Thursday, March 16, 2017

The New Face of Colorectal Cancer Could Be Yours

Too young for cancer? Think again. It’s true that most new colorectal cancer diagnoses occur in people 50 or older, which is why organizations like the CDC and American Cancer Society recommend routine colonoscopies to screen for it beginning at that age. But, as you may have seen in the headlines recently, cases are increasing in young adults.

A Journal of the National Cancer Institute (JNCI) study found that colon cancer rates among people age 20-39 are increasing 1-2.4% per year. The incidence of colon cancer in people 40-49 is increasing more rapidly than for any other age group. Some physicians and researchers believe this alarming trend could be the result of poor diet, inactive lifestyle and simply not knowing the risk factors for or symptoms of colorectal cancer. Watch Robert Donegan, MD, medical oncologist at GBMC, discuss this topic on ABC2 News.

You are at a higher risk for colorectal cancer if you:
  • have a family history of colorectal cancer
  • have a history of colorectal cancer, polyps or inflammatory bowel disease yourself
  • are African American or Jewish of Eastern European descent (Ashkenazi)
  • have type 2 diabetes
  • smoke
  • drink alcohol heavily
  • are overweight or obese
  • are physically inactive
  • consume a diet high in red meat and processed meat
  • have a certain genetic condition (such as Lynch syndrome, Turcot syndrome, Peutz-Jeghers syndrome)

Physicians want you to know that, regardless of your age,
  • there are no early warning symptoms of colon cancer or polyps. Screening before symptoms begin gives the best opportunity to prevent cancer by detecting and removing the pre-cancerous polyps. Detecting cancer during screening tests greatly increases the chance that the cancer is in a curable stage. 
  • once symptoms occur, if there is a cancer, it is more likely to be a more advanced cancer, and is less likely to be curable
  • symptoms that should warrant an investigation at any age include:
    • Persistent, significant change in bowel function (diarrhea or constipation)
    • Rectal bleeding
    • Persistent abdominal pain
    • Rapid, unexplained weight loss and new onset fatigue (It’s important to note that these may be features of advanced cancer from any source and are not specific to colorectal cancer.)
If any of the risk factors apply to you, or if you experience one or more of the symptoms listed above, take action! Talk to your primary care physician about the different types of colorectal cancer screenings and find out which one is best for you. When colorectal cancer is detected early, surgery, radiation and/or chemotherapy can provide effective treatment!

We also encourage you to join us for a Facebook Live on Thursday, March 23 at 10 a.m. GBMC Gastroenterologist Dr. Niraj Jani and ABC2's Ashley James will take questions on digestive disorders. You can click here to submit a question in advance.

Take a Little Time for You!

GBMC invites the men and women of our community to focus on their own health and wellbeing by attending Time for Me!, a FREE health lecture series taking place in April. Connect with our GBMC physicians and medical experts as they offer practical information and advice on the prevention, treatment and management of the most common health issues.

Topics will include genetic health risks, shoulder pain prevention and treatment, caring for your voice as you age and solutions for dizziness, imbalance and falls.

All events are held at GBMC in the Civiletti Conference Center from 6:30 p.m. until approximately 8 p.m. There is no cost to participate and all attendees will receive a special gift and a complimentary parking pass. We also encourage you to bring along family and friends!

For more information, call 443-849-GBMC (4262) or visit www.gbmc.org/timeforme.

Wear Red Day

If you visit GBMC on March 22, you may find yourself seeing red – from the lights in our main corridors and cafeteria to our decked-out employees. Wear Red Day serves as the official kickoff for our second annual Walk a Mile in Her Shoes®. Please join us in sporting red, a power color that represents energy and determination, to take a stand against rape, sexual assault, and gender violence.

Walk a Mile in Her Shoes is a one-mile walk on GBMC's campus on Saturday, April 22. The event raises money for our Sexual Assault Forensic Examination (SAFE) and Domestic Violence programs, while shifting perspectives about these often-stigmatized issues. Our SAFE and DV programs provide free confidential services that are available to everyone, 24 hours a day, 365 days a year. Nurses and advocates perform detailed medical-forensic examinations, collect evidence, and testify in court, but most importantly, they treat survivors with compassion and respect.

Get involved by posting pictures of yourself decked out in red to social media using #GBMCWalkaMile and register for Walk a Mile in Her Shoes by clicking here. If you fundraise $200 by March 21, you'll earn a choice of either red high heels or red Converse sneakers to walk in.

Spring Back from Sports Injuries!

In case you missed it, GBMC and WMAR ABC2News recently hosted an interactive Facebook Live event on the topics of spring sports injuries featuring physical therapist Christina Penny, DPT, OMPT, of Active Life Physical Therapy (a GBMC affiliate). Watch it on YouTube now.

Broccoli with Asian Tofu

Ingredients

1 pkg (16 oz) firm tofu, drained
2 tbsp light soy sauce
1 tsp sesame oil (optional)
½ tbsp brown sugar
1 tbsp fresh ginger root, finely chopped or shredded (or 1 tsp ground)
1 lb fresh broccoli, rinsed and cut into individual spears
1 tbsp peanut oil or vegetable oil
¼ tsp crushed red pepper
4 tbsp garlic, peeled and thinly sliced (about 8 cloves)
1 tbsp sesame seeds (optional)
cooking spray

Directions

1. Slice tofu into eight pieces. Place on a plate or flat surface covered with three paper towels. Top that with four more paper towels. Top with another flat plate or cutting board and press down evenly and gently to squeeze out the moisture. Throw away paper towels. Replace with fresh paper towels and press again. (The more liquid you remove, the more sauce the tofu will absorb).

2. Place tofu in a bowl just big enough to hold all eight pieces laying on their widest side without overlapping.

3. In a small bowl, combine the soy sauce, sesame oil, brown sugar, and ginger into a marinade, and stir thoroughly. Pour over tofu. Carefully turn the tofu several times to coat well. Set aside.

4. Heat a large nonstick saute pan coated with cooking spray. Add broccoli and saute for about 5 minutes, until it turns bright green and becomes tender and crispy. Remove broccoli from pan and set aside.

5. Heat a grill pan or flat saute pan over high heat. Drain tofu, reserving marinade. Place on grill pan to heat for about 3 minutes. Gently turn. Heat the second side for 3 minutes.

6. At the same time, in the saute pan over medium-low heat, warm the peanut oil, crushed red pepper, and garlic until the garlic softens and begins to turn brown, about 30 seconds to 1 minute. Add broccoli and reserved marinade, and gently mix until well-coated.

7. Place two slices of tofu on each plate with one-quarter of the broccoli and marinade mixture. Sprinkle with sesame seeds (optional).

Nutrition Information

Serving size: 4 servings, 2 slices of tofu with broccoli and marinade mixture
Calories: 183
Total Fat: 11 g
Saturated Fat: 2 g
Sodium: 341 mg
Protein: 14 g
Carbohydrates: 13 g

Recipe from Keep the Beat Recipes: Deliciously Health Dinners. Provided by the National Heart, Lung and Blood Institutde

Thursday, February 23, 2017

5 Embarrassing Questions You Don't Want to Ask Your Doctor (But Should!)

In the age of Google, it can be tempting to try to solve your own medical conundrums, especially if you find them a bit embarrassing. However, if you have a new symptom, it's important to talk to your primary care physician, who can evaluate you and provide a much more reliable diagnosis than the internet. It's natural to feel a bit of shyness when sharing certain details about your body, but keep in mind that your primary care physician is a trained professional. It's his or her job to listen to your symptoms, make you feel comfortable, and offer their best possible advice. “Remember, your doctor is used to hearing all sorts of intimate information about patients' bodies, so while it might feel awkward for you, it's actually quite routine for him or her,” says Dr. Robin Motter-Mast, GBMC’s Chair of Family Medicine and a physician with Hunt Manor at GBMC.

If you're worried about how to begin the conversation, try making a list of the things you want to discuss at your next visit. Preparation might make you feel more comfortable. Bring the list with you so you won't forget anything, and if you get tongue-tied, you can always hand the paper to your doctor.

So, how do you know if your query is worth bringing up and could be indicative of a serious problem or if it's a nonissue you should ignore? It's always better to be safe than sorry, as there will never be any penalty for asking a seemingly silly question. Here are five common issues people worry about discussing with a doctor, and why they are worth raising.

1. Sometimes I urinate a little when I laugh and/or sneeze.
This type of urinary incontinence, called stress incontinence, is most common in women. It happens when the pelvic floor muscles can no longer properly support the bladder. When you're experiencing a sudden leak during a cough, sneeze, laugh, or exercise, the bladder is dropping down and pushing against the vagina, but the muscles that close off the urethra aren’t tightening quickly enough. Though this is common if you've recently given birth or gained weight, it is definitely a topic to bring up with your physician. He or she will want to make sure you don't have a urinary tract infection and may be able to recommend treatment or strategies to help with the leaking. This could include pelvic floor muscle exercises, called Kegels, which can strengthen your urinary sphincter, or examining your lifestyle to identify a medication or vitamin that may be exacerbating the condition. It is unlikely that you'll require surgery, but there are surgical options. Be prepared for your doctor to ask questions about your typical fluid and caffeine intake, frequency of urination, and your bowels.

2. I frequently have very bad breath.
If you practice good dental hygiene, including brushing, flossing, and using an antibacterial mouth wash, and still have persistent bad breath, this is definitely a topic to raise with your physician. Bad breath, called halitosis, doesn't just carry a social stigma; it can indicate a variety of other medical conditions including gum disease, yeast infection of the mouth, diabetes, liver or kidney problems, and more. You could also be experiencing halitosis because of dry mouth, which can be a side effect of various medications. When you're going to an appointment to have your breath evaluated by your doctor, avoid wearing perfume, scented lotions, or lipstick, as the type of smell you're emitting can actually help the physician identify what could be causing it. Expect to answer questions about your dental routine, diet, allergies, and your sleeping/snoring habits.

3. My medication/treatment/test is too expensive for me.
No one likes to admit when they can't afford something, but with the rising costs of healthcare, this is an increasingly common problem. If you question whether a test is necessary, you may also be worried that your physician may perceive you as not valuing his or her opinion. Be honest with your doctor about your financial limitations. It's possible there may be an alternative to an expensive medical test, as research is always providing new evidence and less invasive alternatives. You may even be able to enroll in a clinical trial. If a medication has gone up in price, ask your doctor if there is an available generic – or even an over-the-counter – product available that might work for you. Together, you can decide over time if this is an effective enough alternative. Lastly, depending on the drug you’re taking, your physician may have a patient assistance program application from a pharmaceutical company that could help you. It never hurts to ask.

4. I think I noticed blood in my stool.
Though you most likely aren't excited to talk to your doctor about your bowel movements, avoiding discussing this issue could be dangerous. If you think you see blood in the bowl or on the toilet paper, head straight your primary care physician, as this is never considered normal. One of the worst case scenarios could be colorectal cancer, though there are a variety of other less serious causes including hemorrhoids, anal fissures, peptic ulcers, and more. Your doctor will very likely ask you about the color of the blood you saw, as different shades of red can indicate varying conditions. He or she may also want you to have a test such as an endoscopy, colonoscopy, or fecal occult test, which checks for blood (even hidden blood) in stool. Be sure to share any other symptoms you may be having, even if you don’t think they seem relevant. Rest assured that there are many available treatments, ranging from small things you can do at home to medications and surgeries that can address the problems associated with blood in stool.

5. I sweat excessively.
Excessive sweating, called hyperhidrosis, does not refer to the exhilarating and satisfying dampness you feel after an intense workout, but rather to bodily wetness when you aren't physically exerting yourself at all. If you're sweating profusely and you're just sitting around, or if you feel the need to wipe your hands before every handshake, this is not normal. Hyperhidrosis is potentially a warning sign of thyroid problems, diabetes, infection, or drug interaction, though not necessarily. While it isn't medically risky, it can certainly interfere with the quality of your life and is a legitimate medical condition you should raise with you doctor. Be prepared to be asked about which body parts are sweating, medications you're taking, and whether or not members of your family experience the same issue. There are drugs that can stop your sweat glands from activating and treatments that stop your nerves from triggering too much sweat, so don't be afraid to raise this issue.

A good way to overcome your nerves or anxiety about a doctor's visit is to remind yourself that you can't afford to take chances with your health. It's unlikely you will shock your doctor with your symptom(s), and you will feel much better once your problem is in professional hands, even if it is nothing. “Your doctor will not laugh at you or mock your symptoms. Instead, he or she will address your concerns and help determine the best plan of action,” says Dr. Motter-Mast.

By being proactive about attending routine physicals and mentioning all new symptoms (even if you find them embarrassing!) you may even help your doctor catch a health condition before it becomes serious. Click here to find a primary care physician who is right for you.

Taking on Stress, Depression, Anxiety and Addiction

In case you missed it, GBMC and WMAR ABC2News recently hosted an interactive Facebook Live event on the topics of stress, depression, anxiety and addiction featuring primary care physician Kevin Ferentz, MD. Watch it on YouTube now. An estimated 11 to 36 percent of current primary care patients have some type of behavioral health disorder. With that in mind, GBMC HealthCare and Sheppard Pratt Health System are partnering to proactively address the behavioral health needs of the community.

“Our organizations are integrating behavioral health services in GBMC primary care offices and working to better manage all aspects of a person’s health in one setting,” says Robin Motter-Mast, DO, Chair of Family Medicine at GBMC. “For example, we are adding new team members to each of our primary care practices: behavioral health consultant, consulting psychiatrist and substance use consultant. Our work focuses on strong collaboration among the patient, primary care physician and these three new resources, depending on the patients’ needs.”

A Sheppard Pratt Health System behavioral health consultant will be located in each practice, operating as an internal expert for patients’ behavioral health needs. He or she is able to support minor to moderate mental health conditions through counseling techniques such as motivational interviewing, behavioral activation and problem solving therapy. The consulting psychiatrist, also employed by Sheppard Pratt Health System, can recommend medications or programs and may see patients face-to-face, serving as an additional resource to the primary care physician and behavioral health consultant. For patients who would benefit from treatment for addiction, the substance use consultant engages them in counseling (motivational interviewing) and offers resource navigation. Other services may be provided as needed by Kolmac Outpatient Recovery Centers and Mosaic Community Services, part of the Sheppard Pratt Health System.

“We have effective treatments for anxiety, depression, addiction, and other behavioral health problems, but it’s often hard for people to get access to expert care quickly when they need it,” notes Robert P. Roca, MD, MPH, MBA, Vice President and Medical Director, Sheppard Pratt Health System. “Our behavioral health consultants and psychiatrists are part of the GBMC primary care team and are on the spot to help when the primary care physician calls us in. It’s designed to be a seamless experience.” To utilize behavioral health services, simply contact your GBMC primary care provider and ask for more information. Please note: behavioral health consultants are not available in all practices yet, so your physician may put you in contact with a team member from another location.