Acupuncture May Improve Arm Lymphedema



A new study finds that acupuncture may help to decrease lymphedema (arm swelling) in breast cancer patients.


 

ACUPUNCTURE MAY IMPROVE ARM LYMPHEDEMA

Arm lymphedema, or arm swelling, affects between 10 and 30 percent of all women undergoing treatment for breast cancer.Although relatively mild in most cases, lymphedema can be severe enough to interfere with personal and professional activities, and can be associated with significant symptoms such as limb heaviness, and abnormal sensations or discomfort in the affected arm.

Lymphedema is most commonly managed with elastic compression garments, pneumatic compression devices, soft tissue massage, and exercise (collectively, these therapies are often referred to as “decongestive therapy”). However, many lymphedema patients fail to respond to these standard therapies. When patients with lymphedema fail to respond to decongestive therapy, there are few, if any, other noninvasive therapies available that have been proven to be beneficial.

Now, a newly published clinical research study, which appears in the current issue of the journal Cancer, suggests that acupuncture might be useful as a treatment for arm lymphedema associated with breast cancer treatment.

In this small pilot study from the Memorial Sloan-Kettering Cancer Center, 33 breast cancer survivors with chronic arm lymphedema received twice weekly acupuncture treatments for a total of 4 weeks. Arm circumference was measured both before and after each acupuncture treatment.

At the conclusion of this study, 33 percent of the patients who completed this small pilot study experienced a 30 percent or greater reduction in the difference in circumference between their arms, while 55 percent of the study’s volunteers experienced a 20 percent or greater reduction in arm circumference difference.

This is an interesting pilot study, as chronic lymphedema remains such a challenge to manage and treat. Although the mechanism whereby acupuncture might reduce the severity of arm lymphedema remains to be elucidated, the findings of this pilot study are intriguing enough to merit a larger prospective, randomized research study to evaluate the impact of acupuncture on chronic arm lymphedema. Fortunately, the authors of this pilot study are now conducting just such a prospective, randomized clinical study!

 

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!


Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.com Top 100 New Book Releases in Cancer” list.


 

Join Dr. Wascher on Facebook

 


Additional Links for Robert A. Wascher, MD, FACS

New Facebook Page for A Cancer Prevention Guide for the Human Race

CNN Story on CTCA’s Organic Farm in the Phoenix Area

Dr. Wascher Discusses Signs & Symptoms of Skin Cancer

Profile of Dr. Wascher by Oncology Times

Bio of Dr. Wascher at Cancer Treatment Centers of America

Dr. Wascher Discusses Predictions of Decreased Cancer Risk on azfamily.com

Dr. Wascher Discusses Environmental Risk Factors for Breast Cancer on Sharecare

Dr. Wascher Answers Questions About Cancer on talkabouthealth.com

Dr. Wascher Discusses Cancer Prevention Strategies on LIVESTRONG

Dr. Wascher Discusses Cancer Prevention on Newsmax

Dr. Wascher Answers Questions About Cancer Risk & Cancer Prevention on The Doctors Radio Show

Dr. Wascher Discusses Lymphedema After Breast Surgery on cancerlynx.com

Dr. Wascher Discusses Hormone Replacement Therapy & Breast Cancer Risk on cancerlynx.com

Dr. Wascher Discusses Chronic Pain After Mastectomy for Breast Cancer on cancerlynx.com

Dr. Wascher Discusses Sentinel Lymph Node Biopsy for Cancer on cancersupportivecare.com

Dr. Wascher Discusses the Role of Exercise in Cancer Prevention on Open Salon

Dr. Wascher Discusses Aspirin as a Potential Preventive Agent for Pancreatic Cancer on eHealth Forum

Dr. Wascher Discusses Obesity & Cancer Risk on eHealth Forum

Dr. Wascher Discusses the Role of Radiation Therapy in the Treatment of Breast Cancer on Sharecare

Dr. Wascher Discusses the Treatment of Stomach Cancer on Sharecare

Dr. Wascher Discusses the Management of Metastatic Cancer of the Liver on Sharecare

Dr. Wascher Discusses Obesity & Cancer Risk on hopenavigators.com

Dr. Wascher Discusses Hormone Replacement Therapy & Breast Cancer Risk on interactmd.com

Dr. Wascher Discusses Thyroid Cancer on health2fit.com

 

 

Links to Other Breaking Health News

Man Loses 155 Pounds

Naked Mole Rat May Provide Important Cancer Prevention Clue

The Effects of Poverty on the Brain

Half of Us Will Develop Cancer in Our Lifetimes

Protein Critical for Long-Term Memory Identified

HPV Virus and Cancer Risk

Probiotics May Decrease Antibiotic-Associated Diarrhea caused by C. difficile

3-D Printer Helps to Save Baby’s Life

Experimental Drug May Reduce Heart Damage after Heart Attack

Vitamin D May Improve Asthma Symptoms

Doctor Provides Patients with Own Feces for Fecal Transplants

Rising Arsenic Levels in Chicken

Dramatic Increase in Suicide Rate Among Middle Aged Americans Over the Past Decade

Cutting Umbilical Cord Too Soon May Cause Anemia in Newborns

Spiny New Bandage May Speed Healing of Skin Wounds

Study Confirms that Men Really Do Have Trouble Reading the Thoughts of Women

Deadly new Bird Flu Strain Cases Continue to Rise

Abdominal Fat Increases Kidney Disease Risk

Increasing Dietary Potassium & Decreasing Salt Intake Reduces Stroke Risk

A New Explanation for the Link Between Red Meat & Cardiovascular Disease

Deadly New Bird Flu Identified in China

Infection Risk: Keeping an Eye on Your Dentist

Couple Loses 500 Pounds in Two Years

Coffee May Reduce Crash Risk for Long-Distance Drivers

Tiny Implant Tells Your Smart Phone When You Are Having A Heart Attack

Transplanted Kidney Causes Death Due to Rabies

Eating While Distracted Increases Calorie Intake

Resistant Bacteria are on the Ris

High Levels of Stress Linked to an Increase in Heart Disease Risk

Small Snacks Cut Hunger as Well as Big Snacks

Poor Sleep May Increase the Risk of Heart Failure

Ancient Mummies Found to Have Heart Disease by CT Scan

Physically Fit Kids Do Better on Math & Reading Tests

How Melanoma Skin Cancer Evades the Immune System

Possible Link Between BPA and Asthma

Baby Boomers Appear Less Healthy Than Their Parents

The Biology of Love in the Brain

Millennials May be the Most Stressed-Out Generation

Even Modest Alcohol Intake Raises Cancer Risk

Why Do Boys Receive Lower Grades than Girls?

Negative Emotions and Feelings Can Damage Your Health

Canker Sore Drug Cures Obesity (At Least in Mice…)

How Technology is Changing the Practice of Medicine

New Salt Intake Guidelines for Children

High Levels of Distress in Childhood May Increase Risk of Heart Disease in Adulthood

Quitting Tobacco by Age 40 Restores a Normal Lifespan in Smokers

Cancer Death Rates Continue to Fall

Self-Help Books Improve Depression

Marines Try Mindfulness and Meditation to Reduce PTSD

Dying Nurse Volunteers Herself to Teach Nursing Students about the Dying

Regular Walks Cut Stroke Risk

Falling Asleep While Driving More Common than Previously Thought

Celebrity Health Fads Debunked

Obesity Among Young Children May Be Declining

Fresh Fruits & Vegetables May Reduce Breast Cancer Risk

Satisfaction with Life May Actually Increase with Age

Brain Changes in the Elderly May Increase Susceptibility to Being Scammed

 


Dr. Wascher’s Home Page



According to recent Bureau of Labor Statistics, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  Over the past 12 months, 3.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious readers.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 


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Weekend Surgery is More Risky than Weekday Surgery



A new study notes a much higher risk of death associated with surgery performed at the end of the week, compared with Monday surgeries.


 

WEEKEND SURGERY IS MORE RISKY THAN WEEKDAY SURGERY

Previous studies have suggested that surgeries performed after hours and on the weekends are associated with a greater risk of death when compared to surgeries performed earlier in the week.  This finding is not particularly surprising, as patients who undergo surgery after hours and on weekends are more likely to be undergoing surgery for emergency conditions, and are likely to be more severely ill, compared with patients who are undergoing elective scheduled surgery on weekdays.  However, a newly published research study shows that elective non-emergency surgeries are also associated with a much greater risk of death when performed at the end of the week or on weekends, when compared with elective surgeries performed early in the week.  This clinical research study appears in the current issue of the British Medical Journal.

A retrospective study reviewed hospital data between 2008 and 2010 for all public hospitals in England. In particular, the outcomes of patients undergoing elective surgery were analyzed. Altogether, 4,133,346 inpatient admissions for elective surgery were evaluated. These more than 4 million surgical cases were associated with 27,582 deaths within 30 days of surgery.

When compared to elective surgeries performed on Mondays, elective non-emergency surgeries performed on Fridays were associated with a 44 percent increase in the risk of death. The news for elective surgeries conducted over the weekend was even worse. Compared to Monday surgeries, elective surgeries conducted over the weekend were associated with an 82 percent increase in the risk of death!

English public hospitals, like most hospitals in the United States, sharply reduce their staffing levels on weekends. Given that life-threatening complications associated with major operations are most likely to occur during the first 72 hours following surgery, it is not surprising that major operations performed on Fridays or weekends, even elective non-emergency operations, are associated with a higher risk of complications and death, as the patient safety benefit associated with full weekday staffing in the hospital is lost on weekends (and holidays) in the vast majority of hospitals. In my own Surgical Oncology practice, I routinely schedule major elective surgeries at the beginning of the week, in recognition of what has been called the “weekend effect.” I and my Surgical Oncology colleague also personally see all of our surgical patients seven days a week, including weekends and holidays, in an effort to ensure that their ongoing care meets the highest standards, and to closely follow their postoperative recoveries.

Unfortunately, not all complications, and not all deaths, can be prevented following surgery. However, data from clinical research studies such as this study provide important opportunities to reduce postoperative complications, including the “ultimate complication,” to the lowest achievable levels.

 

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, A Cancer Prevention Guide for the Human Race, from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.com Top 100 New Book Releases in Cancer” list.

 

Join Dr. Wascher on Facebook

 

Additional Links for Robert A. Wascher, MD, FACS

CNN Story on CTCA’s Organic Farm in the Phoenix Area

Dr. Wascher Discusses Signs & Symptoms of Skin Cancer

Profile of Dr. Wascher by Oncology Times

Bio of Dr. Wascher at Cancer Treatment Centers of America

Dr. Wascher Discusses Predictions of Decreased Cancer Risk on azfamily.com

Dr. Wascher Discusses Environmental Risk Factors for Breast Cancer on Sharecare

Dr. Wascher Answers Questions About Cancer on talkabouthealth.com

Dr. Wascher Discusses Cancer Prevention Strategies on LIVESTRONG

Dr. Wascher Discusses Cancer Prevention on Newsmax

Dr. Wascher Answers Questions About Cancer Risk & Cancer Prevention on The Doctors Radio Show

Dr. Wascher Discusses Lymphedema After Breast Surgery on cancerlynx.com

Dr. Wascher Discusses Hormone Replacement Therapy & Breast Cancer Risk on cancerlynx.com

Dr. Wascher Discusses Chronic Pain After Mastectomy for Breast Cancer on cancerlynx.com

Dr. Wascher Discusses Sentinel Lymph Node Biopsy for Cancer on cancersupportivecare.com

Dr. Wascher Discusses the Role of Exercise in Cancer Prevention on Open Salon

Dr. Wascher Discusses Aspirin as a Potential Preventive Agent for Pancreatic Cancer on eHealth Forum

Dr. Wascher Discusses Obesity & Cancer Risk on eHealth Forum

Dr. Wascher Discusses the Role of Radiation Therapy in the Treatment of Breast Cancer on Sharecare

Dr. Wascher Discusses the Treatment of Stomach Cancer on Sharecare

Dr. Wascher Discusses the Management of Metastatic Cancer of the Liver on Sharecare

Dr. Wascher Discusses Obesity & Cancer Risk on hopenavigators.com

Dr. Wascher Discusses Hormone Replacement Therapy & Breast Cancer Risk on interactmd.com

Dr. Wascher Discusses Thyroid Cancer on health2fit.com

 

Links to Other Breaking Health News

The Effects of Poverty on the Brain

Half of Us Will Develop Cancer in Our Lifetimes

Protein Critical for Long-Term Memory Identified

HPV Virus and Cancer Risk

Probiotics May Decrease Antibiotic-Associated Diarrhea caused by C. difficile

3-D Printer Helps to Save Baby’s Life

Experimental Drug May Reduce Heart Damage after Heart Attack

Vitamin D May Improve Asthma Symptoms

Doctor Provides Patients with Own Feces for Fecal Transplants

Rising Arsenic Levels in Chicken

Dramatic Increase in Suicide Rate Among Middle Aged Americans Over the Past Decade

Cutting Umbilical Cord Too Soon May Cause Anemia in Newborns

Spiny New Bandage May Speed Healing of Skin Wounds

Study Confirms that Men Really Do Have Trouble Reading the Thoughts of Women

Deadly new Bird Flu Strain Cases Continue to Rise

Abdominal Fat Increases Kidney Disease Risk

Increasing Dietary Potassium & Decreasing Salt Intake Reduces Stroke Risk

A New Explanation for the Link Between Red Meat & Cardiovascular Disease

Deadly New Bird Flu Identified in China

Infection Risk: Keeping an Eye on Your Dentist

Couple Loses 500 Pounds in Two Years

Coffee May Reduce Crash Risk for Long-Distance Drivers

Tiny Implant Tells Your Smart Phone When You Are Having A Heart Attack

Transplanted Kidney Causes Death Due to Rabies

Eating While Distracted Increases Calorie Intake

Resistant Bacteria are on the Rise

High Levels of Stress Linked to an Increase in Heart Disease Risk

Small Snacks Cut Hunger as Well as Big Snacks

Poor Sleep May Increase the Risk of Heart Failure

Ancient Mummies Found to Have Heart Disease by CT Scan

Physically Fit Kids Do Better on Math & Reading Tests

How Melanoma Skin Cancer Evades the Immune System

Possible Link Between BPA and Asthma

Baby Boomers Appear Less Healthy Than Their Parents

The Biology of Love in the Brain

Millennials May be the Most Stressed-Out Generation

Even Modest Alcohol Intake Raises Cancer Risk

Why Do Boys Receive Lower Grades than Girls?

Negative Emotions and Feelings Can Damage Your Health

Canker Sore Drug Cures Obesity (At Least in Mice…)

How Technology is Changing the Practice of Medicine

New Salt Intake Guidelines for Children

High Levels of Distress in Childhood May Increase Risk of Heart Disease in Adulthood

Quitting Tobacco by Age 40 Restores a Normal Lifespan in Smokers

Cancer Death Rates Continue to Fall

Self-Help Books Improve Depression

Marines Try Mindfulness and Meditation to Reduce PTSD

Dying Nurse Volunteers Herself to Teach Nursing Students about the Dying

Regular Walks Cut Stroke Risk

Falling Asleep While Driving More Common than Previously Thought

Celebrity Health Fads Debunked

Obesity Among Young Children May Be Declining

Fresh Fruits & Vegetables May Reduce Breast Cancer Risk

Satisfaction with Life May Actually Increase with Age

Brain Changes in the Elderly May Increase Susceptibility to Being Scammed

 


 


Dr. Wascher’s Home Page



According to recent Bureau of Labor Statistics, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  Over the past 12 months, 3.2 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious readers.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 


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New Scan Almost 100% Accurate in Diagnosing Breast Cancer



A new type of scan is almost 100 percent accurate in diagnosing breast cancer.


 

NEW SCAN ALMOST 100% ACCURATE IN IDENTIFYING BREAST CANCER

An estimated 1.4 million women undergo breast biopsies every year in the United States for abnormal findings on their mammograms, and approximately 85 percent of these suspicious mammographic findings will turn out to be benign following biopsy.

At the present time, breast imaging technology has not advanced enough to replace biopsy for most women with suspicious abnormalities noted on mammograms, or for women who develop palpable breast lumps. For example, MRI scans can detect 95 to 98 percent of early breast cancers, but MRI is also associated with a very high “false-positive” rate, in which as many as 25 percent of identified abnormalities turn out, after biopsy, to be benign. In an ideal world, a “perfect” breast scan would accurately identify 100 percent of cancers and 100 percent of benign breast lesions, but such a scan does not exist at this time. However, a new technology for scanning small cores of breast tissue removed during a needle biopsy may bring us closer to that “perfect” breast scan.

A newly published study suggests that a novel imaging technology may be able to accurately distinguish benign from cancerous breast cells within core needle breast biopsy specimens with almost 100 percent accuracy. This study appears in the current issue of the journal Cancer Research.

In this study, a device known as a spectroscope was used to scan core needle breast biopsy tissue specimens from 33 women. Pathologists then evaluated these same biopsy specimens and compared their microscopic diagnoses with the findings of the spectroscopic examination.

Using an analytic method known as the Raman algorithm, spectroscopic evaluation of these needle biopsy breast tissue specimens was shown to be almost as accurate as the pathologists’ diagnoses. Among the biopsy tissue samples that were identified as having cancer by Raman spectroscopy, 100 percent turned out to be cancer. Among the biopsy tissue samples that were identified as being benign (i.e., no cancer) by Raman spectroscopy, 96 percent turned out to be benign, while 4 percent contained cancer, based upon the pathologists’ findings

This new noninvasive imaging technology offers a number of potentially important benefits to patients with abnormal mammogram findings, as well as, potentially, women who are undergoing breast-conserving surgery (i.e., lumpectomy) for confirmed breast cancer.

For women who are undergoing needle biopsy of their breast following an abnormal mammogram, Raman spectroscopy of core needle biopsy specimens may allow the Radiologist performing the biopsy to determine, in real time, the results of such biopsies, rather than waiting for a week or longer for the Pathologist to report a formal diagnosis. Raman spectroscopy may also assist the Radiologist in determining whether or not the core needle biopsy has been accurately and adequately performed, based upon the spectroscopic “signature” of the breast tissue recovered from the needle biopsy.

There is also great interest in using Raman spectroscopy to more accurately determine the adequacy of lumpectomy when performing breast-conserving surgery for confirmed breast cancer. At the present time, 25 to 40 percent of patients with very small breast cancers have to undergo repeat lumpectomy due to the presence of cancer cells at (or close to) the edges of the lumpectomy breast tissue specimen, as seen under the microscope by the Pathologist. There is, at this time, preliminary data suggesting that Raman spectroscopy may be useful, in the operating room, to identify areas (“margins”) on the lumpectomy breast tissue specimen where tumor cells are too close to the surface of the specimen, thus allowing the surgeon to take additional breast tissue in these suspect areas at the time of the original lumpectomy surgery. In the best case, this novel approach to breast-conserving surgery may spare many women with breast cancer the need for a second (or third) breast lumpectomy.

As a cancer surgeon who cares for a large number of breast cancer patients, I find this novel and noninvasive imaging technology to be very exciting, and full of potential promise and benefit to patients with abnormal mammograms, as well as patients who have already been diagnosed with breast cancer.

 

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.com Top 100 New Book Releases in Cancer” list.

 

Join Dr. Wascher on Facebook

 

Additional Links for Robert A. Wascher, MD, FACS

CNN Story on CTCA’s Organic Farm in the Phoenix Area

Dr. Wascher Discusses Signs & Symptoms of Skin Cancer

Profile of Dr. Wascher by Oncology Times

Bio of Dr. Wascher at Cancer Treatment Centers of America

Dr. Wascher Discusses Predictions of Decreased Cancer Risk on azfamily.com

Dr. Wascher Discusses Environmental Risk Factors for Breast Cancer on Sharecare

Dr. Wascher Answers Questions About Cancer on talkabouthealth.com

Dr. Wascher Discusses Cancer Prevention Strategies on LIVESTRONG

Dr. Wascher Discusses Cancer Prevention on Newsmax

Dr. Wascher Answers Questions About Cancer Risk & Cancer Prevention on The Doctors Radio Show

Dr. Wascher Discusses Lymphedema After Breast Surgery on cancerlynx.com

Dr. Wascher Discusses Hormone Replacement Therapy & Breast Cancer Risk on cancerlynx.com

Dr. Wascher Discusses Chronic Pain After Mastectomy for Breast Cancer on cancerlynx.com

Dr. Wascher Discusses Sentinel Lymph Node Biopsy for Cancer on cancersupportivecare.com

Dr. Wascher Discusses the Role of Exercise in Cancer Prevention on Open Salon

Dr. Wascher Discusses Aspirin as a Potential Preventive Agent for Pancreatic Cancer on eHealth Forum

Dr. Wascher Discusses Obesity & Cancer Risk on eHealth Forum

Dr. Wascher Discusses the Role of Radiation Therapy in the Treatment of Breast Cancer on Sharecare

Dr. Wascher Discusses the Treatment of Stomach Cancer on Sharecare

Dr. Wascher Discusses the Management of Metastatic Cancer of the Liver on Sharecare

Dr. Wascher Discusses Obesity & Cancer Risk on hopenavigators.com

Dr. Wascher Discusses Hormone Replacement Therapy & Breast Cancer Risk on interactmd.com

Dr. Wascher Discusses Thyroid Cancer on health2fit.com

 

Links to Other Breaking Health News

Half of Us Will Develop Cancer in Our Lifetimes

Protein Critical for Long-Term Memory Identified

HPV Virus and Cancer Risk

Probiotics May Decrease Antibiotic-Associated Diarrhea caused by C. difficile

3-D Printer Helps to Save Baby’s Life

Experimental Drug May Reduce Heart Damage after Heart Attack

Vitamin D May Improve Asthma Symptoms

Doctor Provides Patients with Own Feces for Fecal Transplants

Rising Arsenic Levels in Chicken

Dramatic Increase in Suicide Rate Among Middle Aged Americans Over the Past Decade

Cutting Umbilical Cord Too Soon May Cause Anemia in Newborns

Spiny New Bandage May Speed Healing of Skin Wounds

Study Confirms that Men Really Do Have Trouble Reading the Thoughts of Women

Deadly new Bird Flu Strain Cases Continue to Rise

Abdominal Fat Increases Kidney Disease Risk

Increasing Dietary Potassium & Decreasing Salt Intake Reduces Stroke Risk

A New Explanation for the Link Between Red Meat & Cardiovascular Disease

Deadly New Bird Flu Identified in China

Infection Risk: Keeping an Eye on Your Dentist

Couple Loses 500 Pounds in Two Years

Coffee May Reduce Crash Risk for Long-Distance Drivers

Tiny Implant Tells Your Smart Phone When You Are Having A Heart Attack

Transplanted Kidney Causes Death Due to Rabies

Eating While Distracted Increases Calorie Intake

Resistant Bacteria are on the Rise

High Levels of Stress Linked to an Increase in Heart Disease Risk

Small Snacks Cut Hunger as Well as Big Snacks

Poor Sleep May Increase the Risk of Heart Failure

Ancient Mummies Found to Have Heart Disease by CT Scan

Physically Fit Kids Do Better on Math & Reading Tests

How Melanoma Skin Cancer Evades the Immune System

Possible Link Between BPA and Asthma

Baby Boomers Appear Less Healthy Than Their Parents

The Biology of Love in the Brain

Millennials May be the Most Stressed-Out Generation

Even Modest Alcohol Intake Raises Cancer Risk

Why Do Boys Receive Lower Grades than Girls?

Negative Emotions and Feelings Can Damage Your Health

Canker Sore Drug Cures Obesity (At Least in Mice…)

How Technology is Changing the Practice of Medicine

New Salt Intake Guidelines for Children

High Levels of Distress in Childhood May Increase Risk of Heart Disease in Adulthood

Quitting Tobacco by Age 40 Restores a Normal Lifespan in Smokers

Cancer Death Rates Continue to Fall

Self-Help Books Improve Depression

Marines Try Mindfulness and Meditation to Reduce PTSD

Dying Nurse Volunteers Herself to Teach Nursing Students about the Dying

Regular Walks Cut Stroke Risk

Falling Asleep While Driving More Common than Previously Thought

Celebrity Health Fads Debunked

Obesity Among Young Children May Be Declining

Fresh Fruits & Vegetables May Reduce Breast Cancer Risk

Satisfaction with Life May Actually Increase with Age

Brain Changes in the Elderly May Increase Susceptibility to Being Scammed

 


 

Dr. Wascher’s Home Page



According to recent Bureau of Labor Statistics, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  Over the past 12 months, 3.2 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious readers.  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 


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Post to Twitter

American Surgeons in Crisis: Implications for Healthcare






 

A new study finds that more than half of surgeons are experiencing work-home conflicts that threaten their personal and professional wellbeing.


 

AMERICAN SURGEONS IN CRISIS:  IMPLICATIONS FOR HEALTHCARE

As I have discussed in previous columns (The Silent Epidemic of Surgeon Burnout and DepressionEpidemic of Alcohol Abuse Among Surgeons), there are quiet and evolving, and disturbing, developments within the community of American surgeons, and these developments may portend of significant potential future problems for surgeons, and for patients who require surgical care.  Now, a newly published research study, which appears in the current issue of the Archives of Surgery, further suggests that the epidemic of surgeon burnout and depression is indeed real, and has serious potential implications for both surgeons and their patients.

In this study, 7,197 active surgeons were surveyed, electronically, by the American College of Surgeons, using questions from validated surveys that assess for career burnout, depression, quality of life, alcohol use, and other measures of satisfaction with both personal and professional life attributes.

When asked if they had experienced any significant conflicts between their “work lives” and their “home lives” within the previous three weeks, an astounding 53 percent of the queried surgeons replied, “Yes.”  Thus, more than half of all surgeons who participated in this confidential survey reported substantial and distressing conflicts between their professional lives and their home lives within the preceding three weeks.

When the study’s authors analyzed the personal and professional factors that were most closely associated with “work-home conflicts,” and with both personal and professional dissatisfaction, a clearer picture emerged.  For example, the number of hours worked per week, having children, the surgeon’s gender, and the type of surgical practice were all closely linked with work-home conflicts, and with lower levels of personal and professional satisfaction.  For example, surgeons who practiced at Veterans Administration hospitals were 91 percent more likely to report work-home conflicts when compared to surgeons in private practice, while surgeons who practiced at an academic medical center were 19 percent more likely to report such conflicts when compared to private practice surgeons.  Not surprisingly, having children at home was associated with a 65 percent greater likelihood of work-home conflict when compared to surgeons without children at home.  Working more hours per week and being younger were also factors associated with a higher likelihood of work-home conflict, as was being a female surgeon (i.e., when compared to male surgeons).  Surgeon specialty was also significantly linked to work-home conflicts and overall lower satisfaction levels, with broadly practicing general surgeons being twice as likely to report work-home conflicts as surgeons in other specialties (e.g., breast surgeons, heart surgeons, neurosurgeons, and other subspecialist surgeons).

The high level of work-home conflicts identified among surgeons is an issue of great concern to all of us, as such conflicts were significantly associated with career burnout, exhaustion, decreased quality of life, depression, relationship difficulties, alcohol abuse, and overall career dissatisfaction by scientifically validated surveys.  Surgeons reporting recent work-home conflicts were also substantially less likely to recommend surgery as a career option to their children.

In addition to higher levels of burnout, depression, alcohol abuse, relationship difficulties, and career dissatisfaction, surgeons who reported recent work-home conflicts were also 77 percent more likely to be planning to reduce their clinical work hours, and71 percent more likely to be planning to leave their surgical practices for reasons other than planned retirement.

At a time when the demand for some types of surgical care is already outstripping the supply of experienced, competent surgeons in many areas of the country, the findings of this study are cause for considerable concern.  For example, looking into the near future, our population is aging, and many acute and chronic diseases that require surgical treatment are more common in elderly patients.  Therefore, there is real concern that an increasingly burned-out surgeon workforce, and a declining interest in the more challenging surgical specialties (like general surgery) by today’s medical students, will someday soon leave the United States with an inadequate number of experienced surgeons to meet our nation’s healthcare needs.

All of the above noted adverse factors within the American surgeon community, once again, raise the concern that adequate levels of surgical care may not be available in the not too distant future if significant changes in surgical training and surgical practice are not considered and implemented, particularly in the workhorse specialty of general surgery.  The surgical community has been, admittedly, slow to appreciate or embrace generational changes in perceptions about work-life balance, and has only grudgingly (and recently) acquiesced to external pressures to treat its surgeons-in-training in a more considerate and supportive manner, compared to the conditions that surgery interns and residents toiled under during my era of training, as well as previous generations of surgical trainees.  (When I was a surgical intern, in the late 1980s, there were no limitations on the number of hours that interns and residents were expected to work in the hospital, including the number of nights spent on call for emergencies within the hospital, and it was not uncommon for us to spend 100 to 120 hours inside the hospital each and every week.)  Regardless of how more senior surgeons feel about it, it must be acknowledged that the current generation of medical students and young surgeons, both male and female, are much more concerned about work-life balance, and overall quality of life issues, than was typical for my generation of surgeons.

On a brighter note, the American College of Surgeons’ sponsorship of this research study, and others like it, suggests that the older generation of surgeons who currently serve as senior leaders and mentors for young surgeons and surgical trainees may, finally, be coming to grips with the rather dramatic shift in attitudes and priorities among their young charges. Hopefully, it is not too late to make meaningful structural changes in surgical training and surgical practice conditions before there are widespread adverse public health consequences to the ongoing crisis among the community of surgeons in the United States….

 

A Cancer Prevention Guide for the Human Race is now available in both printed and digital formats from all major bookstores.  Get your copy now, and begin living an evidence-based cancer prevention lifestyle!


Dr. Wascher’s latest video:

Dark as Night, Part 1


Dark as Night, Part 1

Dark as Night, Part 1


At this time, more than 8 percent of Americans are unemployed.  According to the Bureau of Labor Statistics, however, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is now more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I would also like to personally urge you to hire a veteran whenever possible.


For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list.




Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


 

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 





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Watchful Waiting (Observation) Versus Surgery for Prostate Cancer





 

A new landmark study suggests that some patients with early-stage prostate cancer can be safely observed rather than undergoing radical surgery.


 

 

WATCHFUL WAITING (OBSERVATION) VERSUS SURGERY FOR PROSTATE CANCER

In the United States, prostate cancer is the most common type of non-skin cancer occurring among men, and the second most common cause of cancer death in men.  (Lung cancer, an almost completely preventable form of cancer, sadly, remains the most common cause of cancer death for both men and women.)  The American Cancer Society estimates that, in 2012, more than 240,000 new cases of prostate cancer will be diagnosed, and more than 28,000 men will die from this form of cancer.

The debate surrounding the ideal management of early-stage prostate cancer has revolved around “watchful waiting” (observation) versus aggressive treatment with surgery or radiation therapy.  In many cases, prostate cancer is a slow-growing cancer, and when it arises in older men in particular, it seldom leads to death.  On the other hand, there are more aggressive variants of prostate cancer that spread rapidly, and these forms of prostate cancer can indeed lead to death.  The dilemma regarding which patients can be safely observed and which should be subjected to aggressive treatment has been difficult to resolve, however, because it can be difficult to determine, up front, which patients will benefit from treatment and which will not.

Last year, I reviewed a prospective randomized clinical research study from Sweden which revealed a significant improvement in survival among patients with prostate cancer who underwent prostate cancer surgery, when compared to patients who were managed with “watchful waiting”  (Prostate Cancer: Watchful Waiting Versus Surgery (Prostatectomy).)  Now, a similar new prospective randomized clinical research study provides additional important clinical information that may help doctors to identify selected prostate cancer patients who can be safely observed, thus avoiding radical cancer treatments that are associated with a high incidence of incontinence and impotence, as well as other potentially serious complications.  This new study appears in the current issue of the New England Journal of Medicine, the same journal that published last year’s Swedish prostate cancer clinical research study.

In this prospective randomized study, 731 men with newly diagnosed prostate cancer were randomly assigned to undergo radical prostate cancer surgery (prostatectomy) versus observation only.  This group of research volunteers, with an average age of 67 years, was then followed for approximately 10 years, and their outcomes were carefully monitored.  It is important to note that all of these men had early-stage prostate cancer, which appeared not to have spread outside of the prostate gland.

Following 10 years of monitoring, on average, 47 percent of the men who underwent prostatectomy died, while 50 percent of the men in the observation group died (this small difference in overall survival was not statistically significant.)  When the researchers looked at the risk of death caused specifically by prostate cancer, or due to complications associated with prostatectomy, 5.8 percent of the men in the prostatectomy group died directly as a result of either their prostate cancer or due to complications of surgery, while 8.4 percent of the men in the observation group died due to their prostate cancer, for a relative cancer-specific survival difference of 37 percent and an absolute difference of 2.6 percent in favor of the men who underwent surgery instead of observation.  Importantly, however, this observed difference in cancer-specific survival did not quite achieve statistical significance, suggesting that the cancer-specific survival benefit of radical prostatectomy in men with early-stage prostate cancer is, in general, either nonexistent or very small, at least over a 10-year period of time.

Importantly, when the authors of this study assessed prostate-specific antigen (PSA) levels, specifically, as a predictor of survival among the two groups of men who participated in this study, they found that prostatectomy did, in fact, significantly improve survival among men with a PSA level greater than 10 nanograms per milliliter (ng/ml), compared to observation alone.

As is often the case, pundits on either side of the prostate cancer treatment debate will find some ammunition in this study’s findings to support their respective positions.  Those experts who espouse aggressive treatment for most or all early-stage prostate cancers will note the nearly 3 percent improvement in absolute survival associated with radical prostatectomy, although, in this study, this difference in absolute survival was not considered to be statistically significant.  (However, it should be noted that the observed survival advantage associated with surgery in this study would have actually been higher, and perhaps statistically significant as well, had there not been a postsurgical death of one of the patients in the prostatectomy group.)  On the other hand, proponents of “watchful waiting” will point to the very small difference in observed death rates between these two groups of patients, and the relatively large number of adverse events associated with radical prostatectomy (21 percent).  However, in my view, this study’s findings offer a reasonable, evidence-based, “middle ground” strategy, based upon patients’ PSA levels.  Specifically, for older patients who have a PSA level below 10 ng/ml and no worrisome microscopic features that suggest an aggressive variant of prostate cancer, observation may indeed be a reasonable alternative to prostatectomy, based upon the findings of this landmark study.  (Unfortunately, this study did not assess radiation therapy, which is the other common form of treatment for early-stage prostate cancer.)

In completing my review of this important clinical study, I should also note that 1 out of 5 patients who enrolled in this prospective study did not remain within their assigned groups and, therefore, crossed over into the opposite group after they entered into this study.  However, while this factor does somewhat complicate the analysis of the data collected in this study, it probably does not affect the overall accuracy of the study’s conclusions.

I do not believe that this important but admittedly imperfect study will, by itself, completely resolve the ongoing debate regarding the optimal management of early-stage prostate cancer.  However, as one of only a very few well-performed randomized prospective clinical studies that have directly compared radical surgery with observation alone, and with reasonable long-term follow-up of patients, this is a very important clinical research study for both patients and their prostate cancer physicians alike.  Because of this study, both patients and their doctors will now be better able to make individualized, evidence-based decisions regarding the likely risks and benefits of surgery versus careful observation as an initial approach to prostate cancer management.


At this time, more than 8 percent of Americans are unemployed.  According to the Bureau of Labor Statistics, however, the unemployment rate for veterans who served on active duty between September 2001 and December 2011 is now more than 12 percent.  A new website, Veterans in Healthcare, seeks to connect veterans with potential employers.  If you are a veteran who works in the healthcare field, or if you are an employer who is looking for physicians, advanced practice professionals, nurses, corpsmen/medics, or other healthcare professionals, then please take a look at Veterans in Healthcare. As a retired veteran of the U.S. Army, I urge you to hire a veteran whenever possible.


For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list.




Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


 

Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


 

I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 






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Epidemic of Alcohol Abuse Among Surgeons





A new study indicates that chronic alcohol abuse among surgeons is far more common than among the general population.


 

 

EPIDEMIC OF ALCOHOL ABUSE AMONG SURGEONS

In a previous column (Surgeon Performance and Alcohol), I reviewed a clinical research study that revealed just how significantly alcohol intake degrades surgical skills among surgeons, even well into the day following alcohol intake.  In another recent column, I examined a study that revealed a disturbingly high rate of burnout and depression among American surgeons (Surgeon Burnout and Depression).  This week, I will present a newly published clinical study that, once again, raises serious concerns about the health and wellbeing of many surgeons in the United States.

In a study that appears in the current issue of the Archives of Surgery, more than 7,000 surgeons in the United States agreed to participate in a confidential assessment of alcohol abuse and alcohol dependence among members of the American College of Surgeons.  Validated surveys and tests were administered to these surgeon-volunteers, and the resulting data was analyzed.

Based upon the results of the Alcohol Use Disorders Identification Test, 15 percent of the responding surgeons, overall, were identified as meeting the criteria for either chronic alcohol abuse or alcohol dependence.  Further evaluation of the data collected in this study revealed that 14 percent of the participating male surgeons met the criteria for chronic abuse of alcohol or alcohol dependency, while 26 percent of the corresponding female surgeons met these same worrisome criteria.  Moreover, surgeons who reported having committed a major medical or surgical error within the previous 3 months were 45 percent more likely to abuse alcohol, or to be dependent upon alcohol, when compared to surgeons who did not report any recent errors.  Similarly, surgeons who reported feeling burned out in their professional lives were 25 percent more likely to be problem drinkers when compared to surgeons who did not report professional burnout.  Finally, surgeons who reported symptoms consistent with depression were nearly 50 percent more likely to abuse alcohol than surgeons who did not report feeling depressed.

Interestingly, surgeons were less likely to have alcohol abuse and dependency problems if they were older, male, or had children.  (Approximately 11 percent of adult males in the general population are thought to have chronic alcohol abuse problems, while only about 5 percent of adult females in the general population appear to abuse alcohol on a regular basis.)

The findings of this study, once again, indicate a disturbingly high rate of substance abuse among American surgeons; and this is the first study to show that female surgeons, unlike women in the general population, are twice as likely as their male counterparts to regularly abuse alcohol.  Taken together with previous studies showing very high rates of depression and career burnout among surgeons in the United States, the findings of this latest study are rather worrisome.  (Previous studies have also linked an increased likelihood of medical and surgical errors to surgeons who are depressed, and who abuse alcohol and other drugs.)

I should also note that only 29 percent of the surgeons who were contacted agreed to participate in this confidential study.  Because this participation rate is much lower than what is typically seen in most survey-based research studies, it raises the important question as to whether or not the rate of alcohol abuse and alcohol dependency might actually be considerably higher among surgeons, in general, than what is reflected in this study.  Indeed, most statistics experts believe that a very common reason for nonparticipation in survey-based studies is a reluctance to divulge negative information about oneself.  Moreover, even people who elect to participate in survey-based studies often “fudge” their responses in ways that tend to underestimate their bad habits and other self-perceived shortcomings.  Therefore, it is entirely possible that the incidence of chronic alcohol abuse and alcohol dependency among surgeons may be even higher than what was reported in this study….

 

As I have observed in previous columns, surgeons who abuse alcohol, or other drugs, are more likely to be associated with medical errors and worse patient outcomes.  However, the stigma of reporting oneself as having an alcohol, or other drug, problem is so great in the medical profession that impaired surgeons (as with other physicians) are generally extremely reluctant to admit that they have an alcohol or drug problem.  Most medical boards still require physicians to indicate whether or not they have a history of drug or alcohol abuse on licensure applications, and the medical profession, in general, still seems to be in a state of denial regarding the unusually high incidence of drug and alcohol abuse among physicians when compared to the general public.  It also goes without saying that the potential consequences of being operated upon by an impaired surgeon can be catastrophic to both patients and their loved ones, and, therefore, the still prevailing “head in the sand” approach to identifying, and rehabilitating, impaired physicians would not appear to serve the public interest very well, in my view.

 

While the vast majority of surgeons are passionately devoted to providing the best possible care to their patients, and would therefore not engage in personal behaviors that might potentially endanger their patients, it is becoming increasingly clear that a sizable percentage of surgeons in the United States are seriously impaired by burnout, depression and other mental health illnesses, and by alcohol and drug abuse.  Therefore, a better system of screening out surgical trainees who are predisposed to these serious health problems should be considered, while, at the same time, medical authorities at the state and federal levels should make it easier, and less threatening, for currently impaired physicians and surgeons to reach out for help without fearing that they will be punished or professionally sanctioned as a result.  I, therefore, applaud the American College of Surgeons for sponsoring and publishing this important study as a preliminary step forward in this direction.


 

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my bestselling book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!

Within one week of publication, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books. Within three months of publication, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list.


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author


For a lighthearted perspective on Dr. Wascher, please click on the following YouTube link:

Texas Blues Jam


I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people from around the world who visit this premier global health information website every month.  (More than 1.3 million pages of high-quality medical research findings were served to the worldwide audience of health-conscious people who visited Weekly Health Update in 2011!)  As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.


 








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Surgeon Performance Impaired After Drinking Alcohol the Day Before Surgery

Welcome to Weekly Health Update


“A critical weekly review of important new research findings for health-conscious readers”



 

SURGEON PERFORMANCE IMPAIRED AFTER DRINKING ALCOHOL THE DAY BEFORE SURGERY

Surgeons, like pilots, are held to a very high standard of conduct when it comes to alcohol and drug use. Unlike pilots, however, there are no rules barring surgeons from having a few beers, or other alcoholic drinks, on the day or evening before they enter the operating room to perform surgery.

While most surgeons drink alcohol responsibly, some surgeons (like people in any other profession) may occasionally have a few more drinks the day or evening before they report for duty than might be considered prudent. When a surgeon has a few more alcoholic drinks than they might have planned on the day before they are scheduled to perform surgery, most will undoubtedly assume that “sleeping it off” overnight will leave them fresh and in tip-top shape to wield the scalpel in the operating room on the next morning. However, a newly published clinical research study suggests otherwise….

A newly published prospective, randomized clinical study, which appears in the latest issue of the Archives of Surgery, included two groups of study volunteers. A total of 8 expert laparoscopic surgeons were included in one group, while the other group consisted of 16 university science students. All 24 participants were trained to use a computer-based laparoscopic surgery training device that is routinely utilized to train new surgeons in laparoscopic surgery skills. The science students were then divided into two groups. The “control” group abstained from alcohol for the 24-hour period prior to being tested on their laparoscopic skills, while the other half of the students (the “experimental group”) were allowed to drink alcohol freely until they felt themselves to be “intoxicated.” The 8 expert laparoscopic surgeons were all permitted to drink alcoholic beverages “until intoxicated.” The following day, all 24 study volunteers were tested on the laparoscopic training device at 9:00 AM, 1:00 PM, and 4:00 PM. All study participants also underwent breathalyzer testing to measure their blood alcohol level, and only one of the volunteers had a blood alcohol level above the legal limit (for driving) of 0.1 percent at 9:00 on the morning after their drinking binge.

Among the science students, performance deteriorated in all of the tested laparoscopic surgery skills among those who had consumed alcohol on the day prior to testing (when compared to the “control group” of students). The outcome was not any better for the expert laparoscopic surgeons, either. These experienced surgeons, all of whom consumed multiple alcoholic drinks on the day before testing, showed significant deterioration in the time that it took them to perform specific laparoscopic surgery skills, as well as a significant deterioration in their coordination and in the number of technical errors that they made. Moreover, this significant deterioration in surgical performance was still detectable at 4:00 PM on the day after these study volunteers had consumed multiple alcoholic beverages, and despite blood alcohol levels well below the legal limit for driving.

As previous research with airline pilots has shown, alcohol consumption within 24 hours of performing critical tasks can cause significant cognitive and physical impairment, even when blood alcohol levels are zero, or near zero. The findings of this clinical study of surgeons came to similar conclusions, and these findings suggest that surgeons should avoid the consumption of multiple alcoholic drinks within 24 hours of entering the operating room.

For a complete evidence-based discussion about how to live an evidence-based cancer prevention lifestyle, order your copy of my new book, A Cancer Prevention Guide for the Human Race For the price of a cheeseburger, fries, and a shake, you can purchase this landmark new book, in both paperback and e-book formats, and begin living an evidence-based cancer prevention lifestyle today!

For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, A Cancer Prevention Guide for the Human Race,” from Amazon, Barnes & Noble, Books-A-Million, Vroman’s Bookstore, and other fine bookstores!

On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books! On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list!


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity



Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author



For a different perspective on Dr. Wascher, please click on the following YouTube link:

Texas Blues Jam



I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month. (More than 1.2 million health-conscious people visited Weekly Health Update in 2010!) As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.





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Prostate Cancer and High Intensity Focused Ultrasound (HIFU)

Welcome to Weekly Health Update


“A critical weekly review of important new research findings for health-conscious readers”


PROSTATE CANCER AND HIGH INTENSITY FOCUSED ULTRASOUND (HIFU)

The two most commonly used treatments for early-stage prostate cancer, surgery and radiation therapy, are both associated with a significant risk of potential complications, including impotence and varying degrees of urinary incontinence.  Because of these serious side effects of prostate cancer therapy, new approaches to the management of this common type of cancer are constantly being evaluated.

High intensity focused ultrasound (HIFU) is a relatively new and non-invasive approach to cancer therapy.  Unlike more invasive cancer treatments, HIFU focuses very powerful ultrasound (sound wave) beams directly at a tumor.  These focused ultrasound beams then cause the tumor to become heated to the point that the tumor is killed.  Unlike radiation therapy, however, which is used to essentially destroy the entire prostate gland (or surgery, which requires the removal of the entire prostate gland), HIFU can be focused onto just the portion of the prostate gland where early-stage tumors are located.

A newly published research study, which appears in the current issue of the Journal of Urology, has evaluated the use of HIFU in carefully selected patients with very early prostate cancer.  In this small prospective clinical research study, 20 men with small, localized prostate cancer tumors were treated with HIFU.  Repeat biopsies of the prostate gland were then performed 6 months later, and these 20 men were then reassessed, once again, 12 months after undergoing HIFU treatment of their early prostate cancers.  (Low-risk cancers were present in 25 percent of these men, and intermediate-risk prostate cancers were present in the remaining 75 percent of these male volunteers.)

At 12 months following HIFU therapy, an amazing 95 percent of these men were still sexually potent.  Moreover, 90 percent of the men had complete control of their urinary stream (urinary continence), and 95 percent of these men did not require a protective pad in their underwear to prevent soiling of their clothes with urine.  Moreover, 89 percent of these men were simultaneously free of urinary leaks, impotence, and detectable recurrences of their prostate gland tumors at 12 months. (These extremely impressive results with HIFU reveal a complication rate that is far below what has been described for surgical removal of the prostate, and for radiation therapy for prostate cancer; as well as an excellent cancer control rate at 12 months.)

Now, a few caveats before anyone gets too excited about the results of this study.  First of all, this was a very small study, and the patients who participated in this study were very carefully selected based upon the very small size of their prostate cancer tumors.  Secondly, prostate cancer is, in general, a slow-growing cancer, and the 12-month period of follow-up of these study volunteers is much too brief to measure the long-term effectiveness of HIFU for the treatment of prostate cancer.  Finally, although HIFU is considered a non-invasive form of treatment, it generates very high temperatures within the tissues that are targeted by the ultrasound beams.  As with radiation therapy, HIFU can, therefore, also cause unintended damage to surrounding organs, and can cause some of the very same complications associated with radiation therapy.

While not yet ready for “prime time,” HIFU may still have an important future role in the management of localized prostate cancer.  However, in my view, larger clinical studies, and longer patient follow-up, will be necessary before HIFU proves itself to be equal to surgery and radiation therapy in the management of prostate cancer.

 

For a complete evidence-based discussion regarding an evidence-based cancer prevention lifestyle, order your copy of my new book, A Cancer Prevention Guide for the Human Race.  For the price of a cheeseburger, fries, and a shake, you can purchase this landmark new book, in both paperback and e-book formats, and begin living an evidence-based cancer prevention lifestyle today!



On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books! On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list!


Disclaimer:  As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity



Dr. Wascher is an oncologic surgeon, professor of surgery, cancer researcher, oncology consultant, and a widely published author



For a different perspective on Dr. Wascher, please click on the following YouTube link:

Texas Blues Jam



I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month. (More than 1.2 million health-conscious people visited Weekly Health Update in 2010!) As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.





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Axillary Lymph Node Dissection for Breast Cancer May Not Be Necessary

Welcome to Weekly Health Update


“A critical weekly review of important new research findings for health-conscious readers”



AXILLARY LYMPH NODE DISSECTION FOR BREAST CANCER MAY NOT BE NECESSARY

The management of breast cancer has undergone many advances since the radical mastectomy that first came into popularity in the United States in the late 19th century.  At that time, even early cancers of the breast were managed by surgically removing the entire breast, the underlying chest wall muscles, and all of the lymph nodes under the armpit (axilla).  It wasn’t until the 1970s that surgeons began to abandon radical mastectomy, in favor of the less disfiguring modified radical mastectomy, based upon emerging research data at the time.  By the 1980s, additional research data had confirmed that women who underwent lumpectomy plus radiation therapy experienced equivalent survival when compared to women who underwent mastectomy.  In the late 1990s, another major paradigm shift in the surgical management of breast cancer occurred with the rapid adoption of sentinel lymph node (SLN) biopsy, which had previously also revolutionized the surgical management of melanoma.  Following the successful application of SLN biopsy to breast cancer, the 60 to 70 percent of women with breast cancer who have normal axillary SLNs (i.e., no evidence of spread of breast cancer cells to the lymph nodes in the axilla) could now avoid undergoing complete axillary lymph node dissection (ALND), wherein about two-thirds of the armpit lymph nodes are surgically removed.  As the risk of arm swelling (lymphedema), numbness, and other long-term side effects associated with ALND are only one-tenth as common following SLN biopsy, the majority of women undergoing breast cancer surgery over the past decade have been able to avoid many of the chronic complications and side effects associated with the more radical surgical approaches used in the past.  However, between one-fourth and one-third of women diagnosed with breast cancer will still be found to have tumor cell in their SLNs, and most of these women have routinely been advised to undergo ALND to remove additional armpit lymph nodes.

Now, a newly published clinical research study from the American College of Surgeons Oncology Group has, once again, dramatically shifted the paradigm of breast cancer management.  This clinical research study, which I was privileged to participate in when I was a Surgical Oncology Fellow at the John Wayne Cancer Institute, enrolled 891 women newly diagnosed with breast cancer, and with early metastatic cancer involving one or more of their axillary SLNs.  These women were evenly randomized into two groups.  One group underwent the standard therapy of ALND, while the other half of these patient volunteers were observed, without further surgery, following SLN biopsy.  The results of this pioneering breast cancer research study appear in the current issue of the Journal of the American Medical Association.

After an average duration of patient follow-up of more than 6 years, this pivotal clinical study has confirmed what many of us oncologists have long suspected.  In women with evidence of microscopic spread of breast cancer to one or more axillary SLNs, there was no difference in overall survival whether or not they went on to undergo ALND, as long as they underwent otherwise standard therapy for lymph-node-positive breast cancer (including lumpectomy, radiation therapy to the breast, and chemotherapy).

I cannot overstate the potential impact of the findings of this important clinical study.  However, while some have heralded the findings of this study as breaking important new ground, in fact that ground was broken by the very same pioneering prospective clinical research study (the National Surgical Adjuvant Breast and Bowel Project’s NSABP B-04 study, which began in 1971) that originally led surgeons to abandon radical mastectomy.  Within this older large prospective clinical study was an important subgroup of 586 women with palpably enlarged axillary lymph nodes (and which actually indicated a more advanced stage of lymph node involvement than the women who participated in the more modern American College of Surgeons Oncology Group study).  Like all of the women who participated in the NSABP B-04 study, these 586 breast cancer patients with enlarged armpit lymph nodes were randomized to undergo radical mastectomy with radical ALND versus mastectomy alone (and no lymph node surgery at all ) combined with radiation therapy.  After an average follow-up of 25 years, there wasabsolutely no difference in survival between the women who underwent radical lymph node surgery combined with radical mastectomy versus those women who underwent simple mastectomy alone (and no lymph node surgery) followed by radiation therapy.

Thus, the newly reported findings of this pivotal American College of Surgeons Oncology Group clinical study only further validates the findings of the nearly 40 year-old NSABP B-04 study, and should put to rest, once and for all, the decades-old debate about the role of surgery in the management of the axillary lymph nodes in patients with newly diagnosed breast cancer.  At a minimum, surgeons should now advise their breast cancer patients that there is now 40 years worth of high-level clinical research data showing that the surgical removal of most or all of the armpit lymph nodes (ALND) does not improve survival in women who otherwise undergo standard breast cancer treatment that includes lumpectomy (or mastectomy), chemotherapy, and radiation therapy.

I predict that the findings of these two landmark breast cancer surgical studies will, together, once again revolutionize the surgical management of breast cancer, and will further reduce the adverse impact of surgery on hundreds of thousands of women around the world each year.  Indeed, this latest revolution in the management of breast cancer has already started at major cancer centers in the United States, where women are already being advised that the finding of early spread of breast cancer cells to their axillary SLNs no longer mandates “completion ALND,” as long as these patients undergo standard chemotherapy and radiation therapy following lumpectomy and SLN biopsy.


For a complete discussion of evidence-based approaches to cancer risk and cancer prevention, order your copy of my new book, A Cancer Prevention Guide for the Human Race.  For the price of a cheeseburger, fries, and a shake, you can purchase this landmark new book, in both paperback and e-book formats, and begin living an evidence-based cancer prevention lifestyle today!


For a groundbreaking overview of cancer risks, and evidence-based strategies to reduce your risk of developing cancer, order your copy of my new book, “A Cancer Prevention Guide for the Human Race,” from AmazonBarnes & NobleBooks-A-MillionVroman’s Bookstore, and other fine bookstores!


On Thanksgiving Day, 2010, A Cancer Prevention Guide for the Human Race was ranked #6 among all cancer-related books on the Amazon.com “Top 100 Bestseller’s List” for Kindle e-books! On Christmas Day, 2010, A Cancer Prevention Guide for the Human Race was the #1 book on the Amazon.comTop 100 New Book Releases in Cancer” list!



Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity




Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author




For a different perspective on Dr. Wascher, please click on the following YouTube link: Texas Blues Jam



I and the staff of Weekly Health Update would again like to take this opportunity to thank the more than 100,000 health-conscious people, from around the world, who visit this premier global health information website every month. (More than 1.2 million health-conscious people visited Weekly Health Update in 2010!) As always, we enjoy receiving your stimulating feedback and questions, and I will continue to try and personally answer as many of your inquiries as I possibly can.







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Prevention of Surgical Site Infections (SSIs) after Surgery

January 10, 2010 by  
Filed under Infection, surgery

Welcome to Weekly Health Update



 

“A critical weekly review of important new research findings for health-conscious readers”

PREVENTION OF SURGICAL SITE INFECTIONS

 

(SSIs) AFTER SURGERY

 

 

Infections following surgery in the United States occur in approximately 3 to 5 percent of all cases, and in more than 10 percent of certain types of operations.  In view of these statistics, surgical site infections (SSIs) are a major public health problem throughout the world.  On average, patients in the United States who develop an SSI will remain in the hospital for an additional week, resulting in an average of more than $25,000 in additional healthcare costs per affected patient.  Patients who develop SSIs are also 60 percent more likely to be admitted to the ICU, and are twice as likely to die, when compared to patients who do not develop SSIs following surgery.   Moreover, at a time when profound changes in the United State’s health care system are being proposed to control skyrocketing health care costs, SSIs are estimated to add an additional $10 billion in national health care costs, annually.   In addition to the economic costs associated with SSIs, serious infections following surgery often cause considerable suffering among affected patients; and in severe cases, SSIs can also result in permanent disability or death.

 

The known causes of SSIs are complex and multiple and, therefore, no single or simple solution is capable of eliminating all cases of SSIs.  However, there is ample research data available suggesting that a number of opportunities exist whereby the risk of SSIs can be further reduced.  For example, one major (and preventable) cause of potentially life-threatening SSIs is the increasing prevalence of antibiotic-resistant strains of bacteria that have developed following decades of excessive and inappropriate antibiotic use.  Among these resistant bacteria, few have raised more concern than methicillin-resistant Staphylococcus aureus (more commonly known by its acronym, MRSA).  MRSA is capable of causing limb- and life-threatening infections, particularly in very ill patients, and in the very young and very old.  When I began my medical career, more than 20 years ago, MRSA was an exceedingly rare cause of bacterial infections.  When MRSA first began to appear, this bacterium primarily caused infections among seriously ill hospitalized patients, and was rarely a source of infection among generally healthy nonhospitalized patients.

 

In a landmark study by the Centers for Disease Control, and published in the Journal of the American Medical Association in 2007, a remarkable 58 percent of invasive infections caused by MRSA in 2004 and 2005 occurred in nonhospitalized patients, while 27 percent of MRSA infections arose among hospitalized patients.  This tectonic shift in the epidemiology of MRSA (and other emerging strains of antibiotic-resistant bacteria and fungi, as well) has grave implications for preventing SSIs, as the majority of SSIs are known to arise from the surgical patient’s own native bacteria.

 

 

Two important new studies related to SSI prevention, and just published in The New England Journal of Medicine, offer important new ammunition in the ongoing fight against potentially deadly SSIs.

 

In the first study, from the Netherlands, patients being admitted to the hospital for elective surgery were tested for the presence of Staphylococcus aureus bacteria in their nasal passages.  In this prospective, randomized, placebo-controlled, double-blind, multi-center clinical research trial, 6,771 patients were screened for the presence of nasal Staphylococcus aureus, and 1,251 of these patients were confirmed to be nasal carriers of this bacterium.  A total of 917 of these patients were subsequently enrolled into this clinical research trial. These 917 patients were then divided into an “experimental” group and a “control” group, although neither the patients nor the research assistants in this double-blind study were permitted to know which group any patient was assigned to until after the study had been completed.  Patients randomized to the “experimental” group were treated, before surgery, with antibacterial ointment (mupirocin) applied to their nasal passages, and with showers using antibacterial soap (chlorhexidine), in an effort to eradicate surface bacteria (including Staphylococcus aureus) from their noses and skin.  The “control group” of patients received identical-appearing nasal ointment and skin soap, but without mupirocin or chlorhexidine.

 

All study patients were tracked following surgery, and the incidence of SSIs was then analyzed.  In this highly-powered randomized, controlled clinical research trial, there was a 58 percent overall reduction in the relative risk of SSIs among the “experimental group” of patients when compared to the patients who received only placebo ointment and placebo soap.  The benefit of preoperative treatment with mupirocin ointment and chlorhexidine soap was even more pronounced for SSIs involving deep body spaces, in this study: the relative risk of deep body space SSIs was reduced by 79 percent in the “experimental group” of patients.  Therefore, the results of this powerful prospective clinical trial suggest that SSIs following elective surgery can be significantly reduced by, first, testing patients for evidence of colonization with Staphylococcus aureus bacteria and, secondly, by “decolonizing” the nasal passages and skin of already-colonized patients with antibacterial ointment and soap, respectively.  Many hospitals already selectively apply nasal cavity testing for MRSA (either before or following surgery), and recommend a shower with chlorhexidine soap prior to surgery.  The results of this important public health study suggest that the incidence of SSIs can probably be further lowered by more rigorous and more universal preoperative screening programs for nasal Staphylococcus aureus (including both MRSA and non-MRSA Staphylococcus aureus) directed at all patients who are undergoing elective surgery.

 

 

The second, and related, study evaluated the impact of two different preoperative skin prep solutions on the incidence of SSIs.

 

For decades, now, iodine-based skin cleansing solutions have been applied to skin surfaces just prior to the start of surgery, in an effort to kill skin-surface bacteria that can lead to SSIs.  While these traditional iodine-based antibacterial skin prep solutions are active against many bacteria and fungi that are known to cause SSIs, their antibacterial and antifungal activity rapidly dissipates after being applied.  Newer surgical skin prep agents that contain alcohol and chlorhexidine have been shown by recent research studies to not only have a wider spectrum of activity against skin bacteria and fungi than traditional iodine-based prep solutions, but these newer surgical prep solutions also sustain their antibacterial and antifungal activity over a much longer duration than their iodine-based counterparts.  In this new prospective, randomized clinical research study, 849 patients undergoing elective surgery were randomized to one of two groups.  One group of patient volunteers underwent preoperative skin preparation with a commercially available chlorhexidine-alcohol solution, while the second group was randomized to undergo skin preparation with the traditional povidone-iodine solution.

 

Following surgery, 16 percent of the patients who had their skin prepped with povidone-iodine solution developed SSIs within 30 days of surgery, while just under 10 percent of the patients who received the chlorhexidine-alcohol skin prep solution subsequently developed SSIs.  (This 41 percent reduction in the relative risk of SSIs was found to be highly statistically significant.)    Although use of the chlorhexidine-alcohol skin prep, alone, did not appear to protect against deep organ-space infections (when compared with the use of povidone-iodine skin prep solutions) in this study, both superficial and deep SSIs of the surgical incision were significantly reduced following use of the chlorhexidine-alcohol skin prep solution.  In this study, the use of a chlorhexidine-alcohol prep solution cut the risk of superficial incisional infection by one-half, while deep incisional infections were reduced threefold.  Thus, the use of chlorhexidine-alcohol skin prep solutions, just prior to making the incision, was associated with a highly significant reduction in the incidence of both superficial and deep infections of surgical incisions when compared to traditional iodine-based prep solutions.

 

 

Taken together, these two very important prospective randomized clinical research trials offer clinically valuable lessons for patients, physicians, and hospitals in our crucial quest to drive down the incidence of SSIs to the lowest achievable level.  In view of the recent and ongoing emergence of highly virulent strains of bacteria and fungi that have become resistant to many of our most powerful antibiotic and antifungal drugs, respectively, it is imperative that we find new ways to reduce the risk of SSIs, and particularly new methods that do not involve the continued inappropriate or excessive utilization of broad spectrum antibiotic drugs.

 

If you are scheduled to undergo elective surgery in the near future, I would advocate that you share the findings of these two clinically important research studies with your surgeon (if they are not already aware of them).



Disclaimer: As always, my advice to readers is to seek the advice of your physician before making any significant changes in medications, diet, or level of physical activity


Dr. Wascher is an oncologic surgeon, a professor of surgery, a cancer researcher, an oncology consultant, and a widely published author


For a somewhat lighter perspective on Dr. Wascher, please click on the following YouTube link: 

http://www.youtube.com/watch?v=7-Tdv7XW0qg

 

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