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Why aren't my bowel habits normal?

Do you have irregular, uncomfortable, or distressing bowel habits? Irritable Bowel Syndrome (IBS) is the most common gastrointestinal condition affecting an estimated 15% of the general population.  It is most common among women aged 30 to 49 years old.

IBS is a chronic condition of the digestive system that is not generally associated with more concerning findings of anemia, weight loss, family history of colorectal cancer, inflammatory bowel disease, or celiac disease. Symptoms of IBS include abdominal discomfort, constipation and diarrhea. Despite extensive research, no common cause of IBS has been identified. Some theories include:

When you should seek treatment for abdominal pain

As a general surgeon, the majority of my practice is spent evaluating patients with abdominal pain and deciding whether the cause of their pain requires surgical treatment. These patients are only a small fraction of the number of people who seek medical attention for abdominal pain. Abdominal pain is fairly common and something almost all of us have experienced. Usually it is not cause for alarm and resolves on its own after a limited course if we wait and treat symptomatically. We have all had a moment however when we wondered whether this time was more serious, and how would we know if it was?

Every organ in the abdomen and pelvis (including the muscles and skin of the abdominal wall) has nerve endings and can cause pain. While nearly everyone has experienced abdominal pain, it is usually self limited and mild. Think antacids for heartburn symptoms, diet modifications for food intolerances, fluids and time for gastroenteritis, stool softners for constipation. While more severe causes of abdominal pain are rare, it is important they are recognized as they may have more severe consequences to health.

Only 15%-20% of people with abdominal pain require surgical treatment (this number increases with age). The most common reasons for surgery are  ...

When do kids need antibiotics?

Winter can seem like one long continuous “sick day” for families - kids pick up frequent infections at school or daycare and pass them around to everyone at home.  Often it feels like by the time the illness has worked its way through the household, a new one has started!  Even for physicians, it can sometimes be difficult to distinguish between viral and bacterial infections.  Since antibiotics cannot treat viruses, they are often over-prescribed - which can lead to significant side effects in children and also contributes bacteria becoming resistant to existing medications.  In November 2013, the American Academy of Pediatrics released an updated guidance regarding antibiotic treatment, helping answer the frequently asked question about when kids need antibiotics.

Here's what you should know about antibiotics in these situations:

  • Ear infections ...

FDA finally defines gluten free

On August 5th, 2013, the U.S. Food and Drug Administration (FDA) at long last published a formal rule regulating the use of the term "gluten free" on foods and beverages.  Even though this came with a big sigh of relief to the millions of people with celiac disease living in the US, consumers should be aware that the law gives manufacturers one year to be in full compliance (and goes into effect August 5, 2014).

As we head into the final months before the law’s final compliance date, I thought I’d highlight a few other key points about this brand new law:

1. No symbols needed.  The law does not require or recommend manufacturers use any particular symbol or food label, but if a label should include any of the following phrases, compliance must be ensured:
    •    “Gluten-free”
    •    “Free of gluten”
    •    “No gluten”
    •    “Without gluten”

2.  It’s voluntary.  A manufacturer may produce gluten-free foods, but just choose not to label them as such.   

3.  “Gluten-free” does not mean “zero gluten”. The new law defines "gluten-free" to mean that a food contains less than 20 parts per million (20 ppm) of gluten.  (This tiny amount can be visualized as less than a tenth of a grain of salt on a slice of bread, and is acceptable as the standard for people with celiac disease).

4.  As with any rule, there are exceptions.  Although ...

What you should know about multiple myeloma

Recent news about the health of the distinguished journalist, Tom Brokaw, has focused attention on multiple myeloma, a malignant disease of the bone marrow. Myeloma is characterized by an uncontrolled growth of marrow plasma cells, which normally produce antibodies for our immune system. In its advanced stages, the overgrowth of these cells and their associated proteins can cause anemia, painful bone destruction, and kidney failure.
 
Until about 10 years ago, advanced myeloma was uniformly fatal with a typical survival of about 3 years. Recent years, however, have seen a remarkable improvement in treatment possibilities for myeloma. This began with the discovery that autologous stem cell transplantation could produce complete remissions and longer survival. In addition, a variety of chemotherapy drugs administered in combination with corticosteroid drugs, now produce responses in up to 80% of patients. This means about 80% of patients are surviving longer than 3 years after chemotherapy and autologous stem cell transplant.
 
Not all patients with myeloma require chemotherapy. Myeloma can exist in an early stage for years. This is called smoldering myeloma. Chromosome analysis is routinely done on myeloma cells and allows us to identify patients with more aggressive forms of the disease, and those requiring treatment due to signs of organ damage or bone pain.
 
The Swedish Cancer Institute has been a participant in clinical trials leading to the development of some of the effective new treatments for myeloma. We are currently participating in a study of pomalidomide, a newly approved agent, for patients with relapsed myeloma. Another study offers an investigational drug, MLN9708, for newly diagnosed patients.
 
While the new drugs are more effective and better tolerated than previous chemotherapy, all  ...

Pivotal time for chronic hepatitis C treatment

An estimated 2.7-3.9 million people in the US are chronically infected with hepatitis C.*  Patients are often diagnosed incidentally, when they donate blood, get life insurance or get a routine physical exam with blood tests showing normal or abnormal liver enzymes.  They may have been diagnosed many years ago with non-A, non-B hepatitis, but forgot about it, never followed up, or did not mention it to their regular health care provider.  In 2012, the Centers for Disease Control (CDC) issued additional recommendations to start screening “Baby Boomers,” those born between 1945-1965.  Though Baby Boomers account for 3.25% of the US population, they account for 3/4 of the hepatitis C infections.*

Patients may have seen a health care provider in the past and told that there is no treatment, that treatments were not effective, or not worthwhile due to side effects.  Patients have been reluctant to seek treatment because they have heard about the terrible side effects associated with treatment, including flu-like symptoms, fatigue, depression, muscle aches, rashes, etc, lasting up to a year. 

However, this is a pivotal time for hepatitis C patients because treatment has improved by leaps and bounds.  In late 2013, two ...

Breast Cancer Survival Guide: Physical & Clinical Updates

A diagnosis of breast cancer sets into motion a whirlwind of appointments, tests, surgeries and possibly chemotherapy and radiation treatment. A new study reviewed the timeline between surgery and initiating chemotherapy for different subtypes of breast cancer and found a survival advantage when chemotherapy was initiated within 30 days of surgery. Although treating within the 30-60 post-surgical window did not show a statistically significant survival advantage, there is a trend towards better outcomes. Exceeding 60 days post treatment had a negative impact on survival. The clinical impact of timing is most relevant for patients with stage II and III breast cancer, triple negative breast cancer and HER2-positive tumors.
 
Treatment for breast cancer can be exhausting and take a toll on the physical health of patients as treatment ends and they begin post-treatment life. Cancer survivors are at an increased risk of poor health, depression and physical disability. Approximately one third  ...

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