Dr. Dave Hnida's Blog

How long is too long? Thats the question when it comes to screening for colon cancer- and today the US Preventitive Services Task Force gave its answer:

Everyone ages 50-75 should get screened by at least one of three tests:

1. a colonoscopy of the entire colon every ten years

2. a sigmoidoscopy of the lower colon at least every five years, combined with a stool blood test every three years

3. a stool blood test every year.

Depending on your family history, personal history, and the results of these tests- the protocols may be different- these are general guidelines.

Whats important is the screening stops at age 75.... as well as the fact the task force nixed the use of "virutal colonoscopy" to screen for cancer. The virtual is a special xray of the colon with a cat scanner.

Now heres the bottom line on some of these- even those these are new and updated guidelines- they are guidelines of one group. For example, the American Cancer Society backs a stool DNA test as well as the virtual Cat Scan- they think these 'easier" tests will encourage more people to ve screened- right now less than half of those who should be screened- are screened.

Personally, I worry the simple stool test for blood may miss some cancers- just like the sigmoidoscopy, since it only looks at the lower end of the colon. I believe using the newer tests, especially when combined with colonoscopy, tube or virtual, is the best way to screen,

As always, talk this stuff over with your doctor.

Here's what you need to know:

Screening Mammogram:

Every year beginning at age 40.

As early as 30 if strong family history, genetic risks, etc

Dont stop having them as you get older unless your doctor says OK- there is no set upper age limit.

Some younger women, especially those at high risk or dense breasts, may benefit from an MRI- in general MRIs are not recommended for routine screening of the general population.

Have a clinical breast exam by your doctor every time you go in for a Pap smear (that may range from every 1-3 years depending on your age)

As for self exams, the cancer society says ,beginning at age 20, you have the option to do a self exam every month- its no longer a hard and fast recommendation. Some research says it doesnt help, but I think it doesnt hurt - so doing a self exam regularly is a smart thing.

The key to all of this- one size doesnt fit all. You and your doctor should discuss an indivdualized screening program right for you.

If the nation's financial woes having you feeling a bit on the stressed side, youre not alone. Sleepless nights, heartburn, and headaches are just a few of the issues money worries can bring- especially in a case like this... and by this, I mean a situation where "experts" are throwing around terms like "Great Depression" and "bank failures."

The great unknown is the one of the biggest threats to health. And I think in this case a big problem is none of the experts seem to agree on whats wrong, let alone on a fix. In fact, I think the general sense is we are all worried that no one really seems to understand economics and can explain whats going on and how we are all going to be ok. (this is a non political judgement on my part)

As a physician, I understand how important it is to be calm, confident and reassuring to my patients- and right now those are things we are not getting... from either side of the aisle or from the "experts." 

From an objective standpoint, when I worked this past week, it seemed like blood pressures were a little higher, stomachs a little more upset, back sores when just weeks before weren't sore at all. Sure, its purely unscientific, but it was disturbing to see people come in with new or worsening health complaints that can certainly be stress related. (in fact, it reminds me of the days after 9/11, though the two situations are different.)

From a subjective standpoint, it seemed like people I ran into or talked with had a little edge to them- a touch of anxiety in the back of the mind. You cant help but be a little worried with the news being only bad news ---with no bright light in sight.

No great advice today- I'm not an economist or a politician- but I do think we could use a little "doctor" qualities in the people who are supposed to get us out of this mess. WE are their patients right now. A soft touch and some calming words can go a long way towards feeling good- mentally and physically.

Interesting study in the New England Journal of Medicine- it says we now have a little more time to use clot busting drugs to stop a stroke. In the past, we believed we had 3hours from the time symptoms appeared to administering the clot busting drug TPA - this study says we now have 4 and a half hours.

I know an hour and a half doesnt sound like much, but frankly, its a huge amount of time for the only treatment we have to stop a stroke in its tracks... meaning before it leaves you with an arm or leg that doesnt work, or the inability to speak. Heres the problem though, I dont know if that extra time will make much of a difference because most people will probably still ignore the symptoms of a stroke and not get to the hospital in time. Sounds harsh, but the reality is even with the old 3 hour window, almost 70% of patients having a stroke waited too long before heading to the hospital.

So heres the deal, if you have symptoms of a stroke, the best thing you can do is get checked. Better to be "embarassed" by over-reacting than ending up with permanent brain damage. The best news I can give to a patient is " It's not a stroke." And trust me, we doctors admire patients who are smart enough to get checked out even when it turns out to be a false alarm.

Here are some of the symptoms you need to know:

Severe headache- and if you regularly get headaches- one thats worse that one youve had before.

Blurred visions

Numbness, tingling, or weakness in an arm or leg or the face.

Difficulty speaking or thinking clearly

Now these are just a few of the symptoms- the bottom line is -if you have weird symptoms going on, check them out before your time runs out.

Although energy drinks are under the gun for high caffeine content, you can consume a lot of "pick-me-up" from a number of other sources. (And as you might think, coffee is way up there.)

Here's a partial list with average caffeine content:

Coffee

brewed- 8 oz                              102-250mg

Starbucks-16 oz                            320mg

Vanilla latte-16 oz                         150mg

instant- 8 oz-                                    90mg

expresso- 1 oz                                 75mg

Tea

Brewed-   8oz                                  50mg

Snapple- 16oz                                 42mg

Arizona iced green - 16oz             15mg

Soft Drinks

Mountain Dew 12oz                       71mg

Jolt- 12oz                                          71mg

Diet Coke- 12oz                              47mg

Dr Pepper- 12oz                              42mg

Coke- 12oz                                        35mg

Energy Drinks

Fixx-20oz                                             500mg

Spike Shooter- 8.4oz                        300mg

Monster Energy-16oz                        160mg

Full Throttle- 16oz                              144mg

Red Bull- 8.3oz                                    80mg

Rockstar-8oz                                        80mg

Amp- 8.4oz                                            74mg

If your motto is "shop 'til I drop", you may want to take a look a study from the Journal of Consumer Research out of the University of Illinois. And take the test that comes with it.

Researchers devised a simple six question test to see if you should think about avoiding the mall or on-line stores. Its a little more complex than what I put here - they used a sliding scale for answering,  such as  "strongly agree", "dont agree" , "maybe agree", and so forth.

Here you go with a simpler "yes or no " version:

1. My closet has unopened shopping bags in it.

2. Others consider me a shopaholic

3. Much of my life consists of buying things.

4. I buy things I really dont need

5. I buy things I didnt plan to buy.

6. I admit I buy a lot of things on impulse.

Supposedly, if you answer yes to 5 of the 7, you may have a problem. The study says about 9% of people, mainly women. are compulsive buyers. (Thats not a women bashing comment- us guys have our own issues, hard to believe as that may be.)

The researchers say shopaholics often suffer from  low self esteem, depression or stress.

Take what you want from this little test- its certainly not perfect--- but it may raise some questions of its own that you may want to answer.

Early Monday morning, a guy in New York City decided he was going to hang upside down for two and a half days. David Blaine is aiming to break the record for "inversion"- dangling upside down as the clock ticks away. The big worry is what will happen to his body in a prolonged upside down world.

The biggest risks are stroke and blindness, as blood rushes to his head... and stays there. As normally upright creatures, us humans use leg muscles fight gravity and push blood back to the center of the body. The problem is the head doesnt work that way. No muscles, no pumping, no way to get that build up of blood out of the brain.

So what could happen?  A slow and steady rise in blood pressure- probably to adangerous levels- as well as a buildup of pressure in the eyes, which can lead to a glaucoma type condition and rapid blindness.

Now there are some people who use inversion therapy to relieve back pain, but even then, theyre not supposed to do it if they have high blood pressure or glacoma. Even if healthy, youre not supposed to hang like a bat for more than a few minutes.

This guy is shooting for 60 hours- sounds a little risky to me- and I certainly wouldnt try this at home, folks. Unless you want to have a stroke or go blind. Good luck to this fellow, he'll need it.

Here's a personal story for you about the importance of cancer screening- plus a little commentary on those who say prostate cancer screening is a waste of time.

Tuesday, I went over to University Hospital for my annual screening- and since it's Prostate Cancer Awareness Week, shoot a story about the importance of screening.  I started doing my annual screenings at age 50, and only missed one year when I was in Iraq. Everything has always been ok, and with zero family history of cancer- figured the screening would be a breeze.

So when I trucked over to Fitzsimmons, I thought I would zip in/zip out. A little paperwork to fill out as well as permission slips- a blood draw for PSA levels, a urine sample for a new test called a PCA3 that detects minute amounts of cancer cells that leak from the prostate into the urine- then the dreaded rectal exam.

A normal rectal exam really isn't all that bad - takes only about 15 seconds and you're done. And in years past, my exams have taken 15 seconds or less-- but not today. A full minute and a half- cameras rolling- and awkward silence. Something was wrong- and whatever ot was, it was wrong with me. Some weirdness to my prostate gland that was never there before- and all the while the only word in my head is : Cancer.

I've got to wait now on the PSA test as well as the new fangled urine test- but nonetheless, I'm glad I found out there might be something wrong at an early time. I don't even want to tell you what I think about those "experts" who say screening for men is a waste of time and money- at least now, for me, I have choices. Choices for diagnosis... and treatment  if necessary. If prostate cancer slowly spread through my body and then killed me - all because I didnt have screening, I wouldn't have choices. We'll see what my doctor has to say and take it from there. So do me a favor men, get screened. If not for you, do it for your family.

The schedule for screening :

WHERE:                    Anschutz Cancer Center 1^st floor (University Hospital)

                               1665 North Ursula Street, Aurora

WHEN:                     Monday – Friday

                             September 15-19, 2008, 2 pm-6 pm

                             Saturday, September 20, 2008, 8 am-12pm                                  

ADDITIONAL:         No appointment necessary

                                    Free

                                    (720) 848-9999 info line          

Also:       

Registration for the screening is preferred prior to September 20. To register or for more information, please call 1.866.931.3677 (toll-free).

WHAT:            A free, comprehensive men’s health screening for the Denver community.
 
WHEN:            Saturday, September 20, 2008
                       8:00 a.m. – 12:00 p.m.
 
WHERE:           The Urology Center of Colorado
                        2777 Mile High Stadium Circle
                        Denver, CO 80211

OK, we've been discussing the BPA (or Bisphenol-A) for a while now, and my position has been- it may be a concern but let's see some more reseach on it. Well, that research is started to appear... and it's research that makes me a little nervous.

This study comes from the Journal of the American Medical Association, and finds the people with the highest levels of BPA in their bodies have double the risk of heart disease or diabetes, Now the study does not say BPA causes  those diseases- but something fishy may be going on.

Now, it is totally impossible to avoid BPA- heck, it's in the water pipes that delivers water to your home (and what are you going to do, switch to bottled water... in plastic bottles?) but there are some things you can do to minimize the BPA you're sucking into your system:

1.       SWITCH TO GLASS, PORCELAIN OR STAINLESS STEEEL CONTAINERS- PARTICULARLY FOR HOT FOODS OR LIQUIDS.

2.       REDUCE THE USE OF CANNED FOODS- SINCE  CANS ARE USUALLY LINED WITH A THIN LAYER OF BPA.

3.       DO NOT MICROWAVE OR HEAT PLASTIC FOOD CONTAINERS

4.       USE BPA FREE BOTTLES AND PACIFIERS IN BABIES- BUT YOU HAVE TO ASK- JUST BECAUSE ANY PRODUCT DOESN’T LIST BPA- DOES NOT MEAN IT IS BPA FREE.

5. AVOID PLASTICS WITH THE #7 ON THE BOTTOM- THEY TEND TO CONTAIN BPA.

Certainly this study is not the final word- and more research needs to be done- but it does raise some new red flags over the safety of the one of the most commonly found chemicals in our daily lives. And by the way, remember the butter in a plastic container is worse for your arteries than any BPA that might be in the plastic. (And take that cigarette out of your mouth as you shop for BPA free products.)

The Surgeon General has launched a new campaign to raise awarenss about blood clots- the targets of the campaign are you AND me. Its seems like a lot of people dont consider a blood clot when they have some problem with a leg- the bigger problem may be some of us doctors dont consider it, either. And thats a problem since blood clots can break off and travel to the lung where they can be deadly.

Blood clots, or Deep Vein Thrombosis (DVT) are called the "great masquerader"- often not causing the same symptoms in each person who develops one.

First the symptoms:

leg pain

swelling

redness

warmth

and if it spreads to the lungs: chest pain and/or shortness of breath

Those most at risk for a DVT include people who have just had surgery, people laid up in bed for long periods of time, people sitting ina cramped position for a long period (ie overseas airplane trip) , women on the pill or hormone replacement therapy, brken bones or trauna to the leg or pelvis, and age 65 or older.

The key point of the campaign is : THINK DVT when you have symptoms. Ask your doctor if a DVT could be causing your symptoms, and if the answer is no, why not?

My one close call with a DVT was a patient who twisted her leg while playing tennnis. She had discomfort behind her knee for a couple of weeks and came in to have it checked out. To play it safe, we did an ultrasound of the leg-- and bingo- she had a clot. We put her on blood thinners, the clot dissolved and she is doing great 15 years later. Its a case i will never forget.