According to a recent study, about one in five teenagers have electronically distributed provocative pictures of themselves that could land them in jail. A joint survey by Cosmogirl.com and The National Campaign to Prevent Teen and Unplanned Pregnancy found that 19% of teenagers answered “yes” when asked if they had ever “sent a nude or semi-nude picture/video” of themselves to someone via email, cell phone, etc. Read more »
Susie Essman, aka Susie Greene of Larry David’s HBO program, “Curb Your Enthusiasm,” has written a hilarious book (and yes, I actually read it) called What Would Susie Say?: Bullsh*t Wisdom About Love, Life and Comedy. For this week’s CBS Doc Dot Com, I talked to Susie about some of her health issues covered in the book, including menopause, fear of germs, and hypochondria. “So far this month,” she told me, “I’ve had Lyme disease, hysterical blindness, enlarged prostate….”
If any woman could actually have an enlarged prostate – either her own or snatched in a fit of pique from her beleaguered television husband played by Jeff Garlin – it would be Susie Green. But as we discussed her real and imagined symptoms, it became clear that Susie Essman can be easily talked down from her flashes of hypochondriacal thinking. So she doesn’t actually meet the official psychiatric definition of “hypochondriasis,” in which a misinterpretation of symptoms leads to a preoccupation with having a serious illness that interferes with daily functions and lasts at least six months despite reassurances from a doctor. In fact, her belief that she’s a hypochondriac is hypochondriacal. Read more »
Several years ago I was urgently paged by a patient who had discovered a lump at the bottom of his chest. He came straight over to my office, fairly certain he had cancer. The lump turned out to be a normal part of his sternum (breastbone), a small piece of cartilage called the xiphoid. Now that’s the kind of diagnosis I like to make. Read more »
There’s a disease that American doctors are absolutely terrible at diagnosing. It’s estimated that three million Americans have celiac disease and only a small percentage of them know it. In celiac disease, a component of wheat, rye, and barley called gluten sets off an immune reaction that attacks the intestine and can affect the entire body. Read more »
If you’re from a Western country, there’s a 10-20 percent chance that you suffer from classic symptoms of acid reflux: chronic heartburn and/or acid regurgitation.
But if you don’t have those classic symptoms you may still have acid bubbling up from the stomach into the esophagus, a condition called “gastro-esophageal reflux disease” (GERD). Over the past decade, research has suggested that acid reflux can cause atypical symptoms such as cough, hoarseness, sore throat, asthma, and even chronic sinusitis. GERD can also cause chest pain, especially if the acid causes the muscle in the esophagus to go into spasm.
As an internist and gastroenterologist, I’ve seen patients who have suffered for years with atypical symptoms of GERD get better with treatment. Although I usually prescribe acid-reducing medication, I try to avoid an approach that relies exclusively on “better living through chemistry.” In fact, my goal is to treat the symptoms with life-style adjustments alone if possible. Smoking and obesity both increase acid reflux and must be addressed. I tell my patients to limit alcohol, caffeine, chocolate, peppermint, and fatty foods (I know, basically anything that gives them even an iota of pleasure in life). I also suggest keeping a food diary to try to identify culprits such as tomato-based products or certain spicy foods. If their symptoms resolve then they can try to reintroduce the things they miss the most. Elevating the head of the bed can sometimes help.
The most serious consequence of chronic acid reflux is esophageal cancer. About ten percent of patients with long-standing acid reflux develop changes in the swallowing tube that increase the risk of developing adenocarcinoma, a deadly cancer with a 5-year survival rate of less than fifteen percent. The condition is called “Barrett’s esophagus. “Fortunately, only about one in 200 patients with Barrett’s esophagus develops cancer each year. And over the last year a treatment called “radiofrequency ablation” has been found to be extremely effective in treating Barrett’s esophagus that is starting to show signs that it may turn into cancer.
It’s estimated that almost 15,000 Americans will die from esophageal cancer this year. Fifty years ago, more than 95% of esophageal cancers were “squamous cell” – the kind caused by smoking and excess alcohol use. As smoking has declined, the incidence of squamous cell carcinoma has dropped. But for reasons that are not clear, esophageal adenocarcinoma – the kind linked to acid reflux (and smoking) – has dramatically increased over the past forty years and now accounts for about half the cases of esophageal cancer. From 1975 to 2001 there was a 600 percent rise in esophageal adenocarcinoma. The obesity epidemic may well be playing a role by increasing the number of adults with acid reflux.
Gastroenterologists can diagnose acid reflux by slipping a thin, flexible instrument (endoscope) through the mouth and down the esophagus. It’s a lot easier than it sounds. Patients are usually given sedation and the back of the throat is sprayed with numbing medicine to avoid gagging. There’s no problem breathing because the tube doesn’t go into the breathing tube (the trachea). Biopsies can be taken from the last part of the esophagus to look for microscopic evidence of Barrett’s and inflammation (esophagitis) caused by acid reflux.
There is currently a controversy about who should be endoscopically screened to look for evidence of Barrett’s esophagus. Only a fraction of the millions of patients with chronic reflux will ever develop Barrett’s. And many patients with Barrett’s have no symptoms at all. In a study in Sweden, 1.6% of the population had Barrett’s but only about 40% had heartburn. And only about half of esophageal adenocarcinoma is estimated to be a result of reflux.
The American College of Gastroenterology recommends against screening the entire population but says it may be appropriate in certain populations at higher risk – such as Caucasian males over 50 with longstanding heartburn. That would be me. So for this week’s episode of CBS Doc Dot Com, I underwent an upper endoscopy, explained and performed expertly by Dr. Mark B. Pochapin, director of The Jay Monahan Center for Gastrointestinal Health at New York-Presbyterian Hospital/Weill Cornell Medical Center. For more information about the Jay Monahan Center, click here.
For information about GERD from the American Society for Gastrointestinal Endoscopy, click here.
To watch my upper endoscopy, click here:
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