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.
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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
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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.
February 29th, 2008 by Dr. Val Jones in Uncategorized
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Happy leap year everyone! The Revolution Health experts have been blogging away furiously, and I haven’t done a Revolution Rounds in a few weeks (naughty) so without further ado – here’s a nice round up of the best of the Revolution Health blogs…
Health tips
Most vitamins and supplements are not necessary if you’re eating a healthy diet. Dr. Joe Scherger summarizes Harvard’s Men’s Health Watch and concludes that only Vitamin D supplements may be warranted for the general population.
Relationships require pruning. Mira Kirshenbaum suggests that if you’re in an unhealthy relationship, it’s best to get up the courage to cut it off.
Ever wonder which arthritis treatments work best? Dr. Jim Herndon has distilled the latest research.
Children need to be vaccinated against the measles. Dr. Stacy Stryer explains that measles can be deadly in 20-30% of the people who get it.
Calcium can strengthen your bones, but may clog your heart? Dr. Vivian Dickerson cautions women about taking too much of this vitamin.
Did you know?
Only one in four people recognize the symptoms of a heart attack. Dr. Joe Scherger describes how you can tell if you’re having one.
Restless legs syndrome might increase your risk of a heart attack. Dr. Steve Poceta explains why.
Stem cell research could be the key to unlocking the mysteries of how cancer develops. Dr. Heinz-Josef Lenz describes some promising new research.
Pit viper venom might be useful in reversing strokes. Dr. Olajide Williams explains that the venom can dissolve blood clots in the brain.
There is a real mind-body connection in health and disease. Dr. Joe Scherger explains how it impacts men with erectile dysfunction.
Nighttime anxiety might convey a survival advantage. Dr. Steve Poceta wonders if we worry more at night because the ancestors who did so, lived to procreate.
A hospital is being sued for denying a surgical procedure to a transgender female. Dr. Cole Brown is not sure that this is fair, since the procedure was not emergent.
Orthopedics Corner
Dr. Jim Herndon is a faithful friend and blogger. He has had a particularly fine week – so many of his posts are great that I thought I’d give you a little summary of them all in one place…
Americans spend as much on back and neck pain treatments as they do on cancer treatment. Jim discusses the incredible financial burden of back and neck pain and the disappointing efficacy rates of treatments.
Neck pain is fairly common and particularly resistant to treatment. Jim describes the prevalence of this condition.
Glucosamine does not seem to improve hip arthritis. Jim discusses the mounting evidence that the benefits of glucosamine are very limited if they exist at all.
Patients with spinal stenosis (narrowing of the canal that contains the spinal cord) may benefit from surgery.
About 10% of total hip and knee replacements require revisions. Before you have yours, be sure that your surgeon is experienced with revisions.
Kiddie corner
Dr. Stacy Stryer is also a faithful friend and excellent pediatrician and blogger. Her sound advice and empathic tone is a key to her success. Here’s what she has to say this week:
First of all, Dr. Stacy reports on the strange practice of a nursing mom on America’s Next Top Model TV show: she’s drinking her own breast milk. Yuck!
Studies show that parents spend more time with their first child. Stacy wonders if she’s been a neglectful parent of her younger child.
Measles is a fatal illness for up to 30% of children who get it. Sadly, measles is on the rise because parents have opted out of the MMR vaccine due to unsubstantiated fears of vaccine harm.
Depression in a parent might be a risk factor for poor health among their children. Dr. Stacy takes a fresh look at how to keep America’s children healthy.
Dr. Jim Hill explains why children who don’t exercise regularly may perform worse on academic tests.
And my final post of Revolution Rounds is from a couple of neurologists who relay a compelling story: they saved a woman’s arm from a mistake made by an orthopedist in Serbia!
This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 22nd, 2008 by Dr. Val Jones in Expert Interviews, News
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Some Hollywood celebrities are up in arms after having been notified of their exposure to hepatitis A through an infected bartender at a trendy New York City club. Those who come in contact with a known virus carrier may prevent infection if they’re vaccinated early. Hepatitis A causes less severe liver disease than its blood-bourne cousin, hepatitis C, but it’s still a formidable foe. (For more information about hepatitis A and its symptoms, check out this article.)
I interviewed Revolution Health consultant and world-renowned liver expert, Dr. Emmet Keeffe, about this outbreak:
Dr. Val: What is the likelihood that people could catch hepatitis A from an infected bartender?
Dr. Keeffe: The hepatitis A virus is transmitted between persons by the fecal-oral route (think unwashed hands after a bathroom break, or drinking water that has come in contact with human sewage). Also this particular virus is very hardy and can live on counter tops and surfaces outside the body for longer than many viruses. Because hepatitis A is found in very high concentrations in an infected persons’ stool, a tiny bit of stool on the hands actually contains large amounts of the virus and can therefore be quite infectious. Although previous outbreaks have primarily been associated with food handlers, there is no reason why a bartender might not also spread hepatitis A virus.
Dr. Val: Yuck. Would a vaccine be effective in preventing hepatitis A after someone’s already been exposed? How quickly after exposure should one get the vaccine?
Dr. Keeffe: The standard recommendation for individuals potentially exposed to hepatitis A is passive immunization using immune globulin administered within 2 weeks of exposure, which is 85% effective in protecting against illness. This is the recommendation for household or sexual exposure, but not generally recommended for “common source outbreaks” (like exposure to food handlers or bartenders), which are usually recognized only after they are well into their course. However, with early recognition, such as the NY case, immune globulin may make good sense. After hepatitis A vaccination, protective levels of antibodies to hepatitis A virus do not appear until 2-4 weeks after vaccination. Thus, active immunization with hepatitis A is used for preexposure prophyaxis, such as in international travelers to areas where hepatitis A is common, but not for postexposure prophylaxis.
Dr. Val: What is the hepatitis A vaccine exactly?
Dr. Keeffe: Hepatitis A vaccine is an injection, which is administered at baseline followed by a booster in 6 to 18 months. Two relatively similar and effective vaccines are licensed in the United States: Havrix and Vaqta.
Dr. Val: What should the bartender do if he has hepatitis A? Can he still work? When can he come back to work?
Dr. Keeffe: To protect the public, the bartender should not work until he has fully recovered. He is most infectious during the late incubation and early illness stage, when excretion of hepatitis A virus in feces is the highest.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
February 20th, 2008 by Dr. Val Jones in Expert Interviews
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I read a recent article about an ongoing debate in Great Britain: whether or not to include fluoride in the water supply. In the United States, we began adding tiny amounts of this naturally occurring substance to the water supplies over 60 years ago. In fact, as much as 75% of the drinking water in the US is artificially fluoridated, and the purpose is to improve the health of our teeth. I was wondering what the research shows about the need for additional fluoride in our diet, and if there are any risks posed by fluoridation of our water supplies. I asked Revolution Health dental expert, Dr. Andres Garcia, what he thought about this issue. Here are his thoughts:
Dr. Val: Is there compelling evidence that adding fluoride to our water system is beneficial for teeth?
Dr. Garcia: Numerous studies by the ADA have shown that a decrease in cavity exposures of 20-40% can be expected when water is fluoridated in communities. In 1999, the CDC listed fluoride as one of the ten great public health achievements of the 20th century. The current goal by the USPHS (U.S. Department of Health and Human Services) is to have 75% of the drinking water in the U.S. fluoridated to optimum levels by 2010.
Dr. Val: how do people get the benefits from fluoridated water exactly?
Dr. Garcia:You get the benefits from drinking fluoridated water in two ways, systemically and topically. Systemically, small children ingest fluoride as the teeth are forming. The fluoride is incorporated into the enamel and causes the enamel to be stronger and more resistant to decay. After the teeth have erupted, fluoride has a topical action. Fluoride from toothpaste, water, or other sources bathe the teeth, and the fluoride ions reverse tooth damage from decay and harden the enamel to resist further decay. The optimum fluoride intake is a combination of ingestion of fluoride before the teeth erupt and subsequent topical application after eruption.
Dr. Val: Is there any risk associated with too much fluoride?
Dr. Garcia: Fluoride toxicity can occur if people are exposed to high concentrations of the substance over long periods of time, though the water supply is closely monitored to ensure that the concentrations are well within acceptable limits. Fluoride toxicity is called “fluorosis.” If toxic amounts of fluoride are ingested when a child is young, the teeth will be weakened when they form. (This is counter intuitive because small amounts of fluoride strengthen the teeth, but large amounts weaken the teeth.) When the teeth erupt into the mouth, the enamel is very thin and breaks easily. The teeth are also prone to cavities. They will have a brown “mottled” appearance. Bones are also susceptible to fluorosis. Excess fluoride is stored in the bone, and the bones can be brittle and more prone to fractures.
Dr. Val: So if small amounts of fluoride are good for us, why are the British so hesitant to add it to their water supplies?
Dr. Garcia: Many European countries, such as Britain, have been slow to adopt fluoride supplementation due to high levels of other natural sources providing an adequate amount of fluoride in the diet. Tea has been shown to contain from 1ppm to 6.5ppm fluoride concentration. In the U.S., the recommended concentration of fluoride is 1.0-1.2ppm/day as recommended by the USPHS. So regular tea drinkers get enough fluoride naturally. There is also strong anti-fluoride opposition in the public with fears of “forced immunization” and possible adverse health side effects.
Dr. Val: Should people living in areas where the water supply is not fluoridated take additional steps to get more fluoride?
Dr. Garcia: Areas that lack fluoridated drinking water should seek other sources for optimal fluoride intake. The best way is to contact your dentist or pediatrician. Supplements in the form of pills or topical gels can be prescribed to supplement a lack of fluoride. Care must be taken to avoid over supplementation. If the community receives its drinking water from an underground source, they may already be ingesting a higher level of fluoride than is necessary. Toothpaste is also a good source of fluoride. Care must be used in infants as they swallow the toothpaste unknowingly.
Dr. Val: What about those additional fluoride treatments that I had as a child? Are those really necessary?
Dr. Garica: Fluoride should only be used in individuals at high risk for cavities. Kids with braces, a high caries rate, adults with xerostomia, these are ideal candidates for fluoride use. I have all patients learn about fluoride and they make a choice for themselves. I personally will not use anything stronger than an OTC toothpaste for myself and family. Fluoride is a known toxic substance that irreversibly binds to the hard tissues of the body. I am wary of the long term effects of any non essential diet supplement. It is equal to taking antibiotics constantly to stave off a possible infection. Good oral hygiene will keep an individual cavity free. Only in rare cases is someone genetically predisposed to cavities. It is usually a consequence of diet (refined foods) and poor oral hygiene that causes the decay.
For more information, check out Revolution Health’s Dental Health Center
.This post originally appeared on Dr. Val’s blog at RevolutionHealth.com.
