Sally had a lumpectomy plus radiation therapy six years ago for two small cancers in her breast. As a cancer survivor, she has never stopped worrying about recurrence. And with good reason.

Even a patient who has been in remission for several years may still harbor malignant cells that remain dormant for an extended period before showing up again like an unwanted house guest. Moreover, cancer treatment itself–whether radiation or chemotherapy–increases the risk of future cancers as well as other medical problems.

The cancer frequently recurs in the same local area where it was before. Although doctors try very hard to remove all of the cancer along with a margin of healthy tissue, some cells may be resistant to treatment and remain dormant for an extended period.

The cancer may also occur in lymph nodes and tissue in the vicinity of the original cancer. Or it may have metastasized and spread to distant areas.

The risk of recurrence and where it appears varies with the individual, the type of cancer and the stage of the cancer when it was diagnosed. For Sally’s cancer, which was detected early and localized to the breast, the risk of recurrence is 20 to 30 percent. If it had spread to the lymph nodes or to distant parts of the body, the risk would have been 30 to 60 percent.

Aggressive cancers are more likely to recur early–during the first four years. Slower growing cancrs may remain dormant and could come back at almost any time.

Although Sally was by now an official “survivor,” her doctor monitored her regularly, with appointments every six months. And Sally was given information about signs and symptoms that could mean a recurrence. For a recurring localized cancer, early detection is even more important than it was for the original cancer.

Guidelines for Prevention

The American Institute for Cancer Research (AICR) has developed a set of specific guidelines for cancer survivors to reduce their risk of recurrence.

• Stay lean but not to the point of being underweight.

• Engage in some physical activity for at least 30 minutes every day. Preferably, at least some of this activity should be at least moderately intense.

• Avoid sugar-sweetened drinks such as soda pop and processed foods, particularly foods that are high in sugar or fat and low in fiber.

• Eat a variety of fruits, vegetables, beans and whole grains.

• Limit your intake of red meats and avoid processed meats.

• Limit your alcoholic drinks to two a day for a man and one for a woman.

• Cut back on foods and processed foods.

• Don’t rely on supplements to protect you against cancer.

• Don’t smoke or chew tobacco.

• New mothers, unless they are receiving chemotherapy, should breast feed exclusively for the first six months before adding other liquids and foods.

Most of these simple recommendations are the same as those advised to prevent cancer, and they also help protect against heart disease, stroke, diabetes and other serious illnesses. They were, however, developed specifically for cancer survivors, based on a study of available research.

Expanding on the need for healthy eating, the AICR called for a low-fat, plant-based diet. To get the vitamins, minerals and phytochemicals needed to protect against cancer recurrence, you should try to get about two thirds of your diet from fruits, vegetables, whole grains and legumes. Focus on brightly colored, highly flavored produce such as dark green leafy vegetables, tomatoes, strawberries, blueberries, carrots and cantaloupe.

For the remaining one third of your diet, look to fish, poultry and cheese. Red meat promotes inflammation in body tissues, and inflammation is believed to promote the growth of cancer cells. Even more dangerous are processed meats like cold cuts, bacon, sausage and ham–not just because they are high in sodium but also because they may contain cancer-causing substances.

Consumption of high-fat foods should be limited. The growth and development of both breast and prostate cancers are affected by the amount of saturated fats in the diet.

Regular physical activity is also important for cancer survivors. An expert panel of the American College of Sports medicine has strongly endorsed exercise as safe and beneficial for cancer survivors and even for those currently in treatment. The nature of the exercise and the intensity depends on the patient’s physical condition.

Many cancer drugs can damage the heart and the cardiovascular system. That’s one reason for the strong emphasis on heart-healthy habits for cancer survivors.

Other possible long-term effects of cancer treatment include weight gain, high blood pressure, high cholesterol and an increased risk of type 2 diabetes.

Excess weight increases inflammation and cardiovascular risk. And body fat, particularly around the waist, promotes the release of hormones and substances that are associated with the growth of cancer cells.

Moderate alcohol use is good for heart health, but no protective effect against cancer has been found. In fact, alcohol use is associated with a higher risk of breast cancer. The AICR recommends avoiding alcohol. For those who choose to drink, the advice is no more than one drink a day for a woman, two for a man.

In addition to its negative effects on the cardiovascular system, tobacco, in any form, is a major cancer-causing substance and should be strictly avoided by anyone who is at risk of cancer or cancer recurrence.

Cancer survivors are usually acutely aware of the possibility of recurrence. They should not allow that possibility to cause them distress, however. Stress affects the immune system, and a healthy immune system is crucial to fighting off cancer as well as other diseases. For the same reason, if cancer does return, it’s even more important to deal effectively with the distress, anger and self doubt that is likely to follow.

Survivors should remember that the same coping mechanisms that brought them through cancer the first time are still available to them. They know more now about cancer and their own bodies than they did at that time, and they have built a successful support network. If the initial cancer treatment was several years ago, they should understand that advances in treatment have probably occurred since that time.

REFERENCES:

American Institute for Cancer Research, “AICR’s guidelines for cancer survivors,” 2012.

American Institute for Cancer Research, “Recommendations for cancer prevention,” 2012.

Laura Bell, “A breast cancer cure?” Prevention, November, 2011, updated September, 2012.

“Breast cancer overview: prevention and lifestyle factors,” New York Times Health Guide.

Breast Cancer Partner, “Preventing cancer recurrence,” LiveStrong.com.

Denice Economou, RN, MN, CNS, CHPN, et al, “Integrating a cancer-specific geriatric assessment into survivorship care,” Clinical Journal of Oncology Nursing,, June 29, 2012.

Zhemming Fu, et al, “Lifestyle factors and their combined impact on the risk of colorectal polyps,” American Journal of Epidemiology, November 12, 2012.

Cesare Hassan, et al, “Primary prevention of colorectal cancer with low-dose aspirin in combination with endoscopy,” Gut, July 17, 2012.

Mayo Clinic Staff, “When cancer returns: how to cope with cancer recurrences,” MayoClinic.com, February 19, 2011.

National Comprehensive Cancer Network, “Nutrition for cancer survivors,” 2012.

01/08/2013

For more information, sample newsletters or to get on our mailing list contact:

        Community Relations
        West River Regional Medical Center
        1000 Highway 12
        Hettinger, ND 58639-753

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Hypertension is well known as a silent killer. If your blood pressure is high, you probably won’t know it, even if it goes dangerously high. And if your blood pressure stays high over an extended period, the consequences are serious–heart attack, stroke, heart failure and end-stage renal disease to name just a few.

Every time you visit your physician, for whatever reason, the nurse probably wraps the cuff around your arm and takes your blood pressure. That’s a major way of detecting hypertension since at least half of Americans with high blood pressure do not know they have it.

There are also blood pressure monitors in drug stores, supermarkets and other places. It’s a good idea to stop at these machines from time to time, even if you are healthy and fit. Controlling your blood pressure is one of the most important things you can do to preserve your good health.

In addition to these spot checks, there are other signs of vulnerability you can look for, even though hypertension will not give you any direct symptoms.

AGE: High blood pressure can occur at any age, but it is most prevalent among persons age 50 and over. Once you reach that anniversary, you should be more aware of your blood pressure.

Blood pressure fluctutes from moment to moment, so one high reading at the doctor’s office or the supermarket may not mean anything. But it’s reason enough to check it again in the next few days or weeks.

SMOKING: If you’re a smoker, you will probably get hypertension sooner or later. Tobacco raises your blood pressure while you are smoking, and it also has a long-term effect, damaging your arteries and causing them to narrow, making the heart work harder to push blood through.

The best thing you can do is quit, but second hand smoke can have a similar effect. So stay away.

WEIGHT: The more you weigh, the more blood you need to feed your fat cells. And the harder your heart has to work to pump this blood where it’s needed.

Putting a greater volume of blood in your vessels also increases the pressure on the vessel walls. The increased load on the heart may cause it to weaken and become less effective at pumping, causing a buildup of pressure.

SEDENTARY LIFESTYLE: While you’re taking your blood pressure, you may also want to check your pulse. If you exercise regularly and are reasonably fit, your resting heart rate should be in the 70s or 60s, or even lower. That’s good.

If you’re not very active, your heart rate is likely to be in the 80s or higher–normal but not recommended over the long term since it puts more work on your heart and more pressure on your blood vessels.

FAMILY HISTORY: Karen’s grandmother had severely swollen feet and ankles in later life and died in her early 70s from heart failure. Her grandfather died of a stroke, probably related to uncontrolled blood pressure. Her older sister has hypertension and an enlarged heart. Karen knows she is at risk too because hypertension tends to run in families.

TOO MUCH SALT: One reason that hypertension tends to run in families is the old nemesis–salt. Because of their cultural background, some families are more likely than others to be attracted to high-sodium foods–sausages, ham, bacon, olives, anchovies, smoked fish and sauerkraut.

Probably more pertinent, some individuals, and families, are salt sensitive; their bodies have an exaggerated reaction to sodium in the diet.

According to one study, persons who are salt sensitive had an increased risk of death even if their blood pressure was normal. About a quarter of Americans with normal blood pressure and 58 percent of those with hypertension are salt sensitive.

RACE: African Americans have an increased likelihood of being salt sensitive. And they also are more likely to develop hypertension and to do so at an earlier age. Strokes and heart attacks are also more common among African Americans.

WEIGHT FLUCTUATIONS: Jack was a big fan of Reuben sandwiches and would often eat an extra pickle or two at his favorite deli. He noticed that he tended to gain several pounds the next day.

Of course, he had overeaten, but weight gain from extra calories takes longer than a few hours to have its effect. Jack was gaining weight because the high-sodium foods were causing his cells to retain fluid.

In women, weight fluctuations can be associated with hormonal changes around the time of the menstrual period. In men, they are more likely caused by salt sensitivity. Jack should try to curb his passion for Reuben sandwiches, reduce the sodium in his diet and monitor his blood pressure.

DIET: Even in persons who are salt sensitive, the amount of sodium in the diet may be less crucial than the balance of sodium and potassium. Potassium helps rid the body of excess sodium, and it also makes blood vessels more flexible.

Potassium is found in apricots, bananas, winter squash and sweet potatoes. And there are other protective substances in these and other fruits and vegetables. The DASH diet (Dietary Approaches to Stop Hypertension) calls for five servings a day of fruits and five of vegetables along with whole grains and low-fat dairy products. If such foods rank low in your diet, you can pretty well count on developing hypertension at some time in your life.

STRESS will cause an almost immediate spike in your blood pressure. And uncontrolled stress over an extended period will have other negative effects–poor eating habits, weight gain, use of tobacco or alcohol.

HEAVY DRINKING: Although moderate drinking–one or two drinks a night–has a positive effect on blood pressure and other cardiovascular risk factors, heavy drinking has a negative effect on the heart, blood vessels and blood pressure.

Knowing your habits–both positive and negative– and your family history will give you a good idea of your risk for developing high blood pressure. The problem affects about half of the population. And even trained athletes who follow a well planned diet can and do get hypertension.

If your blood pressure readings have tended to be a bit high, your doctor may recommend that you get a blood pressure monitor for use at home. The only way of knowing what’s happening inside your blood vessels is to take regular readings several times every day.

REFERENCES:

Veronica Franco, M.D., and Suzanne Oparil, M.D., “Salt sensitivity, a determinant of blood pressure, cardiovascular disease and survival,” Journal of the American College of Nutrition, 2006;25(3):247S-255S.

Daniele del Fruili and the Division of Medicine, Trento, Italy, “Early signs of cardiac involvement in hypertension,” American Heart Journal, 2001;142(6).

Greg Hood, M.D., “Exercise deficiency disorder,” Weekend Call blog, July 15, 2012.

Mayo Clinic Staff, “High blood pressure (hypertension),” MayoClinic.com, August 3, 2012.

“Symptoms and types,” WebMD Hypertension/high blood pressure health center.

“Study shows new link between salt sensitivity and risk of death,” NIH News, February 15, 2001.

William M. Tierney, M.D., et al, “Quantifying risk of adverse clinical events with one set of vital signs among primary care patients with hypertension,” Annals of Family Medicine, 2004;2(3).

Amy L. Valderama, Ph.D., et al, “Vital signs: awareness and treatment of uncontrolled hypertension among adults, United States, 2003-2010,” MMWR, October 12, 2012.

Myron H. Weinberger, “Salt sensitivity of blood pressure in humans,” Hypertension, 1996;27:481-490.

01/08/2013

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        Community Relations
        West River Regional Medical Center
        1000 Highway 12
        Hettinger, ND 58639-753

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Even if you’re not a warrior or risk taker, you’ve undoubtedly suffered many wounds in your life–a scraped knee from a fall off a bike, a bad burn or a cut on the finger from chopping vegetables.

And the wound often looks downright nasty–weeping at first, then crusting over and eventually getting better. You were probably unsure about how to treat the wound, and the advice you got from friends and family was not always consistent.

You might be even more concerned if you knew that some wounds–4.5 to 5 million each year–fail to heal or take an excessively long time to do so. Some of these occur to younger adults who suffer severe burns, automobile accidents or other traumatic injuries, but the majority occur in older persons with chronic diseases such as diabetes, heart failure, lymphedema, peripheral artery disease (PAD), venous hypertension or a compromised immune system.

Diabetics are particularly vulnerable to non-healing ulcers on the legs and feet, and these result in about 86,000 amputations each year. Any slow-healing wound, of course, is reason for serious concern, and it’s important for both patients and their health care professionals to know how to recognize and care for them. Many hospitals, in fact, are establishing dedicated wound healing centers.

Basic Wound Care

In the majority of cases, there is little to worry about. The first step is to clean the wound with running water. Don’t worry about a little bleeding because it helps to flush out dirt and other contaminants. Use soap to clean the skin around the wound; it will sting if you get it in the wound, but otherwise, there is no harm.

Rinse it thoroughly and use tweezers, if necessary to remove any debris. You may have heard about applying hydrogen peroxide or antibiotic ointment, but neither is necessary nor recommended. Some kind of ointment or salve, though, may ease the pain and keep the wound moist for quicker healing.

If the wound is deep and has jagged edges or if you have not had a tetanus shot in the past five years, you should see a doctor. Any time you can see layers of tissue along the sides of a cut, it’s deep enough to seek treatment. Other signs include tenderness, numbness and draining pus.

Normal wound healing follows a typical pattern.

The initial stage involves inflammation. Blood vessels at the site of the wound constrict to prevent blood loss, and platelets gather to form a clot. During this stage, the wound may feel warm and have a red appearance.

White blood cells rush to the area to kill bacteria. And skin cells multiply in an effort to grow across and cover the wound.

The next stage is known as the fibroblastic stage. Collagen starts to grow within the wound, forming a structure on which the new skin will grow. This causes the edges of the wound to close in and shrink. Meanwhile small blood vessels form to make sure the area is nourished with blood.

During the final maturation stage more collagen is added, eventually causing the scar to heal. This may take months or even years, and it’s important to take care of the wound throughout this period.

The wound healing process can be slowed by a number of factors, including:

too much dead skin or foreign matter;

a bacterial infection,

persistent bleeding,

continual pressure or irritation,

poor food choices that lead to deficits of vitamin C, zinc or protein;

medical conditions that restrict blood flow;

age;

smoking;

varicose veins that inhibit blood flow; or

dryness.

Although you may have been told that a wound needs exposure to the air, this practice tends to dry the area and slow the healing process.

Redness in the area does not necessarily mean that the wound is infected. A doctor must determine if there is an infection and adjust treatment accordingly. In most cases, infections should be treated with systemic rather than topical antibiotics. Prolonged use of topical antibiotics can upset the bacterial balance at the site and inhibit healing. It can also promote the growth of resistant organisms.

A wound or sore is defined as chronic when it shows no sign of healing after one month or has not completely healed in two months.

Most chronic or hard-to-heal ulcers in older adults are associated with medical conditions such as diabetes, heart failure or peripheral artery disease. Patients who are bedridden or confined to a wheelchair for an extended period are at risk of pressure sores. One factor common to all of these is poor circulation.

Uncontrolled blood sugar causes blood vessels to harden and narrow, limiting blood flow. With loss of feeling associated with diabetic neuropathy, a patient may not notice the irritation from a small cut on the leg or a blister on the foot until the ulcer poses a serious problem.

Once a chronic sore has developed, prompt, professional attention is crucial. Debridement involves surgically removing dead tissue that may be inhibiting the healing process.

Proper healing requires oxygen. Most wound centers today are equipped to provide hyperbaric oxygen therapy (HBOT). Patients lie inside a chamber filled with a higher than usual level of oxygen for about 90 minutes at a time. The treatment is painless and, some say, even relaxing. The patient can sleep, talk, watch television or listen to music while breathing in pure oxygen that improves circulation and speeds the healing process.

Several studies have demonstrated the effectiveness of HBOT in healing ulcers associated with diabetes and other chronic diseases. All of these chronic wounds have a high rate recurrence, however.

Long-term prevention focuses on treating the underlying causes–keeping your blood sugar, cholesterol and blood pressure under control. Choose your footwear carefully and don’t ignore a blister or any seemingly minor sore.

The other wounds you sustain–the cuts, burns, scrapes and scratches–require prompt treatment and constant monitoring.

REFERENCES:

Laura L. Bolton, Ph.D., FAPWCA, “Benchmarking chronic wound healing outcomes,” Wounds, February 20, 2012.

Rod Brouhard, “How to dress a wound,” About.com First Aid, updated October 8, 2010.

Jason P. Hodde, M.S., ATC/L, and Reynald Allam, M.D., M.B.A., “Submucosa wound matrix for chronic wound healing,” Wounds, August 22, 2007.

Kenneth R. Jones, RN, Ph.D., FAAN, et al, “Chronic wounds: factors influencing healing within 3 months and nonhealing after 5-6 months of care,” Wounds, May 1, 2007.

Catherine R. Tatliff, Ph.D., APRN-BC, CWOCN, et al, “Quantitation of bacteria in clean, nonhealing, chronic wounds,” Wounds, December 9, 2008.

S. Schremi, et al, “Oxygen in acute and chronic wound healing,” The British Journal of Dermatology, September 15, 2010.

Frank Wardin, M.D., et al, “Evidence-based management strategies for treatment of chronic wounds,” ePlasty, 2009;9e19,2009, Open Science Co.

“When time doesn’t heal all wounds see a doctor,” GO San Angelo Standard Times, June 29, 2009.

01/08/2013

For more information, sample newsletters or to get on our mailing list contact:

        Community Relations
        West River Regional Medical Center
        1000 Highway 12
        Hettinger, ND 58639-753

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Progress against Heart Disease is the title of a book published in 2004. It might well have been a title 40 years earlier. And since 2004, enormous progress continues to be made.

Make no mistake about it: coronary heart disease is still the number one killer of American men and women. But heart attacks are decreasing, and persons who have an attack are more likely to survive–continuing a trend that started many years ago and is gathering momentum.

The good news in the 1970s and 1980s resulted from ground-breaking events–the development and use of coronary artery bypass graft surgery and balloon angioplasty; the Framingham Heart Study and better understanding of the role of diet and exercise in the prevention of heart disease; and new drugs to lower cholesterol and treat high blood pressure.

The results of these and continuing advances in treatment are now beginning to show up. Data from three million members of Kaiser Permanente Northern California health system found a 24 percent decline in the number of heart attacks and a similar decrease in heart attack deaths from 1999 through 2008. And for ST-elevation heart attacks, the most damaging kind, the drop was 62 percent.

Those results, published in the New England Journal of Medicine [June 10, 2010], were echoed by a Canadian study [Canadian Medical Association Journal, May, 2009] finding a 30 percent decrease in heart attack deaths from 1994 through 2004. A British study more recently reported a decline of more than 50 percent in fatal heart attacks from 2002 to 2010.

Fewer Heart Attacks

The Kaiser Permanente study found that while the heart attack rate increased the first year (1999-2000), it decreased every year after that.

Authors of the study stressed the importance of adopting healthier lifestyles on a large scale. During the study period, Kaiser patients did something positive about their risk factors: average blood pressure and cholesterol readings were lower and the rate of smoking declined.

We know the risk imposed by tobacco, and the decline in cigarette smoking is undoubtedly based on increased acceptance of that fact.

Less widely known is research showing that exposure to second-hand smoke creates a cardiovascular risk nearly as great as that of active smoking. And several studies have documented dramatic declines in heart attacks following passage of laws restricting smoking in public places.

The American diet has been changing gradually over the past four decades. We know what constitutes a heart-healthy diet and, for the most part, we’re trying to follow it. The early emphasis on strictly low fat eating has been modified somewhat, now focusing on replacing unhealthy saturated and trans fats with healthy ones (monounsaturated oils, nuts, fatty fish). Through the Mediterranean diet and similar plans, it’s possible to pursue pleasurable eating and good health at the same time.

Americans still consume too many calories and too much sugar (much of it in the form of soft drinks). Obesity, particularly among children and adolescents, continues at an epidemic pace. Obesity leads to diabetes, and diabetes increases the risk of heart disease. Considering these facts, the progress found in the study is heartening...although clearly the battle is far from over.

The American Heart Association’s guidelines for regular exercise are also well known. Those who follow those guidelines have a way of controlling their weight, blood pressure and cholesterol through activities that strengthen the heart and blood vessels.

In addition to making lifestyle changes, Kaiser Permanente patients were increasingly likely over the course of the study to use prescribed medications such as aspirin, anticoagulants and blood pressure medications.

During the 1980s and 1990s, coronary artery bypass graft surgery and balloon angioplasty were widely used to treat narrowing of coronary arteries and relieve symptoms such as angina and shortness of breath. Today, cholesterol-lowering statins have taken over much of that role.

Largely because of preventive measures, the heart attack rate has been dropping for at least two decades, but the drop since 2000 is particularly impressive considering that new technology has emerged that allows doctors to detect less serious heart attacks that may have gone undetected previously. It’s easier now to diagnose a heart attack, but the overall rate has fallen anyway.

Better Survival

As the number of heart attacks has declined, so has the rate of heart attack deaths–from 10.5 percent within 30 days of an attack in 1999 to 7.8 percent in 2008. Better detection is believed to be at least one factor in the decline.

In 1999, according to the Kaiser study, 47 percent of heart attacks were the more serious type, but by 2008 this number had fallen to 23 percent. One reason for this decline was prevention; another was undoubtedly better detection of less serious attacks, prompting more aggressive attention to risk factors.

Most heart attacks follow a buildup of plaque that ruptures, creating a clot that blocks passage of blood through a crucial coronary artery. In a non-ST-segment elevation heart attack (the less serious kind), movement of blood is slow but only partially blocked. This can be treated with the use of clot-dissolving medications.

The more severe ST-segment elevation heart attack involves a complete blockage of a coronary artery, and instant action must be taken to prevent death or serious damage to the heart muscle. Today, this is most commonly achieved through balloon angioplasty or coronary artery bypass graft surgery. And doctors have become increasingly proficient at performing these procedures on an emergency basis.

Having proper facilities, equipment and personnel is crucial, of course. But so is timing. Reducing the “door-to-balloon” time has been a major priority of hospitals; this is the time that elapses from the moment the patient enters the door of the emergency room until life-saving treatment is administered.

The battle against heart disease is being waged on many fronts. Prevention–through lifestyle changes and medication–is working. And when heart attacks occur, doctors are prepared to take definitive action.

REFERENCES:

Erin Allday, “Heart attacks down 24% in decade, 62% for worst,” San Francisco Chronicle, June 10, 2010.

Carmen Chai, “Fatal heart attack rates declining by 50 percent, experts say,” Global News, January 25, 2012.

“Deaths from heart disease in Canada decreased 30 percent: 10-year national study,” e! Sciences News, June 22, 2009.

“Decline in incidence of heart attacks appears associated with smoke-free workplace laws,” ScienceDaily, October 29, 2012.

Gene Emery, “U.S. heart attack rates declining: study,” Reuters Health, June 9, 2010.

Leon Michaels, “Progress against Heart Disease (review),” Journal of the History of Medicine and Allied Sciences, July, 2005.

National Health Service, UK News, “Massive decline in deadly heart attacks,” NHS Choices, January 26, 2012.

Progress against heart attack death,” Medical University of South Carolina Healthy Aging

Winston Wong, M.D., et al, “Community implements Permanente’s cardiovascular risk reduction strategy,” Permanente Journal, Winter, 2011.

01/08/2013

For more information, sample newsletters or to get on our mailing list contact:

        Community Relations
        West River Regional Medical Center
        1000 Highway 12
        Hettinger, ND 58639-753

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