March 9th, 2008 by Dr. Val Jones in True Stories
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It was really cold in NYC this weekend. Most of the little Upper East Side dogs were decked out in full coats that matched their collars, some even had booties. I spotted a couple of Italian
Greyhounds looking forlorn and trembling on their leashes. They weren’t
interested in a walk in the park on this day – they just wanted to go home to
their warm condos.
But cold as I was, I didn’t have the option to retreat. I
had come to run in the Colon Cancer Challenge with my friend Seton – a lifelong
marathon runner just finishing her second round of chemotherapy. She was in
high spirits – and laughed at my joke that this was the first race in which I’d
have a “snowball’s chance” of keeping up with her. You see, I’d always wished I could be an
athlete – but the best my genes could do is prepare me to pull the plow. So I
plod along, hoping for the day when I’ll be invited to join a caber toss – and
actually have a chance of doing something I might be good at.
But I digress.
So thousands of runners took to the 4 mile course – and as I
looked around I doubted that too many of them were actively taking chemotherapy
like Seton. She was bound and determined to run at least half of the way, and
had been training for it between IV infusions of very toxic drugs.
Seton’s husband was beaming with pride as he photographed
her at the start gate. I had vowed not to leave her side, no matter what the
pace… She had about 20 other friends who had joined the race as well and a
small handful stayed with us for the entire time. Amazingly, Seton was able to
run 3 of the 4 miles, her hands cramping in the cold, her thin legs carrying
her tingling feet past familiar landmarks. She held her head high, and never
complained – though it must have been hard for a former track star to watch people
of lesser abilities passing her on the trail. Her friends called her cell
phone every 10 minutes to find out how she was feeling/doing. They didn’t know
that it was so hard for her to even open the phone.
As Seton crossed the finish line, she held her arms up in
the air, as if she were breaking through winning tape. Cameras flashed, people
cheered, and I saw tears well up in her eyes as she tried not to show her
exhaustion. She gathered her friends around her and gave this short speech:
“I want to thank all of you for coming out and supporting me
and the fight against colon cancer today. I can’t tell you how much it means to
me to see all of your smiling faces… Although I certainly had some unlucky news
recently, I want you all to know that when I look at you, my dear friends and
family, I feel like the luckiest woman alive. I am so glad to have you all in
my life. I am truly blessed, and I’m going to beat this cancer with you all by
my side.”
There wasn’t a dry eye among us.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 6th, 2008 by Dr. Val Jones in Expert Interviews
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I must admit that I was a bit skeptical of the conclusions drawn by the media about the latest analysis of the Women’s Health Initiative (WHI) data. The WHI study has generated many different spin-off articles about hormone replacement therapy and its potential link to breast cancer. This latest review suggests that the increased risk for cancer persists up to five years after stopping HRT treatment for menopausal symptoms. I asked Revolution Health expert and past president of the American College of Obstetricians and Gynecologists, Dr. Vivian Dickerson, to help us put this new article into context.
Dr. Val: What does this new study contribute to our understanding of the risks of HRT?
Dr. Dickerson: First of all the women in this study were not on estrogen alone (the usual treatment for women who have had hysterectomies). Their HRT consisted of a combination of Premarin (estrogen) and Provera (progesterone). The original study indicated a slightly higher (barely statistically significant) increased risk for cardiovascular disease (CVD) and a statistically significant increased risk in breast cancer (but relative risks were less than 1.5 for both, which is very small).
Now all this new analysis tells me is that the CVD risk appears to extinguish or become negligible after three years though there is still an increase in breast cancers (compared to placebo) but the difference was not statistically significant. This is interesting in that it does add some plausibility to the claim that the reason breast cancer rates declined so significantly in the year(s) after WHI is because of all the women who quit taking HRT. It doesn’t prove anything, but just more grist for the mill. (Unfortunately I don’t see sub-group analyses of the women who chose to continue HRT after the end of WHI and those who quit from the treatment group.)
The study authors used some fancy math to demonstrate that there was a statistically significant increase in all-cause mortality (including breast cancer) for the women in the HRT group. Since the relative risk is so low, all they can say is that there is no reason to use HRT as a protective or primary preventive measure against heart disease, which we’ve known for many years now.
Dr. Val: Would you change your HRT recommendations based on this new analysis of the WHI data?
Dr. Dickerson: I wouldn’t change a thing that I am doing or counseling. These data are weak and the differences are not robust in any parameter.
***
So there you have it, ladies. No need for heightened alarm based on this analysis of the WHI data, especially if you have never been on the Premarin/Provera cocktail. It would be really helpful to compare breast cancer rates in women who stopped HRT versus those who continued it after the initial WHI data were released. Let’s keep our fingers crossed that this subgroup analysis is next up for publication.
Addendum: My friend and HRT expert, Dr. Avrum Bluming, kindly wrote me an email to further underscore the dubious nature of this study’s findings. Here’s what he said:
“The paper reads more like a lawyer’s presentation then a scientific article (i.e. it makes points followed by the disclaimer that the findings represented are not statistically significant—but the points have been registered). Instead of concluding that the very small increased risk of harm associated with estrogen and progesterone combination therapy (reported in the original studies, which were of questionable significance in the first place) are not found 2+ years after HRT was stopped, they find new risks (lung cancer) to allow them to conclude that administration of HRT results in delayed increased risks.”This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 5th, 2008 by Dr. Val Jones in News
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Patrick Swayze, the popular actor perhaps known best for his role in the 1987 hit movie “Dirty Dancing,” reportedly has pancreas cancer (commonly called pancreatic cancer). Pancreas cancer is among the more deadly forms of cancer. I asked Revolution Health cancer expert Heinz-Josef Lenz, M.D., professor of medicine and professor of preventive medicine in the Division of Medical Oncology at the Keck School of Medicine at the University of Southern California, to explain pancreas cancer.
Dr. Val: Why is pancreas cancer so much more deadly (i.e. less treatable) than many other forms of cancer?
Dr. Lenz: Unfortunately we don’t have very effective drugs for pancreas cancer, which makes it one of the deadliest cancers of all. The median survival is about 8 months with metastatic disease. Even when the tumor is successfully removed there is a very high risk for tumor recurrence. We need more funding to better understand the risk for pancreas cancer and identify and develop more effective therapies.
Dr. Val: Can you describe the typical course of metastatic pancreas cancer?
Dr. Lenz: Unfortunately, the 5 year survival rate for pancreas cancer is only 15 to 20%. The average survival after diagnosis is 12 to 19 months. The best predictor of long term survival is if the tumor is found and removed before it reaches 3 cm in size. Patients with metastatic pancreas cancer are usually treated with a combination chemotherapy consisting of gemcitabine, tarceva, xeloda or oxaliplatin. However the response rates are (despite using aggressive combination therapies) low. Large clinical trials recently did not show any benefit from erbitux or avastin, again demonstrating that pancreas cancer therapy is a difficult clinical challenge.
Dr. Val: Are certain populations at higher risk than others for pancreas cancer?
Dr. Lenz: Age is the most important risk factor for this cancer. It is most common in individuals over age 50 and increases in frequency with age. Black men and women are slightly more likely to get pancreas cancer (though the reasons for this are unclear), and men are slightly more likely than women to get the cancer. Other risk factors are smoking, diabetes, and obesity.
Dr. Val: If you suspect that someone is “high risk” for pancreas cancer, what tests should he/she have?
Dr. Lenz: Patients with a genetic predisposition for breast cancer known as BRCA are also at higher risk for pancreas cancer. There is also a familial form of pancreas cancer. These high risk families are being followed up with specific screening plans. However there is not a reliable test for pancreas cancer. Imaging with CT or MRI can miss pancreas cancer and there is no reliable blood marker. The most common used is CA 19-9, which can be used for monitoring and diagnosis but is not elevated in all patients.
Dr. Val: What if the cancer is caught very early? Does that increase likelihood of survival?
Dr. Lenz: Absolutely. The best chance of survival is when the cancer is limited to the pancreas, and is surgically removed before it reaches a size of 3 centimeters. There are certainly people who have been cured this way, but unfortunately it’s very rare to catch the cancer at such an early stage since it usually has no symptoms until it’s quite advanced.
***
There is a wonderful advocacy group for those whose lives are touched by pancreas cancer: PanCAN. One of PanCAN’s founders, Paula Kim, is a friend of mine and was inspired to create the organization after her dad was diagnosed with pancreas cancer in 1999. At that time there was very little advocacy for this deadly disease. PanCAN helps people with pancreas cancer find help and support.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 5th, 2008 by Dr. Val Jones in Expert Interviews, News
2 Comments »
This is a cute story that caught my eye – a couple used in-vitro fertilization (IVF) to become pregnant, and they specifically asked their doctor to implant only one embryo to make sure that they did not have multiple births. In the end, that one embryo split twice, causing identical triplets to grow inside the uterus. All three baby boys were born healthy at 35 weeks gestation.
I asked Revolution Health fertility expert, Dr. Rani Abbasi, to help me to understand if there was any greater risk of twinning in the IVF process. Interestingly, there are some new techniques used to help insure implantation of embryos that can also increase the chances of identical twins forming. I don’t know if this couple’s doctor used either technique, but I thought I’d explain them to you because the MSNBC report might lead you to believe that this event was extremely rare (they quote 200 million to one) when in fact it may not be quite THAT rare.
There are two methods that fertility specialists can use to increase the chances of implantation for a single embryo. First, incubating the embryo in an extended culture (for 5 days rather than the usual 3) makes it more likely that the transfer will implant in the uterus. However, since the embryo is two days older at the time of transfer, it has a higher likelihood of splitting into two, causing identical twins.
Second, some fertility experts use a technique called “assisted hatching” which also improves the likelihood of implantation of an embryo. This involves making a small nick in the embryo’s outer zone (I think of it as an egg shell) to facilitate the cells breaking out of the protective outer coating and implanting in the uterine wall. When the nick is made, it is also possible for a single cell to fall out (rather than the group of cells, called a blastocyst, exiting together) and become its own fetus.
So ultimately, it’s possible that the techniques used by this couple’s doctor to insure a successful implantation of one embryo increased the chance of splitting of that same embryo, resulting in triplets. Granted, the chance of this happening is still rare – and it’s ironic since the couple was doing all they could to avoid twins or triplets – but it’s not nearly as rare as the chance of a random woman having identical triplets outside of IVF.
For more information about twins and triplets, check out my recent podcast interview with pregnancy expert Dr. Mary D’Alton. And for those of you who believe that you can control your destiny, this story should give you pause!This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
March 5th, 2008 by Dr. Val Jones in Health Tips, Opinion
4 Comments »
I’ve wrestled with this question for many years: “When is weight loss surgery an appropriate option?” I used to do weight loss research prior to working at Revolution Health. My studies focused on using “natural” methods to reverse type 2 diabetes – in other words, weight loss via diet and exercise. My study subjects were all obese, and most had struggled with weight for decades.
At some point during the trial, people would often ask: “Can’t I just have surgery for this and not have to struggle so much?” And I would gently remind them that surgery was no picnic, and to try diet and exercise first. “But it’s so hard!” they would say. I would acknowledge their difficulties and offer lots of empathy, and firmly encourage them to stick with their diet. In the end I found that only half of my study subjects could manage to stay on the diet for months at a time. So what should the other half do? Give up and let their diabetes ravage their bodies?
My friend and colleague Dr. Charlie Smith rightly points out that weight loss surgery can dramatically improve the health of people who have been unsuccessful at losing weight through diet and exercise. Heart disease, diabetes, and cancer rates were dramatically improved for morbidly obese people after weight loss surgery. So there is a clear benefit for some people to have the procedure.
However, the caveats should not be overlooked. First of all, weight loss surgery does not guarantee long term weight loss. It’s possible to gain back all the weight lost if eating behaviors are not changed. The human stomach is amazingly stretchy, and even if it’s surgically reduced in size, with repeated overeating it can eventually stretch to accommodate large meals again. Secondly, some types of weight loss surgery (like gastric bypass) can affect the body’s ability to absorb critical vitamins. Without enough of these nutrients, one can end up severely anemic, and osteoporotic just to name a few serious side-effects. And finally, the surgery itself is quite dangerous, carrying with it a potential risk of death as high as 1 in 200!
So weight loss surgery can be life-threatening, and is not a quick fix for a long term problem. However, morbid obesity itself is so dangerous (with the increased risk of heart disease, diabetes, and cancer) that it may require this extreme intervention to actually save lives. For people who have more than 100 pounds to lose, and have sincerely tried diet and exercise without success for a prolonged period, then weight loss surgery may be an appropriate option. For those whose lives are not at risk because of severe obesity, it doesn’t make sense to undergo such a risky procedure.
Are some people successful at losing a large amount of weight and keeping it off without surgery? Yes! The National Weight Control Registry keeps a list of thousands of Americans who have lost at least 30 pounds and kept them off for at least 6 years. What’s their secret? You guessed it – regular exercise and a calorie controlled diet. Some other things that these “successful losers” have in common: 1) they eat breakfast 2) they have a cardio machine at home 3) they weigh themselves regularly.
If you’d like to meet a group of people who are working towards long-term weight loss success, feel free to join my weight loss support group. We have weekly challenges, tools and trackers, a vibrant discussion group, and free medical insights to help you along your way. Weight loss is really hard to achieve by yourself. It takes encouragement, support, and a community of like-minded folks who are determined to make a difference. You can do it!… and I’d be honored to support you along the way.
P.S. There’s a special group forming at Revolution Health for folks who need to lose 100 or more pounds. It’s called “Overweight But Not Giving Up.” Check it out.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
