Wellness Report

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.

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

• Grow Local Tacoma
  
• Grow Local Tacoma: "Getting Started"
  
• Seattle P-Patch Community Gardens
  
• Eat Local Washington
  
• Local Harvest
  

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
<http://www.swedish.org/body.cfm?id=110&oTopID=19>
<http://www.swedish.org/body.cfm?id=126>
<http://www.swedish.org/body.cfm?id=109&oTopID=19>
<http://www.swedish.org/body.cfm?id=1768>

Northwest Natural Health Clinic:
http://www.nwnaturalhealth.com

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

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