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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.
Having a mammogram ranks on the happiness scale somewhere between getting a root canal and taking the car in for repair. The time, discomfort and uncertainty as to what will be the result are sources of stress for every woman for every mammogram. Hopefully nothing is wrong and the mammogram will be negative. When there is an abnormality that requires a return visit for more breast images and testing, the stress is even greater. The ultimate finding may be a breast cancer for which surgery and other treatments will be required. Or, after more tests, they may decide that the mammogram does not require a biopsy and that nothing is wrong. In medical language, this is called a “false positive” mammogram.
A study conducted by the American College of Radiology Imaging Network that addresses the fear and anxiety that go along with having a “false negative” mammogram was published in the Journal of the American Medical Association in April. The 1,028 participants were women receiving mammograms at 22 different centers, who agreed to an interview over the telephone and a follow up interview a year later. The 594 women whose mammogram was negative were compared to 488 women whose mammogram was false positive. The false positive mammogram group reported “at least moderate anxiety” 50.6% of the time, compared to 15.7% of the time for the negative mammogram group. I consider the fact that half of the women experiencing a false positive mammogram had at least moderate to severe anxiety to be huge. When interviewed a year later, the anxiety was much less but still there.
What can be done to decrease the fear and anxiety associated with mammograms in general and false positive mammograms in particular? For one thing, improved communication can help. Doctors need to explain that mammograms are designed to be extra sensitive and have a certain number of expected false positives in order to detect as many early and small breast cancers as possible. Second, younger women in their thirties and forties need to know that the breast tissue is more dense and the likelihood of a false positive mammogram is greater. Third, the likelihood of a false positive mammogram is reduced to half when the radiologist has access to mammograms from previous years.
When I brought this up to Dr. Brian McKinley, medical director of the GHS Breast Health Center, he agreed that doctors should communicate better. He did, however, have a message for women getting mammograms. He said, “A women should feel free to talk to her doctor about her specific concerns so that the physician can offer more personal, targeted bits of information and emotional support. Too often, we doctors assume we know what is causing our patients to worry. Don’t let that happen! Don’t be afraid to engage your doctor and tell him or her what’s really worrying you. For the health of your breasts, get it off your chest!”
What do you think? How stressful is a mammogram? What has been your experience? How well do doctors and nurse practitioners communicate information about mammograms that might reduce the stress? I invite your comments. For more information about mammograms and breast health, call the Breast Health Center at (864) 454-8282.
Today (Sept. 29) is World Heart Day. World Heart Day was founded in 2000 to inform people around the globe that heart disease and stroke are the world’s leading causes of death, claiming 17.3 million lives each year.
Greenville Health System would like to spread the news that at least 80% of premature deaths from cardiovascular disease (CVD) could be avoided if four main risk factors – tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol – are controlled.
As a cardiologist, I would like to remind you of several ways GHS supports the theme of World Heart Day, which is to create heart-healthy environments where you live, work and play.
• How you live – Remember to choose healthy food options, increase physical activity, and say NO to tobacco. GHS offers a free smoking cessation support group that meets every Tuesday from 6:30 p.m. to 8 p.m. on the Patewood Medical Campus. For more information, call 455-WELL (9355).
• Where you work – Support heart health education. Many businesses offer heart education, so be sure to take advantage of these classes or invite an expert to speak on keeping your heart healthy. Walk at lunch, park farther away from the front entrance and take the steps.
• How you play – Walk, run or ride the GHS Swamp Rabbit Trail, join the YMCA or simply choose leisure activities that involve movement!
The environments where we live, work and play can have a huge effect on our ability to make the right choices for our heart health. A heart-healthy environment is a space where people have the opportunity to make the right choices for their health.
For more information on events that support your heart health visit ghs.org/healthevents.
Lymphedema occurs due to a disruption in the lymphatic system. Lymphedema can be primary or secondary. Primary lymphedema is caused by malformations of lymph vessels present from birth. Secondary lymphedema is swelling that occurs when the lymphatic system has been disrupted due to surgery, radiation, infection, disease or trauma and cannot adequately move lymphatic fluid and proteins.
The incidence of lymphedema is related to the extent of treatment intervention. Fortunately, the risk of developing lymphedema has been progressively declining as cancer treatments continue to become better targeted. It is important to realize that the risk of developing lymphedema is relatively low. For instance, patients who have axillary lymph node dissection have a lifetime risk of 15-25%. Patients whose surgery is limited to sentinel node techniques have a risk of about 6%.
Lymphedema normally occurs during or after treatment, but it can develop at any time in a person’s life; therefore, it is best to be aware of the signs and symptoms of early lymphedema.
Signs/symptoms of lymphedema:
While lymphedema is not curable, it is treatable. When managing lymphedema, compression is your best friend. During treatment, a lymphedema specialist may use different bandaging techniques or compression garments to supplement the lymphatic system in moving fluid out of swollen tissue. Also, specially trained physical therapists and massage therapists can perform a hands-on treatment called manual lymph drainage (MLD). This helps jump start your lymph system and re-route fluid away from problem areas.
While compression and MLD are paramount, it is also important to protect your skin and be cognizant of situations that increase lymphatic load, or stress on the lymph system. This means avoiding sun burn, bug bites, restrictive clothing and jewelry, extreme heat or cold, or any activity that compromises the integrity of your skin. If you notice some of the signs of lymphedema, notify your doctor. He/she can then write a referral to a physical therapist certified in lymphedema management.
GHS is progressive in its collaborative, patient-centered care model. As a result, a certified lymphedema therapist is embedded in the Center for Innovative Oncology and Survivorship (CIOS). If a patient develops lymphedema, they can be referred to a lymphedema specialist who is a part of the survivorship team at CIOS. This allows patients to be treated by a unified healthcare team.
Research assistant Alex Christ contributed to this blog.
Currently, almost one third of children and adolescents in the United States are either overweight or obese.
Obesity comorbidities include type 2 diabetes, hypertension, dyslipidemia, cardiovascular disease, stroke, sleep apnea, gall bladder disease, and certain cancers. Additionally, specific pediatric comorbidities include endocrine, orthopedic, and pulmonary disorders. There are also significant social and psychological concerns.
The etiology of obesity is multifactorial. Current studies link both genetics and environment to obesity. Worsening environmental factors include an increase in sugar-containing foods and beverages, an increase in portion sizes, more availability of fast foods, a diminished family presence at meals, decreased physical activity, and an increase in computer-oriented activity.
Both pediatricians and parents need to address this growing problem. Here are five ways we can encourage families to improve weight control in kids include:
1. Change behaviors. Parents should help obese children self-monitor their intake. A good way to start is to keep a food log. This allows children to identify certain stimuli and habits. Families should then set goals on what to change on how to measure improvement. During this process, parents should use plenty of positive reinforcement for the constructive steps kids make.
2. Family involvement. Having an obese parent increases the risk of child obesity by 2 to 3 fold. Parent should model behaviors by themselves maintaining good eating habits. Parents should involve children in both choosing and making foods. This creates an environment of ownership, which encourages children to feel more invested and rewarded with positive changes.
3. Assess comorbidities. Scare tactics are not recommended as an avenue to create change. However, in adolescence, it is acceptable to discuss how weight affects sleep, orthopedics, breathing or their endocrine system.
4. Increase activity. This should happen in two ways. Children need more exercise and activity, and they also need less television and media time. The AAP recommends no more than two hours of media time a day. Children should be encouraged to join organized activities and spend time participating in spontaneous playtime.
5. Seek professional help. An important step in creating change is often seeking the help of a third party. This should be in the form of a nutritionist, pediatrician or a medically validated weight-loss program. Greenville Health System runs a great program called New Impact. New Impact is a year-long physician led program that includes time spent with a nutritionist, exercise therapist, in support groups, and also offers a family membership to the YMCA. Since its creation three years ago, it has shown great success for hundreds of children. Recently, one adolescent boasted a loss of 120 pounds.
Obesity is a national epidemic. It is also a problem that starts in childhood. Of those children that are severely obese in kindergarten, 70% are still obese in middle school. Of those teens that are obese, most (although not all) continue on to become obese adults. It is imperative that both medical and professionals work diligently to combat obesity throughout childhood and adolescence.
A recent announcement from the University of Arizona describes new scientific evidence that curcumin, an ingredient of the spice turmeric, has cancer-fighting properties.
Turmeric is a plant that grows in India and in other tropical climates. It is related to the ginger plant. Like ginger, the root is the source of a popular spice used in many foods. Turmeric is a bright yellow spice called “Indian saffron” and is used in the making of curry. The active ingredient of turmeric is a water-soluble curcuminoid substance called curcumin.
Curcumin is available as a supplement and has been found to have a number of properties, including decreasing inflammation. Indeed, curcumin has been shown to be as effective as Motrin (ibuprofen) for the relief of arthritis knee pain. In a study of 107 participants, half received 800 mg per day of ibuprofen and half received 2,000 mg per day of curcumin. Pain relief was the same for both groups of participants.
Studies of curcumin have also shown it to be helpful in irritable bowel syndrome and major depression. Despite its virtues and remarkably few side effects, curcumin is still a drug. It can affect a group of important liver enzymes called cytochrome P450. If you decide to take it, you should tell your healthcare provider and make sure that it will not interfere with other medicines you are taking.
Curcumin has been studied as a drug to take along with chemotherapy in certain cancers, as it appears to have some anti-cancer effects. Now researchers at the University of Arizona have identified how it might work against cancer cells at the level of the chemistry inside the cells. It turns out that an over-activated chemical called cortactin is important to the growth of colon cancer cells.
The researchers at the University of Arizona treated colon cancer cells in the laboratory with a solution of curcumin. They discovered that the curcumin “de-activated” the cortactin such that the cancer cells were unable to move and spread to other parts of the body. I acknowledge that this is not a cure for cancer or even a new treatment. It is, however, interesting that there is a plausible mechanism for how the curcumin might help inhibit cancer. This encourages me as I add turmeric as a spice to my food or take curcumin capsules for my arthritis.
Bottom line, curcumin is a known anti-inflammatory substance that can relieve arthritis pain and may have anti-cancer properties. It is reasonable to take curcumin at 2000 mg daily as a substitute for an NSAID drug like ibuprofen or naproxen. For more information about curcumin or other herbs and natural medicines, I recommend AboutHerbs.com, which is sponsored by the Memorial Sloan Kettering Cancer Center. If you would like to learn more about how diet and nutrition can help your health, call us at (864) 455-1346 or visit our website at ghs.org/cios. You can schedule an integrative oncology appointment for a personal consultation.
Ninety percent of the time, the genes that you inherit from your parents do not play a clear, major role in your risk of breast cancer. On the other hand, about 10 percent of the time, there are inherited genetic mutations that contribute to breast cancer risk. The most widely known of these mutations were discovered in the 1990’s in the BRCA1 and BRCA2 genes. The name given to cancer risks associated with BRCA1 and BRCA2 is Hereditary Breast and Ovarian Cancer (HBOC) Syndrome. These mutations are found in the DNA of every cell in our body and are called germline mutations. Since then, genetic tests have become available to determine if you carry one of these gene mutations that may increase the cumulative lifetime risk of breast cancer to as much as 85%.
While BRCA1 and BRCA2 account for many cases of hereditary breast and ovarian cancer, there are other gene mutations that increase breast cancer risk, including p53 (Li-Fraumeni Syndrome), PTEN (Cowden Syndrome), and CHD1 (Hereditary Diffuse Gastric Cancer Syndrome). Who should get tested for genetic mutations associated with breast cancer? Ideally, the testing is done for women who have had breast cancer, especially with onset less that age 50, more than one breast cancer, and close family members with breast cancer at a young age, ovarian cancer, or pancreatic cancer. But there is more to it than that.
Over the past 20 years, the field of cancer genetics has grown dramatically, making the answer to the question more complicated. Now there are specially trained genetic counselors who meet with a person, gather information about the person and their family history, and assess their risk for hereditary breast cancer and other hereditary cancers. The genetic counselor explains in detail the pros and cons of genetic testing and the person then decides whether to go ahead with tests of blood (or sometimes only saliva) to see if a high-risk genetic mutation is present. Genetic counselors carefully help the person understand their unique personal and family situation and assist them in making the right decision for them and their family regarding genetic testing. If a high-risk mutation is found, the person (and interested family members) can meet with a physician who has special expertise in cancer genetics to develop a personalized plan to help reduce the risk of future cancers and increase the chance of finding cancer in an early, treatable stage
Sometimes the testing is not conclusive. That is, a woman who has had breast cancer may test negative for mutations in genes we know about today that are associated with breast cancer, such as BRCA 1 and 2, p53, PTEN, etc. There remains the possibility, however, that there is a yet undiscovered inherited genetic mutation that caused the woman’s cancer. Some women with a history of breast cancer who were tested for BRCA 1 and 2 in the 1990’s have come back in the 2000’s to receive additional testing for high-risk mutations that have been discovered since then.
Today, there is a new wrinkle to the story. Research published in the New England Journal of Medicine on August 7 describes a newly characterized gene associated with an increased risk for breast cancer. The gene in question is called PALB2. If a woman carries a single mutation in one of the two copies in her germline DNA, the cumulative risk of breast cancer by 70 years of age is estimated to be 35%. This is big news for women with a history of breast cancer and their families. For some who previously tested negative for mutations in BRCA1/2, testing now for mutations in the PALB2 or other genes might provide an explanation for their cancer and point to a higher risk for family members. Knowledge of such a mutation might help the person or family members make decisions about surgery or medications to reduce the risk of a future breast cancer.
It is impossible to explain genetic risk for breast cancer in one brief article. The GHS Center for Integrative Oncology and Survivorship has a staff of experienced genetic counselors that provide genetic counseling. The medical director, Dr. Carla Jorgensen, is a medical oncologist with special expertise in cancer genetics. If you have questions or would like a consultation, call the Center for Integrative Oncology and Survivorship at 455-1346.
There has been a long standing debate about the best diet for weight loss. The low-fat diet was all the craze in the 90’s and has since transformed into a low-carb trend. A Time magazine article recently discussed the findings from a study done by the Annals of Internal Medicine on the “Effects of Low-Carbohydrate and Low-Fat Diets” related to weight loss and cardiovascular risk factors.
The study included 148 individuals with a BMI greater than 35 kg/m2 with no chronic disease such as diabetes, kidney disease or heart disease. Eighty-five percent of the participants were female and 50% were African American. The study weighed on the side of low-carb diets as the better choice for not only weight loss but also reduction of cardiovascular risk factors. Participants on the low-carb diet lost an average of 11.7 lbs over one year compared to an average weight loss of 3.9 lbs on the low-fat diet. Interestingly, participants on the low-carb diet also had a greater increase in HDL (known as good cholesterol) and equal decrease in LDL (known as bad cholesterol) as the low-fat group. Both groups averaged similar calorie amounts per day with the low-carb group averaging 1,448 calories per day and 1,527 calories per day for the low-fat group. The study also examined symptoms participants experienced throughout the year. Participants in the low-fat diet group reported greater fatigue and headaches over the year-long span.
So what does this mean? Load on the fat and cut the carbs? Not necessarily. The participants were educated on the type of fat and carbohydrate sources to make healthy choices across all food groups and maintain a calorie level favorable to weight loss. At the end of the year-long trial, both groups on average lost weight and maintained or improved cardiovascular health. So you don’t have to choose one side of the diet debate but rather follow a well-balanced diet with heart healthy fats and complex carbohydrates. Moderation is key to any healthy diet, along with a focus on a plant-based foods and appropriate portions. Don’t get hung up a specific diet. Instead, focus on the benefits of eating well and enjoy healthy options from all food groups.
For more information on creating a healthy diet for weight loss and reducing cardiovascular risk factors, contact the Center for Integrative Oncology and Survivorship’s dietitian, Jessica Menig, at 864.455.2862 or visit the CIOS webpage at ghs.org/cios.
Two studies presented at the annual meeting of the American Society for Clinical Oncology (ASCO) in Chicago May 30 to June 3 have given researchers insight into how healthy diet and exercise reduce the risk of cancer. The short answer is that diet and exercise decrease inflammation, which is the word that describes the body’s biochemical response to stress.
There are blood tests that can indicate the level of certain chemicals associated with inflammation and stress. One of these chemicals is called C-reactive protein, or CRP for short. The blood test for CRP shows a high number when stress is high and a lower number when stress is low.
One of the studies was called the Lifestyle, Exercise and Nutrition (LEAN) Study. In the LEAN study, breast cancer survivors who were overweight were divided into two groups. One group received counseling about exercise and weight loss. The other group (control group) received a brochure about lifestyle changes. The CRP was measured for both groups at baseline and at six months. The women in the weight loss-counseling group saw a 30% decrease in CRP while the control group saw no decrease in CRP. Furthermore, those who lost the most weight had the greatest decrease in CRP.
The other study was called the Hormones and Physical Exercise (HOPE) Study. The HOPE study involved breast cancer survivors taking medicines that lower the levels of the female hormone estrogen. One group participated in 150 minutes per week of aerobic exercise plus strength training while the other group (control group) did not. After 12 months, the exercise group saw a 3% weight loss and a 6% decrease in CRP level.
Both of these studies support the hypothesis that healthy diet and exercise reduce inflammation and that we can measure reduced inflammation with blood levels of CRP. It encourages me to know that the benefits of healthy diet and exercise can be measured on a cellular level. More than just feeling good and moving more freely, exercise and healthy diet help us in ways we cannot readily see, but that can be measured in the blood.
For more information about healthy nutrition for cancer survivors and cancer prevention, call (864) 455-1346 or check out our website at www.ghs.org/cios.
On Saturday morning, a colorful and enthusiastic group of cyclists departed from the GHS Cancer Institute on a six-day relay ride to Lewiston, Maine. The name of the event is the Challenge to Conquer Cancer (C3).
This is the ninth year that these cyclists have undertaken a cross-country ride to raise money for cancer research and awareness. All of the riders are experienced and in top physical condition in order to make the ride. All are dedicated to advocacy for people affected by cancer. All have raised money to make the ride and to make a difference for cancer survivors.
The C3 website describes the riders as “a tribe of passionate cyclists who organize fundraising fitness events to raise money for cancer research and advocacy … because we can. Together we can provide hope, encouragement and unity to all those who are affected by cancer.” I call them an amazing group of people who have made possible a number of important programs, services and research studies that benefit cancer survivors at the GHS Cancer Institute, specifically the Center for Integrative Oncology and Survivorship (CIOS) and the Institute for Translational Oncology Research (ITOR). Research into ways to improve the quality of life of cancer survivors, classes in yoga and nutrition, and the latest equipment to identify the specific molecular abnormalities in cancer tissue are just a few examples of what the C3 riders have made possible over the past nine years.
I will be following their progress to Lewiston this week on their website and reading their blog. I am grateful for their gifts of time and energy, and I am grateful for the real benefits that their fundraising brings to the GHS Cancer Institute. I encourage everyone to check out their website and cheer them on this week. You can follow them here.
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Greenville Memorial Receives Prestigious International Award
New center significantly expands options for cancer patients.