December 2012
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December 2012 posts

Tis The Season for Travel - Travel Food Tips

With the busiest long-distance travel period upon us, and my own upcoming 29 hour flight itinerary, I thought it would be an appropriate time of year to present my two favorite topics as one: travel foods!
Whether you are boarding an airplane or cramming into the car, providing the right fuel for your body can support an enjoyable travel experience and deliver you at your destination feeling energized and (physically) prepared for your visit.

Traveling by air

Nearly 90 million Americans already have digestive issues, so 35,000 feet up is not the time to exacerbate existing disorders or experiment to see if you can contribute to this statistic. Here are some general flight food tips to keep your tummy travelling well.

  • Carbonated drinks. Stomach gases already expand by approximately 30% when you reach flying altitude, hence why downing bubbly beverages can make you feeling like Mr. Clause by the time you are deboarding.
  • Alcohol and caffeine. Sure that Jack and Coke takes the edge off turbulence, but alcohol and caffeinated beverages contribute to dehydration. Besides irritated skin and eyes, this can also put you at greater risk for respiratory infections and DVT (deep vein thrombosis). After clearing security, fill or purchase a water bottle and bring onboard, sipping 8fl oz every hour onboard.
  • Avoid fried, fatty foods before flight. These foods are already taxing on the GI system (fatty foods take longer to digest), but when traveling at even higher altitudes can cause exaggerated complaints of heartburn and acid reflux.
  • Cruciferous vegetables. Wait, did the dietitian just say I don’t need to eat broccoli? These cruciferous vegetables (Brussels sprouts, cauliflower, broccoli, cabbage) contain a complex sugar, raffinose, which results in excess gas production in the intestines. Pre-flight is the only time you’ll catch me advising you to stay away from these nutritional powerhouses, as the decrease in cabin pressure results in expansion of stomach gases and a not-so-comfortable traveler. They get the thumbs up the other 360 something other days of the year.
  • Legumes. Skip the chili before you board. Beans have a high raffinose content, and are loaded with difficult to digest soluble fiber.
  • Dairy. Milk and dairy contain lactose, and many of us have a threshold as to how much we can tolerate as we need an adequate amount of the enzyme lactase to breakdown lactose before running into trouble.

Suggestions for in-flight meals:

Traveling by ground

Although you may have the option of stopping during your car trip, it may be smarter to pack your own foods to ensure your tummy remains a happy traveler. For the sake of your car-mates, I would advise avoiding most of the aforementioned flight foods above if you already struggle with these on the ground. I would also emphasize simple, ‘no-assembly required’ foods for car travel. You also have the option of packing a cooler to keep foods safe while en route.

Suggestions for car-trip snacks and meals:

  • Bars (Larabars, Odwalla): Select a bar with at least 3g dietary fiber and 5g protein.
  • Fresh fruit (wash before packing in the car): Avoid those with pits (cherries). Try single serve applesauce.
  • Easy-to-eat veggies: Pre-washed cherry tomatoes, baby carrots, broccoli florets served alongside a thick (no-drip) dip.
  • Yogurt and berry parfait: layer yogurt, fresh berries in traveling cup and seal with a lid).
  • Simple sandwiches: toast bread before adding spread to avoid soggy sandwiches.
  • Wraps: layer hummus, lettuce, veggies and seal in foil or saran wrap.
  • Homemade trail mix: chex mix (or low sugar cereal), toasted nuts, air popped popcorn, dried fruit packed in ziplock.
  • Instead of soda: Water, 100% vegetable or fruit juice (can be cut with seltzer water).

Whether traveling by air or ground, make sure you consider the foods pre-trip to ensure you are as comfortable as possible while traveling this season!

Does it make sense to use two or more drugs in second line therapy for lung cancer?

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Healthy holiday eating and drinking tips

Happy (healthy) holidays! Here's a roundup of great tips, recipes, and videos to help you make decisions about what to eat or what to make & bring to holiday gatherings:

Deciding on surgical treatment for breast cancer

A recent article in the Seattle Times references the 2012 Dartmouth Atlas Report: Improving Patient Decision-Making in Health Care. Unfortunately their take home line, "A new report that found wide geographical variation in the use of elective surgical procedures in Pacific states reflects the preferences of physicians – not what patients want or need, the authors say,” oversimplifies a complicated situation.

On my reading of the report, it stresses the values that an individual woman brings to the decision:

“Different women will prefer one option or the other, depending upon how much they value preserving their breast, their willingness to undergo radiation or more invasive surgery, and the level of uncertainty they are willing to live with in terms of their cancer recurring.”

As a breast surgeon who has practiced in Seattle for almost 40 years, I don’t believe that “the preferences of physicians” are the driving factor. I have a few observations to make.

It is clear that wide variations in treatment of early stage breast cancer can be seen across the USA, as the Dartmouth-Atlas data confirms. Some factors that influence this are physician related – for example, what % of their surgical practice involves treating women with breast cancer. Specialists in breast cancer or general surgeons who treat large numbers of women with breast cancer are motivated to be current in their practice patterns and to make sure that their patients are making considered decisions. The utilization of breast MRI has been shown to influence the mastectomy rates and there is regional variation in the use of that study. Distance to a radiation oncology treatment center is a factor for some women as are potential differences in out of pocket costs between mastectomy and breast conservation.

All of the local breast surgeons that I know strongly value shared decision making with their patients. We all work hard to present treatment options fairly and as neutrally as possible. If we have a patient that we think is choosing mastectomy over breast conservation out of fear – for example, fear of radiation therapy – we will encourage her to consult with a radiation oncology specialist prior to making a final decision. We believe that one of our roles is to help our patients make informed decisions. If there are clear medical reasons why one treatment is preferred, we will state that but otherwise encourage the patient to make the best decision for herself.

For example...

Two key questions to answer in a suspected cancer workup

There are two questions to be answered if cancer is suspected:

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Dysphagia - what it is, what can be done, and why you should speak with your provider if you have trouble swallowing

Dysphagia. This is the technical medical term for difficulty swallowing which is a common complaint. Most people have experienced this sensation in their lives. It can occur when you’re eating something doughy like a bagel or French bread and then take few extra bites before swallowing. If you immediately swallow several times in a row you may get the sensation that the food is slowly passing toward your stomach. Your mouth may salivate; you might get a pressure sensation behind your breastbone; you might experience some pain, burning or discomfort. And, then you will feel instant relief the second the food you swallowed passes from the esophagus into the stomach. This is dysphagia.

For most people, this experience occurs very occasionally and usually when we are trying to eat too much, too quickly.

However, for some patients this symptom may occur more frequently such as daily and sometimes as often as every bite of food. It may also occur with solid food alone or with both solids and liquids. Most people will hope that the symptom will resolve by itself. Over time, they will often change the way they eat to avoid the symptom. They will eat slowly and chew their food till it resembles a paste, or they will use water to make things runny which then allows the food to pass.

What is interesting is that patients are reluctant to see or discuss this symptom with their physicians. In the last few months, I have seen patients who have had the symptom of dysphagia anywhere from 1 year to 40 years before they believed it was important enough to seek medical advice. The simple truth is that dysphagia that happens regularly or requires changes in the way you eat should be reported to a physician to determine the cause of the trouble.

What causes dysphagia?

There ...

What patients should know about small cell lung cancer

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