Diagnosis: Breast Cancer – But What About My Breasts?

The odds are that one in nine women will get breast cancer in their lifetime. Those are staggering numbers.

Once a diagnosis of breast cancer is made a whole team of specialists get involved to guide the patient through the treatment choices. What essentially determines your prognosis and treatment is your staging of the disease – the worse (of higher) the staging, the more aggressive the treatment.

There are essentially a combination of treatments ranging from chemotherapy (including hormone blockers), radiation and surgery that can be used. The best determination will depend on age, stage, certain hormone receptors of the disease and family history.

A majority of women will probably not need plastic surgery because the disease, if caught at an early stage, can be treated with lumpectomy and possible radiation and/or chemotherapy. If these treatments are done then a woman preserves her own breasts and the cosmetic result is excellent.

For those whose treatment regimen may include a total mastectomy the question is, “What about my breasts???”

For women who have more advanced disease, the best treatment may be a mastectomy with or without lymph node sampling. At this stage a thorough consultation with a plastic surgeon is required prior to the mastectomy so that reconstruction can be done simultaneously while in the operating room.

The first meeting should include a thorough history and physical exam. A plastic surgeon will consult with his or her colleagues regarding the type of mastectomy, the staging of the disease and whether post operative radiation or chemotherapy may be used. Most importantly, the patient is examined for the risk of surgery and reconstruction. Is she healthy, does she smoke, are there comorbidities? During the interview, the plastic surgeon will ask whether the patient wants to do reconstruction at all or does she want reconstruction with her own tissue or using implants and other materials.

Some patients that get mastectomies at an older age or have severe comorbidities may not be candidates for aggressive reconstruction. If a patient has aggressive disease and requires radiation, then reconstruction may be delayed for a while until her disease is better controlled.

So what are the options?

OPTION 1: Bypass reconstruction and possibly be fitted for an external prosthesis.

OPTION 2: Reconstruction using your own tissue.

This may require we use the muscle and skin from your back, tummy or buttocks. It may be done as a flap with an artery supply that is intact and simply moved or the blood supply is interrupted and reanastomosed under a microscope (free flap). Sometimes an implant may be needed to get proper size.

Reconstruction using your own tissue (autologous) gives the most natural feel and look to the breast but the trade off is another site of surgery including a scar, longer surgery, more prolonged recovery and possible revisions in both the donor site and the mastectomy site. The transferred tissue may need to be trimmed and revised. Once the proper look is achieved a nipple will have to be reconstructed and tattooed. Also the other breast may have to be augmented and/or lifted or reduced to achieve symmetry. If radiation is used post-operatively then autologous reconstruction is delayed for a while.

OPTION 3: Reconstruct with implants.

Usually a tissue expander is placed at the same time as the mastectomy and expanded post operatively to a desired result. Then the patient is brought back in after a couple of months or after chemotherapy and/or radiation and a permanent implant is inserted. The implant may be saline or silicone. The risks and benefits of both implants can be discussed with your doctor. As with any reconstruction the other breast may be augmented and/or lifted or reduced. Finally, a nipple on the reconstructed breast will have to be made and tattooed. In some instances a muscle may be harvested to add to the reconstruction. Lately to reduce the morbidities, Alloderm (cadever dermis) can be used to substitute for the muscle.

Every patient, regardless of staging, age or comorbidities has to make wise and educated decisions both for their treatment as well as their reconstruction. Whether the reconstruction is done during the initial mastectomy or delayed for a time can be dependent on the disease and subsequent treatment. It may be wiser to treat the disease and then reconstruct once the patient has had chemotherapy and/or radiation. The resultant reconstruction will not be affected by these modalities as much.

All surgeries carry risk and a qualified board certified plastic surgeon can discuss the risks, treatments and possible choices in a simple yet thorough matter.

Dr. Ayoub Sayeg is a Board Certified Diplomate, American Board of Plastic Surgery, Cosmetic and Breast Fellowship Trained. He received his medical degree from the University of Toronto and served his general surgery residency at Washington Hospital Center, Washington, D. C. Dr. Sayeg served his plastic surgery residency at Wayne State University in Detroit from 1998 to 2000.

Skin Cancer: the Common Treatable Cancer

With Wendy McFalda, DO

This year alone, approximately 1,000,000 people will be diagnosed with cancer – not breast cancer, lung cancer or prostate cancer – but non-melanoma skin cancer, according to the American Cancer Society.

Non-melanoma skin cancer will only prove fatal for approximately 2,000 people, but the number of people treated for this disease continues to rise while the average age of new patients diagnosed is getting younger.

“The younger kids have a double hit because they are outside a lot and using tanning booths,” says Dr. Wendy McFalda, a dermatologist in Clarkston. “We’re getting smart and putting sunscreen on kids when they go outside. Even some daycares are using sunscreen on kids when they play outside.”

However, despite this increased awareness most people still do not use sunscreen regularly, or they use it improperly. When using sunscreen, it is recommended that you apply the lotion approximately 30 minutes before going out into the sun. This allows for better absorption and increased protection. This first step is the easiest way to protect yourself from the sun’s harmful ultraviolet rays (UVA and UVB).

One way to make sure you are consistent with using your sunscreen is to make sure you have it readily available. Dr. McFalda recommends placing sunscreen in various areas where you frequent such as your office desk, car, boat and home.

The best time to protect yourself is now, says Dr. McFalda. Most skin damage occurs 20-30 years before the cancer itself may even present. This means people in their 40s, 50s and 60s may have already caused the skin damage that may lead to skin cancer.

The basic types of skin cancer are:

Basal Cell Skin Cancer – This slow-growing cancer is generally found in areas such as the face where sun exposure is most frequent. Rarely does it spread to other parts of the body.

Squamous Cell Skin Cancer – Although similar to basal cell in that it is found mostly in areas exposed to sun, it can also be found on other parts of the body that are not exposed to sunlight. Also, squamous cell skin cancer can spread to other organs and the lymph nodes.

Both basal cell and squamous cell skin cancers can be cured if found early and treated. The first sign of the cancer is usually an abnormality on the skin, or in a mole that begins to change shape, color or begins to bleed. When these changes occur, you should see your physician to take the next steps.

Although we think of skin cancer being a “summer” risk, it is important to protect yourself all year round, says Dr. McFalda. “Reflection of the rays off the snow can be just as damaging,” she says.

One way to catch skin cancer early is to have a full-body skin check. A visit to your dermatologist can help determine whether a new mole or change in skin is normal, or if it is the first sign of skin cancer.

“Men don’t get checked as often, but wives or girlfriends get them to come in because they see a spot change and it turns out to be melanoma. When this happens you should go back and kiss your wife because she may have just saved your life,” says Dr. McFalda.

If a tumor is spotted, a biopsy will be performed to determine if it is benign (non-cancerous) or malignant (cancerous). Most benign tumors can be removed and will not grow back, however, malignant tumors can invade other parts of the body, and may come back after they are removed.

If you are diagnosed with a malignant tumor, your physician will determine what Stage you are in. According to the National Cancer Institute (NCI), stages are generally determined by factors such as size of the tumor, the depth that it has penetrated into the layers of the skin, and whether it has spread to other organs or lymph nodes.

The NCI classifies the stages on a 0-4 scale.

Stage 0: The cancer only affects the top layer of skin.

Stage I: The growth is 2cm wide or smaller.

Stage II: The growth is larger than 2cm wide.

Stage III: The cancer has spread below the skin to the bone, cartilage, muscle or nearby lymph nodes. It has not spread to other places in the body.

Stage IV: The cancer has spread to other places in the body.

*Source: www.cancer.gov

Treatment for skin cancer may include surgery, chemotherapy, photodynamic therapy or radiation, depending on your stage of diagnosis.

As Dr. McFalda points out, being aware of your skin and its condition is important to identifying skin cancer. Do a “self-check” (page 11) of your skin periodically and have a dermatologist examine your skin for a baseline assessment. If you have family history, or are at high risk, you should have skin examinations more frequently.

The bottom line is to take care of your skin by protecting it from the sun’s dangerous rays, and you may not have to worry about future problems.

SIDEBAR: How To Do a Skin Self-Exam

Your doctor or nurse may suggest that you do a regular skin self-exam to check for skin cancer, including melanoma.

The best time to do this exam is after a shower or bath. You should check your skin in a room with plenty of light. You should use a full-length mirror and a hand-held mirror. It’s best to begin by learning where your birthmarks, moles, and other marks are and their usual look and feel.

Be on the lookout for any of the following skin changes:

• Small, smooth, shiny, pale or waxy lump
• Firm, red lump
• A sore or lump that bleeds or develops a crust or scab
• Flat red spot that is rough, dry or scaly and may become itchy or tender
• Red or brown patch that is rough and scaly

Check for anything new:

• New mole (that looks different from your other moles)

• New red or darker color flaky patch that may be a little raised

• New flesh-colored firm bump

• Change in the size, shape, color, or feel of a mole

• Sore that does not heal

Check yourself from head to toe. Don’t forget to check your back, scalp, genital area, and between your buttocks.

Look at your face, neck, ears, and scalp. You may want to use a comb or a blow dryer to move your hair so that you can see better. You also may want to have a relative or friend check through your hair. It may be hard to check your scalp by yourself.

Look at the front and back of your body in the mirror.

Then, raise your arms and look at your left and right sides.

Bend your elbows. Look carefully at your fingernails, palms, forearms (including the undersides), and upper arms.

Examine the back, front, and sides of your legs. Also look around your genital area and between your buttocks.

Sit and closely examine your feet, including your toenails, your soles, and the spaces between your toes.

*Source: National Cancer Institute online at www.cancer.gov

Dr. Wendy McFalda is board certified in Dermatolgy via the American Osteopathic Board of Dermatology. She received her Doctor of Osteopathic Medicine from Michigan State University College of Osteopathic Medicine. She is a member of the Michigan Osteopathic Dermatology Society, American Osteopathic College of Dermatology, the AMA and the American Osteopathic Association.

A Better Way to Beat Breast Cancer

With Dr. Frank Vicini, MD

A diagnosis of breast cancer can be devastating to any woman; unfortunately the treatment and its aftermath can be just as devastating. That story could all be changing with research that is being done around the country and being led by a team right here in the Detroit area. Dr. Frank Vicini and the oncologists and surgeons at Beaumont Hospital have been leading a study into Accelerated Partial Breast Irradiation (APBI) therapy. While this procedure has been utilized around the world since 1992, it was only in 2005, that a randomized, multi-center study was launched under the auspices of the National Cancer Institute and National Surgical Adjuvant Breast and Bowel Project. The study is looking at women with early-stage breast cancer who have a lumpectomy followed by radiation therapy. Originally envisioned to be a study involving 3000 women, it has recently been expanded to 4300. The women are randomized to have either the standard regimen of six and a half weeks of full breast irradiation therapy or partial-breast irradiation therapy twice a day for five days. The study is expected to be completed by 2009.

What does this mean for women with early-stage breast cancer? In the past, women often had to struggle to fit their radiation therapy into their lives since it is every day, Monday through Friday for almost two months. Women who live far away from their treatment centers or who are older and have trouble transporting themselves to their treatment center have often had to choose to have mastectomy rather than the breast-saving lumpectomy procedure. They may also choose to have a lumpectomy without the following radiation therapy which could allow the cancer to return. By being able to shorten the course of radiation therapy to five days, more women may be able to have the lumpectomy with radiation therapy and therefore have the best chance of staying cancer-free. Hopefully the study will also show that the shorter duration therapy is associated with fewer side effects. Preliminary research has shown that partial breast radiation over five days works as well as whole breast radiation for cancer control but these studies involved a smaller number of women. This new study will help to make the five day regimen the standard of care for early-stage breast cancer.

“The medical community has known for some time that radiation administered to the entire breast has its primary effect at or near where the tumor was,” says Dr. Vicini, a radiation oncologist at William Beaumont Hospital in Royal Oak and the principal investigator for the study. “That is what leads us to believe that it may not be necessary to treat the whole breast in certain patients.” Radiation damages the cancer cells and since they are unable to repair the damage, they die and are removed by the body. Healthy tissue that is irradiated is able to repair itself.

Current standard of care for early-stage breast cancer involves either a mastectomy to remove the entire breast which has the cancer, or a lumpectomy with whole breast irradiation plus possible chemotherapy. Whole breast irradiation can have some serious side effects for the healthy breast tissue as well as adjacent organs and tissues. Under this new regimen, patients would undergo a lumpectomy followed by partial breast irradiation plus possible chemotherapy. The partial irradiation is administered one of two ways. The most common form of partial breast irradiation is called breast brachytherapy and involves using a catheter to insert a small balloon into the cavity where the cancer was located. For each session, the balloon is connected to a brachytherapy machine which directs a small radioactive seed into the balloon and is left in place for ten minutes. This irradiates only the tissue surrounding where the cancer was removed and has the greatest likelihood of still containing any remaining cancer cells. Another form of partial breast irradiation is called 3-Dimensional Conformal Partial Breast Radiotherapy and delivers very precise doses of radiation to specific areas of the breast, sparing surrounding normal tissue. The shorter course of treatment is made possible not only by specifically targeting the lumpectomy site, but by also increasing the radiation levels for each treatment. While each treatment involves more radiation, the partial breast procedures involve less overall radiation exposure.

While there still is no cure for breast cancer, advances are being made in its treatment right here in your backyard. With early detection and treatment over 80 percent of breast cancer patients are cancer free ten years after their diagnosis. If you are interested in participating in this study, contact Beaumont Hospital at 248-551-7695.

Dr. Frank Vicini is the Corporate Chief, Oncology, at Beaumont Hospitals and is board certified by the American Board of Radiation –Radiation Oncology. He is a graduate of Wayne State University and completed his residency in Radiation Oncology at Beaumont hospital followed by a fellowship at Harvard University Medical School. He has been in practice 22 years.

The Future of Prostate Surgery is Here… in SE Michigan!

With Mani Menon, MD

Robots. You hear that word and you may think of R2-D2 from Star Wars, or maybe you think of the robot from “The Day the Earth Stood Still”. Maybe, if you work on the line for the Big Three, you actually think of the big machines that help put the cars together. Most people wouldn’t think about robots in medicine unless it was in some sci-fi show. But, robots are here. And, they are helping patients right here in Southeast Michigan.

Unfortunately, prostate cancer is something that many men will face in their lifetime. In the past, men had only a few options when it came to treating the disease, especially if discovered in its later stages.

These options included chemotherapy, radiation therapy and surgical intervention. Each has their drawbacks, but with the advent of robotic assisted laparoscopic prostatectomy surgery, a procedure that was invented and perfected here in Detroit, the surgical route is now a better option than it has ever been.

Dr. Mani Menon and his team at the Vattikuti Urological Institute at Henry Ford Hospital developed the surgical technique to utilize the daVinci™ Surgical System on prostate cancer. The procedure is aptly named the “Vattikuti Institute Prostatectomy” or VIP.

The VIP is the first minimally invasive system used for a major cancer. It has been used to perform almost 3,000 procedures since it’s development in 2001 and is the foundation for the technique now performed all around the world.

“The daVinci Robotic Surgical System has brought the computer age to the operating room,” says Dr. Menon, describing this new system’s impact on the future of surgical medicine. “Patients can now expect faster recovery times, with very little blood loss, and less adverse events than in the past.”

Historically, surgical intervention for prostate cancer was done through a large incision in the abdomen (large enough to allow the surgeon’s hands access to the prostate) and left many men with complications such as incontinence and impotence. The daVinci system utilizes small cameras and pencil thin tools to minimize trauma and speed up recovery times.

When a patient undergoes the robotic assisted laparoscopic prostatectomy surgery, they are prepped and the robot is moved in to place. The robot’s four arms and their associated devices are inserted into the body through much smaller incisions than were previously required.

While the surgical team monitors the patient, the surgeon is actually several yards away working at a special station. This station has a binocular-like viewing port to allow the surgeon a 3D, high definition view of the surgical site. The surgeon’s hands and fingers are placed into the control devices allowing him to make very precise movements that are then carried out by the robot.

The robot’s computer system performs thousands of safety checks per second and also corrects for any tremors or unwanted movement of the surgeon’s hands. It is this new precision that makes it possible to spare the vital nerves to the area and minimize the incidence of incontinence and impotence.

According to Dr. Menon, “The surgeon and the entire team work in a virtual 3D world and are able to plot out their actions and review them prior to implementing them.” This virtual world also makes the system ideal for teaching the procedure to future surgeons.

“The increased cost of the procedure is transparent to the patient. It ends up costing the hospital about $2000 more than the traditional procedure, but this (cost) is offset through increased volume and efficiency,” said Dr. Menon.

Men have traveled from over 22 countries and all 50 states to have the procedure done here in Michigan. One case involved a man stationed at the McMurdo station in Antarctica who flew to Detroit to have his surgery and returned to work in Antarctica shortly thereafter.

This high-tech procedure is revolutionizing the way physicians can treat patients. If you are facing a prostatectomy now, or in the future, you should be glad to know that several of these $1.5 million robots, and the team that developed the surgery, are right here in your backyard.

Dr. Menon, M.D., is chairman of the Department of Urology at the Henry Ford Health System, the Rajendra and Padma Vattikuti Distinguished Chair in Oncology and Director of the Vattikuti Urology Institute. Dr. Menon is tenured professor of urology at Case Western Reserve University School of Medicine, Cleveland. He graduated from JIMPER Pondicherry and did his residency in Urology at the Brady Urological Institute at John Hopkins, Baltimore.

Colorectal Cancer Fact Sheet

FACT SHEET – COLORECTAL CANCER

March is Colorectal Cancer Awareness Month and a time selected by the medical community to focus their communications on the need for early screening, detection and elimination of colon cancer.

Colorectal cancer is cancer of the colon and/or rectum. In 2006, 148,610 people are estimated to be diagnosed with the disease, and men and women are diagnosed in nearly equal numbers. Of those diagnosed, 55,170 are estimated to die from colorectal cancer. However, it is one of the most preventable cancers, because it can develop from polyps that can be removed before they become cancerous.

PREVENTION

• Get regular screening tests

• Exercise regularly, and maintain a healthy weight

• Eat a diet rich in fruits, vegetables and whole grains

• Don’t smoke, and don’t drink alcohol excessively

RISKS

• Men and women age 50 and older

• People with a personal or family history of colorectal cancer or benign (not cancerous) colorectal polyps

• People with a personal or family history of inflammatory bowel disease, ulcerative colitis or Crohn’s disease

• People with a family history of inherited colorectal cancer

• People who use tobacco

• People who are obese and/or sedentary

SYMPTOMS – In the early stages, there may not be any symptoms. Later, these symptoms may appear.

• Rectal bleeding

• Blood in or on the stool (bright red)

• Change in bowel habits

• Stool that is narrower than usual

• General stomach discomfort (bloating, fullness and/or cramps)

• Diarrhea, constipation, or feeling that the bowel does not empty completely

• Frequent gas pains

• Weight loss for no apparent reason

• Constant tiredness

• Vomiting

EARLY DETECTION – Men and women at average risk should begin regular screening at age 50. If you are at greater risk, you may need to begin regular colorectal cancer screening at an earlier age. There are many options for screening.

• Have a Fecal Occult Blood Test (FOBT) annually

• Have a sigmoidoscopy every five years, a colonoscopy or double contrast barium enema every five to 10 years.

• Have all non-cancerous polyps removed to help prevent colorectal cancer before it starts.

• Have a digital rectal exam every 5-10 years at the time of each screening sigmoidoscopy, colonoscopy or barium enema.

• If you have a personal or family history of colorectal cancer, benign colorectal polyps, inflammatory bowel disease, or breast, ovarian or endometrial cancer, talk to your health care professional about earlier and more frequent screening.

TREATMENT – There are many treatment options available. If diagnosed with colorectal cancer, please talk with your oncology team about which is best for you.

• Surgery is the most common treatment.

• Chemotherapy and/or radiation therapy is given before or after surgery to most patients with colorectal cancer that has spread.

For more information about colorectal cancer or National Colorectal Cancer Awareness Month, please visit: www.preventcancer.org/colorectal

Preventing Colon Cancer Starts With You

By Jon Hain, MD

Why are more Americans afraid of colon cancer screening than COLON CANCER? Colon cancer is one of the very few preventable cancers, yet only a fraction of people are screened appropriately. A common myth is that colon cancer screening detects cancer at any early stage. Nothing could be further from the truth. Colon cancer generally starts as a polyp, which over many years transforms into a cancer. The goal of screening is simple: STOP the polyp and STOP the cancer.

Removing a polyp takes only minutes in an outpatient setting. Removing a cancer takes hours, with days spent convalescing in the hospital. The process can be more simple: FIND the polyp, STOP the polyp, and PREVENT the cancer.

Over 55,000 American men and women will die this year of colon and rectal cancer. It’s staggering to realize, that 50,000 – a full 90% – could have lived with simple education and early and regular screening. The screening tests are relatively easy to perform and safe. The hard part is bringing the patient to the screening. Simple tests, such as checking the stool for blood, and looking into the colon with special instruments, could dramatically reduce the incidence of colon cancer.

COMMON MYTHS

Education and myth busting are critical to stopping colon cancer.

Common myths include:

1. “I can’t get colon cancer, because no one in my family ever had it.”

Sadly, only a small fraction of colon cancers are inherited. Most colon cancers are random and sporadic, striking friends and relatives with equal frequency.

2. “I feel great and I never saw any blood.”

Unfortunately, colon cancers rarely have any dramatic symptoms until the tumors are very large.

3. “It’s just my hemorrhoids bleeding. They have bled for years.”

A bit of medical advice, please don’t assume that it’s only hemorrhoids. In general, any bleeding demands some form of evaluation by a physician, especially if it is a chronic symptom.

4. “Why bother to look? Isn’t colon cancer usually fatal?”

Greater than 90% of patients with early colon cancers treated with surgery are alive and cancer free in five years.

5. “Colon cancer only affects older white males.”

Alas, people who don’t get screened sometimes don’t get the chance to get old. Colon cancer is also politically correct and does not discriminate based on race, color or creed.

The most disturbing myth is:

6. “There is nothing I can do about getting colon cancer.”

Colon cancer gives doctors the rare opportunity to eradicate a disease. Early screening detects polyps, which can be removed eliminating the possibility of turning into colon cancer.

Remember our goal is not to find early cancer, but to find polyps before they turn into cancers. FIND the polyp, STOP the polyp, and PREVENT the cancer.

ARE YOU AT RISK FOR COLON CANCER?

Starting at 50, all men and women with no increased risk factors should have regular screening. Remember, most of the colon cancer cases are diagnosed in people older than 50. If you have any of the following risk factors, you may need to be screened prior to 50 years-old.

• Personal or family history of polyps or cancers

• Longstanding ulcerative colitis or Crohn’s disease

• Familial cancer syndromes

• Personal history of other related cancers

Remember, we are all at risk to get colon cancer. Let’s work together to stop colon cancer.

Dr. Hain is board certified in General Surgery and Colon and Rectal Surgery. He is a graduate of Medical College of Virginia. He completed his General Surgery Internship and Residency at St. Joseph’s Mercy Hospital in Ann Arbor, and completed his Colon and Rectal Surgery Fellowship at the University of Minnesota. He is in private practice in Rochester.

Have You Changed Your Oil Lately?

By Bruce Eisenberg, MD

I have been practicing primary care medicine for over twenty-two years, and I have recently begun to notice a trend that concerns me. Numerous patients with a wide variety of backgrounds – both on and off regular prescription medications – have been missing follow-up visits. Some of these are as far back as two to three years and most of these are male patients. I often ask these patients if they change the oil in their car on a regular basis. The answer is always yes. I then suggest that perhaps their own body deserves the same basic maintenance as their automobile.

Most patients are surprised by the length of time that has passed since their last appointment. Many patients state they have not come in because their diet and exercise have not been consistent, or they were in the process of quitting smoking, and they were waiting to come in when their cholesterol, blood sugar and blood pressure were improved. These are, in fact, the patients which need the most attention because they are at the highest risk. If behaviors are less than perfect, I tailor therapy and screening based on these historical patterns for early disease prevention.

Heart disease is the number one cause of death in America. Cancer is the second leading cause of death and illness. Even with the most meticulous balance of diet and exercise, many individuals are susceptible to these potentially life-threatening illnesses because of family history and what I refer to as a “21st century lifestyle.”

With this lifestyle, one may workout vigorously for one hour every single day and watch his diet. But, the other 23 hours of the day are spent sitting at a desk, using remote controls, operating computers, driving around in cars, riding elevators, and eating processed foods too high in sodium and fat. It is nearly unavoidable.

Historically, women have been better at regular follow-up visits because most of them are getting screenings from a gynecologist. Men, on the other hand, often never get into a routine of regular health maintenance.

Here are some general suggestions on how to improve your own health screening.

By age 20, all individuals should have a complete cholesterol profile and know their “good” HDL and “bad” LDL cholesterol as well as blood pressure. This should be repeated approximately every five years along with a diet, exercise, family history and general health assessment.

If there is a family history of illness such as diabetes, high blood pressure, high cholesterol or cancer the intervals should be adjusted. If there are any abnormalities or lifestyle changes such as smoking, abnormal body weight gain or loss, these intervals should be customized as well.

After the age of 40, prostate screening should be done on a yearly basis. A blood test called a PSA and a digital rectal exam are the usual ways this is done. Body mass index (the ratio of height to weight), blood pressure, heart and lung health, along with general blood and urine checks should also be performed regularly.

At the age of 50, (sooner if there are symptoms or a family history) colon cancer screening with a colonoscopy is recommended, with follow up every five years.

Consumers these days are bombarded with a tremendous amount of health information from the media. It is nearly impossible to make sense of this maze of information. One common mistake often made is when a patient alters a prescription medication, or adds a supplement, because of a study they heard about on the news. Please consult your health care professional before making changes and see if it is actually appropriate for you. Your health care provider should be the first one you consult with, not the last to know.

When your doctor asks you about the medications you are taking, be sure to include all medicines and their doses. Do not forget to also include all supplements and herbs you are taking because they may have important health implications, too.

One example is vitamin C. It has been shown not to prevent colds, but has been linked to lowering good cholesterol (HDL) and can raise the risk of heart disease in some patients.

Another topic in the media these days is erectile dysfunction or ED. Many men are reluctant to discuss this with their physician. Remember that the majority of men will have some degree of ED during their lifetime. What is not commonly known is that it is often related to the early blockage of arteries due to elevated cholesterol, blood pressure and smoking. If you are suffering from this condition be sure to seek treatment and be screened for underlying causes of heart disease as they are one in the same.

The next time you notice that little sticker in the corner of your windshield reminding you of your next oil change, think about when the last time you did a body check-up.

With careful attention to the calendar, you can make a positive step toward early detection and prevention of mechanical breakdown in your most precious vehicle – your own body.

Dr. Bruce Eisenberg is board certified in internal medicine. He is a graduate of Wayne State School of Medicine and has been voted one of the “Best Doctors in America” the last 10 years and has been recognized by Top Docs Detroit Monthly.

Women’s Health: Not Just an Issue for October

By Cheryl Wesen, MD

During the month of October we recognized Breast Cancer Awareness Month, heightening interest in women’s health issues. We repeatedly heard about the importance of getting mammograms annually after age 40. Does it really matter? The answer is unequivocally “Yes.” Breast cancer is the most common non-skin cancer in women and the second deadliest cancer in women (after lung cancer). If you didn’t get a mammogram in October, invest 15 minutes – the time it takes to get a complete mammogram – and possibly save your own life.

Women’s health is an issue that deserves attention all year long. Many small changes in lifestyle can result in improved health – and lower risks of breast and other cancers, as well.

Much of the following information is known, but bears repeating: don’t use tobacco, and only drink in moderation. Many women continue to use tobacco because they fear stopping could cause weight gain. However, any pounds gained after you quit can be worked off in the extra years you live once you stop!

Of course, many women diet, whether or not they smoke. A useful approach to losing weight, it’s also an approach that is rarely successful. A better approach to a healthy weight is a healthful diet. That is – diet as a life choice, not as a temporary lifestyle. Too often, altered menus and counting calories is a drastic change to your regular lifestyle, one that is artificial and too difficult to maintain. Subtle, healthful changes over time will gradually become part of a better lifestyle, resulting in permanent changes and better health.

Little changes that add up include: snacking on deeply colored fruits; increasing your intake of fresh vegetables, substituting snacks that are convenient, like chips and candy, for those equally convenient but healthful, perhaps soy crisps or a low-fat, high-fiber health bar. Many treats can be healthful and delicious, allowing you to nibble while maintaining your energy levels and a healthy weight. Eat portion-controlled snacks throughout the day to appease hunger. Soon, you will lose your preference for fats and sugars. Your body and your waistline will both thank you!

Exercise is another hurdle to a healthful lifestyle. Many women don’t like going to the gym, don’t have time to exercise, or simply don’t like it. Yet regular exercise is one of the best ways to boost your metabolism and has been proven to offer multiple health benefits. What can you do? Almost anything! A yoga class at a local center may be just the trick to get you moving. As long as your body is in motion, you are burning calories. Can’t take a 30-minute walk? Try to walk for 10 minutes three times daily. Wearing a pedometer has been shown to help people stay on target. Aim for 10,000 steps daily – about five miles. The steps add up quickly, and you’ll have the benefit of better health.

A boon to exercise and diet is that both help reduce stress. The effects of stress on the body are being studied, and early findings indicate that it’s bad for virtually every part of your body. People who live with chronic stress are more prone to many debilitating illnesses, including various cancers and increased risks of heart disease. Learning to recognize the signs and symptoms of stress so that you can regain control of your life is a critical first step in controlling the effects of stress.

Studies have shown that stress may affect migraine headaches, peptic ulcers, asthma, allergies, kidney disease and thyroid problems. Stress alone probably does not cause these disorders, but it may make them worse. In addition, stress contributes to many types of accidents through human error, fatigue, worry and haste.

There are no quick and easy answers to controlling stress in today’s fast-paced, demanding society. As impossible as it may seem, you must make time to relax. An old saying sums it up best, “If you wear out your body, where will you live?”

Taking time to relax should become a priority habit in everyone’s life. A brief, two-minute stress-break may provide enough calm to help you through the toughest moments on the busiest days. Stop what you are doing, and pay attention to your breathing. Take several deep, belly-breaths, and let them out slowly. The increased oxygen will give you a much-needed boost, as most people tend to take shallow breaths when stressed, and the pause in the day’s pace will allow you to regain some equilibrium and go forward with a more positive attitude.

Pay attention to what you are feeling, and respect what your body tells you. Are you tired all the time? Sleeping too much or not enough? Angry, irritable or upset more than normal? It may be time to assess how you really feel, or to contact a counselor for help in managing stress.

Establish self-nurturing routines and keep them as diligently as you would a date to nurture your loved ones. Women are often still the primary caregivers in many families, and may neglect themselves. Nurture you; remind yourself that you deserve it.

These are simple steps, yet will position women for a healthier life. As director of breast care for St. John Health, I emphasize that it is critical for all women over age 40 to have annual mammograms, whether digital or film. I tell all my patients, and ask that they tell all their loved ones and friends: be kind to yourself and be sure that everyone has their mammogram every year.

October was Breast Cancer Awareness Month, a great start to raise awareness of women’s health. But please remember, we need to take care of our health every day of every month. Right now, today, is the best time to start.

Dr. Wesen has practiced general surgery since 1985. She has two years of additional training in surgical oncology (cancer surgery) from the University of Minnesota. Her practice includes all areas of general surgery such as thyroid and parathyroid colorectal diseases, hernias, gallbladder and breast diseases. She has a special interest in care of cancer patients, especially breast cancer. She is board certified through the American Board of Surgery and has recently re-certified. Dr. Wesen was recognized as one of the area’s most respected general surgeons in Hour Detroit magazine’s 2004 listing of “Top Docs.”

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