April 2013
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April 2013 posts

Cardiac risks associated with radiation therapy following breast cancer

Recently, there has been increasing media attention to the risks of heart damage associated with adjuvant breast cancer radiotherapy.

This observation and debate has been ongoing for a long time in medical literature. Most recently, an article in the New England Journal of Medicine concluded that adjuvant radiotherapy for breast cancer increases the rate of ischemic heart disease. The authors conclude that the risk is associated with the dose of radiotherapy to the heart and begins a few years after the treatment. Dr. Kesarwala, an expert radiation oncologist from Bethesda, reviewed the data and provided a report in the April issue of the ACR Journal Advisor. She noted that “nearly 80% of patients in this study had mastectomies and over 90% had adjuvant chemotherapy with regimens very different from those currently used. This study mixed lymph node-positive patients (48%) with lymph node-negative patients, two sub-populations with different expected overall survival who would also have received different types of radiotherapy.” Other variables such as stage, presence of internal mammary nodes, type of surgery, or details of radiotherapy were not matched between the control and treated patients.

Because the study does not provide details regarding the radiotherapy specifically, it is difficult to interpret the conclusions. The doses of radiotherapy delivered ...

Why is it hard to swallow?

Many people suffer from difficulty swallowing (dysphagia) acutely or chronically. Difficulty with swallowing may be a result of a problem anywhere from the lips to the stomach. It may be identified by weight loss, coughing or choking when eating, delayed cough or regurgitation, or outright obstruction. This is more likely to be an issue after a stroke or in elderly and frail individuals. In the inpatient population, symptoms suggesting some level of dysphagia may be as high as 34%. So what do you do if you feel like your swallow isn’t quite right?

Cancer and the culture of desperation

Cancer “diagnoses” are popularly characterized as death sentences preceded by periods of horrible suffering. This characterization, popularized by media of all types (from movie to the pages of the New York Times), is in fact what motivates much of the real problem of cancer … desperation.

What if the conditions for success could be known?

Is Robotic Surgery Right For You?

In recent years, there has been a surge in the popularity of robotic surgery. This is an exciting new technology that is being actively used by many specialists here at Swedish. In General Surgery, we have been using a minimally invasive approach called laparoscopy for many years. This allows us to use smaller incisions, giving the patient much less pain and a quicker recovery.  Robotic surgery is very similar.

Here are the answers to some frequently asked questions about robotic surgery:

Are incisions smaller with robotic surgery than with laparoscopy?

No. The incisions are pretty much the same. As a patient, you might not be able to tell much of a difference from the surface.

Do the robotic instruments allow the surgeon to perform a better operation?

High blood pressure in the doctor’s office

“I don’t get it! Everytime I come to your office my blood pressure is high. It’s never like that anywhere else!”

“White Coat Hypertension” is very common and affects many people, even those who feel at ease with their physician. But whether your blood pressure is low or high at the doctor’s office, if you’ve been told you might have hypertension, you are likely to find yourself at home, or in a grocery or drug store with your arm in a cuff trying to figure out if your blood pressure is reasonable. A key to successful self-measurement is knowing the proper technique.

The big studies of blood pressure in the population upon which we base all our definitions of normal and high values were careful to take their measurements in a standardized way. The patient should avoid coffee, tea, nicotine, and other stimulants for at least 30 minutes prior to the test. She should sit quietly for a full 10 minutes reading or softly conversing before measurement. Even reaching across the table to pull the BP cuff near is to be avoided. (Get the machinery next to you when you first sit down.) Use an upper arm cuff. Forearm and finger devices are not reliable. Feet should be flat on the floor, clothing comfortable, and a bare arm may be needed for some machines. Two or three measurements a few minutes apart may be averaged.

A few caveats to mention: if one arm is higher than the other, you have to go by the higher side. Humans have a natural ‘diurnal’ variation, with most of us having a little higher blood pressure in the morning compared with later in the day. Blood pressure rises with physical and mental exertion and takes some time to come down, so don’t expect a resting value if you’ve not been at rest for 10 minutes or more.

Blood pressure is dynamic and always changing. The majority of values should be in a good range; your physician can help you determine if your numbers are in the range you need for optimal health.

Fecal Incontinence: You don't have to live with it

Bowel incontinence is a socially disruptive condition. People living with incontinence often plan their daily activities around bowel movements. In some instances, fecal incontinence leads to people being homebound, fearing an accident in public. Fecal incontinence affects nearly 18% of the population. In addition, nearly 50% of people living in nursing homes are affected (ASCRS, 2011).

What Is The Cause of Fecal Incontinence?
There  can be several causes of fecal incontinence. The most common reason is damage to the anal muscle, or nerves with childbirth.

Incontinence is more common in women, but men are also affected. As women age and their tissues begin to weaken, episodes of incontinence can become problematic.

Other causes of fecal incontinence can include...

How to Treat Different Types of Acne

I recently appeared in a video where I discuss the different types of acne and various ways to treat them. Click here to see the video or watch below:

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