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GAM BIT’S HEALTH & WELLNESS > OCTOBER 2010 >VOLUME 2 > NUM BER 10
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Health & Wellness > bestofneworleans.com > OCTOBER 05 > 2010
Blue Cross has publicly said “that you will be forced to pay higher out-of-network rates.” That is not necessarily true. We have taken great strides to ensure that you will not be negatively impacted for choosing EJGH.
02
If you have out of network benefits, you have paid Blue Cross for this product. Now that you want to use them, no one should discourage you – or mislead you about having to pay more for your healthcare. You may have been led to believe that being out-of-network means you cannot go to certain doctors or hospitals, or that your insurance claims will not be paid or processed. That is not true. In fact, those claims must be paid as efficiently as any others. Mark J. Peters, MD EJGH President and CEO
“Out-of-network” does not mean “out-of-access.” You can still come to East Jefferson General Hospital. To us, this is about preserving your right to choose the doctor and hospital that’s right for you and your family.
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Call us at 504-454-4040. Patient representatives are available from 8:30 am to 5 pm Monday–Friday to answer your specific questions and discuss your individual needs.
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Health & Wellness > bestofneworleans.com > OCTOBER 05 > 2010
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both opted for a double Make sure you know your treatMent options, mastectomy and hysterand discuss theM with your physician. ectomy, even though they had not been diagnosed with breast cancer. “Being a nurse in oncology, I have lost way too many patients to breast and ovarian cancer, and I knew I didn’t want to go through this,” Stoulig says. “So I opted to have the surgery, and it has been one of the best decisions I have ever made in my life.” The decision of whether or not to have a prophylactic (preventative) mastectomy is a highly personal one, but in the event of a breast cancer diagnosis, surgery almost always becomes inevitable. “Surgery is usually — not always — the beginning point,” Stolier says. A team of doctors — usually consisting of a surgical oncologist, a medical oncologist and a radiation oncologist — work together in the diagnosis of breast cancer and in the decisions regarding its treatment, she adds. “After an abnormal mammogram and an ultrasound that shows a solid mass, women should have a tissue diagnosis and then see a surgeon who may ask for an MRI scan,” Rugo says. Considering multiple factors including the tumor’s size and aggressiveness, the risk of recurrence, the stage of the cancer and whether it has spread to the lymph nodes, as well as the patient’s age and whether she is trying to maintain her fertility, physicians formulate a treatment plan. “Everybody’s breast cancer is individualized,” says Dr. Roy Kite, medical director of radiology at Lakeview Regional Medical Center. “Depending on how big the lesion is and the type of cancer you have, you can go all kinds of different directions in the way you can treat it.” Chemotherapy or hormone therapy may be used to shrink the tumor prior to surgery, Rugo says. If the cancer is detected early, a lumpectomy (removal of the tumor) followed by six to seven weeks of radiation treatment may be a substitute for mastectomy, Stolier says. Other situations may be better treated with mastectomy. In
Health & Wellness > bestofneworleans.com > OCTOBER 05 > 2010
B
reast cancer is like a story,” says Dr. Alan Stolier, a surgical oncologist at Omega Hospital. “There are so many parts to the story — the hereditary part, the (breast) reconstruction part — that you have to try to get a big picture.” The sagas that play out in Stolier’s office involve a heroine (the patient), a nemesis (breast cancer), a team of helpful allies (primary care physicians, radiologists, surgeons, breast reconstruction surgeons, support groups, friends and family) and a series of events that involve weighty decisions (e.g., is a lumpectomy or a mastectomy the right choice? What are the best reconstruction options?). The story unfolds for more than 230,000 women in the United States annually, and each woman’s experience is different. Because of the gravity and quantity of treatment-related decisions, it is crucial for women to equip themselves with information so they can collaborate with their doctors to decide what treatment plans are right for them. “Treatment should be a conversation between the patients and their treating physicians,” says Dr. Hope Rugo, a medical oncologist at the University of California, San Francisco. “When the patients partner with the physicians, you end up with a better situation.” Every woman should know her body and her risk for breast cancer. According to the American Cancer Society, women should schedule yearly clinical breast exams and mammograms after age 40. During their 20s and 30s, they should have clinical breast exams performed as part of their annual checkups. “If you notice something that concerns you in your breast, don’t delay going to your doctor,” says Dr. Thomas Cosgriff, a medical oncologist at Cancer Care of Louisiana. “The earlier we catch breast cancers, the more curable they are.” Because breast cancer tissues are sensitive to estrogen, any uninterrupted estrogen exposure caused by having children later in life (after age 30) or not at all, or not breast-feeding increases the risk of breast cancer, Cosgriff says. Other risk factors include a family history of cancer, smoking, moderate alcohol consumption and a highfat diet. Women with a family history may have a mutation of the BRCA1 or BRCA2 (breast cancer type 1 and breast cancer type 2) genes, and these women comprise up to 10 percent of diagnosed breast cancer cases. Cosgriff advises women with a strong family history of breast cancer to see a physician and get tested for the mutation. “These genes account for a majority of hereditary forms of breast cancer,” Stolier says. “Women who carry a gene mutation have more than an 80 percent risk of developing breast cancer in their lifetime.” “If you have a family history of breast or ovarian cancer, it is a done deal. You know you should get tested (for the gene mutation),” says Ponchatoula resident Pam Crimmins, 60, who got tested for the gene mutation after her mother, aunt, sister and niece were diagnosed with breast cancer. Crimmins tested positive for the gene mutation. She and her sister Susie Stoulig, 57, who also tested positive,
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addition to lumpectomy and mastectomy, “we almost always sample the auxiliary lymph nodes to see if there is any cancer there,” Cosgriff says. Every treatment option has drawbacks and benefits, and women should feel comfortable discussing different plans with their doctors. “There is not one operation that fits everyone,” says Dr. Scott Sullivan, co-founder of the Center for Restorative Breast Surgery. “If there is any level of discomfort with the plan, get a second opinion. Patients need to seek the best care for themselves.” Sullivan points out that more than 70 percent of women who have undergone mastectomies are not informed of options for breast reconstruction, according to a study by the American Society of Plastic Surgeons. “We try to help educate patients on what their options are,” he says. “It helps them handle a very adverse situation in a better way.” Once considered the “bastard child of plastic surgery,” Sullivan says reconstruction techniques have become more refined, with an increased focus on the aesthetic outcome. Performed at the time of the mastectomy, breast reconstruction is covered by insurance and takes one to one-and-a-half hours if implants are used, or three to four hours if the breast is reconstructed from the patient’s tissue via a microsurgical technique. “We can take fat from any part of the body and transfer it to the breasts,” Sullivan says. “The breast will be warm, soft, supple, and it moves naturally and changes its volume as (the woman’s) weight fluctuates, and it lasts their entire life.” This approach involves a longer hospital stay (three to four days versus an overnight stay) and recovery time than implants. But Implants carry a risk of capsular contraction and infection. “Some people have the misconception that (implants) will look like an augmentation,” Sullivan says. “That’s not true. You just have skin laying over the implant, so you see the imperfections in the implant, and the breast always feels cool.” He also addresses lymphedema, a side effect of lymph gland removal that results in chronic swelling of the arm. Very few women would choose to
SiSterS (left to right) Pam CrimminS, SuSie Stoulig and deedee King Share a Strong family hiStory of breaSt CanCer.
cast themselves as the heroine of a breast cancer story, but those who find themselves in this role can take comfort that frequently, it’s a story with a happy ending. “Eighty percent of women treated for breast cancer today will be cured of their disease,” Rugo says. Sisters Crimmins and Stoulig urge women to be proactive — to know their bodies, get tested for the BRAC1 and 2 genetic mutations if they have a family history of breast cancer, have regular mammograms and find doctors they trust. The support of family, friends and other women can be invaluable. “(Susie and I) did the surgery at almost the same time, and (our sister) Deedee took care of us,” Crimmins says. “It strengthened us. We were close before, but we are extremely tight now. We know we can live a long life laughing.” For information and resources, Rugo recommends the websites of the National Comprehensive Cancer Network (www.nccn.org) and Living Beyond Breast Cancer (www.lbbc.org ).
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and depression that often accompany a cancer diagnosis. To help women recovering from a mastectomy rebuild strength and stay in shape, Marks suggests an exercise routine that includes core and lowerbody strength training. Marks suggests cycling as a cardiovascular workout, as it does not require use of the arms. After surgery, these women should focus on posture and breathing while limiting use of the arms and shoulders for the first few weeks, Marks says. “Movement starts at the core,” he says, “so you want to begin strengthening this area.” Marks demonstrates a hip tilt exercise, a gentle movement that strengthens back and abdominal muscles — the “core” muscles. Before undertaking this or any exercise program, consult your doctor, who may refer you to a physical therapist who will design an individual exercise program tailored to your body’s needs and your recovery.
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HEALTH & WELLNESS > BESTOFNEWORLEANS.COM > OCTOBER 05 > 2010
s a personal trainer at Velocity Sports Performance (4115 S. Carrollton Ave., 861-5000; www.-velocitysp.com), Jasman Marks merges his love for sports with his desire to help others. “I was pre-med in college, but I didn’t want to lose my involvement in sports,” Marks says. “I realized that sports science would allow me … a career between the two fields.” Marks graduated from Nicholls State University with a degree in sports science and is currently pursuing his master’s degree in kinesiology at Georgia Southern University. Marks often trains high school and college athletes, but fitness is important for everyone, even patients undergoing or recovering from cancer treatments. According to the National Comprehensive Cancer Network’s website (www.nccn.org), moderate exercise during cancer treatment can reduce patient fatigue by 40 to 50 percent, in addition to boosting cardiovascular health and alleviating the stress
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r. Ellen Zakris, director of radiation oncology at Touro Infirmary (1401 Foucher St., 897-8387; www.touro.com), addresses misconceptions about male breast cancer and shares advice on keeping the disease at bay.
How common is breast cancer in men?
Should they have regular breast exams?
It’s very uncommon. It’s a rare disease. There are 2,000 men diagnosed with breast cancer every year in the United States, and about 450 die per year. [Male breast cancer] is less than 0.5 percent of all male cancer deaths in the United States. I’ve probably treated 25 men with breast cancer, and I’ve been doing this for 20 years. I’ve treated about 1,000 women or more.
They should be aware of their body. If they have a family history or some of the other risk factors, they might want to consider doing breast exams or having their physician do it. Certainly if they feel a lump, they should bring it to their doctor’s attention. If their doctor blows them off and it doesn’t go away, they should ask to see a surgeon or someone who treats breast diseases.
What are some common misconceptions about male breast cancer?
What are the signs and symptoms men should be aware of regarding breast cancer?
What are the risk factors, and do they differ from those for women? They’re very similar. There seems to be a higher incidence of breast cancer if you’ve never been married, if you have liver disease or cirrhosis of the liver, if you’re Jewish, if you’ve had previous benign breast disease, if you have the BRCA2 (breast cancer susceptibility gene 2) genetic mutation, or if you have a family history (of the disease). If you have a genetic disease called Klinefelter’s syndrome, then you actually have a 20 to 50 percent higher chance of breast cancer. Breast cancer is higher in women who are obese, and that hasn’t been found to be a risk factor in men.
What should men do to prevent breast cancer?
Mass below the nipple, nipple discharge or any type of ulceration, tenderness in the breast or skin changes in the breast … can be an early sign of breast cancer. Other things are a lump under the arm, which would be a sign of a lymph node that has spread … or (a lump) below or above the clavicle. More common than breast cancer is something called gynecomastia, which is benign breast enlargement. A number of things can cause gynecomastia, from medicine to being overweight.
What are the common treatments for male breast cancer? To diagnose it, you do a biopsy. The main treatment is a total mastectomy with sentinel node biopsy. If (the cancer) is too advanced, then you can’t do a mastectomy; you might want to give chemotherapy first, or radiation. We treat (a man with breast cancer) very similarly to a woman with breast cancer.
What is the prognosis for men diagnosed with breast cancer? Stage per stage, it’s the same survival (rate for men and women). What that means is that if you’re stage one, you have an 80 percent chance of five-year survival. (Male breast cancer) is one of the diseases that should be picked up early. Men don’t have big breasts to examine, so if they get (breast cancer), you can feel it right away.
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HEALTH & WELLNESS > BESTOFNEWORLEANS.COM > OCTOBER 05 > 2010
First of all, men don’t even realize they can get breast cancer, so if they feel a lump under their breast or in both breasts, or under their arm or in their neck, or a skin change or nipple discharge, they don’t even think breast cancer. In fact, some physicians don’t even think breast cancer; they think there are other reasons for breast enlargement. Men may have to educate their physicians about (performing breast exams) if they have risk factors. Every man I’ve treated (for breast cancer) went to their primary care doctor with a lump, and it didn’t get diagnosed right away.
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Health & Wellness > bestofneworleans.com > OCTOBER 05 > 2010
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the uterus and cause premature labor, for example), the benefits can be vast. According to a study published in the Journal of Psychosomatic Obstetrics and Gynecology, depressed women who received massage during their second trimester reported lower anxiety, less pain and better moods than depressed women who did not receive massage. In addition, those receiving massage had reduced levels of the stress hormone norepinephrine. The same types of results have been reported for women who were experiencing otherwise normal and happy pregnancies. In another study, it was found that women receiving massage during pregnancy had increased levels of serotonin and dopamine, chemicals known to elevate mood, and decreased levels of cortisol, which is associated with stress. “Because prenatal massage is so nurturing and stressreducing, when a woman goes into labor, her baseline of stress is already lower, so the peak anxiety during labor remains relatively low,” Gary says. Prenatal massage also helps ease many of the typical physical complaints of pregnant women. A few massages during the second and third trimesters can increase range of motion, reduce swelling, relieve joint pain, reduce leg cramps and back pain, increase blood flow and circulation, alleviate headaches and sinus congestion and even ease the labor experience. Massage by a pre- and postnatal certified therapist also can be used postpartum to help speed recovery, shrink the uterus and speed fluid reduction. Although not all therapists require it, Gary asks that clients obtain a physician’s release before they come in. “I can communicate with my client and her physician as much or as little as she needs,” Gary says. Communication is key, especially since pregnancy brings up an abundance of emotions. For that reason, Gary speaks with each client before scheduling a massage. Gary also makes sure to keep the lines of communication open during the massage so expectant mothers feel comfortable speaking up if an area is sensitive or needs additional attention. Many families view prenatal massage as an indulgence they cannot afford, but another way to look at it might be as part of a healthy, preventative care routine — much like exercise and proper diet. Stress and pain have long been identified as factors in lowered immune systems and slow recovery times, so any reduction of these culprits can only be positive for the health of the mother and developing fetus. “I tell my clients that massage is not selfish,” Gary says. “It’s self-care.”
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Health & Wellness > bestofneworleans.com > OCTOBER 05 > 2010
ayla Gary, a massage therapist at East Jefferson General Hospital Wellness Center (3726 Houma Blvd., Metairie, 849-6868; www.ejgh.org), is the kind of person who inspires a sense of calm. Even without knowing she has 17 years of massage therapy and seven years of pre- and perinatal experience, nervous moms-to-be can sense they are in good hands upon meeting Gary. However, a calming demeanor isn’t the only attribute an expecting mother should look for in her massage therapist. Prenatal massage can yield benefits (including alleviating swelling and joint pain, easing the pains of labor and reducing anxiety and stress), but there are risks, like stretched ligaments or premature labor, if massage is improperly administered. Prenatal massage therapists must have specialized knowledge of the pregnant form and a thorough understanding of which massage techniques are beneficial and which may be harmful. In Louisiana, therapists attain a prenatal massage certification in order to practice. Gary also suggests that before they make a decision about which therapist to use, potential clients learn how long the therapist has been practicing, how long he or she has specialized in prenatal massage and what his or her philosophy is on positioning during massage. The position in which a pregnant woman is massaged plays a pivotal role in the safety and comfort of the experience. Although some therapists use a massage table that includes cutouts for the belly, breasts and face, lying prone can be uncomfortable. Allowing the belly to hang through a hole in the massage table can stretch out ligaments, which, unlike muscles, do not re-form to their previous shape. The weight of a hanging belly also can put undo strain on an already stressed lower back. In addition, women in their second trimester and beyond are discouraged from lying on their backs, because the uterus’ weight can inhibit blood flow to the heart and fetus, lowering circulation and reducing the baby’s oxygen intake. The solution that Gary and many massage therapists employ is designed to protect and relax both mother and fetus. To work on the front side of the body, Gary creates a wedge of pillows that lifts the head and torso to about a 45-degree angle and slips another wedge beneath the knees. In order to massage back muscles, she gently turns her clients on their sides and uses pillows to support the head, neck, belly and legs. These positions eliminate strain, worry and any potential harm. Although some caution must be used when giving and receiving a prenatal massage (massaging certain areas can stimulate
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