Gut Instincts

An interview with Carey Strom, M.D. FASGE

March is colon cancer awareness month, and it seems apropos to post my interview with Dr. Carey Strom this month. 

Whether you are approaching or have settled into the mid life years, there are a considerable number of gastrointestinal issues that arise that need to be addressed. Below is my interview with Dr. Carey Strom, who has been a practicing gastroenterologist for 32 years. Dr. Strom received his medical degree from Chicago Medical School. He completed his residency at The University of Illinois, and received his fellowship from the UCLA-Cedars combined program.

LW: What is the overall chief GI complaint from women in their 40’s and 50’s?

CS: Bloating with intermittent distention, sometimes with constipation, as well as reflux.

 

LW: What is the cause of these symptoms?

CS: If nothing is structurally wrong, it could be hormone related. Also, emotions play a big part in the manifestations of these symptoms. Depression, anxiety and stress can cause gastrointestinal problems.

 

LW: If it is hormone related, do you treat it with hormone replacement?

CS: Hormone replacement is usually used for symptoms that are more gynecological, such as hot flashes, vaginitis, things of that nature.

 

LW: In the absence of those symptoms, how would you treat the issues of reflux, bloating and constipation?

CS: First of all, you have to ensure that there is nothing pathological going on. If they are in their 50’s you want to make sure that their colon is clear. If the constipation is accompanied by bleeding, for instance, then the colon needs to be examined.  Colonoscopies are strongly recommended at the age of 50 and then every 5-7 years thereafter. It is dangerous to assume that these symptoms are merely related to menopause. If you assume that, you could be making a fatal mistake.

 

LW: What if a woman in her 40’s presents with these symptoms, in the absence of family history of colon cancer or other gastro diseases. How would you proceed?

CS:  If a woman is 45, there is no family history of anything, and there is a change of bowel habits, I would look at her diet, check for blood in the stool, do a blood analysis for anemia, etc. If all of that comes back negative, then it is probably a sluggish, spastic colon. I cannot say with absolute certainty that I wouldn’t scope her. It depends on the specific situation. If there is nothing structurally wrong, and it is just an irritable bowel, then hormone replacement may help. 

LW: What is irritable bowel?

CS: Irritable Bowel is a motility disorder of the gut that has many different causes. It can occur at any age. It could be related to stress or anxiety. It can also be Celiac disease, bacterial overgrowth, use of artificial sweeteners or some type of infection. These are all part of the differential. You need to rule all of these out. Once these are ruled out, the diagnosis of Irritable Bowel is made.

 

LW: What do artificial sweeteners cause?

CS: Bloating, distention, gas, diarrhea.  Once you cut out the artificial sweeteners, these symptoms should disappear. I often recommend a probiotic, like Culturelle.

 

 

LW: What are things that you would discover in a colonoscopy that are abnormal?

CS: Polyps

 

LW: Describe to my readers what polyps are?

CS: Polyps are growths. They resemble mushrooms.

 

LW: What is so dangerous about them?

CS: Polyps can become cancerous. Benign polyps are precursors of cancer.

 

LW: If someone has a benign polyp, will they get cancer in the future?

CS: That is NOT true. It means that the patient has to be followed a little more carefully. Depending on the size, the number and cell type, a colonoscopy should be performed anywhere from 1 to 5 years. It would be unusual to have a colonoscopyevery year, but it can happen. It is more common to have it every 3-5 years, under the aforementioned circumstances.

 

LW: What are some of the symptoms of reflux?

CS: Heartburn

 

LW: What does heartburn feel like?

CS: Like acid coming up and causes a burning sensation in your heart or in your throat. It can mimic a heart attack. So in a 50 year old person, you can’t just assume that it is reflux, you have to make sure the heart is ok.

 

LW: Could you have both reflux and heart problems?

CS: Yes, you must make sure that the heart is ok, because the heart will kill you, the reflux won’t.

 

LW: How do you treat the reflux?

CS: Antacids and diet can cure it. There is an extensive list of foods that one needs to decrease or cut out of their diet altogether. Things like red wine…there is something about the red grape that relaxes the sphincter and causes reflux. Spicy food is another trigger, red sauce, licorice, chocolate, nuts carbonated beverages, just to name a few.

 

LW: Wow…that is a lot of different food to have to give up.

CS: Everyone is different, and you don’t have to give it up. I don’t think that diet is all that important.

 

LW: So what is important?

CS:  Obesity is a predisposing factor. Having weight in that middle area is really bad.

 

LW: Why is belly fat so dangerous?

CS: Belly fat is dangerous because it causes a release of inflammatory hormones called cytokines, which causes inflammation in the body. That’s why you floss your teeth. Flossing your teeth gets rid of the bacteria, which can lead to inflammation. Your immune system will naturally fight off the bacteria. That creates conflict in your body, which is inflammation. Inflammation in the body is not good.

 

A huge thank you to Dr. Strom for sharing all of his knowledge and expertise with all of us. This has been very helpful. For more information, you can visit Dr. Strom’s website. 

Up with Protein, Down with Pounds

Interview With Diet Specialist, Susan Cohen

Accountability

L.W.: Why do you ask your clients to keep a record of their food intake?

S.C.: Successful diet and weight loss can be attributed to keeping a record of your food intake. When a client records what they are eating during the day, they become conscious and more accountable.

L.W.: So once the client reaches their goal weight, do they discontinue the food intake record?

S.C.: It really depends on the client. I have clients who, for years, have been emailing me what they eat each day. Some clients feel that when they do this, there is no room for error. It also enables me to see every detail of what and how they are eating.

L.W.:  How do you help clients solve problems by reviewing this record?

S.C.: I had a client tell me that she was eating according to the plan, but feeling hungry. After we reviewed the record together, we were able to see that she was not eating a salad with 2 of her meals. Salad is crucial to making you feel full. By adding that to her diet, she was satisfied and not looking for other foods to stave off the hunger.

L.W.: I know you have a quote that you live and work by: “Show me a person who doesn’t weigh themselves, and I’ll show you a person who is slowly gaining weight.”

S.C.: That’s right. We all need to be accountable to someone or ourselves if we want to maintain a healthy weight. The scale is one form of measurement that accomplishes that.

The Mammogram and Pap Smear Controversy

An interview with Dr. Bobby Katz M.D., FOCOG

Dr. Katz received his undergraduate degree from UCSD, and his medical degree from The Chicago School of Medicine. He interned and completed his residency in Obstetrics and Gynecology from Cedars Sinai Medical Center.

Dr. Katz is an attending physician at Cedars Sinai Medical Center and an associate clinical faculty member of UCLA.

L.W.: There is a lot of buzz about the great controversy surrounding the new recommendation against yearly mammograms.

Can you shed some light?

 

B.K.: The American Cancer Society guidelines for early detection of breast cancer recommend annual screening with mammograms at age 40 in addition to breast exams. By adhering to these guidelines there was a 29% decrease in the   number of breast cancer deaths.

The American College of OB/GYN agrees with annual mammography after the age of 40. The concerns for annual screening include exposure to low levels of radiation and false positives results. However, the arguments in favor, outweigh these concerns.

I agree with the above recommendations, and in addition, the need for testing should be strongly determined by family history and age factors.

 

L.W.: Is there a high degree of radiation exposure from a mammogram?

B.K: The exposure is minimal. The risk of missing a potential tumor is a greater risk factor than the radiation.

As an adjunct to the mammogram, for women who have a 1st degree family member with breast cancer or if a woman has fibrous breast tissue, a breast ultrasound or MRI are high recommended.

 

L.W.: What is the BRCA test and who should have it?

B.K.: The BRCA test is the genetic test for breast and ovarian cancer. The person affected with the cancer is the one who should be tested.

 

 

L.W.: Since the U.S. Department of Health recommends PAP Smears every 3 years, are you finding that women are waiting 3 years to have gynecological check ups as well?

 

B.K.: Yes, and that is the problem. A woman still needs to have her ovaries, uterus and breast exam every year. Unfortunately, when a woman hears that she is not an at risk candidate, then there is no need to go for regular check ups, when in fact, she still needs to have them.

 

L.W.: What is HPV and how is it related to Cervical Cancer?

B.K.: HPV or Human Papillomavirus is a virus that is tested for via the PAP Smear. If a woman tests positive for the virus, it indicates that she was once exposed to it. It can lead to venereal warts, abnormal cells on the cervix, and cervical cancer. If a woman tests positive for HPV, she should continue to have yearly PAP Smears.

 

L.W.: Now that they have developed a vaccine for HPV, which our children have been receiving, will this wipe out the existence of the virus and reduce the need for PAP Smears in the future?

 

B.K.: Unfortunately, the vaccine only protects against 4 strains of the virus, which happen to the most virulent ones. there are, however, over 30-40 strains of the virus that affect the female parts.

 

L.W.: So just to recap, is it correct to say that if one chooses not to have a yearly mammogram and PAP Smear in the pre and post menopausal years, then one should still have yearly gynecological exams, so that the ovaries, uterus and breasts continue to be examined.

 

B.K.: That is what I would recommend, yes.

Your Skin and the Sun

Meet Dr. Leslie Rosoph M.D., C.M., C.C.F.P., E.M., F.R.C.P.C. Les, as he is known to our family, is one of my husband’s dearest friends, and our go to MD for just about everything.

Dr. Rosoph received his Medical Degree from McGill University. He obtained a residency in Emergency Medicine at The University of Manitoba, in Winnipeg.  Dr. Rosoph went on to obtain a residency in Dermatology at University of Toronto.

Dr. Rosoph currently practices dermatology in North Bay, Ontario.

First off, I want you to know that I am someone who enjoys being outside.  I love to walk, run and hike in the great outdoors, and that includes being in the direct sunlight. I love to sit in the sun, read, and get a little color.  However, I am here to tell you that I am no longer going to partake in this activity, because Dr. Rosoph scared me straight. If nothing else, I hope that this enlightening interview does the same for you!

L.W.: I see my dermatologist twice a year for skin checks. How can I get the most out of my visits with her?

L.R.: In order to get the most out of your visits to the dermatologist, here is what I recommend:

1. Come in with NO makeup. This sounds logical enough, but often, female patients stick to their daily routine of applying makeup, and forget that this makes it difficult for the doctor to thoroughly and properly check the facial skin.

2. Do not come in with a spray tan. Like makeup, it can alter the look of the skin, by darkening otherwise benign moles because the spray deposits the color unevenly.

3. Do not pick off any lesions. You would be surprised just how many of my patients do this.

4. Do not be embarrassed to show the doctor your feet. Many people are surprisingly self-conscious about the appearance of their feet. In my practice, I have actually had to request that patients allow me to thoroughly check between their toes and other areas of their feet.

5. Participate in the process.

If you are concerned about something, tell the physician early on in the visit, or circle the mole with a pen. It is also a good idea to come in with a list.

L.W.: I wholeheartedly agree! I can’t tell you the amount of times that I have left the doctor’s office and remembered that I forgot to ask him/her about something!

L.R.: The patient could also take a photo of a suspicious looking mole and that way its size is documented. This assists us in seeing the changes in size and color. A physician needs to see the landmarks in order to compare.

Taking the photo on your cell phone is a good idea, since the quality is good and you are likely to have your phone on you at the time of the visit.

 

Up to 1/3 of all Caucasians will be diagnosed with a Non Melanoma Basal or Squamous Cell Carcinoma in their lifetime. This is treated surgically.

 

1 in 60 will be diagnosed with a Melanoma in their lifetime, and that number is on the rise.

 

Risk Factors

1.         Coloring: Fair skinned people who are not good tanners are at risk. Most people are in denial about this. Patients will often tell me that they are good tanners, neglecting to say that they almost always burn first.

2.         Having more than 50 moles on your body increases your risk of developing a Melanoma.

3.         If you experienced a lot of sunburns as a young person, your chances of developing a melanoma, increases significantly.

4.         Intermittent high intensity sun exposure, like that experienced when on vacation, increases your chances of developing a    Melanoma.

ALL SUSPICIOUS LOOKING MOLES SHOULD BE BIOPSIED. IF A PHYSICIAN TELLS YOU ITS “NOTHING,” ASK HIM/HER “WHAT IS NOTHING?”

 

Sun Protection

Sun protection is key! It is never ever too late so start right now!

 

1.         Dr. Rosoph recommends applying a sunscreen with an SPF of 60, especially if you are planning to be outdoors for more than an hour. SPF implies the degree of UVB protection. However, look for a sunscreen that has both UVB as well as UVA protection. When you read that SPF 30 has been proven effective against sun damage, you must remember that the amount used in the testing is quite copious. Dr. Rosoph believes that the average person is NOT going to apply copious amounts of sunscreen to their face and body so he recommends using a normal amount of SPF 60, both on the face and the body.

2.         For daily use that does not involve prolonged time in the sun, SPF 30 is fine. Any SPF contained in make up is fine and will provide extra protection as well.

3.         We all know that sun damage ages the skin, but did you know that a smoker’s skin ages faster than a nonsmoker?

4.         When in the sun, wear a hat. There has been a significant increase in skin cancer on the scalp.

5.         As we age, the chances of skin cancer increases. Plan now, in your middle age, for maintaining the health of your skin in your elderly years.

6.         Check your skin once a month using two mirrors. Hold a hand held mirror to see the reflection of your back in a large mirror. Look for new moles and show your doctor immediately. Added problems occur when people delay or neglect to report things.

 

L.W.: What is your opinion of spray tans?

L.R.: Spray tans are fine, and certainly a much healthier alternative to sun tanning.

 

 

Readers, I hope that you have gleaned much from this discussion. Personally, I have begun to eliminate my bad habits. For instance, I was reading the paper at 5:30 PM in our back yard the other day, and ran inside for a sun hat. I will be spray tanning only, and if I feel like reading in the sun, I will have nothing less than 60 SPF on my face and body, wearing a hat and sitting under an umbrella!

Women and Heart Disease

Women and Heart Disease

An interview with cardiologist, Dr. Robert Corne

 

LW.: I have read that heart disease surpasses any other disease as the leading cause of death amongst women.

R.C.: That fact has only been appreciated more recently. The perception among the medical community was that heart disease was uncommon in women, although, in fact, AFTER menopause, prevalence of coronary disease INCREASES.

L.W.: Why is that?

R.C.: There are several reasons:

          Firstly, the symptoms of heart disease in women are often atypical and more      difficult to recognize and establish a diagnosis. Women may present with a general feeling of unwell, nausea and/or arm discomfort and not with the classic symptom of central chest heaviness.

          Secondly, Conventional noninvasive testing, such as a stress test (performed on a treadmill), or cardiac nuclear imaging, has a lower predictive accuracy in women, i.e. false positives.

L.W.: Is heart disease in women related to hormonal changes?

R.C.: A lot of evidence suggests that estrogen is protective and has a favorable effect on lipid (cholesterol/fat) metabolism, blood clotting parameters and the response of blood vessels to chemical and nervous stimulation. These factors, coupled with the low prevalence of coronary diagnosis in premenopausal women, led to the “Estrogen Hypothesis,” namely that estrogen treatment in post menopausal women should be cardio-protective.

Large clinical trials, such as The Women’s Health Initiative, have NOT validated that hypothesis. This is largely due to the combination of progestin with estrogen treatment in women with an intact uterus. The progestin has been added because estrogen alone can increase the risk of uterine cancer.

L.W.: What about the effects of estrogen in women who have undergone a hysterectomy?

R.C.: There is the suggestion that estrogen alone in women who have had a hysterectomy may be cardio-protective.

L.W.: What should premenopausal women do if they experience hot flashes, excessive perspiration and other unpleasant symptoms?

R.C.: Short term estrogen combined progestin treatment can be helpful in reducing these vasomotor symptoms. However, if it is elected to use estrogen ALONE in a woman who has NOT had a hysterectomy, then it is important for her gynecologist to periodically check her uterus for endometrial cancer.