Monday, October 20, 2014

College Student Health: UK versus the US

A recent study found that compared to UK college students, US college students live a healthier lifestyle. As a percentage, UK students smoke twice as much as US college students (39% vs 16%). This in part may be due to the 1,478 smoke-free campuses in the US, of which 976 are 100 percent tobacco-free and 292 prohibit the use of e-cigarettes anywhere on campus. US students also self-reported greater fruit & vegetable consumption and greater physical activity. Read More

Thursday, October 16, 2014

The Prevention of Breast Cancer

Breast cancer continues to be a prevalent, and deadly cancer. It is the most common cancer in women and next to lung cancer, the second most common cause of death from cancer in women. 
A recent column in the Times Colonist lamented that with all the focus on screening and the use of mammography, what gets lost in the story is the need to pursue aggressive prevention strategies such as a health diet and adequate exercise. With the recent U.S. and Canadian governments issuing major guidelines on the use of a technology, and another recent U.S. Food and Drug Administration change in approval for a pharmaceutical, one has to wonder why isn't more attention being paid to prevention? 
There are strong evidence based recommendations on how to prevent breast cancer. One is to eat a healthy diet. This means maintaining a healthy weight and for most of us eating more vegetables. A major goal is to increase the fiber-to-sugar ratio in the diet. 
Exercise has been shown consistently to positively affect the healthy life span. This is also true when it comes to breast cancer. Not only is exercise a preventive strategy, it likely is also of benefit to increase the percentage of otherwise health, cancer survivors. 
The situation with alcohol usage is not as clear. It appears to increase the rate of breast cancer but when taken in moderation, also decrease the risk of an adverse cardiovascular event. Smoking, because of its strong association with other severe diseases, namely lung cancer and heart disease, is not recommended. Greater emphasis toward smoking cessation, or ideally never starting, would thereby make an enormous impact upon women's health. 
Alberta Physical Activity and Breast Cancer Prevention Trial: Inflammatory Marker Changes in a Year-long Exercise Intervention among Postmenopausal Women. Friedenreich C, Neilson HK, Woolcott CG, Wang Q, Stanczyk FZ, McTiernan A, Jones CA, Irwin ML, Yasui Y, Courneya KS. Cancer Prev Res (Phila). 2011 Oct 7. [Epub ahead of print]
Effect of supervised and home exercise training on bone mineral density among breast cancer patients. A 12-month randomised controlled trial. Saarto T, Sievänen H, Kellokumpu-Lehtinen P, Nikander R, Vehmanen L, Huovinen R, Kautiainen H, Järvenpää S, Penttinen HM, Utriainen M, Jääskeläinen AS, Elme A, Ruohola J, Palva T, Vertio H, Rautalahti M, Fogelholm M, Luoto R, Blomqvist C. Osteoporos Int. 2011 Sep 3. [Epub ahead of print]
Vegetables, but not pickled vegetables, are negatively associated with the risk of breast cancer. Yu H, Hwang JY, Ro J, Kim J, Chang N. Nutr Cancer. 2010;62(4):443-53. Erratum in: Nutr Cancer. 2010 Jul;62(5):700.
Published by Tom Heston MD 11/30/2011
Tom Heston MD is a Johns Hopkins trained physician who practices clinical medicine in the Pacific Northwest.

Wednesday, October 15, 2014

Thus Came the Opportunity

A villanelle on the meaning of community

The important thing was integrity.
Especially at first, from the start.
Thus came the opportunity.

As he joined the crowd in gaiety
acting together came music and art,
the important thing was integrity.

Who was he, what was destiny?
A shadow, yes, but unique and a lark.
Thus came the opportunity.

So venture adventure, ride calamity
he thought. This was his truth, his art.
The important thing was integrity.

Then came the curious trip, a bold serenity
coming from his spirit and deep in his heart.
Thus came the opportunity.

This is the strength of community:
the people together yet uniquely apart.
The important thing was integrity.
Thus came the opportunity.

Going Home for Christmas

All she wanted was to go home for Christmas.

As I looked down upon her, laying there on the hospital bed as she constantly gasped for another breath, it was clear that there was no cure. There was no earthly salvation that would bring her back to what she used to be, many years ago, in her youth.

She once was a lively, young and energetic woman. Got married. Had kids, even grand kids. But for some reason, a long time ago, she started smoking. Now she was paying the final price. End-stage emphysema with a constant air hunger that nobody could satisfy.

In between short breaths, she spoke one or two words at a time.

"Please.... help me.... I want.... to go.... home.... for.... Christmas."

I nodded in assent. Sometimes a physician cannot cure, cannot heal, and the chance for prevention long past. But this wish of hers, maybe I could help give her some comfort.

The family came in later that day and we talked. They understood that the number of mom's days were coming down to the single digits. They knew there was nothing more that medical science could do for their mother. And they agreed. Mom would spend her Christmas at home! Not in a hospital ward. Not in her hospital bed. Home!

Then, later, when doing my evening rounds on my patients, the nurse told me the family had changed their mind. Taking care of their mom at home would be simply too much, they said. It would ruin Christmas, for years to come. "We need to leave her here so she can have a nurse, a doctor, and all the medical equipment nearby," they said.

So along came Christmas, and it was my turn to cover the hospital for the group of physicians I worked with. I had two young boys at home, a loving wife to go back to. But they understood. Today would not be my last Christmas spent at the hospital.

My patient again looked at me with pleading eyes, gulping in small bites of air. It was clear to all of us that her number was now down not to days, but to hours. Terminal disease, that's what we called it. We had done absolutely everything we could medically. Those damn cigarettes, we'd say. But nevertheless, the time was close. Maybe yet I could do something for her. Maybe my calling was not to simply apply medical technology, but to give of my spirit, and share my soul. Maybe.

So I sat with her. We held hands. And the time, well it came peacefully. Without drama or fanfare, but with serenity and calmness. Our hands clasped, we spent the moment together in that empyrean realm beyond words.

She got her Christmas wish.

Peace. Friendship. And going home.

The New Idea Out West

Old doc Clarence filled his black medical bag back up with the tools of his profession: several knives, his glasses, some bandages, a few potions, some whiskey, and needle and thread. It was over. Now things fall into the hands of nature, whether to take its course towards death or turn back towards life.

"I've done everything possible, Ma'am." he said to Mrs. Turner. He had forgotten her name so just said Ma'am.

With that, he wrapped up in his coat, hat, and gloves, bracing himself for the cold outside. Doc Clar was practical, no-nonsense, and effective. From his boots, to his horse, to his medical bag, his way was simple practicality.

"And you might want to clean things up with some soap and water" he said as leaving the warmth of the hearth and the seriousness of the family emergency. He was asked to help, he had done his best.

His not-so-close neighbor, Franklin Turner, farmed barley to support his wife and two young boys, both of whom were under 3 years of age. It was when riding out into the field that his horse got startled, jumped, and threw Frank off the saddle and onto that craggy tree root. His head was headed straight at the twisted shard of thick tree roots, but at the last split-second he was able to throw an arm in front of his eye, saving his vision but causing a deep gash into the meat of his arm. His right arm. His dominant hand. His work hand. He was thinking about the survival of his family. What would this injury mean?

What good could he do without the use of his right arm? Plenty, yes, but it would slow him down, and he even knew of some people who would die of such a wound. What he could do in an hour with both arms now would take two hours, or three hours, or even longer. A good thing doc Clarence was nearby.

"I'll keep it clean, just like you say, doc."

Frank would follow that crazy man's advise, and use plenty of soap and water to keep things clean. Doc Clar wasn't the fanciest dresser, or the most talkative person around, but he did seem to get results. It was Frank's best chance.

"Uh-huh" the doc grunted as he went out to his horse.

He was going to miss dinner again, not that he was hungry anyway. The country roughened doctor's thoughts were consumed with that new idea from Europe, that a clean wound heals better. Made sense. He just hoped that crazy Hungarian Semmelweis was correct, and that it would help.

Frank Turner was a good man, a good father, and although they weren't that close, Clarence considered him a friend. Maybe hand washing really did work. Maybe. At least that's what his buddy told him over a beer at the tavern. Maybe it would even work for Frank.

"Come on, Ginny" he said to his horse, as they started the long, night, ride. Back on the trail, back home.

What's Inside

I fear becoming my patient.
Positron emissions where they shouldn't be,
x-ray deflections that aren't quite right.

On the outside he smiles,
with only the faintest hint
of the terrible, tragic, and
deathly wrong.

I give the radioactivity
- yes I'm helping! -
then, bad news comes,
the disease progresses,
and pain happens.

The wife, the child at home,
the things left undone.
The great beyond of forever.
An unstoppable tsunami,
not far off.

So I smile warmly.
We share a laugh.
We still have this moment.
We still have this joy.

The burst of light we share can't be seen,
yet it shines brighter
than the photon flux,
that hits the crystal,
inside my camera.

The scan is real,
but what does it reveal,
about what's inside?

The Power of Snow (Haiku)

The coughs and the colds
and all the runny noses
cured by winter's snow.

The ABC's of Heart Health

Although many heart problems cannot be prevented, there are a few principles that will at least lower your risk of getting heart disease or suffering from complications of existing heart disease. While you should always consult your personal health care provider first, my patients have found that this simple ABC plan helps them focus on what is important. 
A- stay ACTIVE. This is perhaps the most important principle of good health. Science has consistently shown that regular exercise not only helps you stay healthy, it also helps prevent the development of many heart diseases. Regular exercise can lower the risk of heart disease and evens some forms of cancer. In addition, it seems to be helpful in lowering the risk of diabetes, obesity, and high blood pressure which all can contribute to heart disease.
B- regularly check your BLOOD PRESSURE. In most cases, high blood pressure occurs slowly, and does not cause any symptoms. You could easily have high blood pressure, but not even know it! Be sure to get your blood pressure checked using a machine that is regularly calibrated so that the results are accurate. Good blood pressure control helps reduce the risk of heart disease and stroke.
C- control your CHOLESTEROL levels. High cholesterol levels, over time, can increase the risk of coronary artery disease, peripheral vascular disease, and stroke. High cholesterol levels are almost always entirely asymptomatic, meaning that you need to get a blood test in order to know if your levels are increased. Although cholesterol levels typically go up with increasing weight, in some people there is a genetic predisposition, and their cholesterol levels may be increased even though they have a normal body weight. If your cholesterol levels are high, there are several different options of getting it back into the healthy range, so feel comfortable getting medical treatment for this. High cholesterol levels do not necessarily mean a lifetime of taking a prescription medication.
D- consume a healthy DIET. Perhaps the most important component of a healthy diet is to maintain a healthy weight. So eat a wide variety of foods, but be particularly careful about controlling your calories so your weight is in a desirable range. Most people could benefit from eating more green vegetables and less sugar. It sometimes seems like there are millions of different diet programs available, but the major objective is to control your calories with a healthy diet that you enjoy and can follow for a long period of time. A good start is the MegaSimple Diet which emphasizes more fiber and less sugar. Of course, a healthy diet means that you DON'T SMOKE and don't abuse alcohol or other drugs.
E- make sure you ENJOY LIFE. A happy and positive outlook seems to help the heart stay healthy and strong. Although there are many things you cannot control, having an optimistic view of your life can improve your situation. We cannot prevent all heart disease, and cannot control our genetics. Accidents and sporadic illnesses occur, and even if we live a perfect life we are still vulnerable to random diseases and accidents. So enjoy the present moment, today.
That's it ! Stay ACTIVE, control your BLOOD PRESSURE, control your CHOLESTEROL, eat a healthy DIET and DON'T SMOKE, and finally ENJOY LIFE. By focusing on these simple, fundamental principles you can help lower your risk of heart disease, help prevent complications of existing disease, and stay healthy.
Tom Heston MD is a Johns Hopkins trained physician and a Fellow of the American Academy of Family Practice and a Fellow of the American Society of Nuclear Cardiology. He practices medicine in the Pacific Northwest.