New Information on Ovarian Cancer Screening

Thank you for your responses and suggestions to our first newsletter. Our hope is to bring you something different with each volume. Some of these are stories you may have heard or read about in the previous weeks. Other articles are designed purely to provide you with information that may be useful for you, a family member or friend. I hope you have a sense of humor— laughter is still the best medicine I know of and we owe it ourselves to laugh whenever possible. You might find things in this newsletter that have nothing to do with medicine but are hopefully enriching for your soul.

So before we begin please visit the following website:

http://www.boingboing.net/2009/04/22/musicians-around-the.html

If you enjoy this please pass it on to your friends and loved ones or anyone that just needs a moment to connect with the good that the world has to offer.

If you have suggestions for other newsletter articles please send them to newsletter@cmdrc.com. I promise that all of these are carefully read and considered.

Did you know…

  • That our office is the only one in Monroe County that performs ultrasound exams as part of your annual exam? The vast majority of these are performed at no charge to you or your insurance company. This has been our policy for more than a decade.
  • That our office has had a longstanding policy to provide annual exams for you if you’re out of work–at no charge? We will do this for 2 years!
  • The best present method for screening for ovarian cancer is a combination of ultrasound and CA-125? If you’re menopausal remember to ask for the blood test!

Permanent female sterilization (“having your tubes tied”) without surgery and in our office!

There was a time when permanent sterilization–also known as “tubal ligation”–required hospitalization, a general anesthetic and surgery. This is no longer true. In fact the “gold standard” for sterilization is rapidly becoming permanent “tubal plugs.”

“Tubal plugs”, also known as the Essure device was first introduced in Europe over a decade ago and has been used in the United States since 2002. Hundreds of thousands of these procedures have been successfully performed in this country.

Here are the advantages:

  • It’s an office procedure. It literally takes minutes to perform.
  • It’s a painless procedure. All you’ll require is some intravenous pain control. Some women just take a few Motrin prior to the procedure.
  • There are NO incisions
  • Recovery time is measured in hours not days.
  • It’s MORE effective than conventional tubal ligation.
  • Because it’s an office procedure there is great flexibility in scheduling it. Some women have it scheduled at 4:30 PM on a weekday (taking only an hour off from work) and return to work the following day. Others like to have it performed on a Friday and take a long weekend.

For more information please visit our website at www.cmdrc.com (click on “Non-surgical In- Office Sterilization) as well as www.Essure.com.

Perception and reality

Over the years I’ve heard and read many things from patients, newspapers, the “old media” and the “new media”. Often they get it right frequently they don’t. I suppose the best I can do as a physician is to provide you with the best information I have based on scientific evidence. As you know, over time, this too can change. We—doctors and patients—all have “biases.” We “perceive” certain truths. The problem is that they’re often wrong. Here are a few examples.

Coffee—it’s bad for you!

I’ve been a coffee drinker as far back as I can remember though I don’t see any reason to plunk down over 5 dollars at a Starbuck–to each his or her own. Over the years I’ve met many women who insist that coffee can’t possibly be a good thing. This is yet another example of our perceptions being out of line with reality. In the article above I talk about STDs and the difference between our perceptions of what’s damaging versus the reality. Many women think that coffee is a “vice” or a “bad thing” and feel guilty if they have a cup or two. In fact, coffee is rich in anti-oxidants—there is no difference between caffeinated and decaffeinated coffee in terms of its health benefits. So if you’re one of those people whose blood pressure increases with coffee stick to the decaf—you’ll still get the benefits. In recent decades over 19,000 studies on the health risks and benefits of coffee have been published. In the Harvard Nurses’ Health Study over 83 thousand women were studied over a period of 20 years.

http://www.gastro.org/wmspage.cfm?parm1=429
http://www.channing.harvard.edu/nhs/
http://clinicaltrials.gov/show/NCT00005152/

Among the outcomes were the following:

Stroke Prevention:

  • Women who drank 2-3 cups of coffee per day had an almost 20% reduced risk of strokes compared to women who drank less than a cup per month. More coffee was not better.
  • Both caffeinated and decaffeinated coffee offered similar protection.
  • Tea does not offer a similar protection against stroke.

Other benefits of coffee include:

  • Type 2 Diabetes: Six cups of coffee per day reduced the average women’s risk by 30% compared to non-drinkers.
  • Parkinson’s Disease: At least six studies indicate that regular coffee drinkers are 80% less likely to develop Parkinson’s disease.
  • Colon cancer: Those who drink at least 2 cups per day are 25% less likely to develop colon cancer.
  • Gallstones: 2 cups per day may reduce gallstones by 50%
  • Liver disease: 2 cups per day may reduce cirrhosis by up to 80%
  • Migraine headaches are often improved with coffee
  • Asthma is often easier to treat and often improved with coffee
  • Dental cavities may be less common in coffee drinkers

So when all is said and done coffee may have more benefits than risks for most of us. So if you enjoy a cup of coffee and it isn’t causing you any problems go right ahead. Remember, I said coffee—not your Starbucks Venti Peppermint White Chocolate Mocha (660 calories, 22 grams of fat and 95 grams of sugar)!

Cancer—my biggest fear!

Women fear breast cancer more than any other health risk. The reality is that 40,000 women die of breast cancer in the U.S. each year. A significant number of women believe that ovarian cancer is their biggest cancer threat—the reality is that 16,000 women die of ovarian cancer each year. The number one cancer that women die of each year—lung cancer! If you really want to decrease your risk of cancer death quit smoking.

Just as important, many women believe that they’re most likely to die of a “female cancer” – breast, ovarian, uterine or cervical cancer. The real “killer” among women is heart disease and strokes. For every woman that dies of breast cancer in the U.S. each year 15 will die of heart disease and strokes. For every woman that dies of cervix cancer each year over 160 will die of heart disease and strokes!

So the bottom line is this—while it may make you feel that you’re “taking care of yourself” by getting your annual Pap smear and mammogram each year the real killer is heart disease and strokes. That’s the reality. If you’re not paying attention to your heart and your cardiovascular risk factors you’re missing a real opportunity to help yourself.

New information on Ovarian Cancer Screening

Ovarian cancer affected over 21,000 women and was responsible for over 15,000 deaths in the U.S. in 2008. Because ovarian cancer produces few and nonspecific symptoms in its early stages most cases present in Stage III or IV. In fact only about 20% of newly diagnosed cases of ovarian cancer are found before the tumor has spread beyond the ovaries. Women who are diagnosed in the earliest stages have a 5 year survival rate of over 90%–obviously the future of ovarian cancer remedies need to be focused on early detection.

The results of the largest ovarian cancer screening trial to date, the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) involved 202,638 women and suggests that a combination of transvaginal ultrasound in addition to a blood test (CA125) may offer the best hope, to date, in detecting ovarian cancer in its earliest stages.

It will be years before this work can be repeated and validated. In the meantime it would be reasonable to request the testing if there is a family history of ovarian cancer or other factors that place you at high risk.

On the Lighter Side

“A Journey into my colon—and yours”

by David Barry

This Dave Barry column was originally published in the Miami Herald on Feb. 22, 2008.

OK. You turned 50. You know you’re supposed to get a colonoscopy. But you haven’t. Here are your reasons:

1. You’ve been busy.
2. You don’t have a history of cancer in your family.
3. You haven’t noticed any problems.
4. You don’t want a doctor to stick a tube 17,000 feet up your butt.

Let’s examine these reasons one at a time. No, wait, let’s not. Because you and I both know that the only real reason is No. 4. This is natural. The idea of having another human, even a medical human, becoming deeply involved in what is technically known as your ”behindular zone” gives you the creeping willies.

I know this because I am like you, except worse. I yield to nobody in the field of being a pathetic weenie medical coward. I become faint and nauseous during even very minor medical procedures, such as making an appointment by phone. It’s much worse when I come into physical contact with the medical profession. More than one doctor’s office has a dent in the floor caused by my forehead striking it seconds after I got a shot.

In 1997, when I turned 50, everybody told me I should get a colonoscopy. I agreed that I definitely should, but not right away. By following this policy, I reached age 55 without having had a colonoscopy. Then I did something so pathetic and embarrassing that I am frankly ashamed to tell you about it.

What happened was, a giant 40-foot replica of a human colon came to Miami Beach. Really. It’s an educational exhibit called the Colossal Colon, and it was on a nationwide tour to promote awareness of colo-rectal cancer. The idea is, you crawl through the Colossal Colon, and you encounter various educational items in there, such as polyps, cancer and hemorrhoids the size of regulation volleyballs, and you go, ”Whoa, I better find out if I contain any of these things,” and you get a colonoscopy.

If you are as a professional humor writer, and there is a giant colon within a 200-mile radius, you are legally obligated to go see it. So I went to Miami Beach and crawled through the Colossal Colon. I wrote a column about it, making tasteless colon jokes. But I also urged everyone to get a colonoscopy. I even, when I emerged from the Colossal Colon, signed a pledge stating that I would get one.

But I didn’t get one. I was a fraud, a hypocrite, a liar. I was practically a member of Congress. Five more years passed. I turned 60, and I still hadn’t gotten a colonoscopy. Then, a couple of weeks ago, I got an e-mail from my brother Sam, who is 10 years younger than I am, but more mature. The email was addressed to me and my middle brother, Phil. It said:

“Dear Brothers,

“I went in for a routine colonoscopy and got the dreaded diagnosis: cancer. We’re told it’s early and that there is a good prognosis that they can get it all out, so, fingers crossed, knock on wood, and all that. And of course they told me to tell my siblings to get screened. I imagine you both have.”

Um. Well.

First I called Sam. He was hopeful, but scared. We talked for a while, and when we hung up, I called my friend Andy Sable, a gastroenterologist, to make an appointment for a colonoscopy. A few days later, in his office, Andy showed me a color diagram of the colon, a lengthy organ that appears to go all over the place, at one point passing briefly through Minneapolis. Then Andy explained the colonoscopy procedure to me in a thorough, reassuring and patient manner. I nodded thoughtfully, but I didn’t really hear anything he said, because my brain was shrieking, quote, “HE’S GOING TO STICK A TUBE 17,000 FEET UP YOUR BUTT!”

I left Andy’s office with some written instructions, and a prescription for a product called ”MoviPrep,” which comes in a box large enough to hold a microwave oven. I will discuss MoviPrep in detail later; for now suffice it to say that we must never allow it to fall into the hands of America’s enemies.

I spent the next several days productively sitting around being nervous. Then, on the day before my colonoscopy, I began my preparation. In accordance with my instructions, I didn’t eat any solid food that day; all I had was chicken broth, which is basically water, only with fewer flavors. Then, in the evening, I took the MoviPrep. You mix two packets of powder together in a one-liter plastic jug, then you fill it with lukewarm water. (For those unfamiliar with the metric system, a liter is about 32 gallons.) Then you have to drink the whole jug. This takes about an hour, because MoviPrep tastes — and here I am being kind — like a mixture of goat spit and urinal cleanser, with just a hint of lemon.

The instructions for MoviPrep, clearly written by somebody with a great sense of humor, state that after you drink it, ”a loose watery bowel movement may result.” This is kind of like saying that after you jump off your roof, you may experience contact with the ground.

MoviPrep is a nuclear laxative. I don’t want to be too graphic, here, but: Have you ever seen a space shuttle launch? This is pretty much the MoviPrep experience, with you as the shuttle. There are times when you wish the commode had a seat belt. You spend several hours pretty much confined to the bathroom, spurting violently. You eliminate everything. And then, when you figure you must be totally empty, you have to drink another liter of MoviPrep, at which point, as far as I can tell, your bowels travel into the future and start eliminating food that you have not even eaten yet.

After an action-packed evening, I finally got to sleep. The next morning my wife drove me to the clinic. I was very nervous. Not only was I worried about the procedure, but I had been experiencing occasional return bouts of MoviPrep spurtage. I was thinking, ”What if I spurt on Andy?” How do you apologize to a friend for something like that? Flowers would not be enough.

At the clinic I had to sign many forms acknowledging that I understood and totally agreed with whatever the hell the forms said. Then they led me to a room full of other colonoscopy people, where I went inside a little curtained space and took off my clothes and put on one of those hospital garments designed by sadist perverts, the kind that, when you put it on, makes you feel even more naked than when you are actually naked.

Then a nurse named Eddie put a little needle in a vein in my left hand. Ordinarily I would have fainted, but Eddie was very good, and I was already lying down. Eddie also told me that some people put vodka in their MoviPrep. At first I was ticked off that I hadn’t thought of this, but then I pondered what would happen if you got yourself too tipsy to make it to the bathroom, so you were staggering around in full Fire Hose Mode. You would have no choice but to burn your house.

When everything was ready, Eddie wheeled me into the procedure room, where Andy was waiting with a nurse and an anesthesiologist. I did not see the 17,000-foot tube, but I knew Andy had it hidden around there somewhere. I was seriously nervous at this point. Andy had me roll over on my left side, and the anesthesiologist began hooking something up to the needle in my hand. There was music playing in the room, and I realized that the song was Dancing Queen by Abba. I remarked to Andy that, of all the songs that could be playing during this particular procedure, Dancing Queen has to be the least appropriate ”You want me to turn it up?” said Andy, from somewhere behind me.

”Ha ha,” I said.

And then it was time, the moment I had been dreading for more than a decade. If you are squeamish, prepare yourself, because I am going to tell you, in explicit detail, exactly what it was like.

I have no idea. Really. I slept through it. One moment, Abba was shrieking “Dancing Queen! Feel the beat from the tambourine . . .”

. . . and the next moment, I was back in the other room, waking up in a very mellow mood. Andy was looking down at me and asking me how I felt. I felt excellent. I felt even more excellent when Andy told me that it was all over, and that my colon had passed with flying colors. I have never been prouder of an internal organ.

But my point is this: In addition to being a pathetic medical weenie, I was a complete moron. For more than a decade I avoided getting a procedure that was, essentially, nothing. There was no pain and, except for the MoviPrep, no discomfort. I was risking my life for nothing. If my brother Sam had been as stupid as I was — if, when he turned 50, he had ignored all the medical advice and avoided getting screened — he still would have had cancer. He just wouldn’t have known. And by the time he did know — by the time he felt symptoms — his situation would have been much, much more serious. But because he was a grown-up, the doctors caught the cancer early, and they operated and took it out. Sam is now recovering and eating what he describes as ”really, really boring food.” His prognosis is good, and everybody is optimistic, fingers crossed, knock on wood, and all that.

Which brings us to you, Mr. or Mrs. or Miss or Ms. Over-50-And-Hasn’t-Had-a- Colonoscopy? Here’s the deal: You either have colo-rectal cancer, or you don’t. If you do, a colonoscopy will enable doctors to find it and do something about it. And if you don’t have cancer, believe me, it’s very reassuring to know you don’t. There is no sane reason for you not to have it done.

I am so eager for you to do this that I am going to induce you with an Exclusive Limited Time Offer. If you, after reading this, get a colonoscopy, let me know by sending a self-addressed stamped envelope to Dave Barry Colonoscopy Inducement, The Miami Herald, 1 Herald Plaza, Miami, FL 33132. I will send you back a certificate, signed by me and suitable for framing if you don’t mind framing a cheesy certificate, stating that you are a grown-up who got a colonoscopy. Accompanying this certificate will be a square of limited-edition custom- printed toilet paper with an image of Miss Paris Hilton on it. You may frame this also, or use it in whatever other way you deem fit.

But even if you don’t want this inducement, please get a colonoscopy. If I can do it, you can do it. Don’t put it off. Just do it.

Be sure to stress that you want the non-Abba version.