CMN: Managing with care

Source: Dr Shang Yeap, MBBS, FRCP, Consultant in Medical Oncology, Johns Hopkins Singapore International Medical Centre

Non-governmental organizations, volunteer groups and hospitals have created national awareness, encouraged breast screening, promoted the benefits of treatment, celebrated success stories of breast cancer survivors, and honored those who fought bravely.

Sad to say, too many women in Singapore and Southeast Asia continue to be plagued by this disease and the numbers are increasing every year. This has to stop! Preventing breast cancer is achievable and not painful.

First, we need to identify strong risk factors that will likely lead to developing breast cancer. Some of the risk factors we identify today, such as early start of menstruation, late childbirth, high fat diet, obesity, and mothers with no breast feeding experiences are helpful, but are not strong risk factors. They are only indirectly related to the development of breast cancer and account for modest increases in risk. Do not get me wrong, I’m not implying that eating right, cutting down on alcohol and quitting smoking are not important in preventing breast cancer. Those are still essential activities that we should try to implement in our daily lives.

The general public has to know that there are also strong risk factors linked to biological and genetic changes occurring in the breast, which causes a normal healthy breast to become cancerous. About 5-10% of breast cancers are linked to hereditary causes. An example is the mutation is the BRCA1 or BRCA2 genes. Women with these mutations are extremely likely to get breast cancer.

Research in breast cancer is constantly progressing in terms of new therapies. Whether an intervention comes in the form of a dietary supplement or drug, it cannot be too costly and should have minimal side effects. Many new drugs used today, such as, tamoxifen, raloxifene, and exemestane, have certainly prevented many women from getting breast cancer.

For now, mammography remains as one of the most effective preventive measures for women above the age of 40 years. Firstly, there is no other breast cancer screening tool that has a better combination of sensitivity and specificity. The use of MRI (magnetic resonance imaging), though touted to be more sensitive than standard mammography has a tendency to cause unnecessary “false” alarms. It is also costly. Secondly, mammography is well tolerated and relatively inexpensive. If more can be done to improve mammography – to make the process less painful and that will certainly reduce incidences of breast cancer.

I participated in the “Race against cancer” held in July 2011 that was organized by the Singapore Cancer Society. As I watched the runners and walkers stream past the finishing line, I was impressed that we are on a mission. We are out to overcome cancer. As the theme proclaimed – “Race against cancer”, defeat is not an option for many of us.

Source: Dr. Chuck Freedman – Associate Medical Director, CMN Global Inc. – A Europ Assistance Group Company

Sugar, although it seems quite sweet, it may be the most lethal thing we ingest in our lifetimes. It has been called white gold and sweet salt, and has been an incredibly valuable commodity, but now it is put in almost everything we eat or drink! Amazingly it was discovered only 8000 years ago and up until approximately 40 years ago it was used sparingly. In the 1930s Americans consumed the equivalent of ¾ teaspoon a day, and unbelievably, by the 1970s consumption increased to over 109 pounds per person per year. Now the demand for sugar has decreased since an even more sinister sweetener has become available. That product is high fructose corn syrup, a liquid form of sugar, which is now put in fruit juices, baby formulas, cereals, sodas and almost everything else. Sugar consumption has now increased to over 170 pounds per person per year! Just writing these figures is giving me diabetes!

Seriously, the amount and type of sugar we are all now ingesting is more of a poison than a treat. To paraphrase Dr. Robert Lustig, a pediatric hormone and childhood obesity specialist at UCSF, white sugar and high fructose corn syrup, when consumed in sufficient quantities or in a liquid form, go straight to the liver where they are converted to fat. That fat is then responsible for inducing insulin resistant diabetes. Another term for this is Type 2 diabetes or “adult-onset diabetes”, the latter , no longer an appropriate moniker, since there are now so many adolescents and young children with this condition. According to a 2007 report from the World Cancer Research Fund and the American Institute for Cancer Research “the western diet high in refined sugars manifests itself through obesity, diabetes, fatty liver, and metabolic syndrome. This increase in insulin resistance leads to the secretion of more insulin which acts like a growth factor for cancer cells and promotes tumor growth”. This is an unbelievably scary statement and should be enough to inspire anyone to decrease their daily sugar intake.
Unfortunately it is not that easy to do. It is unbelievable how much sugar is in sodas, especially super-sized ones, and sugar is added to so many canned, bottled and processed foods so we often don’t even know when we are consuming it. In addition reports have shown that sugar is addictive, and acts on the brain in similar ways as do cocaine and heroin. People who stop it too quickly have shown signs and symptoms quite similar to drug or alcohol withdrawal. There are many sugar substitutes, but their safety is highly debated, and they may even “fool the body” into thinking it is ingesting sugar and then it produces insulin and then may lead to the same long-term effects as sugar.

My recommendations would be to try and cut by at least ½, the amount of sugar that anyone ingests, as well as drinking plenty of water, instead of sodas, fruit juices or sports drinks. I would certainly decrease candy intake and of course, exercise frequently. In addition, if you are able, eat more natural home-grown foods and check labels of canned or bottled foods you eat for the amount of added sugars. Not only will you be helping yourselves, but you will be helping society in general, since diabetes is such a drain on medical budgets around the world.

In writing this blog I paraphrased liberally from a Kaiser Permanente Positive Choice Wellness Center article, because I believe what was written was expressed well and was so highly informative.

Source: Oncology Referral Network of America (ORNOA)

Something as easy as hanging a picture requires a ruler or other device to make sure it’s leveled. Dr. William A. Leone, Orthopedic Surgeon and head of the Leone Center for Orthopedic Care in Ft. Lauderdale , took what may seem like a simple concept and applied it to total hip replacement surgery by inventing the Pelvic Alignment Level™ or PAL, a surgical device that allows for greater implant precision when performing total hip replacements. The PAL is receiving recognition throughout the orthopedic community, including a published article in Techniques in Orthopaedics, September 2011, as a powerful, new tool that helps to facilitate accurate component positioning and proper leg length during and after total hip replacement surgery. What this means for orthopedic surgery patients is that during surgery, when a patient’s position may shift, PAL readings assure that the artificial joint maintains proper positioning for a better outcome including correct leg length and angle of the prosthesis. According to Dr. Leone, “This device eliminates the ‘guess factor’ and the potential for error when relying strictly on visual assessment for prosthesis placement.”

Using the PAL during surgery does not require surgeons to significantly alter operating techniques. The PAL device has a sterile bubble level, similar to common construction levels, which attaches to a small pin anchored in the pelvis. It allows surgeons easily to see pelvis movement by monitoring the bubble level. The PAL also can be placed on instruments used to implant the prosthetic hip cup, directly measure cup position and is equipped to measure leg length. “PAL gives surgeons a simple method to visualize unintended pelvic motion which can occur during surgery and to make any necessary corrections,” added Dr. Leone. “There has been a need for this type of device for hip replacement surgery, especially with use of smaller surgical incisions and an increased rate in obesity.” As the baby boomer generation ages, the number of total hip replacement surgeries is predicted to increase. According to a study by US Markets for Large-Joint Reconstructive Implants, more than 400,000 total hip replacements are performed annually in the United States alone.

Re-doing a hip surgery, called a revision, can be painful and reduces mobility. Revisions also result in higher costs, because the patient or insurance company has to pay for the new corrected surgery. A tool like PAL, invented by an experienced orthopedic surgeon like Dr. Leone, reduces the likelihood of revision surgery. “I invented the PAL because I saw the need,” said Dr. Leone. “It’s all about balance, providing a better experience for my patients and helping people return to full and active lives.”

Dr. William A. Leone for the past 20 years has helped thousands of patients from around the world and today his practice focuses exclusively on solving complex hip and knee problems, including hip and knee replacement surgery.