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Gout—a pain in the butt!

If you’ve had gout, or know anyone who’s had it, you know it’s a pain in the butt… I mean the toe! This week’s blog is about what gout is, what causes it, and what you can do about it.

Years ago, when I was a young pharmacist just beginning my career, a poor guy hobbled into the pharmacy one evening after office hours, with a loose overshoe on one foot. He had the gout, he told me, and was in terrible pain. I remembered from pharmacology classes that colchicine was a drug of choice and didn’t require a prescription at that time (that’s changed now). Our professor had stressed that colchicine quickly decreased the pain and inflammation but didn’t correct the underlying problem. So, I sold him a few tablets to get him through the night and told him to see his doctor the next day for assessment.

The next day, a gruff voice on the doctors’ line asked if I was the pharmacist who had supplied the colchicine to his patient. Nervously, I admitted yes it was me (I’d only been a pharmacist for a few months), and he said, “You did well!” Whew!! Of course, now, many pharmacists are permitted to prescribe for certain conditions, and some governments actually pay them for this service.

But what is gout anyway?

Gout is a form of inflammatory arthritis, that is caused by too much uric acid in the blood (“hyperuricemia”… hyper [too much]-uric [uric acid]-emia [in the blood]). The uric acid precipitates out of the blood, forming sharp crystals of sodium urate inside a joint, most often in the big toe because of gravity. The crystals can also form inside the ankle, knee or fingers, especially when blood uric acid is very high. In advanced long-term gout, the collection of crystals can sometimes be seen as hard bulges called “tophi” under the skin that covers the joint as the crystals expand beyond the joint.

The rough needle-like crystals scrape the inside of the joint causing pain and inflammation (redness and swelling). Anti-inflammatory drugs are generally the first treatment offered, to reduce the inflammation and control pain, and often the crystals will dissolve on their own.

Where does uric acid come from?

Uric acid is created in the body when we break down purines, a component of DNA in human and animal cells known as nucleosides, essential for life. So, animal and human cells all contain purines that are used when the cells grow and divide. Plants contain them too, but generally in lower amounts.

We get purines in our diet when we eat anything that was living, but plants are not considered a significant source. It is animal protein, especially red meat, organ meats, some types of alcohol (beer), some seafood (sardines, anchovies), and high fructose foods (soft drinks) that contain the highest amounts of purines. Foods low in purines include eggs, nuts, legumes, fruit, whole grains, vegetables (except asparagus, cauliflower, spinach, mushrooms, and green peas have relatively more), dairy products, poultry, crab, salmon and herring.

I’m sure I remember learning that alcohol makes uric acid less soluble (and therefore, more likely to form urate crystals) but I’m not seeing that in the literature now…

Quick chemistry lesson… Skip this section if you hate chemistry!! �

DNA is the genetic material in the nucleus of every cell that carries the programming information to make proteins that do the work in our bodies. Purines and their partners, the pyrimidines form the “bridges” between the 2 backbones of the DNA double-helix, creating the twisted ladder of DNA that’s familiar to most of us.

There are 2 purines (adenine and guanine) and 2 pyrimidines (thymine and cytosine), and they always pair up, one of each, the same way. This ensures that when a cell divides and the strands of DNA split apart, they always match up correctly, creating 2 new cells with the same DNA as the original. Each group of 3 “bridges” codes for one amino acid, and a series of amino acids creates a protein that could become an enzyme used to build a structure in the body or enable a chemical reaction that has a function.

A picture is worth a thousand words, isn’t it?

Basically, we make our own purines as well as get them in our food. Any increase in protein breakdown (which would increase purines that need to be eliminated) or reduction in elimination of purines can result in increased blood uric acid. A defect in the genes that create enzymes that manufacture or breakdown purines can also result in an increased risk of gout, so sometimes gout runs in families.

Uric acid is cleared from the body by the kidneys in the form of urea in the urine so if kidney function is poor, uric acid clearance is reduced. Many kidney stones are made of urate crystals (equally sharp!) and the process is probably similar. Not surprisingly, there’s a tie between kidney stones and gout—kidney disease can cause gout (because of reduced clearance of uric acid/urea) and gout can cause kidney disease (lots of uric acid available to form those nasty kidney stones that scrape the inside of the kidney).

And when more cells than usual are broken down, for example during cancer therapy, more purines are freed-up to be metabolized and can overwhelm the body’s ability to keep up, resulting in increased blood uric acid. I remember my Dad having gout during his leukemia treatments, years ago.

OK, enough biochemistry… here’s how it’s treated

If a person only has occasional attacks of gout, anti-inflammatories or corticosteroids (also anti-inflammatory) are used to relieve pain and swelling, until the body clears the urate crystals from the joint, usually within a few days to a few weeks, depending on how severe the attack. Later repeated attacks tend to last longer. The pain is usually most severe in the first 4 to 12 hours, with lingering soreness as the joint heals.

If the gout is continuous or reoccurs frequently, it makes sense to correct the cause rather than continue to just treat the symptoms. This is done by changing the diet and/or taking a medication to reduce the amount of uric acid in the blood.

So, in addition to choosing foods that are lower in purines to prevent gout, we also have medicines that can slow down purine metabolism, by partially blocking one of the enzymes that break down adenine and guanine, allowing the body to keep up to the production of uric acid. There are two: allopurinol (Zyloprim and generics) and febuxostat (Uloric). An anti-inflammatory may be continued for the first few weeks of this therapy, until blood uric acid is normalized, to prevent return of symptoms.

You’ll remember the drug colchicine, a strong anti-inflammatory I talked about at the beginning of this article, and other anti-inflammatories are used too, such as indomethacin, celecoxib, and the non-prescription drugs, naproxen and ibuprofen, in less severe attacks. Corticosteroids are sometimes prescribed, and colchicine is now considered 2nd line in some jurisdictions due to side effects (digestive problems, possibility of bone marrow suppression) especially if used long-term.

And another prescription drug, probenecid, is sometimes used to increase the kidneys’ ability to remove uric acid from the body.

What can you do?

  • Choose healthier drinks… limit alcoholic beverages, avoid drinks sweetened with fructose. Instead drink plenty of water.
  • Avoid foods high in purines… red meat, organ meats (like liver), high-purine seafood (anchovies, sardines, mussels, scallops, trout, and tuna). Low-fat dairy products may be a better source of protein for those prone to gout.
  • Exercise regularly and maintain a healthy weight… excess weight can increase risk of gout. Choose low-impact exercise like walking, biking and swimming, as these are easier on the joints.

But be sure to see your doctor for a correct diagnosis, and to help you decide what level of treatment you need. Gout is sometimes confused with a joint infection, or other types of arthritis (such as rheumatoid/inflammatory arthritis). When severe enough and left untreated for too long, gout can develop into gouty arthritis with resulting permanent damage to joints.

If you found this article helpful, please like or comment so others will be more likely to see it. And, if you know someone who might benefit from this information, consider forwarding this to them!

References:

The chemical structure of DNA (diagram and explanation)

Hyperuricemia—Wikipedia

Purine—Wikipedia

Foods High in Purines—WebMD

Gout—Centers for Disease Control and Prevention (CDC)

Gout—Mayo Clinic

Photo credits:

https://www.cefootandankle.com/blog/gout/

Braňo on Unsplash

#gout #UricAcid

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PFAS… “Forever” chemicals

Do you use water/stain-resistant products and clothing? You could be exposing yourself and others to persistent, harmful chemicals… And since some products that contain these chemicals don’t say so on the label, you could be completely unaware they are there.

Per- and Poly-Fluorinated Alkyl Substances (PFAS) are a newer class of chemicals used to make products resist oil and water. They’re supposed to be safer than the older PFOS (Perfluoro Octane Sulfonates) like Teflon and Scotchgard. But are they?

These chemicals have been detected in over 98% of blood samples of tested Canadians and are showing up in the environment, sometimes in levels high enough to harm wildlife (and us!). And some of them disappear quickly from the blood but are stored in organ tissues (such as lungs). Researchers are learning how they disrupt our hormones and immune systems…

What are PFAS chemicals?

The PFAS class of chemicals are used to waterproof fabrics and clothing; to stain-proof fabrics, carpets and furniture; in coatings for non-stick pans; to keep food wrap paper from soaking up grease; for water-resistant cosmetics, and in fire-fighting foams.

The chemicals are only loosely attached to fabrics so are often detected in measurable amounts in house dust. They are persistent and mobile: they do not break down for decades and travel easily in the atmosphere. They concentrate in animals high in the food chain, resulting in higher levels in larger animals and humans as we eat contaminated food. Levels gradually increase over time from these low-level exposures, because the chemicals are not eliminated from our bodies or broken down over time.

What do PFAS do to us?

There are over 5,000 different PFAS chemicals that have been synthesized. The harmful effects vary, but some are known to either block or mimic our hormones, and inhibit the effectiveness of our immune systems. Sadly, these chemicals have been presumed to be safe, partly because they are so stable. Like cigarettes, the burden of proving they are harmful falls to governments and environmental groups, rather than requiring the companies who manufacture them to prove they are safe long-term.

One early sign there was a problem was when an increase in cases of breast cancer in women and testicular cancer in men were noted in firefighters regularly exposed to high levels of PFAS in firefighting foams. As well as exposure while putting out fires and during training, their protective equipment often contains similar chemicals, so they were being exposed to these chemicals more than most. “Canaries in the mine…”

Other diseases and conditions have also been found to be associated with exposure to these chemicals, too. Some of these include:

· increased risk of prostate, liver and kidney cancer,

· ulcerative colitis (inflammatory bowel disease),

· increased blood cholesterol,

· increased blood pressure during pregnancy,

· thyroid and other hormone changes,

· early menopause,

· decreased birth weight in babies,

· decreased fertility,

· changes in bone density, and

· Type 2 diabetes.

A 3M sponsored study in the 1970s showed this type of chemical could decrease immune response in monkeys, and another at Harvard University in 2015 showed the same in humans. A 2015 study in children demonstrated that higher levels of PFAS in the blood were associated with a decreased immune response to vaccines.

Ongoing studies report that patients with higher levels of PFAS, especially one known as PFBA that deposits in lung tissue, tend to have worse outcomes from COVID-19 infection. The fact that men and older individuals tend to have higher levels of these chemicals may explain the increased risk these groups have of more severe COVID infection. Note that PFBA was thought to be safer because less was detected in the blood, while instead it was being pulled directly into the lungs where it appears to be having a local effect in lowering the immune response there.

CEPA, the Canadian Environmental Protection Act, was written in 1999 and is now outdated. It needs to take into consideration newer studies, vulnerable populations (like those working in the industry), those who live near hot spots (like previous spills or plants that create or use these chemicals), possible contamination of food by packaging, and babies born to mothers who are affected. PFAS and the similar, older PFOS are excreted in breast milk and can result in babies having 10 times the level of the mother, at a crucial time in the development of the immune system.

Older chemical safety tests generally consisted of a 1-time high dose test in an animal, but what about chronic low dose exposure? Because these chemicals do not break down and are stored in body fat, they accumulate in us over the years. Chronic low dose exposure is now considered more harmful than a single large dose exposure, in which the body appears to have a better chance of eliminating the chemical. These kinds of exposures need to be tested, too, before deciding a chemical is safe.

Although none of these chemicals are currently manufactured in Canada, according to a report I read, they are found in products we import. A recent CBC Marketplace investigation found 1 in 5 imported children’s clothing items they examined contained elevated levels of harmful chemicals, including PFAS, lead and phthalates (chemicals used in plastic that can contaminate the product packaged in it). On a positive note, all the companies were contacted and immediately removed the affected products from sale. They also committed to examining their supply chains for other harmful products.

Meanwhile, like PCBs and dioxins, these chemicals appear to be concentrating in the North. They travel easily through the atmosphere, enter the food chain there and concentrate in larger animals, like seals and polar bears… and humans.

Chemicals are too often considered safe until proven dangerous. Even with evidence, laws are slow to change. We saw this in the many years it took for tobacco to be considered a harmful substance (and it is still being sold today for daily use!). Because of their persistence and stability, we will continue to be exposed to forever chemicals like PFAS for many years after they are finally banned from use.

Current regulations need to be updated, and safety testing must improve to protect us from potential harm from newly synthesized chemicals. It’s just not acceptable to allow persistent substances to be sold with insufficient testing, only to discover the harm they cause after years of exposure to the public. Full labelling of chemicals added to products needs to be required.

So, how can you avoid these chemicals?

Be suspicious of any product that is water, grease, or stain resistant. These include food packaging, rain gear, waterproof cosmetics, stain resistant carpets and furniture, and non-stick pans. I’m choosing to cook in stainless steel and cast-iron pots these days!

References:

A new class of ‘forever chemicals’ is an emerging threat to our health and environment—CBC Radio series: Quirks and Quarks episodes on Oct 9, Oct 23 and Nov 6, 2020 (find it on the CBC Listen app)

Experts warn of high levels of chemicals in clothes by some fast-fashion retailers—CBC News Marketplace

PFAS exposure linked with worse COVID-19 outcomes—Harvard T.H.Chan School of Public Health

Severity of COVID-19 at elevated exposure to perfluorinated alkylates—PLOS ONE

Photo by Alex Kondratiev on Unsplash

#ForeverChemicals #PFAS

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Long Neuro-COVID…

Understanding how COVID could affect your brain

Now that we have vaccines and better treatments for COVID, researchers are finding time to investigate the possible long-term effects of this infection. Although most people recover completely within 2 to 4 weeks, as many as 1 person in 3 continue to have effects from the virus more than 3 months after diagnosis. For some, these problems continue for many months, and doctors are struggling to find effective treatments to get them back to normal. Long-COVID-19 [also called “post-acute sequelae of SARS-CoV-2 Infection” (PASC) or just post-COVID-19 syndrome], is defined as the effects of COVID-19 that persist more than 3 months (or 4 weeks, depending on whose definition you use!) after being diagnosed with the SARS-C0V-2 coronavirus. And the stats of how many have these complaints are all over the map, because of poor definition and diagnosis of this condition patients call “long COVID”.

A recent study of surviving patients (with no previous neurological symptoms) hospitalized for COVID-19, examined symptoms they continued to experience 6 months after leaving hospital:

  • Fatigue 34%
  • Memory/attention problems 31%
  • Sleep disorders 31%
  • Hyposmia (loss of sense of smell) 18%
  • Cognitive defects 17.5%
  • Postural tremor 13.8%
  • Subtle motor/sensory deficits 7.6%

Overall, 40% of people in the study had neurological abnormalities. Increased age, other health conditions, and severity of COVID-19 were all risk factors for this long neuro-COVID. Although this study examined people who were hospitalized with the virus, other studies are finding similar numbers in those with mild symptoms who did not require hospitalization.

With approximately 240 million cases and almost 5 million deaths confirmed worldwide as I write this, there will be a large population of recovered COVID-19 patients that could end up with long-term consequences of this contagious disease. Multi-organ effects of the virus are well-documented, but the potential long-term effects are just now being collected and assessed.

There are 3 main types of long-term effects of COVID: respiratory (shortness of breath, chest pain), cardiac (heart inflammation or damage), and neurological symptoms (brain fog, fatigue, headache, numbness/tingling, disorders of taste/smell, sleep disorders, decreased exercise tolerance, dizziness, problems with body temperature regulation, and muscle/joint pain). I’ll be focusing on the neurological symptoms—those related to nerve function.

Some lingering neurological symptoms can be common in anyone needing a stay in ICU—1/3 of ICU patients with respiratory failure or shock from any cause can have cognitive (thinking) impairment that compares to moderate traumatic brain injury. This is referred to as “post intensive care syndrome” and it’s more common in the elderly and those with underlying health conditions. However, some people are also reporting similar impairment in their thinking after recovering from mild or moderate COVID that did not require hospitalization.

Although the coronavirus is named SARS-CoV2 (SARS stands for Sudden Acute Respiratory Syndrome), scientists now know that it has effects on many body systems. In addition to respiratory symptoms (cough, fever, shortness of breath), it also increases the ability of the blood to form clots, and clots can cause damage in the heart (heart failure, myocarditis), and brain (strokes, seizures) as well as the lungs (scar tissue) that can cause health problems and increase risk of other diseases in the future. In addition, COVID-19 can weaken blood vessels and cause them to leak, potentially contributing to long-term problems with the liver, kidneys, and brain. Increased rates of new onset diabetes, heart disease and kidney are also reported.

Other effects are believed to be caused by how our bodies’ immune systems respond to the virus infection, creating multisystem inflammatory syndrome, with some organs and tissues becoming severely inflamed. Immune cells go everywhere in the body, so inflammation and an immune response elsewhere in the body can result in overactivity of immune cells in the brain—sometimes creating an “autoimmune” reaction where the body attacks itself.

Researchers are also suggesting the possibility of ongoing viral infection as a potential source of long COVID symptoms, possibly in the gut or elsewhere outside the respiratory system. The infection is known to affect the olfactory glands (the “smell” organ in the nose), with loss of smell and taste relatively common in acute COVID-19. This is thought to be a possible route for the virus to infect the brain, a possible cause of the brain damage they see in neuro-COVID. However, no virus has yet been detected in the brain itself. The research continues…

Experts warn the combined effects of COVID—direct viral effects, system inflammation, strokes, and organ damage (lungs, liver, pancreas, and kidneys)—might even increase risk of developing Alzheimer’s disease in the future. Inheriting the ApoE4 gene increases risk of both developing Alzheimer’s and severe COVID, a connection that researchers note and something that COVID survivors might want to keep in mind. Investigating possible parallels between Alzheimer’s and Neuro-COVID could potentially find better ways of preventing and treating both diseases.

Some long-term effects of COVID-19 are similar to those of Chronic Fatigue Syndrome (CFS)—extreme fatigue that is worse after physical or mental activity, but doesn’t improve with rest. Like Post COVID-19, it often begins after a viral infection. There is some hope that research into long-COVID-19 causes and mechanisms, may also help those who suffer from CFS.

But COVID can have subtle long-term effects too—one small study found persistent impairment in sustained attention in a group of younger people thought to be fully recovered from COVID. Whether this is due to underlying inflammation, silent strokes (a stroke with no obvious immediate symptoms) or lack of oxygen while sick is not known. Silent strokes typically affect the brain’s white matter that contains the nerves that connect different parts of the brain. This wiring is needed for attention and, when it’s damaged, it is more difficult to sustain and focus your attention for a length of time.

So, there is still a lot to learn about this new(ish) virus and what it can do to us. Organizing and sharing information between researchers around the world will help find the answers we need sooner.

The World Health Organization (WHO) recently published a standardized definition of Post COVID-19 syndrome, something needed to help researchers gather data in a consistent manner world-wide. The following are the criteria they describe, after consultation with international experts and patients:

  • A history of probable or confirmed SARS CoV-2 infection
  • Symptoms for at least 3 months from the onset of COVID-19
  • At least 2 months of the symptoms that cannot be explained by an alternate diagnosis
  • Common symptoms: fatigue, shortness of breath, cognitive (thinking) dysfunction, and others (such as anxiety; depression; pain; and hearing, smell and taste changes or loss)
  • Symptoms generally affect everyday functioning
  • Symptoms may be new-onset following an initial recovery or continuing from the original infection and may fluctuate or relapse over time

There have been some criticisms of this definition: it bases the diagnosis on excluding other causes rather than by simply including a set of symptoms, and some think the definition could have included new-onset diabetes, heart disease and kidney disease as symptoms of ongoing COVID related disease.

By comparison, the Centers for Disease Control (CDC) in the US defines “Post COVID conditions” as symptoms of COVID-19 that persist beyond the acute phase of 4 or more weeks.

We may also need a separate definition to describe post COVID-19 in children, as their symptoms can be different from those in adults. So far, there is limited data in young patients, but case reports are beginning to be collected and shared. A UK study published in January 2021 found 13 to 17% (depending on age) still had symptoms at 5 weeks from onset of the virus infection. Another study in Italy in November 2020 found 52.7% of the 120 children studied had at least 1 symptom at 4 months after diagnosis. Again, statistics all over the map, probably due to a lack of definition and diagnosis of the disease.

Symptoms in children included sore throat, joint pain, fatigue, headache, chest pain, gastrointestinal (digestive) problems, nausea, mood swings, dizziness, and rashes.

In children, the virus can trigger Multisystem Inflammation Syndrome (MIS-C), also known as Pediatric Inflammatory Multisystem Syndrome (PIMS). Case reports describe some children with extensive neurological symptoms and fatigue, similar to that in adults.

One benefit of developing and sharing a strong definition of a disease is to help doctors learn about it and diagnose it more accurately. Because of a lack of knowledge and awareness of Post COVID-19, many patients have been misdiagnosed over the past year and a half, some being told it was just stress, anxiety or “all in their head”.

As one woman said: “I just want doctors to have the courage to say they don’t know what’s wrong, and to offer to read, consult or test further to find out what it could be.” Having had a series of (non-COVID) misdiagnoses in the past few months myself, I must say the doctor who most impressed me was the one who said he didn’t know what I had, shared several possibilities, and asked if I wanted to have another test that might give more information. For whatever reason, it’s hard for some doctors to be “human” and admit they’re sometimes making an educated guess, and studies have shown it often takes women longer to be diagnosed (and women are less likely to be believed when describing symptoms) than men. As a patient, I really appreciated the doctor sharing the thought process of his diagnosis and discussing my options.

Meanwhile, in early September, the British Medical Journal (BMJ) hosted a webinar with a group of experts to discuss how to diagnose and treat Post COVID-19 most effectively. That’s a giant first step toward sharing current information.

There are so many reasons to do everything we can to avoid catching and passing on this contagious virus. It’s important to understand the risk of long-term effects, that they can develop even after mild cases and may not be evident until well into the future, and the possibility that the virus has to potential to affect our brain function. These give us more reasons to do everything we can to avoid this infection!

Lastly, on a positive note, there are some basic strategies that are known to decrease the risk of neurological disorders, like Parkinson’s disease, Alzheimer’s disease, and might be expected to decrease the chance of long neuro-Covid getting worse rather than better. These include getting regular exercise (sometimes within set limits), eating a healthy diet, and staying socially engaged with other people. These strategies can reduce risk of developing Alzheimer’s by 40%!

So, next time you’re talking to someone who’s hesitant about whether to take the plunge and get that vaccine, you can tell them about how doing so might help protect their brain!

P.S. Had my long-awaited surgery 24 hours ago, and starting to feel better already! In spite of its shortcomings, and even with all the COVID tests and protocols it must deal with, modern medicine is still wonderful. The doctors, nurses and all the support staff are still working hard to keep us healthy and safe. I thought it was cool that I was introduced to the entire team before I was put under!

This blog was longer than usual, but there’s so much information and research coming out now about previously unknown consequences of COVID-19. There seem to be new articles on this topic every week. If you’re interested in reading more, here are the references I delved into when writing this week’s blog…

References:

COVID-19: from an acute to chronic disease? Potential long-term health consequences—NIH National Library of Medicine PubMed.gov

WHO Coronavirus (COVID-19) Dashboard—World Health Organization

COVID-19 (coronavirus): Long-term effects—Mayo Clinic

Long-term neurological manifestations of COVID-19:prevalence and predictive factors—EAN Pages

‘Ill, abandoned, unable to access help:’ Living with long COVID—Medical News Today

Women and pain: Disparities in experience and treatment–Harvard Health Publishing

#longcovid #longhaulers #neurocovid

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Breast cancer… sometimes misunderstood!

Since October is Breast Cancer Awareness Month, I thought I’d dedicate a blog to this terrible disease that affects 1 in 8 women in North America, not to mention the impact it has on their families and those they love.

So here are some myths about breast cancer, and what the experts say about them…

Myth #1

A breast injury can cause breast cancer. Although a breast injury can sometimes cause changes in the breast tissue that might mimic the look of a cancer in a mammogram, it cannot cause cancer. But just to be sure, your doctor may want to do a needle biopsy, removing a small amount of breast tissue with a needle and syringe to examine in a lab, if an area looks different than usual due to a previous injury.

Myth #2

Underwire bras increase the risk of breast cancer. The wires do not cause cancer, but they can irritate the skin under the breasts, causing it to break down. Irritated skin is less resistant to bacteria and fungi which could cause an infection or abscess in the breast. Also non-wired bras are more comfy!!

Myth #3

IVF increases the risk of breast cancer. In vitro fertilization (IVF) involves the use of estrogen-like drugs to stimulate the ovaries to produce eggs. This led some experts to wonder whether the treatment could increase the risk of hormone-sensitive cancer cells developing, or at least speed the growth of any of this type of cancerous cells that might be forming. Although no studies have specifically been done to confirm this doesn’t happen, one trial compared the cancer risk of women who had had IVF with those who had not, and found no difference.

Myth #4

I won’t develop breast cancer because no-one in my family has had it. Most women who are diagnosed with breast cancer have no family history—only 5-10% of breast cancers are caused by a genetic mutation that was inherited. In fact, many diagnosed women have no known risk factors at all. Obviously, we’re missing something… (perhaps an environmental connection?) More research into the causes, please!!

Myth #5

Stress can cause breast cancer. While too much stress can certainly affect our health, there is evidence to show there is no association between stress and breast cancer. On the other hand, breast cancer most certainly causes stress! We can all benefit from learning effective ways of dealing with the stresses of modern life…

Myth #6

A healthy lifestyle eliminates breast cancer risk. A healthy lifestyle can reduce the risk of breast cancer, but it can’t eliminate it. Refer back to Myth #4… we need more research into the causes of breast cancer!

Myth #7

Breast cancer only occurs in older women. It is true that most cancers occur in older women. Age is a known risk factor—one we can’t do anything about. Screening mammograms are recommended only after age 50 in most countries, and after 40 in the US, as they are less accurate in younger women with more dense breast tissue. But about 5% of cancers are diagnosed in women under 40 years, typically in those with a strong family history of the cancer. It is recommended to watch for any unusual breast changes, like lumps, puckering of the skin or a nipple pulling inward (inverted nipple) and to see your doctor right away if any of these occur.

Myth #8

All breast lumps are cancerous. Actually, most new breast lumps are not cancer. A cyst (a pocket of liquid surrounded by a membrane) feels like a lump, and these are fairly common. However, always see your doctor right away for an evaluation if you notice a new lump or any other unusual breast change.

Myth #9

An abortion increases the risk of breast cancer. An abortion interrupts the normal hormone cycle of pregnancy (and pregnancy before age 30 is believed to reduce breast cancer risk), causing some to wonder whether it could increase the risk of a hormone dependent breast cancer. However, a large observational study in Denmark and several other smaller studies found no link between abortion and breast cancer.

Myth #10

Nipple piercings increase breast cancer risk. Piercings do not increase cancer risk, but they can lead to increased risk of infection, abscess, nerve damage, scars, cysts and difficulty breastfeeding (due to blocked ducts from scar tissue).

Myth #11

Sugar causes breast cancer. Refined sugar in excessive amounts is bad for our general health, but there is no evidence it directly causes breast cancer. I have read reports of research looking at very low sugar/high fat diets (an extreme form of the keto diet) to slow the growth of cancer cells in general, but the studies are not yet conclusive. Studies specifically looking at sugar and breast cancer have had “mixed and inconclusive” results, according to experts.

Myth #12

Men do not get breast cancer. Yes, they do! One in every 100 cases of breast cancer occurs in men. Men also should stay alert to any changes in the breast area, particularly as it can spread more quickly in males since they do not have as much breast tissue to contain it. As well, men are not screened for this cancer and tend to have less support when they are diagnosed with it.

Myth #13

Mammograms and biopsies can cause breast cancer to spread. The thinking here is that the squeezing and poking of a potential cancer could cause the cells to seed in another part of the breast. Some women also worry that the radiation of the mammogram could cause a cancer to begin. However, very low doses of radiation are used in current mammograms, and these are considered safe (although the operator, being there daily, needs to protective themselves from work-related exposure). No evidence has been found that these tests cause cancers to spread and they give valuable diagnostic and early-detection information that save many lives.

Myth #14

No lump means no cancer. Cancers that have formed “palpable” lumps (ones that can be felt with the fingers) have often been there, growing, for several years. The advantage of screening mammograms is that they can often detect a cancer before it is large enough to be palpable, greatly increasing the chance of a complete cure.

Myth #15

Anti-perspirants cause breast cancer. This myth started because many breast cancers occur in the upper outer area of the breast, the area closer to the armpit. However, very little if any of the ingredients in anti-perspirants are absorbed and there is no evidence that they would cause cancer if they were absorbed. At least one large well-conducted that compared breast cancer survivors with healthy women found no evidence of a problem with anti-perspirants or deodorants. The tiny grains of minerals left on the skin by antiperspirants do, however, show up on a mammogram, causing confusion for the radiologist interpreting the image. This is why they always insist that these products not be used on the day you are having a scan.

Myth #16

Carrying a phone in your bra can cause cancer. While most experts will say there is no evidence that cell phones cause any type of cancer, a few have reported case studies of unusual cancers that began in the same location where the woman carried her phone for several hours every day. Not proof of a cause, but one doctor was suspicious enough to publish a report after seeing several similar cases (which I linked to in my Sept 17th blog on environmental links to cancer). It might be a good idea to carry your phone in a purse or proper phone case, both to protect it and possibly also you! Cell phone manufacturers do recommend avoiding exposure of the phone to sweat, as the liquid could cause damage to the phone (as happened to my daughter, who no longer tucks hers into the waistband of her workout pants!)

So, there you go… less to worry about, right? I think the key in avoiding many diseases, including cancer, is to strive for as healthy a lifestyle as possible: eat well, exercise, limit alcohol to recommended amounts, and avoid exposure to nasty chemicals. And, since it’s Breast Cancer Awareness month, maybe make a little donation that might help researchers find the causes and cures for this disease that affects too many women…

References:

Medical Myths: 15 breast cancer misconceptions—Medical News Today

Antiperspirant Safety: Should You Sweat It?—WebMD

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Self-hypnosis… not what you think

For most of us, “hypnosis” brings to mind a stage show where people are made to do silly things by a hypnotist. But any hypnotist will tell you the participants do these things willingly, eager to be part of the show, and that they can’t really hypnotize anyone into doing something they don’t want to do. They’ve all had skeptics who just sat on the chair, wanting to prove hypnosis doesn’t “work”.

But the Practical Pain Management website tells us that “Hypnosis is a cognitive (mental) process such as imagination in which a patient is guided to respond to suggestions for changes in perceptions, sensations, thoughts, feelings, and behaviors. It involves learning how to use your mind and thoughts to manage emotional distress (such as anxiety), unpleasant physical symptoms (such as pain), and certain habits or behaviors (such as quitting smoking). People can be trained to self-hypnotize, guiding themselves through a hypnotic procedure.”

You could think of hypnosis as a combination of the placebo effect, meditation and positive affirmation. When we focus on something positive we want, eliminating other thoughts, we can encourage our subconscious mind to help us work toward our goal.

Placebo effect

With the placebo effect, believing that a medication or treatment will work activates the immune system and when they work together you can expect a better result. All valid drug trials are required to compare the medication to a placebo, and it is the difference that shows the effect of the drug. The placebo effect can be as high as 90% for some treatments, for example tension headaches. This is an example of how influencing the mind can have physical effects.

Pharmacist, Émile Coué (1857-1926), noted that more of his patients got better when he praised the effects of the medications he dispensed, than when he did not. Today, pharmacists are taught to always share the benefits of a drug before talking about the side effects to promote a positive attitude toward the treatment.

Meditation

Relaxing the body and clearing your mind, focusing on pleasant thoughts and images, and “mindfulness” techniques of focusing on the present (rather than dwelling on the past or worrying about the future) are techniques used in inducing a state of hypnosis that are similar to meditation.

Positive affirmation

Seeking help from a professional hypnotist to change a habit—for example quitting smoking—can help you bolster your determination to succeed. One technique used is to repeat a statement of the result you want, for example “I am a non-smoker” to change your beliefs deep in your sub-conscious. Of course, if you really don’t want to quit, the hypnosis just won’t work. You need to want the change and be ready to do what it takes. Hypnosis just helps increase your determination and belief that you will succeed.

So, what about self-hypnosis? Do you need to worry that you won’t “wake up”? When can it be useful? Is it difficult to do? I was curious, so I decided to read about it. Here is some of what I learned…

Hypnosis has been used as a medical treatment for centuries. The name comes from the sleep temples, or “hypnos” used by the Greeks to treat ailments. Imagery (picturing yourself on a beach), chants, drumming and dancing rituals while focussing on a goal could all be considered forms of hypnosis. However, it is less well-known than other alternative therapies, as most medical schools do not include it in their curricula.

It can be used to provide analgesia, reduce stress, relieve anxiety, improve sleep, improve mood, and reduce the need for strong pain medication such as opioids. It is not recommended for anyone with a severe, untreated psychological disorder, those under the influence of recreational drugs or alcohol or a person who has delusions or hallucinations at the time of treatment.

Hypnosis by a professional achieves its goals more quickly than trying to do it by yourself. If you are wanting to help address a more serious issue or habit, it’s the way to go. But for simpler goals, it might be worthwhile giving self-hypnosis a try. There are several techniques that can be successful, depending on the person. Professional hypnotists will sometimes teach patients self-hypnosis or provide recordings to continue the benefit of treatments between appointments.

We know that anxiety can increase pain perception and that distraction can reduce it. I used iPad games for years to reduce the pain of injections I was giving to children. Even a simple “Take a deep breath” was often enough of a distraction to help adults feel less needle pain. Closing your eyes and picturing yourself on a beach (or wherever your favourite vacation place might be) can help you reduce anxiety, decrease pain or fall asleep more quickly. Our dentist even has a TV mounted on the office ceiling for distraction!

So, I can understand how hypnosis can be beneficial. You’re basically learning to distract yourself and replace negative thoughts with positive ones more effectively. So, I gave it a try… but I found it was harder to achieve pain reduction than I thought it might be. Apparently, it takes practice!

But, several methods are suggested, and some work better than others, depending on the person. Here are some basic strategies used by professional hypnotists:

1. Autosuggestion—This is repeating suggestions to yourself, while closing the eyes to decrease other sensations and distractions

2. Autogenic training—This involves learning to create physical change from within, with the use of meditation, visualization and the mind’s ability to control the autonomic (“automatic”) nervous system that controls the body functions we don’t think about, like blood pressure, heart beat, reaction to stress, etc.

3. Progressive muscle relaxation—Consciously tensing then relaxing muscles (for example, from head to foot) helps reverse unconscious muscle tension, inducing relaxation.

4. Mindfulness—Focusing thoughts on the present with no worry about the past or anticipation of what the future holds. Focusing on the breath can be used to relax, clear and focus the mind in preparation to receive desired suggestions.

Steps used in hypnosis:

a. Induction of a trance or focus—guiding or being guided to focus your attention. Note that a trance state occurs any time you are selectively focused so deeply on something that you block out other sensations and stimuli.

b. Deepen focus—increasingly relax and focus your mind on the task you want to accomplish. Assistance from a professional would be helpful in this stage.

c. Auto-suggest (make a positive suggestion to yourself)—Make suggestions for the outcome you want to align your actions with your desires. For example, say “I am a non-smoker” rather than “I want to quit smoking”. This can be done by using a recording of your voice or by speaking to yourself repeatedly. Identify and write or record your mantra before you begin.

d. Termination—in self-hypnosis, you are always awake and can end the session whenever you choose.

A session with a professional hypnotist may have several more steps than this. Most are trained psychologists who explore your underlying issues before beginning and combine hypnosis with other psychological techniques. Therapists will often teach clients self-hypnosis so they can continue the benefit between treatments.

When training patients to perform self-hypnosis, some hypnotists will suggest placing a reminder in a prominent place, for example, writing your mantra with dry-erase marker on the bathroom mirror or on a sticky note on the edge of your computer screen. I like the mirror idea as it would remind you every morning and evening, ideal times to set your mood and intentions for the day, and to relax you for a good night’s sleep…

One hypnotist-author whose work I read suggests following the P.O.W.E.R. acronym to organize a self-hypnosis treatment:

P—Present. Don’t worry about the past or the future. Allow your mind to only consider the present.

O—Open your mind to using your internal creativity and intuition to solve your problem.

W—Written affirmation. State the change you want to accomplish and 1 to 3 actions that will make this happen.

E—Explore. Spend a few minutes exploring the benefits of embracing and achieving your affirmation.

R—Ratify. Commit to the outcome in your affirmation. Lock your mind around it. Put the idea of success exclusively in your mind.

Biofeedback

There is another similar technique, called biofeedback, that uses instruments (for example a blood pressure cuff) to motivate and confirm the patient’s success in influencing actions that are under the control of the autonomic (subconscious) nervous system. Studies have found people can be taught to lower blood pressure, slow heart rate, reduce anxiety, increase blood flow to certain areas of the body, and modify other similar parameters using various instruments as an external source of motivation rather than an internal one as with hypnosis. Since the instruments also confirm success, biofeedback is considered more scientific by some people than hypnosis, but the processes are actually quite similar.

The bottom line…

Self-hypnosis can only do what is physically possible. For most people, it should be regarded as an “add on” to other standard treatments, not as a substitute. And it takes practice. As I read various articles plus a book about hypnosis over the past couple of weeks, I tried some of the techniques. The best I was able to achieve was a slight and very temporary reduction in pain, so I won’t be throwing away my Tylenol any time soon! But I could see that hypnosis could be helpful in some situations, and the benefit of consulting a professional if you are serious about learning self-hypnosis. I also learned you would need plenty of practice to achieve lasting benefit.

PS: The “mandala” drawing above is a relaxing, meditative form of art that I learned this summer… a Zen combination of drawing, colouring and meditation!

References:

Hypnosis: Tool for Pain Management—Practical Pain Management

The Seven Most Effective Methods of Self-hypnosis: How to Create Rapid Change in your Health, Wealth, and Habits—Richard K. Nongard, Certified Professional Hypnotist

Biofeedback—Mayo Clinic

Chronic back pain: Can psychological therapy be an effective treatment? Medical News Today

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Avoiding “cracks” in the system…

After my “Falling through the cracks” blog a couple of weeks ago, I received a lot of comments and notes from people who have experienced healthcare hiccups like I have. One reader shared two excellent suggestions to add to my list, based on her experiences, that hadn’t occurred to me when writing. I thought they were worth sharing…

1. Don’t self-diagnose. Give all your information to your doctor (don’t hold anything back that might be relevant!) and get a diagnosis from a professional.

Many of us turn to “Dr. Google” when we have symptoms (I’m guilty of it too!) but, of course, there’s a lot of misinformation out there. And even if you’re reading a reputable website, it often takes background knowledge and expertise to interpret your symptoms– that’s why your doctor’s training and experience are so important. They know the questions to ask to rule out that disease you’re worried about, or to suspect a condition unfamiliar to you. Sometimes a test or physical examination is needed to find what is wrong.

I have seen the recommendation, though, that if you suspect you have a particular medical condition, you should mention it to your doctor, whether it’s something you’ve had previously, you know someone with the condition, or it’s just something you’ve just read about. Your doctor will explain why they know your problem isn’t what you suspect (putting your mind at ease!) or, especially if it’s a condition you’ve had before, they might consider it in their search for a potential diagnosis.

I recall an elderly gentleman years ago, asking at the pharmacy counter where he might find the non-prescription muscle relaxant tablets. As I escorted him to the shelf where the product was displayed, he grumbled that he wasn’t confident in the young doctor who had recommended this treatment… he’d had back pain for years and “knew” it was arthritis. Apparently, he didn’t think it was important to inform the doctor of this. And the young physician, obviously, didn’t ask about the duration of the pain. Diagnosing is like solving a puzzle, and every piece of information is important!

2. If you are not getting results with your doctor and your symptoms are getting worse, head to the emergency room (or local after-hours) for a second opinion. Be sure to tell them all details of treatments you’ve tried thus far.

You know the saying: two heads are better than one. And, in medicine, knowing what treatments didn’t work also helps to find the correct diagnosis. So, even returning to your own doctor when a treatment doesn’t work, will help her figure out what’s causing your problem.

But doctors do put their heads together to discuss patients who aren’t improving as expected with treatment. In hospital, they call these meetings “grand rounds” and the meetings include many different health professionals, all sharing their expertise and suggestions for treatment. In an ideal world, this would happen in community medical clinics too. A goal to strive for!

But it can sometimes take time to get an appointment with your family doctor – they have many patients to keep up with and personal lives too. And some offices are better at triaging who needs to be seen sooner than others and keep slots open for those who shouldn’t wait to be seen.

If you are in immediate distress, for example with severe pain or difficulty breathing, the emergency department is the place to go. Or call an ambulance if it might be life-threatening, especially if you live a distance from the hospital. Often the ability to conduct blood tests or scans can take a lot of the educated guesswork out of diagnosing the problem on the first try. However, booking a follow-up appointment with your doctor later will ensure they know about new developments, and they will be able to monitor the results of any prescribed treatment.

Knowledge is good

Of course, knowledge about any medical condition you have is a good thing. If you do decide to learn more about a disease you have, ask your doctor to recommend a source of information. There are often non-drug approaches you can incorporate into your lifestyle that can improve your condition or reduce the risk of it developing again. Websites hosted by established medical clinics, universities, government, and medical schools are generally based on science, and monitored and updated regularly. National health organizations (for example, a national diabetes association, if you are diagnosed with diabetes) often provide good quality patient information that is easy to read and understand. If you are unsure of the validity of any information, ask your doctor to confirm that it is correct and applies to you.

Most high-quality websites will show the references used to supply information for the article. You have probably noticed that I do this most of the time (apart from opinion articles and those based on personal experiences, when I will be clear that is what the article is). In fact, when I read an interesting health-related article, I also look up the original references they used to gather information for the article to learn more, as well as to verify their interpretation of the information. I’d encourage you to do the same!

Of course, today’s blog is in the “personal experiences” category so no references. But I will mention a few of my favourite sites… they include Mayo Clinic, Health Canada, British and American government sites, and I love Google Scholar—the search engine that searches published scientific literature. Sadly, more and more articles are now behind paywalls, unlike when I first started using it in the early 2000s. In an ideal world, knowledge would be shared for the benefit of all, enabling better evidence-based decisions and furthering research and treatments.

PS…

So, more good news on a personal level… I won’t have to wait months for treatment as the receptionist warned me I might. Pain has been called the 4th vital sign—it’s important to let your healthcare provider know the level of pain you are experiencing and how long you’ve had it. I think that’s probably what made the difference for me… I have an appointment on October 21st! Just 3 weeks away.

Hopefully I will be able to put all this behind me, but I’ll continue to look for ways to improve our health system and to help others navigate it efficiently. Nice to know it all works when you really need it, though! Communication is key.

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A nail-biter week…

It was a long week, waiting for my appointment day to arrive, but my hubby was coaching me to not get overly anxious about what my biopsy results might be. Why get upset over a potential bad result that might not happen? Just keep busy with other things… Good advice.

I also thought about wise counsel from another relative who was diagnosed with breast cancer. Scream, cry and get angry for a week or so, then get busy working to defeat the disease. Ten years or so post-diagnosis, this strategy has worked well for her. She has a zest for life that anyone would envy.

It’s all about keeping your quality of life, I think. It’s easy to let yourself drown in a bad diagnosis, even before you receive it, as you worry about worst-case scenarios. A good life strategy for any of us is to look for what you can do to make whatever time you have the best it can be, regardless of good or bad diagnoses. Take the bull by the horns, my hubby likes to say… live life to the fullest, do all those things you’ve always wanted to do, focus on happy thoughts.

But part of me wanted to prepare myself, just in case… sort of like before childbirth: if you know what’s coming and prepare for it as objectively as possible, it’s not as bad. It can be easier to handle news and stay in control when you’re prepared for anything.

But it was good news!

The first thing the doctor said, is that it’s not bad news. I imagine she’s had to deliver her fair share of devastating diagnoses over the years. So, no cancer, thank goodness! But my heart goes out to others in that situation that didn’t get the results they were hoping for. This week has made me more understanding of what it would be like to learn that you or someone you love has cancer.

My doctor talked about my problem likely being a polyp—a growth of some sort inside the uterus—and described the pain as being due to the uterus’s attempt to push out what shouldn’t be there.

But what’s the cause?

I wanted to discuss potential causes of an overgrowth of hormone-sensitive tissue. I guess I’ve always been a person who wants to understand why things happen. Everything has a cause and, if we learn what drives a disease, we can change our behaviour to lower the risk of it returning or worsening in the future. And maybe we can help to protect our kids from developing the same problems.

But she didn’t have any thoughts on what could be promoting growth of hormone-dependent tissue in a post-menopausal woman currently producing only low amounts of hormones. I briefly explained my previous unintended chemical misadventures and my understanding of the environmental connections I’d learned about—the topic of last week’s blog —but it didn’t appear to be something she’d heard or read about before. I guess doctors have their hands full just trying to cure us all, leaving little time for reading about theories that are not easy to prove.

Still, I can’t help thinking they might not be as busy, nor waiting times as long, if we could make a few behaviour changes that would lower our disease risk. I’ll keep looking for the cause and encouraging research, so we can avoid needing so much treatment!

And the next queue…

So now I’m on another wait list—the one for the OR. Yes, at least the next “surgery” will be done with a general anesthetic in an operating room. It will just be a day surgery, so relatively minor, but apparently some women experience more pain than others when being poked, prodded, and trimmed on the inside. I’m one of the sensitive ones, I guess! So, yes, general anesthetic please!!

The downside is that it could again be a wait—perhaps months, the receptionist says. OR times are assigned at the beginning of each month at our hospital, so no way of knowing very far in advance. Hard to say whether we will get to Spain this winter (booked to leave Jan 18th!) but with COVID the trip is a bit up in the air anyway… They are saying we should expect a mild, wet winter in Canada this year. I wonder how they can make these predictions so far in advance???

So, all is good or, at least, as good as it can be. But it was a nail-biter week… literally. No fingernails left! I’m feeling better, mentally and somewhat physically, but still counting out my Tylenol for the day to make sure I don’t take too much (8 tablets of 500mg is the maximum safe dose!).

I’ve had more good days than bad lately, fortunately. I think I might investigate biofeedback (controlling a body function with your mind) now that I know the mechanism of my pain (spasms in the uterus). I’ve read that people can be trained to lower their blood pressure or increase blood circulation to part of the body by focusing their mind. I wonder whether biofeedback could be similar to the placebo response I’ve written about previously … your subconscious triggering your immune system to do what you want. Stay tuned!

Thanks for all your messages over the past few weeks—I so appreciate the support! Hope I can pay it forward to a couple of dear friends who were not as fortunate as I was when they received their news…

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Environmental links to cancer

I used to give a presentation on breast cancer prevention some years ago, and I just realized I’ve never blogged about this subject. Though years have passed and, sadly, little has changed in information on environmental connections to cancer, much of what I learned is still not well known by the public.

I recall reading somewhere that breast and prostate cancers are suspected to have similar causes, both being hormone-related cancers, so this information will be of interest to the guys too. I’ve always thought it was better to prevent cancer than to have to treat it… and the strategies to prevent cancer may help to prevent a recurrence in someone unfortunate enough to have already been diagnosed with it.

The causes of cancer have eluded us for generations, despite the “war on cancer” announced so many years ago. This may be because the cause, as understood by many researchers is likely to be a combination of factors that add together. These likely include genetics (less than 10% of breast cancers), exposure to cancer-causing chemicals or “carcinogens” (sometimes causing problems years after exposure), a poorly functioning immune system (that does not repair cell damage efficiently enough) and perhaps diet and other lifestyle factors.

However, little research money appears to be allocated to finding the causes, with much more going to early detection and treatment. I guess you’d want this, if you had cancer, but wouldn’t we all rather not get it in the first place? Of course, with much research money being supplied by manufacturers, the fact that preventing disease doesn’t result in income could also be a factor in where research dollars are spent… It’s up to government to take the lead in prevention and environmental research.

And it’s up to us to push them to do it!

My story…

I’ve known too many friends and family members who’ve been diagnosed with cancer. Unfortunately, the incidence continues to increase, even as treatments become more targeted and successful. But, like much I blog about, I have personal reasons for taking a particular interest in this subject.

My story started back 25 or 30 years ago when, for some unknown reason, I started having problems with some “lady parts”—lumps in the breast (fortunately all non-cancerous), bad PAP tests that required cryosurgery. Like most people, I just assumed these things were random occurrences and never thought to search for a cause. No one asked about my lifestyle or medications, to check for a change that might have been connected to my problems.

Tupperware parties were popular then, and I had bought a wonderful set of plastic cups with the “sipper seal” that prevented many spilled milk days in our house. After my kids outgrew the kiddie cup stage, the idea hit me that they would make great coffee cups—ones that would fit into the tiny cupholders in my car. No more spilled coffee on my way to work!

Eventually my coffee started to taste more and more like plastic, as the hot beverage broke down components in the plastic cup. Finally, one day it tasted so bad I pulled over and dumped it out and stopped using the cups for my coffee. A few months afterward, all my health problems went away.

A support group event

I didn’t associate the health events with my plastic consumption until a friend who was a breast cancer survivor invited me to an event her support group was hosting, a year or so later. It would have been the late 1990s. They presented a documentary film created in 1997 called “Exposure: Environmental Connections to Breast Cancer”, hosted by Olivia Newton-John, also a breast cancer survivor.

The 55-minute film interviewed cancer researchers and clinicians, and the award-winning producer and director were there for a discussion afterward. My friend and I bought a VHS copy of the film and I started giving a presentation based on the documentary’s research to any groups of women who wanted to listen.

The information in the film is still relevant now, over 20 years later, and many of the strategies for avoiding known carcinogens still seem to be surprising to many. This is just another example of the lack of “knowledge translation” I talked about last week. I’ll post a link to the film in the references, so you can check it out yourself if you’d like.

Plastic and cancer

So, back to plastic. One of the researchers in the film talked about an experiment they were doing with breast cancer cells. They had placed the cells in a plastic test tube with no nutrients or hormones to help them grow. They should have been just lying there quietly but, instead, they were growing like crazy. Something in the plastic was feeding the cancer cells. It was a revelation to the researchers—the first realization that something in plastic was hormonally active.

Since then, plastics have been classified into safer or more harmful types. You may have noticed a number enclosed in a triangle of arrows on most plastic containers. This is a classification of the plasticers (chemicals that make plastic flexible) in the plastic into various types. Although safety recommendations vary slightly by source, most recommend 2, 4 and 5 as the safest, and 1, 3, 6 and 7 to be used in moderation and never reused. No plastics are recommended to be heated, including in the microwave, or used for hot food.

Here’s a chart from the David Suzuki Foundation:

So, you see, my plastic cup didn’t just make my coffee taste like plastic, it was delivering a hormonally active substance into my body daily, that was making me sick. The worst part is that these chemicals are fat-soluble… they dissolve in oils and fats and are stored in the fatty tissues of the body. Now, 25 years later, I expect they’re still hiding in my body. Losing weight could be expected to liberate these chemicals as my body converts to using up fat I’ve stored away over the years.

If you look closely at the packaging, you’ll notice that Styrofoam cups and plastic utensils are generally made of plastic #6, a plastic that should not be used with food. Of course, we can choose not to use these items, but why are they still being manufactured and sold? Our governments are often slow to create regulations that protect us!

As a hormone specialist pharmacist, I learned that the hormone, progesterone, “opposes” or balances the action of estrogen. It’s not a leap to expect that it would also counter the action of estrogen-like chemicals as well, although I’ve not seen studies that specifically looked at this—and I have to wonder why these studies haven’t been done. I still use a low dose of progesterone to try to prevent problems because of what I learned as a compounding pharmacist.

Cellphones

While searching for an online version of the Exposure video, I stumbled across case reports of breast cancer that appeared to be associated with storing a cellphone close to the breast. These cancers were unusual, occurring in young women, exactly beneath the area where they habitually carried their phone, sometimes with several different types of cancer occurring at once. These women had developed a habit of carrying their phone tucked into their bra for hours each day.

In the report, they pointed out that most cellphone manufacturers recommend holding your phone slightly away from the body (or using a Bluetooth headset), and not storing the phone close to the body, especially not against the skin. I think I’ll start carrying mine in the front pocket of my purse, farther away from my body, rather than in the back pocket so I can feel it vibrate (telling me I have a message or call). I’ll just turn up the volume instead! Microwave radiation drops quickly with distance… creating a small space or non-metal layer quickly makes a large difference in the strength of the radio waves.

However, it is noteworthy that these cases were in people who carried their phone in direct contact with the skin, in the same spot for many hours each day. Overall, cellphone use has not been demonstrated to increase risk of cancer significantly. (See Mayo Clinic reference below).

And more…

Of course, there are other environmental factors that are of concern that should be discussed–pesticides being one. Chemicals that are designed to kill pests could be expected to do us harm too, if we are exposed. How much is too much? Which (if any) are safer? A subject for a future blog, perhaps.

But I’d encourage you to watch the “Exposure” video (link below in the references) that delves into the subject… an hour well spent in my opinion (and I’ve watched it quite a few times!)

PS…

One thing that has changed since the documentary was made, is that mammograms use less radiation now, resulting in a safer test. The test is also less accurate when breast tissue is more dense, as it is in premenopausal women. Many jurisdictions (with the notable exception of the US) begin screening mammograms only at age 50 and perform them only every 2 to 3 years to minimize exposure and maximize benefit.

PPS…Faith restored

On the “good news” front, I just got an appointment for early next week to hopefully (finally!) find out what is causing my “falling through the cracks” symptoms. My faith in the Canadian healthcare system has been restored! Fingers crossed for a clear explanation of what’s going on and a plan to get things back to normal as quickly as possible…

References:

Women’s reproductive system as balanced estradiol and progesterone actions—A revolutionary, paradigm-shifting concept in women’s health—Science Direct

Exposure: Environmental Links to Breast Cancer (1997)—Culture Unplugged

Cellphones and Breast Cancer—Environmental Health Trust

Is there any link between cellphones and cancer?—Mayo Clinic

Photo credit: Ishan @seefromthesky on Unsplash

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Staying positive… taking control

As you can imagine, waiting (not always so patiently!) for test results has made me even more interested in reading articles about lifestyle strategies for disease prevention. Doing something positive by creating a healthier lifestyle, one that can reduce the risk of cancer and other diseases, is something patients can do for themselves. Feeling that you’re in control of something in your life is good for both your mental and physical health.

On the upside, two health professionals have told me that slow results usually mean the test result will be negative. More suspicious samples are fast-tracked through the system, as they should be. So, perhaps slow is good. I’m afraid last week’s blog was a bit of a frustrated rant… so I’m trying to shift to a better, more positive frame of mind by taking control of what I can, and changing to a healthier lifestyle!

Looking at the research…

While I still like Michael Pollan’s Food Rules best for their simplicity: [Eat food (real food, not processed), mostly plants, and not too much], there certainly is some interesting research that many of us don’t hear about.

It’s always been difficult to conduct diet research on humans—it’s just too hard to completely control a person’s diet for the years it would take to really learn what’s best. But here are some of the diet recommendations and strategies being investigated that have caught my attention and that seem to make sense…

Eat more foods with flavonoids

For years researchers have found that some people who eat more foods with antioxidants, called flavonoids, have extra protection against heart attack, stroke, Type 2 diabetes, and some types of cancer, as well as lower blood pressure. But they weren’t sure why eating more of these foods didn’t work as well for everyone.

New research has discovered that certain bacteria in the gut break these compounds down into substances that deliver the benefit. Those with more diverse gut bacteria are the ones who benefit more.

Foods rich in flavonoids include berries, apples, pears, dark chocolate, and red wine. Ensuring you also have some fermented foods in your diet, like sauerkraut, yoghurt, kombucha and others, can help to ensure you benefit maximally from these tasty flavonoid-containing foods.

Meanwhile, increased diversity of gut bacteria is being found to be associated with reduced risk of several inflammatory and autoimmune diseases. Antibiotic overuse and poor diets are believed to have reduced the variety of microbes in our guts, with some species actually now extinct in some populations.

Ditch sugar and processed food

For all that we’ve been warned to avoid fatty foods, sugar is now believed by some researchers to be much worse. And when the fat is removed from food, it loses a lot of its taste. So, food processers have been making up for this by adding sugar (which we all love!). Multiple studies have suggested that increased amounts of processed foods in our diets can increase risk of cancer and heart disease.

Besides the obvious weight gain too much sugar can cause, there’s also Non-alcoholic Fatty Liver disease (NAFL) that is caused by the body storing some of that excess sugar in the liver as fat. Fatty liver disease is a risk factor for liver dysfunction as well as cancer.

Of course, if one were to eliminate both fat and sugar, that would leave only protein… and high protein diets can be hard on kidney function, as the kidneys are required to filter all the amino acids from the excess protein. To me this suggests a balanced diet with some fat and protein, plenty of fiber (think vegetables!) and a very low amount of sugar.

My sister (also a retired pharmacist) loves to watch videos of researchers discussing their work and she passes some of them on to me. A recent one discussed the effects of sugar on cancer cells and whether cancer is a genetic disease (caused by damage to DNA), or a disease of damaged mitochondria (the tiny energy-producing organelles in the cytoplasm (the fluid part of the cell outside the DNA-containing nucleus). Transferring damaged over-producing mitochondria from a cancer cell to a normal cell caused it to become cancerous but transferring DNA did not.

This suggests that cancer could be a disease of excess energy production by damaged mitochondria, allowing a cell to grow non-stop, rather than a disease of damaged DNA. The researcher suggests the damage seen in DNA could well be a “downstream” result of the rampant cell growth, not the cause of it. He also discussed that, since cancer cells are known to use mainly sugar for energy (and not fat or ketones, produced when fat is used for energy rather than sugar), removing sugar from the diet may be a strategy for future cancer treatment.

So, what the heck—I figure I might as well go “Keto” for a while, as I wait for my test results. At least I’ll be doing something positive rather than just sitting around waiting for a letter in the mail…

Intermittent Fasting

While I’ve blogged about intermittent fasting before, it’s worth mentioning again. When you limit your eating to less than 8 hours each day, your body goes into “clean up” mode, devouring dead and damaged cells… basically clearing out the garbage. This is called “autophagy” … eating oneself! (I’ll post the link to my article below, if you’re interested in reading it.)

The premise behind intermittent fasting is to stop eating and snacking throughout our waking hours so our body can spend time cleaning house rather than just processing a constant intake of food. This can be done either by compressing daily food intake into 8 hours or less, or by taking in less than 600 calories on 2 non-consecutive days of the week.

Many cultures have fasting rituals—the month-long celebration of Ramadan is one example, where followers do not eat during daylight hours. Historically, humans did not have the plentiful food supply we have today, and this has created a huge change in modern eating habits, with 3 full meals plus 2 to 4 snacks every day. Grazing, as one friend calls it, leaves little time for cleaning out the garbage in our cells.

“Knowledge translation” takes a long time…

When I retired from active pharmacy practice and started this blog, I had the time and interest to read as much as I could about creating a healthy lifestyle. I subscribed to several health newsletters that give me a steady stream of research-based information to share with you all. It is notable that new medical discoveries take an average of 17 years to become standard medical practice. They call this transfer of knowledge into practice “knowledge translation” and it’s a big problem in the world of science. Writers like me are trying to speed this up a little…

The IF Diet (Intermittent Fasting blog (Jan 2020) link: https://jeanniebeaudin.wixsite.com/author/post/the-if-diet

References:

Consumption of ultra-processed foods and cancer risk—British Medical Journal

The Effects of High-Protein Diets on Kidney Health and Longevity—Journal of the American Society of Nephrology https://jasn.asnjournals.org/content/31/8/1667

Flavonoid-rich foods lower blood pressure via gut bacteria–

Medical News Today

Microbial Diversity and Abundance of Parabacteroides Mediate the Associations Between Higher Intake of Flavonoid-rich Foods and Lower Blood Pressure—Journal of Hypertension

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Falling through the cracks…

Some patients have always fallen through the cracks of our medical system, with unnecessary delays in diagnosis. We’re all human… a significant symptom can be ignored or misinterpreted, or we can put off investigating the cause of a nagging problem that could suggest a serious condition. But during the COVID pandemic, the cracks in the system have become wider. With fewer in-person appointments, cancelled screening clinics and hesitation to seek treatment because of worry about virus exposure, experts are warning that diseases are likely being diagnosed later when they’re harder to treat.

They worry that because early-detection procedures like PAP tests, mammograms and the PSA test for prostate cancer are being postponed, we may see cases where the diseases these tests screen for are more advanced at diagnosis. This can sometimes mean more expensive treatment and worse outcomes because diseases are more likely to have spread when diagnosed. Just like a house fire, cancers and infections are best treated sooner before they have a chance to advance and spread.

It will take time for statistics to show how much of this is happening and to what extent the problem of decreased health screening is affecting our health and our chances of surviving health problems that are detected further along in the course of the disease. But, anecdotally at least, I’m seeing that this is happening.

Of course, for privacy reasons, I don’t want to describe the cases I’ve learned about amongst family and friends, but I can tell you my story. You may have noticed that I took a break from blogging this summer… but it wasn’t because I was having too much fun to write. The truth is, I haven’t been feeling well for the past several weeks. And I still don’t know the cause.

So, from my point of view, here are some of the “cracks” that it’s easy to fall through…

Crack #1: one thing at a time

In mid-May I noticed some abdominal discomfort—nothing too terrible. Then a week later a sudden severe pain sent me to Emergency… Crack #1 to avoid: try not to have 2 things going on at once (not that we really have that choice…). If you do, be sure to explain that there seem to be two unrelated things going on. Turned out I had a kidney stone (perhaps obvious from the level of pain…) but since they couldn’t see the stone on a CT scan it was diagnosed as a kidney infection. I spent the next 2 weeks on an antibiotic that made no difference. A later scan showed several smaller stones, confirming what I had suspected must be the cause at the time because the pain was so severe.

But in spite of visits with 4 doctors and a nurse practitioner, along with a series of tests, there’s still something else going on that hasn’t been diagnosed yet. At least I’ve progressed from phone appointments to in-person ones as my symptoms have gradually worsened.

Crack#2: describe symptoms clearly

I can see that the system is backed up, with longer delays than usual in getting appointments and results of tests. Crack #2: make sure the person on the phone understands your symptoms and how severe they are. Avoid the “Fine, thank you” automatic response when a health professional asks how you’re feeling—be truthful and accurate. Let them know how the symptoms are affecting your daily life.

Crack #3: know your receptionist

One important lesson I’ve learned is that the receptionist is the gatekeeper of the doctor’s time. While it may seem weird to be describing details of an illness over the phone to someone who isn’t a health professional, she is the person who decides how soon you need to be seen. So, heed Crack #3 and treat the receptionist like the important person that they are… describe what’s going on politely and carefully along with any frustration or desperation that you may be experiencing! And thank them profusely for helping you to be seen in a timely manner—it’s probably due to their actions. Usually, they’re the ones who manage the doctor’s schedule and often are the ones with the connections to the receptionists in the specialists’ offices.

Crack #4: communicate well

Crack #4 is about lack of communication. If you go to an after-hours clinic or emergency department, your doctor may or may not know about it afterward. Even if the Nurse Practitioner in your Family Doctor’s office sees you and documents her observations on your chart, your doctor may not see it until your next visit with them. Your family doctor should be the central hub of your healthcare and seeing them regularly, especially when you have a health issue, helps keep your care from various sites coordinated. Make sure they are well informed and aware of any care you receive outside their office. At least now we have electronic health records in most areas, so information about various treatments in different locations is accessible to everyone who is treating you and needs it. They just need to know it’s there and to look.

Crack#5: avoid vacations!

And Crack #5 is: don’t get sick during vacation (as if we have a choice!). Many doctors are not able to find locums to cover the office when they take vacation, leaving patients to rely on after-hours clinics and emergency departments. Even our local blood collection/lab sample drop off clinic, usually lined up daily to overcapacity, just closed up for a week to take a holiday. For many like me, we were left wondering where to go and this resulted in yet another extra week’s delay for me and many others in getting test results needed to help find a diagnosis.

My story…

So, where am I now? I just learned this week that my latest test, the one that should finally provide a diagnosis and the test I’ve waited 2 months to get, has a 2 to 3 month wait for results. I can’t believe it. I’m unbelievably frustrated that any lab could take 2 months to process a sample and that, as the receptionist told me, it could take an additional month in this age of electronic communication to send me a letter by snail mail with an appointment to hear the results. I think I cried on the phone in frustration. I’m hoping my newest favourite receptionist may be able to work some magic and expedite this process somewhat for me, the way the receptionist in my family doctor’s office was able to get me into the specialist more quickly. The words “possible carcinoma” on a June 30th test should have resulted in quick action but here I am, 2 months later, still waiting for a diagnosis. Whatever it is, I just want to know. It’s more than a little stressful and certainly not the norm in any medical system, including ours. Might be time to send an email to my local politician…

The bottom line

I guess, the bottom line is that we all need to be proactive about our health. Even in these days of the continuing pandemic, we still should insist that routine care and screening tests are completed in a timely manner. Vaccines and well-fitting masks are tools we have to make sure we stay safe from the virus while we do this. If you have unusual unexplained symptoms, insist that they be diagnosed. Keep asking for investigations until the problem is resolved. Remember that your family doctor is usually the most important healthcare professional to work with you and to coordinate and oversee your care.

So, if you’ve missed any screening tests in the past year and a half, now is the time to book an appointment. Just like a house fire, it makes a big difference if you catch it early. If something seems to be wrong with your health, check it out right away and keep pushing until you get an answer… that’s what I’m doing, even though it seems to be taking much longer than it should.