bb Albert Provocateur: March 2010

Albert Provocateur

Monday, March 22, 2010

Obsessing on Ovaries

We obsess about so many things today. What the weather is going to be like, will we have enough money for retirement, should we purchase big screen televisions today or wait for the next technological marvels, will our children be safe in school this week, is the IRS going to audit us, will there be enough money in Social Security for our golden years, will war in Iraq and Afghanistan ever end, and a host of other concerns dominate our waking hours. Now, that is all well and good, when we are being civically minded, concerned citizens, hoping to make a difference. We must ask ourselves, however, what benefit is to be derived from solving the woes of the world, when we may not be around to see such resolution? Our health, and we’ve heard it all before, is first and foremost. One has nothing without health, and obsessions, if they are, indeed, necessary, should be directed at “silent killers,” like ovarian cancer, which, if we are not vigilant like Paul Revere and his “oneth by land, and twoeth by sea,” can devastate families and the ones we love, as we contemplate that new car in our driveways. We don’t know the exact cause of ovarian cancer, nor can we fathom why some women are marked for it, while others lead relatively tranquil lives. What we do know are the numbers, and they certainly are not encouraging. Only about 20 percent of ovarian cancers are detected before tumor growth has spread beyond the ovaries, and the Grim Reaper is advised. How disheartening, when studies have shown that 93 percent of women diagnosed in the early stages of the malady survive at least five years. The lesson to be learned from this is early detection is the name of the game, and, what was once considered a silent enemy that wreaked havoc before discovery, has now been found to cause symptoms even at onset.
There are three basic types of ovarian tumors, “coming out of nowhere” in healthy women in many cases, and perhaps triggered by a wide variety of risk factors ranging from inherited gene mutations, family history, age over 50, history of breast cancer, infertility, and being childless to hormone replacement therapy (HRT) with estrogen, obesity, and male hormones given to women to treat painful conditions such as endometriosis. It becomes obvious that risk factors abound, but with no threshold to trigger vigilance or obsession with ovaries, they simply pass, like the box scores of a Major League Baseball game a couple of days later. Symptoms? Perhaps we should concentrate on the minor aches and pains that might drive us to seek professional consultation. One small problem, however, is the fact that ovarian cancer is quite nonspecific in its symptomatology, and may mimic a vast assortment of bladder and digestive disorders, such as irritable bowel syndrome, for example, as well as stress and depression. What we do know is that women with ovarian cancer consistently experience abdominal pressure, fullness, swelling, or bloating, urinary urgency or an incessant sensation to urinate, and pelvic discomfort or pain. While there may be other signs and symptoms, when those key players are persistent or worsen, we become cognizant of our own mortality and the need to see a physician.
Before performing a pelvic examination, an ultrasound, and a CA 125 blood test, a health care provider will most likely ask a series of questions dealing with the initiation, continuity, severity, improvement, worsening, and family history of the symptoms experienced, as well as the existence of ovarian, breast, and other cancers in the immediate family and first-degree relatives. No standardized screening tests for ovarian cancer currently exist, and it should not come as a surprise that doctors don’t recommend screening for this type of cancer in most patients. It must be pointed out here that many medical papers have been published on the conventional wisdom of employing a blood test called the CA 125 blood test as a screening procedure for ovarian cancer. There has been a great deal of confusion in its regard, and we must state categorically that CA 125 is a protein made by the body in response to many conditions, that many women with ovarian cancer have abnormally high levels of CA 125 in their blood, that a number of noncancerous conditions also cause elevated CA 125 levels, and that many women with early-stage ovarian cancer have normal CA 125 levels. Therefore, to rely on a nonspecific CA 125 blood test to screen for the malady can only cause more harm and grief than good. When, on the other hand, the battery of exams listed above, as well as other diagnostic tests such as computed tomography (CT), magnetic resonance imaging (MRI), or even chest x-ray (to detect cancer spread to the lungs), suggest ovarian cancer, then a surgical procedure called a laparotomy or a less invasive surgical procedure called a laparoscopy will be required to explore the abdominal cavity, collect abdominal fluid and tissue samples, and perhaps remove an ovary for pathologic examination. If ovarian cancer is detected, surgeon and pathologist will team up to identify the type of tumor and whether it has spread.
Now that we know the problem, what are our treatment options? It doesn’t take a Nobel Prize laureate or gynecologic oncologist to point to surgery and chemotherapy, with radiation therapy in some cases to treat the symptoms of advanced cancer, as the mainstays of treatment. Without going into the detail of those modalities for lack of space and time constraints, our time might be better spent discussing lifestyle and home remedies to provide that “ounce of prevention” that we have heard so much about recently, especially in these times of Medicare, Medicaid, and private health insurance cutbacks. Staying physically active and managing stress, by knowing what to expect, becoming proactive, maintaining a strong support system, letting family and friends help, and setting reasonable employment goals that allow sufficient time for yourself, go a long way to stemming the physical and mental onslaught of ovarian cancer and prolonging survival. In younger women, oral contraception (birth control pills), pregnancy and breast-feeding, and eventual tubal ligation or hysterectomy can also reduce the risk of ovarian cancer. But haven’t we forgotten a substantial part of the equation? What about diet? Eating protein-rich foods that help build and repair body tissues, such as beans, cottage cheese, eggs, fish, lean meat, lentils, peanut butter, poultry, and yogurt, and packing calories into the foods eaten, as well as eating smaller amounts of food more frequently, boost immunity and help our bodies ward off the deleterious effects of serious illnesses when we just don’t feel well. Ovarian cancer is no exception to these rules. Far from being a death sentence, cancer provides a new lease on life and an excellent opportunity to put into practice a lifetime’s worth of preaching.
Obsessed? You bet we are, and with good reason!

© 2010, Albert M. Balesh, M.D. All rights reserved.

posted by Dr. Al at 3/22/2010 02:08:00 PM | 0 comments

Monday, March 08, 2010

Malign Neglect

You’ve put the kids through college and then saved for decades, putting away a nest egg for those Golden Years when retirement would dictate trips to Europe, extended play on the golf course, more time for what matters most, and a new devil-may-care lease on life. Everything is rosy, and it’s good to be alive. Then it strikes you or your significant other, chipping away steadily at financial resources that were originally set aside to see you both through the rest of your journey on earth, until the Almighty beckoned. Currently, millions of people, 5.5 million in the United States, to be exact, and 35 million worldwide, and those who care for them, have been grimly awakened by a malady created by a medical science that has given us longevity. Alzheimer’s disease reigns, bringing minds to a halt immediately and hearts subsequently, within 3 to 9 years after diagnosis. To make matters worse, we should beware of what we wish for, namely, a ripe old age, as the incidence of the disease doubles every 5 years after 65 years of age. The good news is that studies on centenarians have shown that Alzheimer’s disease is not necessarily the outcome of aging. The bad news is that as the aging population increases, the prevalence of the disease will approach 13 to 16 million cases in the United States by mid-century. With medical costs continuing to spiral out of control, the bitter pill we will need to swallow is the malign neglect that will be afforded to those and their families who wander the physical world, in complete sensorineural oblivion, without the creature comforts and medical care that a life’s worth of savings was earmarked to provide but fell hastily into the red.

So, as is usually the case today, we are left with many questions and very few answers. Alzheimer’s disease is a strange one, at best, and we haven’t even scratched the surface of its causes, let alone therapies to cure, correct, or reverse its devastating effects. While ignorant bliss is perhaps the coin of the realm for those afflicted, it is the spouses and children of Alzheimer’s victims who bear the brunt of the financial and emotional pain surrounding the disease. There is no end in sight either, as unlike other chronic illnesses such as diabetes and heart disease, the biochemical and physiologic mechanisms of the malady have as yet to be elucidated. Yet, although we know neither the causes nor how to stop the devastation of dementia, we learn more each year about combating the small losses in brainpower that often occur after age 50. There are even some brain benefits of getting older.

Speed is the name of the game, when it comes to nerve impulses, which can travel as slow as a tricycle or faster than a NASCAR racecar. Reaction time often slows with age, but, with practice, the elderly can improve their mental speed by more than 50 percent. Scientists have been stunned to find full-blown Alzheimer’s disease on brain scans of people in their 70s who continue to get top scores on memory and IQ tests. In fact, in some studies, up to 20 percent of people autopsied who had no major memory problems were found to have had Alzheimer’s. So, what is going on? What dictates damnation or relative impunity to the long arm of the disease? Why does the brain continue to function efficiently in some cases, despite changes that should cause severe disability? Perhaps the answer lies in what is called “cognitive reserve,” which is the sum total of a person’s innate abilities plus the additional brainpower that comes from challenging one’s mind. No malign neglect there! Studies have shown mentally stimulating tasks increase brain cells, improve connections between those cells, and help bypass age- or disease-related trouble spots in the brain. In short, the more we work our minds, the greater our cognitive reserve; and the greater our cognitive reserve, the greater our ability to mitigate the inevitable challenges of aging.

Despite a youth-oriented culture that wants to bury us before our time, we can take comfort in a body of scientific knowledge indicating that accumulated knowledge, expert skills, wisdom, and emotional savvy all increase with age. Furthermore, higher-order decision making, such as choosing the best investments, and learned skills, such as driving, usually do not decline with age, unless, of course, one is afflicted with Alzheimer’s. Not all silver linings are 100 percent, however, and memory for events, short-term memory, and brain speed all suffer with age. The most likely explanations for such deficits are loss of neural connections, blockages of blood supply, and decreases in nerve transmission chemicals.

With no answers forthcoming on the causes and cures of Alzheimer’s, and with no stopping the march of time, what can we do to stop, or at least slow, malign neglect? The rule of ten applies here, as we make the best of what doesn’t have to be a losing hand, and, namely, boost our brain health by finding stimulating walking partners, varying our daily routines, becoming lifelong learners, playing games with several levels of difficulty, de-stressing with meditation or exercise, getting enough sleep, increasing creativity through new hobbies, socializing and making new friends, following healthy diets rich in fruit, vegetables, whole grains, and fish, and, finally, watching our blood pressure, weight, blood sugar, and cholesterol numbers.

Ignorance is bliss only for the ignorant and those too far gone to care or notice. For the rest of us, it is downright dangerous!

ã 2010, Albert M. Balesh, M.D. All rights reserved.

posted by Dr. Al at 3/08/2010 11:17:00 AM | 0 comments