says Goldberg, “they may have iron deficiency anemia, they may have problems with their liver, hepatitis that nobody can find an answer for."

Once doctors do find the answer, patients must put themselves on a very strict diet. Items to avoid include bread, most soups, beer, even salad dressing.

"It was a completely change of lifestyle for me,” says Trafman, “Luckily, I've always liked fruits and veggies. So, for a while one of the important things was being able to maintain my weight."

Even luckier for Brandy was the opening of this nearby eatery in Evanston, Illinois. The name, "Rose's Wheat Free Bakery."

"We are the first bakery in the Chicago area that's completely gluten-free," says Owner Rosemarie O'Carroll who cooked up the idea cooking for her family. Her mother, sister, three children, and herself are all gluten-intolerant.

"I knew there was a market out there and I knew there was a need. I have people coming in everyday saying thank you."

Brandy is one of them. Because of the bakery, she not only can live a normal life, she can live a normal college life.

“It's not just breads and pastas and things but they actually have the junk food that a college student like me would enjoy eating."

As for her future plans she intends to turn her original "mis"-diagnosis into a "Miss" Illinois title. Her pageant platform: making others aware of celiac disease.

CLICK ON LINKS FOR INFORMATION ON CELIAC DISEASE:

The Mayo Clinic: Celiac Disease

Seattle Celiacs Group

Northwest Gluten Group: Gluten-Free Diet

Northwest Gluten Group: Gluten-Free Companies

VIEWER RECOMMENDATIONS:

Bastyr Center for Natural Health

Gluten Free Joe's In Tumwater

WEB EXTRA: The "Bad Buzz," "Trampoline Terrors," and the therapy that's "Music To Your Brain"

A warning about one of the newest energy drinks to hit the market. Spike energy drink has a whopping 300 milligrams of caffeine--that's nearly 4 times as much as Red Bull and 10 times as much as a soda. One young woman had a severe allergic reaction that sent her to the hospital.
A reminder that none of these energy drinks is regulated by the FDA. Doctors say teens and kids should probably avoid them all together.

And: parents think about this before you consider buying a trampoline. Sales are up and emergency room doctors nationwide are now seeing 88,000 trampoline injuries every year-that's double the number from a decade ago. The most common injuries: broken bones, but doctors are also seeing serious head and neck injuries.

Last: some interesting research into treating migraines--along with other stress-related problems. Doctors are finding what's called "brain music therapy" has been highly successful in treating most patients with severe migraines. It's primarily listening to soothing music before you go to bed. It cost her $550 for her sessions but she says it was worth it.

June 23, 2008

The "Wrong" Workout

You've been exercising for years and you are sure you know what your doing. Tim Koffler, Fitness Director for the Seattle Athletic Club, has been teaching people how to workout "right."
Along the way, he's seen a lot of people doing things wrong…

“In reality they may be able to do it, but they're not doing it correctly,” says Koffler.

He says you may also be hurting yourself. So, his first bit of advice is simple: use a trainer or ask a friend for help.

“Not only will you keep yourself from getting hurt, you don't waste your time, and you don't get discouraged too easily.”

Here are some of the most common-and potentially dangerous--workout mistakes to pay attention to.

LIFTING WEIGHTS:

“They do a lot of swinging with their arms. That it increases the chance they will hurt themselves. Keep your body still, focus on slow, controlled movements and keep your back straight, and only move the muscles that you are actually working out” he says, “which will actually make your body workout harder.”

BENCH PRESSES:

“When you drop your arms, make sure they don’t drop farther than level with your shoulders otherwise you are putting too much stress across the shoulders and the chest,” says Koffler. “So pick the arms up a little bit, and stop where you're upper arm is more parallel to the floor.”

SQUATS:

“One thing we see a lot of problems with is people rounding the lower back and loading it up with a lot of weight when it was never meant to do that,” he stresses. “Your back should be fairly straight up and down, flat and supported.”

PUSHUPS:

So a proper push up would be to bring the chin and the chest to the ground, keeping the back straight and not letting the rest of the body touch unless you want to make it easier by dropping knees down, but again keep your back straight and bend your arms.”

CRUNCHES/SIT-UPS:

“Often times people yank, pull on their necks. Not only are they potentially hurting themselves, they just aren’t getting that good of a workout. They’re working out their arms more than their abs. The right way would be to stare at the ceiling, lift up toward the ceiling, keeping the back relatively straight and do the same motion without using the hands or putting your hands on your thighs and moving them toward the top of the knees.”

LEG LIFTS:

“Most importantly you want to keep the pressure off your back. You’re back should be flat on the ground when you lower your legs. If you can't keep that position,” says Koffler, “tuck your fingers under the lower back kind of hold it there, and try and put pressure on the hand.”
Koffler has also created fitness cards, and suggests putting a workout calendar together. He says ultimately: try to do exercises that work your whole body or mimic movements you would do in your everyday life.

“When people really get that this is a long term process and this is not about getting on a scale and seeing their weight go down, it's about having your clothes fit comfortably, and having the energy to do the things you want, then people get more committed to making the lifestyle change.”

Web Extra: “The At-Home Quick Fix”

"At The Core"

1. Pelvic Tilt (12 reps)
2. Floor Cobra (12 reps)
3. Plank (10 reps)

Pelvic Tilt
Lie on your back with your feet flat on the floor and knees bent at ninety degrees. In this relaxed position, the small of your back will not be touching the floor. Tighten your abdominal muscles so that your lower back presses flat against the floor. Hold for five seconds then relax. Gradually build to 12 repetitions.

Floor Cobra
Lie on your stomach with legs together and arms in front of you with the palms down. Tighten your glutes and core then lift your chest off the floor. Lift your arms up and back toward the hips, rotating thumbs toward the ceiling. Hold for 2 seconds then return to the starting position. Your chin should stay tucked into the chest. Don’t arch excessively when lifting the chest; no lower back pain should be felt. Complete 12 repetitions.

Plank
Lie on your stomach with legs together and forearms supporting your upper body weight on the floor. Draw your abs toward your spine, tighten your glutes and lift your body onto your forearms and toes. Your body should be parallel to the floor and your chin tucked into your chest. Keep your spine in neutral position during each 15 second hold. Repeat 10 repetitions. If you experience any pain, reduce the hold time. Beginners may balance on their forearms and knees until sufficient strength is developed to progress to the toes.

"No Ifs Ands or Butts"

1. Step-Ups (10-15 reps)
2. Lunges (8-12 reps)
3. Quadraped Hip Extension (10-15 reps)

Step-Ups
Stand with good posture behind a tall step or box (at least 15 inches high) while holding a dumbbell or other weight in each hand. Place your right foot on the step and transfer your weight to that leg as you step up, pushing through your heel. Push with the right leg only; using the left for balance, especially as you initiate the step-up. Slowly step down and repeat 10 to 15 reps. Change legs.

Lunges
Stand tall with good posture while hold a dumbbell or weight in each hand. Step forward with the right foot, keeping the head up and spine neutral. Drop your left knee toward the floor by bending both knees, making sure to keep the front heel down and the knee directly over the center of the foot. Both knees should end up at a 90-degree angle at the bottom of the movement. Push down and forward through your right heel to return to the starting position. Complete eight to 12 reps. Change legs.

Quadraped Hip Extension
On hands and knees, keep the abs tight as you lift one leg up, knee bent at a 90-degree angle throughout the movement. Keep lifting the leg until the bottom of the foot faces the ceiling and the hip, thigh and knee are all in alignment and parallel to the floor. The back and neck should not arch, remaining parallel to the floor. Return to the starting position and repeat 10 to 15 times. For more intensity add ankle weights or a light dumbbell behind the knee.

June 16, 2008

The 'Right' Workout

All right. Summer's about here and you really want to get in shape, but life is busy and it's just not working out. We talked to a man with a great plan who will convince you, you can do it!

“So many people set themselves up to fail,” says Tim Koffler, Fitness Director at the Seattle Athletic Club in Downtown Seattle. He has spent years, watching people exercise, and along with life-changing successes he's seen bad habits, bad programs and the typical excuses.

“I really want everybody to have the opportunity to feel successful. It changes people’s lives, but when it comes to working out they often have the wrong idea as to what will work for them. In the end they fall back on ‘my life is too busy and I just didn’t have time,’” he says.

Today, he's sharing his program for success, and it's surprisingly simple.

“It really comes down to getting a plan together,” says Koffler.

Koffler says start by finding a reputable personal trainer-even if it's only for one session, or work with a friend you think you can trust for good advice.

“If you start that way, hopefully you don't get hurt, you don't waste your time, and you don't get discouraged too easily.”

Then, make a 4-week calendar *just for your workouts* and put it some place visible-like on your refrigerator. At the bottom, put exercises you plan to do each week. Pick what you think are the best days and times to get it done--based on your schedule.

“So if you have it in front of you what you have to do and you have to record it in a 7 day period, the chance that your going to complete your goals are significantly increased,” he adds.

An important point: Koffler says schedule *one day less* than you think you can actually fit in.

“It's only intimidating if they set their goals to high for what their time allows.”

Also, make a promise to yourself, no matter how you feel, to workout for *at least* 10 minutes.

“If you want to stop after 10 minutes go ahead and stop,” he allows, “but most people don't!”

But Koffler says if you *really* want to see results: mix it up.

“Your body is very amazing at adapting to what you do, so the more you do something, the better your body gets at it, the more efficient it gets at it so the less benefit you start to receive.”

Koffler has created what he calls “Home & Travel Workout Cards.”

They are all simple, common exercises using no equipment and they can all be easily done at home or on the road.

“They'll shuffle them up, they'll pull out 8 cards and that will be their workout for the day,” he says.

He's also created a program called "100 Days of Fitness" where for 100 days participants try a new sport so they can find the workout that they think is fun!

“Most people go to a gym because they think they need to lift weights, and they don't like to lift weights, but they may like playing squash.

They are all ideas for a new start and a permanent change-for the better.

“ Fitness is a lifestyle. It's a healthy choice that you want to do forever-not just until you go on the cruise. When people really get this is a long term process and this is not about getting on a scale and seeing their weight go down, it's about having your clothes fit comfortably, and having the energy to do the things you want, then people get more committed to making the lifestyle change.”

Go to Tim Koffler's "Exercise To Go" Site Here!


Web Extra: “The At-Home Quick Fix”

We bring you key exercises from Seattle Athletic Club Fitness Director Tim Koffler. They are simple and quick and you can do them all at home with no added equipment. You can add these to a regular work routine or do them separately. Koffler recommends completing 2-4 sets of each exercise three times a week.

"The Mini-Workout"

1. Jumping Jacks (60 seconds)
2. Squats (20 reps)
3. Reverse Lunges (12 reps each leg)
4. Pushups (15 reps)
5. Crunches (25 reps)

Jumping Jacks
Standing with your legs together and arms at your sides jump and land with your feet spread apart and arms overhead. Jump again and return to the starting position.

Squats
Standing with your feet spread twelve inches apart, squat down as if you are sitting in a chair, keeping your heels on the ground. Return to standing.

Reverse Lunges
Standing with your feet together, take a large step backwards bringing your back knee almost to the ground. You should have a 90-degree bend in both knees and have your back upright. Push off your back foot to return to the starting position.

Push Ups
Lying on your stomach, place your palms on the ground next to your chest. Leaving your knees in contact with the ground, push your entire body off the ground in one motion without bending the back. Return to the starting position keeping the body just slightly off the ground before repeating.

Crunches
Lying on your back with your knees bent at 90 degrees, place your hands on your thighs. Keeping your arms straight, curl your body, bringing your hands to your knees, then return to the starting position.

Perform all exercises in the order listed, moving from one to the next without rest. After completing all exercises take a 1-minute rest before repeating the circuit.


"Arm Strong"

1. Seated Dip (12 reps)
2. Close Grip Push Up (15 reps)
3. Weighted Tricep Extension (12 reps)

Seated Dip
Sit on the edge of a solid chair or bed. Place your hands on both sides of your body, holding on to the edge. Your knuckles should be facing forward. Place the backs of your ankles on a bench in front of you so that your butt is suspended in the air. Beginners, plant your feet firmly on the floor with your knees slightly bent. As you progress, move your feet further out until your legs are straight. Push yourself off the seat and lower your buttocks until your elbows form a 90 degree angle. Then, push yourself back up to the starting position. Repeat for 12 repetitions.

Close Grip Push Up
Start on your hands and knees with your hands 6-8 inches apart. With your arms straight walk your knees back until your body is straight, as if you were lying on the floor. This position is the start of the movement. Slowly lower yourself until your chest almost touches the floor, keeping your elbows close to your body. Return to the starting position. Repeat 15 repetitions. If this movement is easy, place your feet on the ground and straighten your legs so you are balancing on your hands and toes.

Weighted Tricep Extension
Sit or stand and hold a weight with both hands, elbows bent behind the head at 90 degrees. The weight can be a dumbbell, weighted plate, or any other ten to twenty pound object you have available. Keeping the elbows in, pressing the weight overhead until the arms are straight. Return the weight to the starting position. Repeat for 12 repetitions.

June 10, 2008

Wellness Roundup

With the warm weather hopefully coming up we’ve got some helpful news on healthy choices, and a way to curb your appetite. We start with the latest study on eggs.

We've all heard the warnings: "watch out for cholesterol" in eggs. A new research in the archives of pediatrics shows eggs contain a lot of "good cholesterol" too. They are also packed with protein and more than a dozen vitamins and minerals. Experts say for most of us: 1 to 2 eggs a day are fine.

In another study this week OJ gets an extra boost. Not only is it good for your body it's good for your skin. In a study of 4,000 volunteers, those who took the most vitamin c had fewer wrinkles! The lead author believes it's the anti-oxidants that help build collagen.

Equal and Splenda watch out. There's new competition on the market. It's called "sweet leaf" and it comes from the South American Stevia plant.

"From this leaf we can extract the sweet glycosides which gives us a white powder 300 times sweeter than sugar,” says Jim May, CEO of Wisdom natural brands. ‘

It's generally considered safe, but it is not FDA approved yet. It’s categorized as a supplement and doctors say pregnant or nursing women should avoid it for now.

Pregnant women should consider taking more salt though. A study by health magazine showed iodine intake in the last 20 years has dropped by 50 percent.

Low levels can slow metabolism, and iodine deficiencies in pregnant women can harm the mental and physical development of a fetus. If you're pregnant talk to your doctor about prenatal vitamins with iodine.

Most of us know green tea is good for us... and now research shows it could help with sleep apnea. Sleep apnea blocks airwaves during the night and among other problems can lead to high blood pressure and brain damage. In lab animals, green tea reduced the level of cell damage.

And last: stronger research on the benefits of peppermint. In the latest study: participants consumed 3,000 fewer calories a week, after being exposed to peppermint. The aroma appears to trigger a sense of fullness after eating, and it improved concentration. Experts suggest chewing sugarless mint gum, or dabbing-on peppermint oil to curb cravings.

Web Extra
There is promising new research in fighting alcohol addiction. 400 diagnosed alcoholics participated in a new study by the University of Virginia using the drug Topamax.

It showed the drug decreased heavy drinking. Doctors also found it helped volunteers lose weight, lower cholesterol and blood pressure. All problems researchers say often comes hand in hand with drinking. The study appears in Monday's "archives of internal medicine" one of the journals for the American Medical Association.

In another study in the Archives of Internal Medicine, the French based research institute Inserm found smoking not only ruins your lungs, it saps you of your memory. This was a big study--10, 000 people participated. Those who smoked scored the worst on memory tests, but once they quit during the study their memory improved and on top of that they started to exercise and eat better.
Last: some promising news for those battling brain tumors. UCLA has been studying a personalized cancer vaccine for 7 years now. It works by combining a portion of the tumor with a patient's own white blood cells.

"This is an exciting new study that is trying to trigger the patients own immune system to recognize the tumor as a foreign object and to attack it and kill it," says Dr. Michael Gruber, Overlook Hospital Neuro-oncology Director

In 19 patients: the 2-year survival rate went from 27 to 50 percent. It's not a guarantee but it does appear to add precious time to a patient’s life.

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