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May Blog: National Stroke Awareness Month


May is national stroke awareness month. Every year 800,000 people suffer from a stroke, which makes the incidence of stroke equal to that of heart attacks. While stroke is the fifth leading cause of death, the majority of stroke Read more

May is: Melanoma/Skin Cancer Detection & Prevention Month


  May is skin cancer awareness month. Skin cancer is the most common cancer in the United States and one in five of us will develop skin cancer in our lifetime. Like many other cancers, successful treatment of skin cancer Read more

National Prescription Drug Take Back Days Ensure Proper Disposal of Prescription Drugs


In the US, the use of prescription opioids has skyrocketed. Since 1999, the prescription of opioids has increased four-fold. While it is true that the use of these drugs has led to improvements in medical pain management, it has Read more

April: Alcohol Awareness Month


  April is Alcohol Awareness Month. Marking April as Alcohol Awareness Month began in 1987 with the goal of raising awareness that alcohol abuse is a disease, and, like many diseases, it is a public health concern that can, and Read more

Save Your Vision


Your vision is priceless. When it comes to eye health, sometimes our concerns start with visual acuity problems and end with contacts or glasses. It can be easy to forget that the eyes are related to the health of Read more

May Blog: National Stroke Awareness Month

Physicians Health Network Blog

May is national stroke awareness month. Every year 800,000 people suffer from a stroke, which makes the incidence of stroke equal to that of heart attacks. While stroke is the fifth leading cause of death, the majority of stroke victims do survive. Therefore, stroke is the primary cause of long-term disability.

Strokes fall into two main types. There are ischemic strokes which account for 85% of all strokes. Ischemic strokes occur when the delivery of blood to the brain is blocked by a clot. The brain requires large amounts of blood all day every day, which means this type of blockage quickly causes serious damage to the brain in areas downstream of the blockage. The second main stroke type is a hemorrhagic stroke. In these cases, a blood vessel ruptures and the bleeding creates swelling, pressure, and cell damage. It is also important to recognize a third type of stroke called a transient ischemic attack or TIA. This is not a full-blown stroke, but instead a short-term event that causes symptoms similar to a stroke. TIA’s are sometimes call “mini-strokes”. While individuals with TIAs often recover without permanent damage, having a TIA should be considered a very serious warning sign for a future stroke. In fact, 40 percent of people who have a TIA will have a stroke.

Eighty percent of strokes are preventable. This means that spreading awareness about stroke risk factors and warning signs is a powerful way to reduce the number of individuals who suffer long-term disability after a stroke.

Recognizing when an individual is having a stroke is crucial because faster treatment means less damage to the brain. It is common for an individual who is suffering from a stroke to experience confusion, headache, dizziness, or vision issues. There is also a handy acronym, F.A.S.T., that can be used to quickly recognize when someone is suffering from a stroke:
● F – Face: Is one side of the face drooping or numb? Ask the person to smile and check.
● A – Arms: Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
● S – Speech: Is their speech slurred?
● T – Time: If someone has these symptoms, even if they go away, call 911.

Strokes most often affect older adults; however, 15 percent of ischemic strokes occur in adolescents and young adults and the number of strokes in young adults has increased 44 percent over the last ten years. These statistics mean that spreading awareness about strokes can have a meaningful impact on people of all ages.

SOURCES:
http://newsroom.heart.org/news/may-is-american-stroke-month
http://www.strokeassociation.org
http://www.stroke.org
https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_stroke.htm


National Prescription Drug Take Back Days Ensure Proper Disposal of Prescription Drugs

Physicians Health Network Blog

In the US, the use of prescription opioids has skyrocketed. Since 1999, the prescription of opioids has increased four-fold. While it is true that the use of these drugs has led to improvements in medical pain management, it has also resulted in an Opioid Crisis. The term Opioid Crisis refers to the abuse and deaths associated with illegal and prescription opioids. In 2015, six million Americans abused prescription drugs and the majority of these individuals obtained their drugs from the legal prescriptions of family and friends. In fact, one study found that 61 percent of patients who were prescribed opioids for pain management were given more than they needed and only 41 percent of these patients reported disposing of their unused opioid pills safely. This means there are large quantities of excess pills in the community that could potentially be abused.

The goal of the Drug Enforcement Agency (DEA) sponsored National Prescription Take Back Day is to provide a safe, convenient, and anonymous way to dispose of excess or expired prescription drugs. In other words, the goal is to get these unneeded drugs out the medicine cabinets and out of the community so that they cannot be abused and further contribute to the Opioid Crisis. During just one Take Back Day last year, 456 tons of prescription drugs were collected and safely removed.

Each Take Back Day is also an opportunity to encourage those with substance abuse issues to seek help. A local substance abuse treatment professional can be found using the anonymous locator at https://takebackday.dea.gov/

The Sheboygan Police Department, 1315 N.23rd St. accepts prescription drugs for purposes of disposal every day of the year. For information, call 920-459-3333.
The next community Drug Take Back Day is Saturday, April 21, 2018 at St. Nicholas Hospital from 10:00 a.m. until 1:00 p.m.

If you’re not in the Sheboygan area you can search for you nearest sit on the DEA website and if you can’t make it to a Take Back site you can also search for sites in your area that accept drop-offs all year.

Sources:
https://takebackday.dea.gov/

Sabatino, M. J., Kunkel, S. T., Ramkumar, D. B., Keeney, B. J., & Jevsevar, D. S. (2018). Excess Opioid Medication and Variation in Prescribing Patterns Following Common Orthopaedic Procedures. The Journal of Bone and Joint Surgery, 100(3), 180–188. doi:10.2106/jbjs.17.00672


Save Your Vision

Physicians Health Network Blog

Your vision is priceless. When it comes to eye health, sometimes our concerns start with visual acuity problems and end with contacts or glasses. It can be easy to forget that the eyes are related to the health of the whole body. In fact, the eyes, which are only two percent of your body weight, burn 20 percent of your daily energy. This is a massive amount of energy. Your visual system is the single largest energy user in your body. This means that the health of your eyes and the health of your body as a whole are intimately linked.

Here are some lifestyle factors that can impact your eye health:
• Diet
• Eye protection
• Smoking
• Screen time
• Regular eye exams

Let’s look at some of the details of each one:

Diet – Carrots are not the only vegetable to benefit your eyes. Although they are good sources of carotene. Consider other vegetables as well; especially dark leafy greens such as spinach and kale. In addition, the omega-3 fats found in fish and other seafood are important for retinal health. Deficiency of these fatty acids may increase your risk of certain eye diseases.

Eye protection – Protective eyewear includes safety glasses, goggles, and splash shields. The type of protective eyewear needed depends on the activity. Wear protective eyewear for sports, work, handling chemicals or any activity that puts your eyes at risk. If possible look for polycarbonate glasses which are very strong and shatter-resistant.

Smoking – It is no surprise that smoking is bad for your health, but this is especially true for eye health. All the energy that your eyes use creates a lot of inflammatory by-products. The eyes must deal with these by-products and smoking makes the problem even worse. This is why smoking is related to the development of age-related macular degeneration, cataract, and optic nerve damage.

Screen time – Modern computer screens, TVs, phones, and tablets all flicker and are saturated with blue light. As mentioned, the eyes burn enormous amounts of energy and need to deal with the inflammatory by-products. Because of its wavelength, blue light is high-energy radiation which stresses the eyes by fatiguing the eye’s waste disposal systems. The flickering of computer screens is too fast for us to notice, but it is a source of eye fatigue. When using a screen take breaks every 20 minutes. In addition to resting the eyes use these breaks to look off into the distance. If your device features allow, change the setting to lower the amount of blue light and increase the amount of red light coming from the screen. Examples of these features include night mode on Android devices and night shift on Apple devices.

Regular eye exams – Often eye exams are not a top-priority for children and young and middle-aged adults. However, a dilated eye exam can be important for to assess your eye health and screen for progressive diseases. These exams are recommended annually for any individual over 60 and for African Americans over 40. Regardless of your age, if you feel an eye exam is right for you contact your eye care professional.

Sources:
https://nei.nih.gov/healthyeyes/eyehealthtips

https://www.aoa.org/patients-and-public/caring-for-your-vision/diet-and-nutrition/essential-fatty-acids

Campello, L., Esteve-Rudd, J., Bru-Martínez, R., Herrero, M. T., Fernández-Villalba, E., Cuenca, N., & Martín-Nieto, J. (2013). Alterations in Energy Metabolism, Neuroprotection and Visual Signal Transduction in the Retina of Parkinsonian, MPTP-Treated Monkeys. PLoS ONE, 8(9), e74439. doi:10.1371/journal.pone.0074439


February: Go Red for Women!

Physicians Health Network Blog

You may know that heart disease is the leading cause of death for men. But did you know that heart disease is also the leading cause of death for women? In fact, in the US, 44 million women are affected by heart disease and women under the age of 55 who suffer a heart attack do not recover as well as men in the same age group. In other words, heart disease is as important for women to pay attention to as it is for men.

Heart disease affects all women, but it is important to note that African American and Hispanic women are at greater overall risk and more at risk of developing heart disease earlier in life.

It is estimated that 80 percent of heart disease and stroke events can be prevented with lifestyle changes.

This is why spreading awareness among women is so important and that’s exactly what the American Heart Association’s Go Red for Women campaign is all about. On February 2nd women, and men, will wear red to call attention to the importance of cardiovascular health for women and to help bust the myth that heart disease is only an issue for men.

The connection between heart disease and men’s health is well-known but cardiovascular research has begun to appreciate the risk women face and how that risk differs from men. For example, the classic heart attack symptom for a man is chest pain. While women may also experience chest pain, they are more likely to experience the other types of discomfort associated with a heart attack such as shortness of breath, nausea, vomiting, back pain or jaw pain. Here is a list of heart attack warning signs for women:
● Chest discomfort that lasts more than a few minutes or that goes away and comes back.
● Discomfort in other areas such as one or both arms, the back, neck, jaw or stomach.
● Shortness of breath.
● Cold sweat.
● Nausea or lightheadedness.

Some heart disease risk factors cannot be controlled such as age, race, and family history. But women still have an enormous ability to change their personal risk of heart disease by paying attention to the risk factors they can control by making changes in their lifestyle behaviors. The following lists the risks that can be managed through lifestyle changes to lower your risk of heart disease.
• High blood pressure
● Smoking or tobacco use
● High blood cholesterol
● Lack of regular activity
● Obesity or overweight
● Diabetes

If you need to make improvements in these areas be sure to see your doctor.

Remember to put on your red apparel on February 2nd and help spread the word. Heart disease isn’t just a concern for men.

Sources: https://www.goredforwomen.org/
https://www.cdc.gov/dhdsp/data_statistics/fact_sheets/fs_men_heart.htm


Opioids and the Battle Against Pain

Physicians Health Network Blog

Atit Shah, MD
Advanced Pain Management
2124 Kohler Memorial Dr.
Sheboygan, WI 53081

Medical Education
University of Illinois College of Medicine, Peoria, IL
Internship
Advocate Lutheran General Hospital, Park Ridge, IL
Residency
Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, N.Y.
Fellowship
Case Western University, Cleveland, OH

Board Certifications
Anesthesiology
Pain Management
Fellowship Trained in Pain Management

Professional Memberships
American Medical Association
American Society of Anesthesiology
New York State Society of Anesthesiology
North American Neuromodulation Society

The only person who really knows the extent and severity of your pain is yourself. It is my mission and goal to help alleviate your pain and allow you to gain your life back. I believe if we work together, we can accomplish this mission. – Atit Shah, MD

Prescription opioids, such as oxycodone, hydrocodone, and morphine, do more than block pain. Dr. Atit Shah, MD from Advanced Pain Management explains, “Opioids can have undesirable effects. They can depress the respiratory system which can become dangerous and lethal even when not abused or misused. They can also create feelings of euphoria and lead to dependency.” In fact, one-quarter of the patients on long-term opioid therapy will develop dependency.

The risk of prescription opioid abuse varies widely between people and the incidence varies widely between regions of the US. Risk factors for opioid abuse include:
• Obtaining overlapping prescriptions from multiple providers.
• Taking high daily doses of prescription pain relievers.
• A history of mental illness or alcohol or substance abuse.
• Living in rural areas and having a low income.

Achieving effective pain management presents a challenge. Healthcare providers must strike a balance between the chronic pain management needs of their patients and the risks of longer-term abuse or addiction. Dr. Shah says, “While we need to find solutions to the Opioid Crisis, we do not want to stop focusing on how important pain is to the patient and their health. The solution is not less pain management. Rather, it is better pain management.”

One of the pillars of the Department of Health and Human Services’ strategy to combat the opioid crisis is to promote better pain treatment. Such improvements may come from the development of better opioid medications that act on the specific receptors for pain but ignore the receptors that create euphoria and addiction. Other alternatives are pain-blockers from other drug classes such as anticonvulsants, cannabinoids, anti-inflammatory, corticosteroids, antidepressants, or interventional options.

Dr. Shah says, “A pain treatment does not have to completely replace opioid drugs to help. Any treatment that lowers the patient’s need for opioids is a step in the right direction.” Nerve blockades, for example, help patients use fewer opioids immediately after surgery. Modalities such as electrical stimulation, through the skin or directly to the spinal cord, can lower pain perception. Non-drug treatments, such as cognitive behavioral therapy, physical therapy, yoga, or meditation, may also help liberate patients from opioids.

Another important step in combating the crisis is overcoming the stigma surrounding it. Dr. Shah says, “Prescription drug dependency is often perceived as a criminal issue. Rather, opioid dependence should be a medical issue. Stigmatizing it like a criminal issue makes those individuals suffering from opioid dependence less likely to tell their loved ones and seek help.”

The recognition that pain control is integral to good patient care and medical outcomes has led to an explosion of opioid prescriptions. So much so that it has turned into a crisis of abuse, addiction, and overdose. As we search to resolve the crisis we must avoid minimizing pain and the suffering that occurs with inadequate pain control. Dr. Shah says, “The pitfalls of pain management strategies that over-rely on opioids are becoming more and more apparent. As we shift away from overreliance on opioids, we must take care to keep our sights set on pain and the effect pain has on patients and their health outcomes.”

Sources:
https://www.cdc.gov/drugoverdose/prescribing/guideline.html
https://www.cdc.gov/drugoverdose/opioids/prescribed.html
https://www.drugabuse.gov
https://www.hhs.gov/opioids/

Boscarino JA, Rukstalis M, Hoffman SN, et al. Risk factors for drug dependence among out-patients on opioid therapy in a large US health-care system. Addiction 2010;105:1776–82.


Stay on Your Feet This Winter

Physicians Health Network Blog

Falls due to winter conditions are a safety issue but it is important to note that they are also a healthcare issue. This is because the consequences of a fall can be serious, and in the case of the elderly a fall can lead to a loss of independence. The grim truth is that for older adults some falls ultimately lead to death, which we may call fall-related death. The risk of fall-related death increases dramatically after the age of 65. While women are at a greater risk of non-fatal falls, men are at greater risk of a fatal fall. The higher rate of fall-related deaths in men may be more a result of complicating health issues at the time of the fall rather than the severity of the fall itself.

Individuals under the age of 65 are not immune to falls or fall-related injuries. While younger individuals seldom fracture a bone, they can often experience muscle strains or back injuries. These injuries happen when the individual slips and, to stay vertical, jerk their body or quickly reach out to grab hold of a solid object.

Perhaps the most important defense against falls is awareness. Reminding yourself that slippery hazards are to be expected all winter and that walking outdoors may require shorter, slower steps. The fact that 56 percent of all falls occur outside of the home highlights the need to be mindful of the extra hazards in winter. Good fall prevention can mean strategically planning your route in and out of buildings based on the location of ice and snow hazards. Also, consider that some ice, the dreaded clear “black ice” for example, can be quite hard to see or lurks under a fine dusting of snow. Likewise, the short winter days mean there is little sunshine to light our way. We sometimes have to cross slippery surfaces in the dark. A keychain flashlight can be handy tool to spot any ice in your path.

Falls can also be prevented where the rubber meets the road. In other words, by choosing the appropriate footwear. Rubberized soles with a traction pattern can help keep you stable on snow or slush covered surfaces. If you often need to walk through slippery, ice-prone areas consider augmenting your existing grip with spikes or treads that pull over the sole.

The increased risks of winter falls are a concern for everyone but, as mentioned, older adults are particularly vulnerable. One quarter of Americans over the age of 65 falls once a year and it is no surprise that the incidence of falls among older adults increases in the winter. Falls are the leading cause of accidental death in those older than 75. A hip fracture, which occurs in one to two percent of falls, is the number one reason for fall-related hospital stays. Of those individuals who suffer a hip fracture, half must be discharged from the hospital to a nursing home and one quarter die. Here are some known risk factors for falls:
● Greater than 75 years of age
● Living alone
● Prescription drug use – especially the use of multiple drugs
● Use of a cane or walker
● Cognitive impairment
● A history of falling
● Poor vision
● Poor hearing
● Foot problems – such as the type that occur with diabetes
● Environmental hazards (such as snow and ice)

Winter is known for throwing slippery obstacles in our path. Prepare yourself and avoid potentially serious fall-related injuries. If you are at risk of falling or lack confidence outdoors in the winter, see your doctor or physical therapist. These healthcare providers can screen your balance, help you make balance improvements and reduce your risk of a serious fall-related injury.

Sources:
https://www.osha.gov/dts/weather/winter_weather/hazards_precautions.html#walking
http://www.sciencedirect.com/science/article/pii/S2210833511000050
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686332/
http://www.who.int/ageing/projects/1.Epidemiology%20of%20falls%20in%20older%20age.pdf

Yeung, P.-Y., Chau, P.-H., Woo, J., Yim, V. W.-T., & Rainer, T. H. (2011). Higher incidence of falls in winter among older people in Hong Kong. Journal of Clinical Gerontology and Geriatrics, 2(1), 13–16. doi:10.1016/j.jcgg.2011.02.002
-disease


Energy and Alzheimer’s Disease

Physicians Health Network Blog

Imagine this: You have been put in charge of a crew that must dig an underground tunnel across town. The tunnel is going to be narrow, just big enough to stand in. Somehow you have to get the work crew, generators, lights, and tools in and the rocks and dirt out. If you can imagine how difficult this would be then you have some sense of how hard it is for the neurons in your brain to stay healthy. Neurons have long, thin tubes called axons that they use to send messages. To do this they need lots of energy and supplies. But, much like the tunnel project, how do the neurons transport all these materials? Understanding this problem can help us understand Alzheimer’s disease.

There are 5.5 million cases of Alzheimer’s disease in the US. Almost all of these case are in individuals older than 65 years. Two-thirds are women and Alzheimer’s disease is more common in African Americans and Hispanics compared to European descendants. Alzheimer’s disease is a progressive, degenerative neurological disorder. The hallmark symptom of the disease is memory loss but a collection of symptoms occur depending on what brain areas are affected and to what extent. Other symptoms can include personality changes, issues communicating, and an inability to recognize people, including loved ones. As the neurological degeneration progresses the individual’s symptoms worsen.

The human brain is unique. While it makes up only about two percent of our body weight it uses a full 20 percent of our daily energy. In other words, the brain needs enormous amounts of cellular energy to work properly. It also means that the brain has a lot of oxidative stress to deal with. You might think of oxidative stress like the exhaust fumes from an engine. Just like digging that underground tunnel, meeting the neuron’s energy demands presents an engineering problem. If you were in charge of the tunnel project you might set up a railway system to bring gear and workers in and the dirt out. Your neurons do something very similar. They construct a railway system made of microtubules.

With these massive energy requirements, the brain is very sensitive to any changes in the hormonal control insulin has over blood sugar. Alzheimer’s disease starts when the process of taking fuel from the bloodstream and converting it to a usable form becomes impaired. As the brain’s energy production falls behind a set of chain reactions begin. Although, there may be years between the first lag in energy production and the first symptoms. Slowly, the cellular hallmarks of Alzheimer’s disease begin to appear. Those microtubule railways become blocked by what are called neurofibrillary tangles. These tangles are made of a protein called tau protein that is supposed to help build the railways. The tangles block the delivery of nutrients down the long thin axons. The neuron doesn’t get the energy and resources it needs and it becomes stressed. The circuits between neurons that make up memories and perform important brain functions begin to break down. Eventually, the neuron will die. It is here, among the stressed, energy-starved, and dying neurons that oxidative stress increases and chronic inflammation develops. This begins a cycle where more damage to the neurons begets even more damage.

The neurons begin to secret plaques made of beta-amyloid peptides. These plaques build up around the cells and, in the Alzheimer’s brain, they are not properly broken down and cleaned-up as they are in healthy brains. As the disease progresses these plaques further block the flow of resources. As more and more neurons die the brain shrivels. The hippocampus, an area of the brain which is crucial for memory, is hit hard by Alzheimer’s disease. As the hippocampus shrivels it causes memory failure and dementia.

There is no cure for Alzheimer’s disease. The neurofibrillary tangles and the beta-amyloid plaques are often the targets for drug development but, to date, none are effective in fighting the disease. There are other treatments that can address the symptoms only, but unfortunately, these treatments do not stop the overall progression of the disease.

The connection between Alzheimer’s disease and cellular energy production is receiving more and more attention. The term type III diabetes is being used specifically to highlight the role that insulin resistance and impaired sugar metabolism play in the disease process. In the past, when Alzheimer’s disease was less common, it was seen as a stroke of unfortunate luck. Emphasizing the role impaired energy production helps medical professionals and patients reframe Alzheimer’s disease as something that is intimately tied to lifestyle factors. This opens the door to other treatments and preventative measures that involve lifestyle, nutrition, metabolism, and exercise. Afterall, long before symptoms appear the first sign of Alzheimer’s disease is a change in the way neurons use energy. This means that the time to think about prevention is, likewise, long before symptoms appear. Alzheimer’s prevention isn’t just for those who just blew out the candles on their 65th birthday cake. Rather, it becomes one more reason to target lifestyle changes at any age. Here is a list of habits for Alzheimer’s prevention from the National Institutes of Health that are appropriate for people of all ages.

● Exercise regularly.
● Eat a healthy diet that is rich in fruits and vegetables.
● Spend time with family and friends.
● Keep one’s mind active.
● Control type 2 diabetes.
● Keep blood pressure and cholesterol at healthy levels.
● Maintain a healthy body weight.
● Stop smoking.
● Get help for depression.
● Avoid drinking a lot of alcohol.
● Get plenty of sleep.

Sources:
De la Monte, S. M., & Wands, J. R. (2008). Alzheimer’s Disease is Type 3 Diabetes—Evidence Reviewed. Journal of Diabetes Science and Technology, 2(6), 1101–1113. doi:10.1177/193229680800200619

Kodl, C. T., & Seaquist, E. R. (2008). Cognitive Dysfunction and Diabetes Mellitus. Endocrine Reviews, 29(4), 494–511. doi:10.1210/er.2007-0034

Raichle, M. E., & Gusnard, D. A. (2002). Appraising the brain’s energy budget. Proceedings of the National Academy of Sciences, 99(16), 10237–10239. doi:10.1073/pnas.172399499

http://www.alz.org/facts/overview.asp

https://www.nia.nih.gov/health/assessing-risk-alzheimers-disease


Breast Cancer Awareness Month

Physicians Health Network Blog

October is a busy month. Schools and universities are back in their routines, often complete with football games, soccer matches, and cross country meets. The fall harvest is in full swing and the trees are changing from green to a blaze of orange, yellow and red. And, we are about to be ‘spooked’ by the first holiday of the season.

October is also breast cancer awareness month and regardless of how busy October’s routines can be, it is important for women to become more aware about the importance of early detection and think about their breast care and screening plan. Women who are approaching the age of 40 need to discuss breast screening with their health care provider and determine their schedule.

Breast cancer tumors can often develop quickly and progress well-before a woman experiences any symptoms.

This October, let us stop to recognize the importance of breast cancer awareness. Let us realize that awareness of breast cancer and the importance of screening can lead to earlier diagnosis and better outcomes.

The number one cancer affecting women is breast cancer and it is the second most common cause of cancer death in women, regardless of ethnicity. The lifetime risk for developing breast cancer (for a woman) is one in six. Clearly, this makes screening an important and powerful part of any woman’s health care plan.

While screening does not lower a woman’s risk of developing breast cancer, it can lower the risk of death from breast cancer. Any discussion on breast cancer screening will include mammography which is breast cancer’s primary screening tool. A mammogram is a breast image created with low dose x-rays for screening or diagnostic purposes. Mammography comes with few risks and is the best current technology for detecting breast cancer early.

The recommended screening routine depends on the woman’s age and risk level. The American Cancer Society (ACS) defines average risk as those women who:
• Do not have a personal breast cancer history.
• Without strong family history of breast cancer.
• Have not had chest radiation before the age of 30.
• Have no known genetic mutation that puts her at higher risk.

According to the ACS, women who meet the definition of average risk should have yearly mammograms between the ages of 45 and 54. After age 54 ACS recommends that women have a mammogram every other year, unless the woman chooses to maintain her annual mammogram screening schedule.

ACS recommendations differ for women in a high-risk category. These women have:
• A strong family history of breast cancer.
• A known gene mutation in themselves or first-degree relatives.
• Had radiation therapy to the chest between the ages of 10 and 30.
• One of the rare genetic syndromes which are known to elevate the risk of cancer.

For women in this category, ACS recommends annual mammogram and magnetic resonance images (MRIs) of the breasts.

In addition to mammography, a clinical breast exam (CBE) may also be performed to screen for breast cancer. A CBE is a check for lumps or other physical changes by a trained healthcare provider and typically done during a woman’s annual physical. Clinical organizations are not unanimous in their stance on CBE. The ACS does not recommend a CBE for women getting regular mammograms, while the American College of Obstetricians and Gynecologists recommends that women aged 29 through 39 have a CBE at least every three years. Women may also perform self-exams, but this is also met with differing recommendations. Organizations that recommend self-exams suggest they be done monthly and at the same time of the month. Women who want to make self-exam a part of their screening should discuss a systematic method with their physician.

While there is differing recommendations around breast cancer screening, the most important message for women, not only in October, but in all the months of the year, is to discuss breast cancer screening guidelines with their providers and do what they feel is right for them.

Don’t allow this October’s breast cancer awareness campaign slip by. Make this your reminder, for yourself or the women in your life, of the importance of regular screening based on age and risk profile. If you don’t have an ongoing screening plan take this opportunity to contact your physician and start one.

Sources:
https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/american-cancer-society-recommendations-for-the-early-detection-of-breast-cancer.html

https://www.radiologyinfo.org/en/info.cfm?pg=mammo

http://www.froedtert.com/healthlibrary/default.aspx?sid=1&id=401&pTitle=CondDisease&ContentTypeID=85&ContentID=P00169


The Health Benefits of Vegetables and Fruits

Physicians Health Network Blog

Plants bearing vegetables and fruits have a lot of work to do. Each day, they must take sunshine, nutrients from the soil, the air’s carbon dioxide and turn it all into something you’d like to bite into. While the plant is hard at work making a vegetable or fruit, it has to fight off fungi, bugs, and somehow avoid a sunburn. To pull off this feat the plant produces various chemicals. Some of these chemicals are the vitamins we all need. Other chemicals, made by the plant for self-defense, are called phytonutrients. These phytonutrients are often colorful, concentrated in the outer layers of the vegetable or fruit, and have a strong flavor. In fact, this is why wild plants are often smaller, less sweet and more bitter than the garden variety.

Think of the difference between a crab apple and a grocery store apple, or a wild strawberry compared to farmed strawberries. They are different because the wild plant had to put more energy into its chemical defenses rather than growing bigger and sweeter. This also explains why organic produce has a higher nutrient content. It’s because the organically raised plants had to fight their own battles and, in the process they create more nutritious food for us.

Many of these phytonutrients are health promoting in humans, but the way they do this is surprising. Take the case of glucosinolates. These are the class of compounds behind the spicy flavor of radishes and a few other vegetables. The vegetables don’t make the glucosinolate compounds for our gustatory pleasure, rather they are produced by the plant for pest control. And, if we were the size of aphids, eating some radish could be fatally toxic. However, since we are much bigger than insects these plant phytochemicals are, typically, not powerful enough to cause harm but they do stimulate our cell defenses. This is where much of the healthful effects of vegetables, fruits, herbs, and spices come from. By being strong enough to stimulate our own antioxidant systems at the cellular level but not strong enough, or consumed in large enough amounts, to be toxic. This benefit can be especially important in the areas of our body where energy use is always very high and oxidative damage is always a risk. These areas include the heart, the liver, and the brain.

Anthocyanins are another good phytonutrient example. Anthocyanins are a family of phytonutrients found in many red, blue, and purple fruits and vegetables; for example, blueberries.

If you would like to take advantage of these phytonutrients there a few things to consider when loading up your dinner plate. Fruits and tubers can be great sources of phytonutrients but be sure to take their sugar content into consideration. As a rule, vegetables that grow above ground are pretty much always low in sugar. Another general rule is this: colorful and strongly flavored produce is high in phytonutrients. Take the blues and reds of berries or the orange of carrots as examples. As for strong flavor, consider the radishes mentioned above. Onions, mustard seed or peppers also have strong flavors which they owe to their phytonutrients.

Sources: Son TG, Camandola S, Mattson MP. Hormetic Dietary Phytochemicals. Neuromolecular medicine. 2008;10(4):236-246. doi:10.1007/s12017-008-8037-y.

Yuni Choi et al. Vegetable Intake, But Not Fruit Intake, Is Associated with a Reduction in the Risk of Cancer Incidence and Mortality in Middle-Aged Korean MenJ. Nutr. 2015 145: 6 1249-1255; first published online April 15, 2015. doi:10.3945/jn.114.209437
-data-report-2012-final.pdf


Suicide Prevention

Physicians Health Network Blog

Suicide is the tenth leading cause of death in the US. Between the ages of 15 and 34 it is the second leading cause of death and men die of suicide four times more often than women.

The groups with the highest rates of suicide are Native Americans, veterans and white males. About 50 percent of suicides involve the use of firearms and 90 percent had a mental health disorder at the time of their death.

Wisconsin’s suicide rate is 14 per 100,000 people which is slightly higher than the national average of 13 per 100,000 people. To put this into perspective the national homicide rate is about 5 per 100,000 people. While the homicide rate has been falling for many years, the suicide rate has been climbing since 2000 when the national average was about 10 per 100,000 people.

The way we talk about suicide matters. In fact, news coverage, such as a celebrity suicides, can become an unfortunate influencer rather than a deterrent of suicide. Facing, discussing and removing the stigma that surrounds mental health will greatly impact the number of suicides that occur in people who are living with a mental health disorder.

Recognizing warning signs and intervening can be lifesaving. Here are some of the common warning signs:
● Expressing a desire to die
● Looking for items that can be used for suicide such as guns and poisons
● Expressing feelings of hopelessness
● Talking about feeling trapped or experiencing unbearable pain
● Increasing use of alcohol or drugs
● Showing increased anxiety or agitation
● Reckless behavior
● Choosing isolation
● Extreme mood swings

There are factors that can be promoted to lower an individual’s risk of suicide. The Suicide Prevention Resource Center lists the following as important preventative factors:
● Access to effective behavioral health care
● Connectedness to individuals, family, community, and social institutions
● Learning life skills such as problem-solving skills, coping skills, and an ability to adapt to change
● Help in developing self-esteem and a sense of purpose or meaning in life
● Involvement in cultural, religious, or personal beliefs that discourage suicide

If you need to intervene with someone who is a risk of suicide, the American Foundation for Suicide Prevention recommends the following:
● Do not leave the person alone
● Remove any firearms, alcohol, drugs or sharp objects that could be used in a suicide attempt
● Call the U.S. National Suicide Prevention Lifeline at 1-800-273-TALK (8255)
● Take the person to an emergency room or seek help from a medical or mental health professional

If you need more information, the American Foundation for Suicide Prevention (www.asfp.org) and the Suicide Prevention Resource Center (www.sprc.org) are excellent resources.

Sources:

https://suicidepreventionlifeline.org/how-we-can-all-prevent-suicide/
https://afsp.org/about-suicide/risk-factors-and-warning-signs/
http://afsp.org/wp-content/uploads/2016/01/recommendations.pdf
https://afsp.org/about-suicide/state-fact-sheets/#Wisconsin
http://www.sprc.org/effective-prevention/comprehensive-approach
https://www.va.gov/opa/docs/suicide-data-report-2012-final.pdf