About Cancer

Another day, another patient, who I wished had come earlier with those symptoms.

I am not trying to write a scientific paper here. Just some thoughts from the primary care physician's perspective. In my view, there is nothing more challenging than dealing with cancer. Starting with the diagnosis. Cancer can be so vicious. I have been completely blindsided by it before. I am supposed to know, and never saw it coming myself, until it was too late.

That is why screening is so important. The earlier the diagnosis, the better the outcome. I just read that, despite all what we know, cancer screening tests are still being underutilized. http://www.huffingtonpost.com/2011/07/06/colorectal-cancer-screening-1-in-3_n_891310.html?ir=Divorce

There are some cancers, where screening clearly can make a difference, even if patients have no symptoms yet. I am thinking of colon cancer - the test would be a colonoscopy. For breast cancer we have mammograms, and just as important, doing self exams. Pap smears help detect cervical and to some extent uterine cancer. Guys above 45 should come in once yearly for a prostate check. Also, we can screen for skin cancer during a physical by looking at suspicious spots.

Also knowing your family history is very important. Do some research, and then tell your doctor about it.

With other cancers, unfortunately, we are not so successful from our end in terms of "routine screening tests". In those cases, routine tests have not shown any improvements in survival rates for patient who have no symptoms. For example, it seems intuitive to send a smoker for a chest x ray once a year. But this has failed to really save lives in large studies.

As a matter of fact, there is is really no generally accepted test to screen for lung cancer at all, and neither is there one for stomach, pancreatic, ovarian, bladder or brain cancer, to name some others. Some studies are still ongoing. But then comes the whole cost question. Would insurances really cover an annual cat scan or even MRI for a high risk patient, or just someone with a family history, who has actually no symptoms. And how often would we need that MRI to make a difference? Every year? Twice a year? At what age?

So can anything be done with those type of cancers?

The answer is "maybe, but we would need a little luck", and obviously an office visit.

I believe that with some good fortune, we could pick up on those cancers a little earlier, but we would have to be tipped off by them causing symptoms or perhaps an abnormal exam or even blood test. But without symptoms, like abdominal pain or perhaps abnormal routine labs, there is no way even the best doctor would know that a patient has a small tumor growing inside. So make sure to tell your doctor about anything that seems off, even if it seems unrelated.

But back now to the beginning:

Another day, another patient, who I wished had come earlier:

Please never sit on a palpable breast lump, blood in the stool, sputum or urine, sudden postmenopausal bleeding, strange looking and growing skin lesions, bowel changes, abdominal pain, chronic cough, new onset of severe or frequent headaches, weight loss....and the list goes on.

See your doctor immediately. Be persistent. Demand answers.

And please go for that annual mammogram, prostate exam, pap smear, and book your colonoscopy if you fall into the category - usually age 50 for most patients. And go for that annual routine physical, even if all seems fine.


- Posted using BlogPress from my iPad

Thoughts about dieting. We are all sitting in the same boat!

So I have been dieting for the last 4 weeks.

I am not obese or even really overweight. But after stepping on the scale about 4-5 weeks ago one morning, I was shocked to see that the scale had reached 185 pounds - the heaviest I had ever been. And I had developed those famous love handles around the waist. I realized that the lack of daily walks with Buster - those rough winter conditions - the opening of Panera 5 minutes from the office - I had gotten hooked on those chocolate pastries - plus delivered office luncheons 2 times per week with all those leftovers - had made my pants shrink around the waist line. Or something like that.

So I decided to go on a diet...!

When I had gone through my first midlife crisis about 7 years ago - the famous "Four O" - I turned to good old Dr. Atkins, who enabled me to lose about 25 pounds during the summer months with a hefty dosage of obsessive compulsive running through Maudlesy on the side. In the end, I actually looked rather sick than healthy. Too thin. My mother thought I was sick when she came to visit me. I was craving carbs so bad, that I turned into a chocolate addict for a while when I was done. It took about 2-3 years to regain 2/3 of the weight, and another 3-4 to top my previous high weight.

And as we learn from our mistakes - or not - I tried to go for it again over the last 4 weeks. This time I called it the South Beach Diet - sounded more contemporary to me.

www.southbeachdiet.com

I do know a lot of people, especially guys, who have had great success with that approach in terms of pure weight loss - at least for some time. Same concept: Lots of eggs, cheese, meats, some vegetables - the low carb ones - and a ton of salad, but careful with the dressings. No bread or baked goods, no pasta, no sweets, no potatoes, no soda, no alcohol. And gallons of water.

I lasted only 4 weeks this time - and who has time for exercise? Down about 15 lbs, I relapsed 4 days ago, when a patient brought me "Ritter Sport" Chocolate from a Germany trip. And that felt so good! Since then over the last few days, I went to Chili's for a family dinner and to an end of season baseball cookout with pizza and some beers. Plus another couple of those office luncheons. And here we go - the needle is moving up again.

Now I sit here all confused what the next step is going to be. And a lot of folks feel exactly just like that - no matter what diet path they had chosen. Once the weight goal has been reached, what to do next? Off the diet - back to the old bad habits - weight goes back up.

And in the end, the answer seems so clear. Is it really so hard to just try to exercise on a more regular basis, make better decisions what to eat, and try not to eat too much. And everybody needs a treat sometime, but one should have to earn those treats and work for them. A cookie for a workout type thing. But this really is a tough battle and requires a daily commitment. It is amazing and stunning how simple it seems to be, and how difficult it is to execute. And I can't imagine how hard it must feel for all those patients out there who have serious weight issues and feel they have to climb this huge mountain. But even if a person is 100 pounds overweight, a 35 pound weight loss over a year can make a difference. That would be just about 3 pounds per month. Or less than a pound per week. A full propane tank weighs about just that - about 35 pounds. Imagine not to have to carry that on your back after one year.

So it is not only my job to try to encourage my overweight patients to change their ways, but also the job of every family member, friend and coworker. And this means constant and daily encouragement.

And to try to lead by example.

Off we go!