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Greenville Health System (GHS) has been advancing health care for generations. The stories below provide an inside look into GHS and how we’re transforming health care for the benefit of the people and communities we serve.
Greenville Health System (GHS) has been advancing health care for generations. The stories below provide an inside look into GHS and how we’re transforming health care for the benefit of the people and communities we serve.
There is a growing amount of medical evidence to indicate that stress affects us in ways that we can feel and notice, but also in silent ways that we neither immediately feel nor notice. That silent stress causes inflammation at the individual cell level and stimulates the body’s nervous system in unhealthy ways. Specifically, it stimulates the sympathetic nervous system and causes imbalance with the parasympathetic nervous system. These effects alter the immune system, making us more susceptible to a variety of illnesses, including cancer. Drinking a Coca-Cola seems harmless enough, but it sets off an unhealthy chain of events in the body.
The connection between diet, stress and inflammation was the subject of a recent article in Science News. It turns out that many processed foods with added sugars, high salt concentrations and high saturated fat content tend to disrupt the body’s natural defenses and immune system. On the other hand, foods with fiber and the complex carbohydrates found in whole grains do the opposite. They reduce inflammation and improve the body’s natural defenses and immune system.
How does this work? The answer may be found in how different foods affect the bacteria that normally live in the intestinal tract. Pro-inflammatory foods like sugary soft drinks irritate our body’s intestinal bacteria, resulting in release of inflammatory chemicals to the bloodstream and negative messages to the immune system. Anti-inflammatory foods like the fruits and nuts we should be packing in our lunch every day do not irritate the normal healthy bacteria, such that inflammation and negative messages to the immune system do not occur.
Our body has an extraordinary amount of bacteria distributed throughout our digestive tracts, glands and skin. They have many different effects on digestion, immune function and normal body processes. The sum total of all of the bacteria and fungus is called the human microbiota. Good nutrition is important because the human microbiota is very sensitive to the kind of food we feed it. The kind of food we eat can change the microbiota balance in a matter of weeks.
This is why integrative physicians in particular and doctors in general recommend that our diet include five servings of fruits and vegetables a day, whole grains (whole wheat bread, not white), limited saturated fats and high fiber. The effect of added sugars, highly salted foods and foods high in saturated fat is silent but real. I encourage everyone to become conscious of the content of the food you are eating and to choose wisely. Look at the nutrition labels on foods and note the amount of sugar per serving. Your health is worth it.
Do you wash your fruits and vegetables with dish detergent? What about baking soda or vinegar? Have you ever thought about the best way to wash your fruits and vegetables? The more we learn about pesticide residues and food-borne illness from raw produce, many may question the most effective method to clean produce before consuming. I personally use cold, running water and rinse well. However, if the produce has a hard skin or rind, I will give it a good scrub.
The first important thing to note is that all produce, organic or conventionally grown, needs to be washed before eating, unless it has been pre-washed and packaged. Also, be sure to wash your hands with soap and water prior to cleaning and cooking produce to prevent the transfer of naturally occurring bacteria from your hands to your food.
Let’s look at the Dos and Don’ts that help reduce bacteria and pesticide residue found on fresh fruits and vegetables.
Long story short, the best way to clean produce is with clean, cold water following the specific guidelines above. While you are thinking of washing your produce, don’t forget to consume your five cups of fruits and vegetables daily!
For many women with breast cancer, the treatment includes taking a tablet that blocks estrogen in the body. Some of these are in a group called aromatase inhibitors. They include anastrazole (Arimidex), letrazole (Femara), and exemestane (Aromasin). One common side effect is hot flashes. Another more common side effect is achiness in the muscles and joints. This is called aromatase inhibitor musculoskeletal syndrome (AIMS).
The range of symptoms of AIMS includes arthritis (inflammation in the joint), arthralgia (pain in the joint), myalgia (pain in the muscle), carpal tunnel syndrome (pain in the wrist and hand), joint stiffness, and paresthesia (abnormal sensation over the skin). When AIMS occurs, it usually does so in the first two months. It frequently gets better after three months or so, but it can persist for years.
In a study presented at the 2014 San Antonio Breast Cancer Symposium by Dr. Janine Lombard, 81% of 370 women who were taking aromatase inhibitors reported joints symptoms, most often in the feet (68%), hands or wrists (65%), knees (62%), hips (56%), shoulders or elbows (49%), and back (46%). For the 27% of women in the study who stopped taking the aromatase inhibitor early, symptoms of AIMS were the most common reason.
Usually, the first treatment for AIMS is an over-the-counter medication, such as acetaminophen (Tylenol), or non-steroid anti-inflammatory drug (NSAID), such as ibuprofen (Advil) or naproxen (Aleve). Commonly used prescription drugs include NSAIDs such as diclofenec (Voltaren) or meloxicam (Mobic). These medications give some relief some of the time, but there remains a need for more effective treatments for AIMS. For people who do not tolerate NSAIDs, I have found that curcumin, available in health food stores, is comparable to NSAIDs when taken as 2000 mg daily. Another strategy worth a try is glucosamine (without chondroitin) at 500 mg three times daily.
At the GHS Center for Integrative Oncology and Survivorship, we have seen success with exercise, yoga, massage and acupuncture. We are currently conducting a clinical trial of heart rate variability (HRV) biofeedback. Exercise deserves particular mention because it also helps with hot flashes, and it is so good for our mental and physical health overall.
A study recently reported in the Journal of Clinical Oncology by Dr. Melinda L. Irwin demonstrated the benefits of exercise for reducing the pain of AIMS. The study involved 121 breast cancer survivors taking aromatase inhibitors. Half did aerobic exercise 150 minutes per week and supervised strength training two days per week, while half followed their usual routine. The exercise group reported less pain and more mobility after three months and even more after 12 months. This study is consistent with our experience at the Center for Integrative Oncology and Survivorship. Exercise helps many things, and it is especially helpful for breast cancer survivors taking aromatase inhibitor drugs.
If you are a breast cancer survivor taking an aromatase inhibitor and experiencing hot flashes and achiness in the joints, I encourage you to have a talk with your oncologist or nurse. There are good strategies available to get relief from these symptoms.
Fourteen years ago, the U.S. Surgeon General’s report highlighted that African Americans, Latinos, Asian Americans and Native Americans were less likely to receive mental health care than their white counterparts. Today, it has still been noted that ethnic minorities continue to be less likely to receive mental health care and are more likely to receive a poorer quality of care once in treatment. Thus, the Centers for Disease Control (CDC) define mental health disparities as the differences between populations with respect to their accessibility, quality and outcomes of mental health care as a major component of disparities. It has further been noted that disparities are inequalities that are potentially unexpected, undesirable and problematic. As such, mental health issues can affect many areas of one’s life, home, school, work, relationships and may increase other health problems. However, despite the efforts to improve mental health services for culturally diverse groups, barriers remain in access to and quality of care: Some of these barriers to care are:
Currently, one in five Americans lives with some form of mental health challenges and even though mental illness does not discriminate, it disproportionately affects ethnic minority groups. When mental health strikes, it may be harder on ethnic minorities because many do not get the mental health services they need. Having a mental illness is not something ethnic minorities want to discuss. But mental illness is nothing to be ashamed of! It is a medical problem, just like diabetes, hypertension or heart disease.
July is National Minority Mental Health Awareness Month and many organizations and racial and ethnic minority groups will host a variety of events and activities in communities throughout the country. Why Minority Mental Health Month? In 2008, Congress established the National Minority Mental Health Awareness Month in honor of the late African-American novelist and advocate Bebe Moore Campbell. The goal of National Minority Mental Health Awareness Month is to increase awareness of mental illnesses, prevention, treatment and the challenges unique to the multi-cultural communities. Building awareness of racial and ethnic minority mental health concerns is important because ethnic minority groups tend to be marginalized in the field of mental health. For ethnic minorities mental health services are often underutilized and highly stigmatized in their communities. According to the Office of Minority Health:
As emphasized by the Rep. Charles Gonzalez, Congressional Hispanic Caucus Chairman, “this month must be seen as an opportunity to not only increase awareness for mental illness, but also to promote long-term solutions that address the uniqueness of America’s minority communities.” In helping to bridge the gaps and increase awareness in mental illness, the National Alliance on Mental Illness (NAMI) provides awareness through over 1,000 state and local affiliates. NAMI is the nation’s largest grassroots mental health organization offers the understanding that only those with the lived experience of mental illness can provide. For more information, visit www.nami.org.
NAMI Greenville was established in 1986, the mission of NAMI Greenville is to serve the needs of all whose lives are touched by mental illnesses, improve the quality of life and treatment for those who live with mental illness and their family members, through education, support and advocacy. For more information about NAMI free community programs, visit namigreenvillesc.org or contact at email@example.com or 864-331-3300.
Summer is just about the best time to develop a healthy fitness regimen. The weather outside allows you to get out of the house and participate in many different forms of physical activity. Did you know that even a little amount of leisure physical activity can help you avoid cancer and live longer?
A recent study published in the JAMA Internal Medicine found that performing even some leisure time physical activity reduces overall risks of death, including risks due to cancer and cardiovascular disease. In the study, even individuals who exercised less than the recommended 150 minutes of moderate exercise per week had a 20% lower mortality than those who had no leisure physical activity. For those whose exercise exceeded 150 minutes of moderate exercise, the decrease in premature death was 31%. The lesson I take from this study is that exercise beyond 150 minutes per week is very good for one’s health, but less exercise is still beneficial.
In 2008, the Physical Activity Guidelines for Americans recommended a minimum of 75 minutes of vigorous-intensity activity or 150 minutes of moderate-intensity aerobic activity per week. Aerobic activity should be performed in episodes of at least 10 minutes, and it should be spread throughout the week. Meeting the minimum level of physical activity recommended by the Physical Activity Guidelines for Americans would require walking a 20-minute mile every day, swimming for 35 minutes twice a week, biking for 45 minutes twice a week or running 10-minute miles for 45 minutes once a week.
These guidelines are attainable for most people and are worth the time and effort. If you end up exercising less, know that you are still receiving some benefit. My message is, “Let not the perfect be the enemy of the good.” Exercise regularly and try to work up to 150 minutes per week. How to do it? Where to start? The answer is different for every person. A person who has not been exercising might start by walking five minutes per day. Once a routine is established, then one can increase the time. The key is to start with a small, achievable goal and to stick with it long enough to create a healthy habit.
Cancer survivors can help themselves and improve their mental health with exercise. I encourage you to look at your own weekly exercise and talk it over with your healthcare provider. To paraphrase the television commercial, “Ask you doctor if you are healthy enough for exercise.” For more information about the benefits of exercise for cancer survivors or to make an appointment for an integrative oncology visit, call the GHS Center for Integrative Oncology and Survivorship at (864) 455-1346.
Special thanks to Clemson University health science major, Courtney Fallon, for her contributions to this blog post.
When I trained in oncology in the 1980’s, the treatment of cancer was very different than it is today. I could count the number of chemotherapy drugs on the fingers of both hands and a few toes. Our understanding of the science was limited. The few chemotherapy drugs we had were used for most tumor types because they were all that we had. Three decades later, as Bob Dylan would say, “the times, they are a changin.” Our scientific understanding has improved dramatically. In 2014 and 2015, the FDA approved fourteen new cancer drugs. The newer cancer drugs are not as broad spectrum as the old drugs. In fact, some focus narrowly on features found in cancer cells, but not in the body’s normal cells. This is an example of what is now called precision medicine.
Each of us has a unique fingerprint based on the swirls of skin ridges on our fingertips. So it is when cancer occurs. Each cancer type has a particular fingerprint. It is based on the gene mutations that have occurred over time leading up to the cancer. Some of the mutations that lead to cancer cause the cancer to be susceptible to a particular anti-cancer drug that is active against cancers with that specific gene mutation. These anti-cancer drugs are called “targeted” therapies because they target the cancer cells and tend to spare the body’s normal cells. In other words, the targeted therapies are better at getting the weeds out without disturbing the grass in the lawn.
For some cancers, these targeted therapies with tongue twister names are new treatment options that have allowed people with these cancers to live much longer than they could before. For example, about 20 percent of the time, breast cancer has a mutation in the Her 2 gene that codes for a protein on the cell surface. Transtuzumab (Herceptin) was the first drug available to target Her 2. Now pertuzumab (Perjeta) and others are available. About half of the time, melanoma has a mutation of the b-raf gene. For these melanomas, vemurafenib (Zelboraf), dabrafenib (Tafinlar), and trametinib (Mekinist) are options. For chronic myelogenous leukemia (CML) and gastrointestinal stromal tumors (GIST), a mutation in the c-kit gene is present in most cases and imatinib (Gleevec) is very effective.
Research continues at a rapid pace, such that new gene mutations and new cancer drugs, which target these mutations, are reported in medical journals and in the news every few months. In an effort to find mutations that can lead to targeted therapies, oncologists have begun testing cancers for large panels (64, 256 or more) of gene mutations. Through this process, called precision oncology, the oncologist may identify an already approved cancer drug or a drug in a clinical trial that could help the person with cancer. Although still in its infancy, precision oncology is making cancer chemotherapy more helpful and less difficult than it was just a few short years ago.
We tend to shield our children from pain and death, so when disease or death comes we tend to keep the details from children. Since disability and death are part of life, I encourage children to be part of the caregiving team. Even young children can bring a glass of water or a smile. Although adults may worry about kid’s inappropriate questions, a child’s questions may actually help us to face difficult topics. Children provide physical contact, playfulness, hugs and in-the-moment-ness in a way we adults can’t.
Not only do our loved ones appreciate children, but children grow from the experience of being a caregiver. Children who live with someone with a handicap tend to be more patient, kind, supportive, accepting of differences and empathetic. They grow into adults who have more insights into coping with challenges and are more likely to stand up for those who are different. We shouldn’t shield children from the illness or the chance to grow into a more compassionate individual.
Summer means that kids are home, so let the children help set up a TV, bring food, listen, share stories, color, play with toys, cuddle, bring messages, pick up things, assist with Skype or other technologies that help our loved ones connect, teach games (including video games) and help with personal care. Kids also offer chances for an outing such as a zoo or playground. Being outdoors and with children tends to brighten moods.
Senior citizens often may wish to share their history with the younger generation. Give the child a set of questions to ask like those in Telling My Life’s Story by Marty Hogan. Kids who can’t imagine what life was like before computers and cell phones often get caught up in stories of the past. Older kids easily use technology that allows them to record the answers and even make an edited video or book. Both will feel proud after completing such a shared product for the family.
If you’re having trouble motivating a pre-teen, consider paying them a token “salary” to be a caregiver. If you do let an older child do some of the caregiving, be sure to test their ability while you are present before leaving them “in charge.” Children’s involvement helps elders have a sense of contributing and being responsible in a way they often can’t feel with their adult children who are caregivers. Be sure to be available to answer children’s questions honestly as they learn about the disease or death.
Want your children to do some caregiving but don’t have older relatives? Consider taking the children to a nursing home or seniors’ group. Simple activities like coloring together are good ways to pair seniors and preschoolers. Older kids can help with programs and meals. Staff at assisted-living facilities are usually appreciative of children volunteering with their parents.
Most of us can remember an elder who taught us something life changing. Encourage the children in your life to have those experiences with your loved ones this summer.
Summer means vacations, swimming, fireworks and just plain fun. Unfortunately, some of the summer activities can be a potentially hazardous to your ears and hearing. Taking just a few simple precautions can make your summer fun just as enjoyable but with less risk.
Common causes of hearing loss are loud noises. Exposure to loud damaging noise can result in damage to the ear and hearing. Examples of summer sounds that may cause hearing damage include lawn mowers, power tools, fireworks, motorcycles and concerts. The world has become a very noisy place and hearing loss due to noise exposure is increasing at a rapid pace. One of the first symptoms of damaging noise exposure is tinnitus or ringing in the ears. When the sun is too bright sunglasses are worn. When the noise is too loud, hearing protection should be used.
The only defense against damaging noise is to wear hearing protection. Earplugs or ear muffs reduce some of the noise and do provide some relief. Adults should lead by example by wearing and demonstrating use of hearing protection to their children. Ear plugs and muffs are available at most sporting goods stores.
Swimming increases the risk for swimmer’s ear and more serious infections. Moisture that remains in the ear canal provides bacteria and other organisms an opportunity to grow. Normally the ear canal produces earwax which repels the water out of the ear. However, some people try to clean their ear and either pack the wax into the ear canal or they remove all the wax which is just as bad. Q-Tips, paper clips or car keys should never be used to clean the ear canal. The ear will clean itself if left alone. Ear canals have been producing earwax for thousands of years as a preventative against ear infections.
Ears also need protection from ultraviolet rays produced by the sun. Do not forget to apply sunscreen with at least 30 SPF, especially if not wearing a full brimmed hat. Read the application instructions and reapply as needed. This will help prevent irritation, sunburn and skin cancer. The top of the ear is the most common location for skin cancer.
Summer time is a time for fun, not a time to visit the emergency room. A few simple precautions will help make your summer enjoyable.
If you or someone you know has been diagnosed with cancer, the topic of radiation will likely come up during the course of treatment. As a radiation oncologist who is responsible for delivering this form of treatment, it’s important to me that patients have the facts before they begin treatment.
Let’s start with the basics. What is stereotactic radiation therapy? Stereotactic radiation therapy uses small, focused radiation beams to treat a well-defined tumor with high doses of radiation. It can be performed in a single treatment or a small number of treatments, depending on the tumor and its location within the body. Stereotactic treatment requires an extreme level of accuracy and precision. It also requires expertise and equipment capable of achieving that level of precision.
It is important to note that stereotactic radiation therapy is a technique of delivering radiation to the tumor – it is not a machine or piece of equipment. It can be performed on a machine that only does stereotactic treatment or on a machine appropriately designed to also treat cancer in a more conventional manner. So, what does this mean? Let me offer an analogy. If you need to fly from Greenville/Spartanburg to Chicago, do you look for an airline that has a plane designed to fly just between these two cities? Or does an airline that has a plane that flies between these two cities but also makes trips to New York and Miami work just as well? The two planes essentially do the same thing – one just goes to other cities when it’s not being used to fly between here and Chicago.
There is a lot of information out there right now about the machines used to deliver stereotactic radiation therapy. The CyberKnife is one example, and in the plane analogy I used above, it would be like the plane that flies only between two cities. At GHS, we use Novalis or Varian TrueBeam. Both of these machines offer us the ability to deliver stereotactic radiation therapy with the same level of precision as the CyberKnife, but we can also use the machines to treat cancers that are not conducive to stereotactic treatment.
In the end, all three of these machines (CyberKnife, Novalis and Varian TruBeam) offer the same service, just as the two planes in my analogy both got you from here to Chicago. They just do it differently. But different doesn’t necessarily make the treatment better or worse. Imaging and tumor tracking techniques may vary, but they all must be able to treat a well-defined tumor with high doses of radiation. In the Upstate, we are fortunate that most hospitals have the ability to deliver stereotactic radiation therapy no matter what machine they use. What’s most important, though, is the quality of care you receive and the skills of your healthcare team.
If you have questions about stereotactic radiation therapy or the machines used to administer treatment, talk to your doctor or a radiation oncologist.
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