Global Health Tribune - March 2012 issue by Global Health Tribune

Global Health TRIBUNE

MARCH ISSUE - 2012

S er vin g: J upiter

SPECIAL SECTION

Colorectal month

Jerome Spunberg, mD “Saving Lives, Saving Sphincters” (The Role of Modern Radiation Therapy in Rectal Cancer) ............8

Boca Raton

Boynton

Lantana

Lake Wor th

Belle G lade

Wellington

w w w. g l o b a l h e a l t h t r i b u n e . c o m

Royal P alm Beach

P alm Beach G ar dens

Surgeon General: Nearly 4 Million U.S. Kids Still Smoke movin’ on mobility”

PAGE 6

Humberto CalDera, mD Current Management of Colon Cancer Medical Oncology Perspective ...10

palms West Hospital implements tobacco-Free Campus policy PAGE 8 SrinivaS Kaza, mD Colorectal Cancer..........13

CatHia rene, mD Colorectal Screening ....14

more than 600,000 middle school students and more than 3 million high school students smoke. and three out of four teen smokers will continue to smoke into adulthood, the surgeon general's report warned. PAGE 2

Healthy Kids of Jupiter and the Whistling moon travelers PAGE 11

more than one in 10 americans over the age of 12 takes an antidepressant, a class of drugs that has become wildly popular in the past several decades, u.S. government researchers said. PAGE 2

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2 MARCH ISSUE

• 2012

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CLINICAL RESEARCH IN PALM BEACH COUNTY

HEALTH AWARENESS, INC. and FAMILY PRACTICE ASSOCIATES By Erica Whyman

Jupiter, FL --- Ever wonder about the side-effects listed on the back of your monthly prescription, or how effective and safe your medication is? For each medication, it is often the result of years and years of laboratory and human clinical research. This type of important clinical research is being conducted right here in Palm Beach County. Health Awareness, Inc. founded in 1999, by Dr. Ron Surowitz in Jupiter, Florida, is a multi-specialty clinical research company that has been conducting successful clinical studies for over ten years. Health Awareness, Inc. coexists

with Dr. Surowitz’s family medical practice, Family Practice Associates. With 48% of Americans using at least one prescription drug, the safety and efficacy of drugs used to improve health and quality of life is of primary concern for most Americans. Clinical studies, such as the ones being conducted at Health Awareness, Inc. ensure consumers that prescription, generic and even over the counter drugs have undergone a series of trials before a medication or device can be sold in the consumer market.

Dr. ron Surowitz.

After years of laboratory based research for a drug, if successful,

the FDA grants approval for continued research and human based testing. Typically conducted in four phases, each clinical study and associated research must be sent to the FDA and approved prior to moving to the subsequent phase. Conducted according to an established plan, called a protocol, clinical studies are done basically to see if a new drug or device is safe and effective for people to use. Palm Beach County’s diverse population is a perfect location for clinical research and allows for a wide variety of study participants or volunteers. Health Awareness, Inc. has a state of the art 4,300

Surgeon General: Nearly 4 Million U.S. Kids Still Smoke Report says tobacco industry targets marketing toward children.

ore than 3.6 million children and teens in the United States smoke, according to a Surgeon General's report released that calls on the nation to curb youth smoking. "Today, all over America, there are middle-schoolers developing deadly tobacco addictions before they can even drive a car," said Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services (HHS), during a morning press conference. More than 600,000 middle school students and more than 3 million high school students smoke. And three out of four teen smokers will continue to smoke into adulthood, the surgeon general's report warned. Surgeon General, Dr. Regina Benjamin said "the report challenges us to end the epidemic of smoking among young people.

"Cigarettes are designed for addiction," she explained at the press conference. Added ingredients such as sugar, flavoring and moisteners make them even more addictive because they remove the harshness of tobacco. In addition, additives like ammonia make it easier for nicotine to get into the brain, she said. The report -- the first since 1994 to focus on young smokers -blames tobacco companies, specifically tobacco marketing, for the onset of adolescent smoking, noting that tobacco companies, despite claims to the contrary, continue to direct their ads at children. Dr. Howard Koh, assistant secretary for health at HHS, said it is no accident that "too many of our children are addicted and too many cannot quit and too many go on to die far to young." Koh said tobacco companies spend more than $1 million dollars an hour -- some $27 million a day -- on marketing and promoting their products in ways that make smoking look acceptable. These messages are particularly

prominent on the Internet, in movies and video games, he said. "The tobacco industry says its intent is only to promote brand choices among smokers, but there is a difference between stated intent and documented impact. Because regardless of intent the impact of tobacco marketing is to encourage underage youth," he said. According to the report, tobacco is the leading cause of preventable and premature death in the country, killing more than 1,200 Americans every day. For everyone who dies from tobacco-related causes, two new smokers under age 26 replace them, the

report said. Almost 90 percent of these new smokers smoke their first cigarette by the time they are 18, the report noted. "From 1997 to 2003 youth smoking fell rapidly, but since that time the rate of decline has slowed," Koh said. "In fact, there would be 3 million smokers today if we as a society had sustained the declines seen between 1997 and 2003." Many teens are also using other tobacco products and using several tobacco products together, he said. The report also provides more data on the addictiveness of cigarettes. The younger people are when they start smoking, "the more likely they are to become addicted and the more heavily addicted they will become," it said. Moreover, starting to smoke early in life increases the risks for the early development of cardiovascular disease and reduced lung function, the report said. "We can and must continue to do more to accelerate the decline in youth tobacco use," said Koh.

square foot medical facility equipped to handle extensive clinical studies, everything from Cholesterol to Osteoporosis to Arthritis to Diabetes. Health Awareness, Inc. can conduct studies in all four phases of clinical research, with its primary focus on phase II and III. Health Awareness Inc. is dedicated to offering the highest quality and integrity in the conduct of clinical trials. http://www.cdc.gov/nchs/fastats/drugs.htm For more information call Dr. Surowitz at Health Awareness 561-741-2033 or visit www.healthawarenessinc.com

Global Health TRIBUNE

Deborah lynn Staff Writer and Sales Executive (312) 351-2383 deborah@globalhealthtribune.com

erica Whyman Staff Writer and Sales Executive (561) 308-1428 erica@globalhealthtribune.com

GRAPHIC DESIGN / PHOTOGRAPHY Sergio Aguilar (561) 797-2325 ads@globalhealthtribune.com

CONTRIBUTING ARTICLES U.S. Department of Health and Human Services, ARA Content, Hispanic PR Wire, Centers for Disease Control and Prevention, METRO Editorial Services, Family Features © SEA PUBLICATIONS, INC. ALL RIGHTS RESERVED. Printed in United States.

Global Health Tribune is a newspaper published every month in Palm Beach county and surrounding areas. Copyright 2012, all rights reserved by SEA Publications, Inc. Contents may not be reproduced in any form without the written consent of the publisher. The publisher reserves the right to refuse advertising. The publisher does not accept responsibility for advertisement error beyond the cost of the advertisement itself. All submitted materials are subject to editing.

MARCH ISSUE • 2012 3

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There’s a Fungus Among Us Since its best not to itch, you don't have to suffer. Try these treatments for athlete's foot.

Take an antihistamine. It doesn't treat the fungus, but an over-the-counter antihistamine can simmer the irritating need to scratch. Arthur Hansen DPM, M.S.

h, how we love our most comfortable sneakers. You know the ones, the ones that are ‘perfectly’ broken in, the ones you have had for the last 6 years. Guess what? Someone else loves them too; the ubiquitous fungus we South Floridians have the pleasure of hosting. In our, oh so comfortable and broken-in sneaker, the warm moist environment is the most favorite place of the fungus Trichophyton rubrum. It thrives in the sweat and heat inside our sneaks multiplying to cause athlete’s foot.

Our feet stay in shoes most of the day with no air circulating, and the fungus grows. And once athlete's foot breaks out, scratching the maddeningly itchy irritations between the toes can cause a break in the skin, allowing a second, even more painful bacterial infection to develop. It burns, it itches, it hurts.

Wet it and dry it. Use an over the counter astringent, like Domeboro, to swab the infected area leaving the gauze pad on the site. As the gauze dries, it will draw moisture from the skin, aiding in the fight against infection. Toast those tootsies. After bathing, dry carefully between toes using a clean towel.

Get creamed. After drying well between the toes, apply an antifungal cream. It is best to apply the antifungal cream just prior to bedtime.

Dust those dogs. Take a few minutes twice a day to sprinkle antifungal powder like Tinactin or Lotrimin on your feet and in your shoes.

Sock it to ‘em. If your feet are prone to sweating, take an extra pair of cotton socks with you and change them midday.

Take a shoe break. Instead of wearing the same shoes every day—to the office or to work

out—give them a 48-hour break to allow them to air out. You might even leave them in the sun to help dry them out completely. While your shoes are on a break—and even on days when they're not—dust them with an over-the-counter antifungal powder or spray that contains an antifungal agent such as tolnaftate to kill any bacteria living inside the shoes. Athlete’s Foot can have an embarrassing side effect, it stinks! Try to control the foot odor with the following suggestions.

Go natural. Try to wear shoes made only from natural materials

like leather. Weatherproof and plastic shoes don't "breathe," creating the ideal environment for hostile fungi.

Watch what you eat. Like the spicy stuff? Got a taste for jalapeños and other hot stuff? In some people spicy foods can cause odor by making the feet sweat. It is best to wash your feet soon after spicy meals. Throw a tea party. Tannic acid, a substance found in tea, can help eliminate foot odor. Make some tea, let cool, then soak your feet. Ten minutes should do the trick to fight off odor caused by fungus and bacteria.

See your podiatrist. If after trying the above, you continue to have itching, burning and pain make an appointment with your podiatrist you may need a prescription strength antifungal.

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4 MARCH ISSUE

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Is Private Duty home care right for my loved one or myself? sudden loss or emergency, making adjustments all the more painful and difficult. Take a look at your options, your budget, and some of the alternatives.

What can help me stay at home? Sarah Hansen

any older adults prefer to stay at home as they age. But is this the right choice for you? The goal of home care is to help you remain at home as long as possible, rather than moving into a long–term care facility. It may be right for you if you only need assistance with your daily activities and enjoy a close network of nearby family and friends.

There is a wide range of private duty home care services that can help you maintain your independence within the comfort of your own home. Learn about your options, explore how to choose the right private duty home care service provider, and find tips for discussing concerns with your loved ones. It’s natural to want to stay at home as you grow older—most seniors hope to be able to. However, taking a step back to look at the big picture can help you decide whether staying at home for the long-term truly is the right step for you. Too often, decisions to leave home are suddenly made after a

You may be used to handling everything for yourself, dividing up duties with your spouse, or relying on family members for help. But as circumstances change, it’s good to be aware of all the private duty home care services available that might be of help. What you may need depends on how much support you have, your general health, and your financial situation.

Household maintenance Keeping a household running smoothly takes a lot of work. If you’re finding it hard to keep up, you can look into laundry, shopping, gardening, housekeeping, and handyman services. If you’re having trouble staying on top of bills and appointments, financial and healthcare management may also be helpful.

transportation Transportation is a key issue for older adults. Maybe you’re finding it hard to drive or don’t like to drive at night. Investigating transportation options can help you keep your independence and maintain your social network. You may want to look into local transportation such as buses, reduced fare taxis, and senior transportation options to appointments.

Home modifications If your mobility is becoming limited, home modifications can go a long way towards making your home more comfortable. This can include things such as grab bars in the shower, ramps to avoid or minimize the use of stairs, or even installing new bathrooms on the ground floor.

personal care Help with activities of daily living, such as dressing, bathing, feeding, or meal preparation, is called personal care or custodial care. You can hire help with personal care, ranging from a few hours a day to live-in care. People who provide this level of care include personal care aides, home care aides, and home health aides. Home health aides might also provide limited assistance with things such as taking blood pressure or offering medication reminders.

Health care Some health care services can be provided at home by trained professionals, such as occupational therapists, social workers, or home health nurses. Check with your insurance or health service to see what kind of coverage is available, although you may have to cover some cost out of pocket. Information on Medicare coverage in the U.S. can be found in the Resources section below. Hospice care can also be provided at home.

Day programs Day programs, also called senior

daycare, can help you keep busy with activities and socialization during the day, while providing a break for caregivers. Some day programs are primarily social, while others provide limited health services or specialize in disorders such as early stage Alzheimer’s.

Finding the right home care services for you Once you’ve figured out your needs, it’s time to evaluate what home care services are right for you.

Finding outside providers • Start with your networks. Sometimes the best referrals come through family, friends, neighbors, or colleagues. There may be a neighbor interested in brief check-ins or providing yard maintenance, for example. If you’re part of a local church or synagogue, there may be meals or socialization activities available. Ask the people you know if they have care providers they have used and trusted. Your doctor or other healthcare professional may be able to provide referrals as well. • Utilize older adult resources. Your local Area Agency on Aging, Eldercare resources, or senior centers are good places to start. For home health care you should check with your doctor or other healthcare professional to get the referral process started, and find out exactly what is covered by insurance.

agency or independent provider? As you search for home care services, especially personal care and health care, you will probably start getting referrals from full-service agencies, registries, and independent providers. Which is the best option? Here are some issues to consider when considering an agency, registry, or independent provider. • Full-service agencies and registries usually provide prescreened applicants who have already had background checks. Since the caregiver works for the agency, tax issues and billing can be simpler. You can also check the licensing history of agencies and find out if they are bonded for issues such as theft. If a caregiver quits or is not working out, a replacement can be rapidly provided, and coverage may also be provided if a caregiver calls in sick. • Independent providers come at a lower cost, but require careful legwork on your part. You need to be aware of any tax and Social Security requirements since in most cases you will be hiring a home care helper as an employee. It’s also good to consider careful background checks and identity verification, since there is no independent verification. You are responsible for backup coverage in case of illness or sudden termination. Even if you are considering these options due to a word of mouth referral, it’s good to be aware of these.

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MARCH ISSUE • 2012 5

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A True Gift… To Any Cancer Survivor By Deborah Lynn

ave you ever met someone that puts their heart, soul and every ounce of energy into helping others? Judy Armstrong is the epitome of such a statement and I was fortunate enough to meet with her recently as she discussed survivorship and the development of a new clinic to help cancer patients navigate through their journey.

Judy is a Board-Certified Advanced nurse Practitioner at South Florida Radiation Oncology in Palm Beach Gardens. She is also a blessing to any cancer survivor that is fortunate enough to have her at their side, a guardian angel of sorts. As with any guardian angel, they need someone to watch over - to guide - to give them the strength to believe. She believes in all of her patients… her survivors. You see, Judy feels that once a patient is diagnosed with cancer, they are a survivor. Others may consider you a survivor after treatment or five years. Regardless of which definition you prefer, as long as someone chooses to fight, they are in fact, a survivor. In the coming months, SFRO will be opening a new cancer survivorship clinic which will be located on the same grounds as

their office in Palm Beach Gardens. Judy and the entire staff will help survivors navigate through their initial diagnosis and prepare them for what’s to come. The clinic will offer just about everything you would need to help you through such a difficult fight. They will offer numerous types of alternative therapies such as; acupuncture, physical therapy, massage therapy, psychotherapy, as well as studied therapies. In addition, they will offer nutritional advice, meditation; yoga, a hair stylist, and a research library with computers and literature to help you better understand your disease. There are also a number of support groups that are currently in place. Studies clearly prove that people who have support in their lives do much better than those that have none. Sometimes when people find out they have cancer, they turn to spirituality as it’s an awakening. “They need to realize that from the day of their diagnosis, their life will never be the same. They make decisions differently; they will choose things differently because just about everything has changed. They may decide to go on a vacation that they never would have or spend more time with kids as they normally wouldn’t, just things like that.”

Judy Armstrong, ARNP, OCN Certified Family Nurse Practioner Oncology Certified Nurse Judy Armstrong is a Board-Certified Advanced Nurse Practitioner and a graduate of the Peter Bent Brigham School of Nursing in Boston. She completed her Bachelor of Science degree in Nursing at Framingham State College in Massachusetts and her Master’s degree in Nursing and Nurse Practitioner education at Florida Atlantic University. Since the new location will not be ready for a few months, the therapy is currently being done in the SFRO office. “Patients need to realize that once they are diagnosed, time is of the essence. Some people think that going for a biopsy in four weeks is the appropriate step, but that is simply not the right way to deal with the diagnosis.” Unfortunately, the individual that answers the phone at your physician’s office is unaware of your diagnosis. Therefore, it’s important to let

them know that you need an appointment right away. “When someone has cancer, they need to be moved through the system much quicker. Often patients that have had cancer are fearful that with every ache and pain the cancer may have returned. That is why it’s very important for them to do the follow-up as each cancer will have a different type.” Judy and her staff strive to help patients understand what to expect from the treatments and what life will be like afterwards.

In addition to being there to help guide you through the initial diagnosis, helping you through the entire treatment and post treatment, they will also try to help you find financial assistance. There are many foundations that can help you pay some of your household bills, one of which is the Cancer Alliance of Help and Hope (CAHH). As Judy is a volunteer committee member, she will absolutely try her best to find a way to not only get the support you need, but the monetary help you need as well. To date, these organizations and foundations have helped Judy with a number of patients and continue to do so. “I can call them and say, I need your help with this and they’re there. I also work with Caridad and help with immigration patients also with Project Access, which is supported by the Palm Beach Medical Society.” “Our goal is to use a foundation and get donations and charge the patients from little to nothing by having fundraisers. It’s a huge effort, but this is my baby. My job is my life.” For additional information about Judy Armstrong, ARNP, OCN or South Florida Radiation Oncology, you can visit their website at www.sfrollc.com.

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6 MARCH ISSUE

• 2012

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Movin’ On Mobility By Erica Whyman

ndrew Goodyear is one of those people who is lucky enough to get up every day to a career he is passionate about, and one that makes a positive impact on people’s lives. More than just a difference, in some instances, he gives people a life that was otherwise unattainable.

Goodyear is the owner of Wheelchair Getaways and Movin’ On Mobility, both companies dedicated to finding customized vehicle solutions for those with disabilities. He was gracious enough to spend some time telling me about his companies and the hour I spent chatting with him and his staff made a positive impact on my life. “We are like the Hertz of van rentals for those with disabilities,” says Andrew with a smile, when explaining Wheelchair Getaways. In 1988 Andrew was preparing to travel from Virginia to South Florida for a wedding, and found very quickly there was a gap in the market in South Florida for people to rent vans that were wheelchair accessible. Andrew, a quadriplegic at age 17, said he was surprised, that especially in South Florida, an area that markets to tourists and seniors, that there were not any rental options. The sentiment was echoed when he began calling around to medical supply companies and even the chamber of commerce. People kept saying that while they did not know of a company that rented wheelchair accessible vans, they did get many calls requesting the very same thing. In 1991, Goodyear opened a Wheelchair Getaways franchise in South Florida. He purchased the territory rights from West Palm Beach to Miami Dade as well as the naples and Fort Myers areas. In 2003 with his now business partner, Rod Alt, Goodyear expanded his business to a partnership in Movin’ On Mobility, a company that customizes vehicles specific to the needs of those with disabilities. The business specializes in the sales of new and used wheelchair vans as well as the installation and service of scooter and wheelchair lifts, hand controls, electronic driving controls, and turning automotive seating.

“We are like the Hertz of van rentals for those with disabilities,” says andrew with a smile, when explaining Wheelchair getaways. “Often times when I meet a new customer for the first time, I see a sense of relief come over them, says Goodyear, or he hears comments like, “as soon as I saw you, I knew I was in the right place.” This is because at the end of day Andrew truly does understand, because he lives with a disability every day. Goodyear’s goal is to find the right mobility solution for each customer. This solution may be different for someone with a new injury, a temporary injury or someone whose disability may worsen with time. He will often rent accessible vans to customers prior to them purchasing, so they can be positive that a customized vehicle meets their needs.

The technology is very impressive and continues to evolve, allowing for more streamlined equipment and increased functionality for the user. I was personally impressed with Andrew’s own personal van, which to me, looked more SUV than mini. In a matter of seconds, he opened the van and was in the driver position ready to start the ignition. Goodyear is a passionate man, yes about his business, but more about the people he helps. He shared many accounts of customers who he has been able to “get in a van,” and the positive difference it has made in their lives. He really lights up when speaking about his hopes for a future charitable foundation that raises money to

donate wheelchair accessible vans to those who cannot afford them. “An accessible vehicle has the ability to give someone hope, a life, the ability to work, all basic desires…” effuses Goodyear. What else makes Andrew tick? Football, that is coaching football. Goodyear has been a Pop Warner youth football coach for the past 15 years in Jupiter. He has coached kids as young as 8 and as old as 15. One of his favorite things is being out and hearing a kid, now all grown up, yell, “hey coach,” and come over to talk about the positive experiences he had while playing on his team. As Andrew saw me to the door, I had the sense that I had just spent an hour with a friend, and maybe I had. To learn more about Movin’ On Mobility and Wheelchair Getaways visit www.movinonmobility.com or www.wheelchairgetaways.com or call (561) 881-5600.

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MARCH ISSUE • 2012 7

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Palms West Hospital Welcomes New Chief Executive Officer

oxahatchee, Florida, March 6, 2012 - Palms West Hospital is pleased to announce that Eric Goldman has joined the hospital as Chief Executive Officer. Eric comes to Palms West from Memorial Hospital in Jacksonville, an affiliate HCA facility, where he was the Chief Operating Officer since 2006.

Being involved in the community is important to Eric. He most recently served as Chairman of University of north Florida Healthcare Administration Program and is on the board of Directors for The Blood Alliance, Blood Bank and Martin J. Gotleib Day

DEAR DEBORAH: I’m a 40 year old divorcee with three children and I haven’t gone on a date in three years. Believe me, I’m attractive, funny, nice, dress well and I think I’m a good catch. I am ready to meet my next husband, but I don’t want to go through the dating process. Do you recommend any places to just meet and marry? - I’m Ready Dear I’m Ready: That’s a lot to ask for in one paragraph. What is wrong with dating? That is such an exciting time in the relationship - when you are just getting to know someone new and everything is fresh and exciting. However, since you are only interested in finding a husband, then my advice to you is to join a dating website, write a very detailed profile and include exactly what you are looking for... a husband!!!

Eric has 17 years of healthcare experience with HCA. Prior to moving to Jacksonville, Eric was Chief Operating Officer at Columbia Hospital in West Palm Beach. Eric received his Bachelor’s degree at Ohio University in Athens, Ohio and a Masters of Health Science in Health Finance Management at The John Hopkins University in Baltimore, Maryland.

Dear Debora h

eric goldman.

School. He was also an inaugural participant in United Way’s Stein Fellowship Program. Michael Joseph, President of HCA East Florida Division explains “We are pleased that Eric has joined the Palms West family. His extensive healthcare background, drive and enthusiasm make him a perfect fit for the hospital and the community.” Eric will start at Palms West Hospital on March 19th.

DEAR DEBORAH: I went out with my boyfriend and a girlfriend last week. While I was in the restroom, he asked her for her phone number and she gave it to him. I just found out about it yesterday when she had an interview with my company and he called her to wish her luck! I feel that this is wrong on many levels.

I am really upset with him, but also with her. He doesn’t need to be friends with my friends. I already have trust issues because I have been cheated on in the past and he knows that. Why would he ask her for her number and why would she give it to him? Do I need to keep all of my girlfriends away from him? - Wrong on all levels Dear Wrong on all levels: I can only imagine why he asked her for her phone number while you were nOT around. My concern is that he asked her behind your back and that she gave it to him. If he didn’t have an ulterior motive, he would have asked her in front of you. Since you have trust issues from previous relationships and he is aware of this, he should be more cognizant of your feelings. I would probably have a talk with both of them. Unfortunately, there is really no way for you to find out if they are currently talking, short of them telling you. Since you are already experiencing trust issues with him, I feel that you are wasting energy that could be applied elsewhere, or perhaps to someone else. If you do not feel that he is being honest and monogamous, then you have to let him go. The same goes with your friend. If you feel as though she is not being completely honest about this situation, then perhaps you should rethink her

friendship as well. Remember, you need to surround yourself with people that make you happy and inspire you. Good luck. DEAR DEBORAH: I met a really nice guy and we spoke on the phone a few times. He’s 46, divorced, has two kids and from what he said, he doesn’t want to get serious with anyone since he’s still recovering from taking a big financial hit in the divorce. The problem, he has an on-again, off-again girlfriend, but I really like him. Do you think I would be terrible if I went out with him? - Is he taken? Dear Is he taken: If he has a “girlfriend” wouldn’t that imply a relationship? I would first put myself in her place and see if it would bother me if my on-again, off-again boyfriend went out with another woman. Then, if you can get past that and really want to go out with him, you can wait until he is “off-again” with his “girlfriend” and go out with him then. However, you also need to realize that in doing so, you are leaving yourself open and vulnerable to a man that has clearly told you that he is unavailable mentally, emotionally and part of the time – physically.

Dear Deborah is a monthly advice column written by Deborah Lynn with a common sense approach to dating. If you have any questions or comments, please forward them to: questions@globalhealthtribune.com as we would love to help.

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8 MARCH ISSUE

• 2012

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“Saving Lives, Saving Sphincters” (The Role of Modern Radiation Therapy in Rectal Cancer)

Jerome J. Spunberg M.D., FACR, FACRO

olorectal cancer is the fourth most common cancer in the United States in both men and women, with more than 143,000 new cases predicted for 2012. The term “colorectal” actually comprises two different entities that are often treated very differently. They behave differently, having different patterns of spread and a different prognosis for each stage at presentation. In particular, radiation therapy frequently plays a major role in the treatment of rectal cancer, both in terms of increasing survival rates and improving the quality of life of our patients through preservation of the anal sphincter, thereby eliminating the need for a permanent colostomy (a bag attached to the front of the abdomen to collect the feces). Modern cancer treatment often involves what we call “multi-disciplinary care,” whereby multiple specialists such as surgeons, medical oncologists (chemotherapy specialists), and radiation oncologists work together to maximize the chances for success by combining our particular areas of expertise. Rectal cancer is an excellent example of this process! The rectum is defined as the last portion of the large intestine, the portion of the bowel extending from the sigmoid colon to the anal canal. Its major function is to store the stool prior to elimination, and the muscle that controls this process is called the anal

sphincter. The type of surgery that is necessary for the removal of a cancer arising in this region is very much dependent upon the exact location of the tumor – the closer it is to the critical anal sphincter (a low rectal cancer), the more likely it is that an APR (abdominoperineal resection) will be required which involves a permanent colostomy. If the tumor is located far enough away from the anal sphincter (an upper or mid-rectal cancer), then a different surgical procedure called an LAR (low anterior resection) is feasible and will avoid the need for the colostomy as the sphincter is preserved. Many cases are “borderline,” that is, the cancer is just a little too close for comfort to spare the sphincter but, with a little shrinkage, it might just “make the cut.” That is where radiation therapy, with the help of concurrent “sensitizing” chemotherapy, comes in! Pre-operative radiation therapy, with help from sensitizing chemotherapy (often with a wellknown drug called 5-FU, or sometimes with an oral version known as “Xeloda”), can frequently allow these borderline patients to become eligible for sphincter-saving procedures. The usual course of treatment lasts around 4-5 weeks, and is very well tolerated with only mild to moderate, usually temporary side effects. Using modern radiation therapy techniques, such as IMRT (Intensity Modulated Radiation Therapy) or IGRT (Image Guided Radiation Therapy) or both, the side effects are much reduced and often eliminated completely. Then, the patient is re-assessed after around four weeks or so and a decision reached as to whether the sphincter can be spared, making some fortunate patients (and their treating physicians like me) very happy indeed! For other patients with rectal cancer, surgery can be performed immediately after diagnosis and

Treatment of colon cancer depends on the stage, or extent, of disease

Rectal mucosa

Columns of Morgagni

Levator ani Muscle external sphincter ani Muscles deep

dentate (peclinate) Line

Subcutaneous Skin Superficial

Squamous Mucosa

Normal

Rectum

Stage I

Stage II

Stage III

dentate line anal crypts

Stomach

Small intestine Colon

Rectum

Lymph nodes

anus

then post-operative radiation therapy and chemotherapy may be utilized to increase the chances for long-term survival and cure. Once again, modern treatment techniques such as IMRT help to make the course of radiation therapy much more tolerable and with a greatly reduced risk of complications. The major factors determining whether radiation therapy is needed are the depth of penetration of the tumor

into the wall of the rectum and if the cancer has spread into the regional lymph nodes. These factors are expressed in the term “staging,” usually using the “TnM” system, which stands for Tumor, nodes, and Metastasis. Patients, based upon the findings at the time of surgery, are given a staging designation, such as T2 n1 M0 for example, which helps to define the best treatment for that patient afterwards.

anal canal

Internal sphincter

external sphincter

All patients should be appropriately staged, and you, as a colorectal cancer patient, should know your own stage. Stages are often also grouped together into simpler categories, such as Stage I, Stage II, Stage III, or Stage IV to make it easier to report on treatment results. With the appropriate use of post-operative radiation therapy, clinical research studies have consistently demonstrated improved rates of local and regional control of disease in the pelvis as well as survival. Much is known about rectal cancer, but clinical trials continue in order to improve upon these already favorable outcomes for many patients. Survival is extremely important, but so is quality of life, and anal sphincter preservation is an excellent example of how modern cancer treatment can offer optimal function and cure at the same time. Make sure that you receive the best treatment possible the first time around, as recurrences are often more difficult to treat and cure. Seek out the best physicians and facilities with the most modern, up-to-date equipment and staff to give you the best chance to “save your life and your sphincter!”

Palms West Hospital Implements Tobacco-Free Campus Policy Loxahatchee, Florida, February 15, 2012- Palms West Hospital will become tobacco-free on March 5, 2012. As of this date, we are implementing a new policy in which we will not permit the use of cigarettes, cigars, chewing tobacco or pipe smoking on our campus. As a healthcare organization, we are committed to the health and safety of our patients, employees, physicians, and the community. We believe that we have a responsibility to take a leadership role on this major health issue, and establishing the campus as tobaccofree firmly supports that belief.

The US Surgeon General has confirmed that exposure to secondhand tobacco smoke is a serious health hazard and that there is no risk-free level of exposure. Tobacco use in and around hospitals poses health and safety risks. Palms West Hospital’s decision to go tobacco-free is not an attempt to force anyone to quit using tobacco products. Rather, the tobacco-free initiative is a concrete way to demonstrate our ongoing commitment to healthy living. We are asking for community support and understanding as we launch this initiative.

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10 MARCH ISSUE

• 2012

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Current Management of Colon Cancer Medical Oncology Perspective However, most patients with occult blood in the stool will not have colon cancer. They may have benign problems such as hemorrhoids, polyps, diverticulosis, or other conditions.

Dr. Humberto caldera MD. Medical Oncologist Hematologist

olon cancer is a disease that we treat with a multidisciplinary team. There are several physicians that get involved in the treatment of patients with colon cancer: the primary care physician, gastroenterologist, surgeon, medical oncologists and the radiation oncologist. All of those providers are usually involved in the diagnosis and care of patients with colon cancer.

Most patients with colon cancer are asymptomatic upon diagnosis. This is a malignancy that is highly curable if detected early, before it has had time to spread. Malignancies of the lower gastrointestinal tract are often referred as colorectal cancer, but they are actually two different entities. There is rectal cancer, and there is colon cancer, and each is treated differently. I would like to concentrate on colon cancer for this article. The ideal colon cancer patient will be someone that is following up with his or her primary care physician and follows routine advise such as checking blood counts at least once a year and screening colonoscopies as per practice guidelines. In general, for someone who has no family history of colon cancer or other risk factors, the guidelines suggest screening after 50 years of age, and every five years, or sooner, if there are other risk factors, such as certain kind of polyps or a positive family history. That is the general screening process for a patient that is asymptomatic, has normal blood work and nothing else going on. However, there will be many others that may need screening sooner, if other risk factors do exist. A common form of presentation of colon cancer and other gastrointestinal malignancies is the presence of anemia and occult blood in the stool. Those are patients that don’t realize they are losing blood in the stool and on routine blood work they are found to be anemic. Further studies may show that their iron levels are low. Those patients need a colonoscopy. They may have silent colon cancer that is causing a minute bleeding every day and over time they can develop anemia, which is usually asymptomatic.

The primary care physician will order either a routine screening colonoscopy, or other studies prompted by the discovery of anemia. These are outpatient tests performed by the gastroenterologist. Routine colonoscopy is often refused by the patient due to the invasiveness of the procedure or issues with the pre-operative preparation. It is our job as physicians to emphasize to the patients the importance of routine screening colonoscopy to detect early stage colon cancer. Our hope is that patients eventually understand that the colonoscopy is as useful and necessary as the Pap smear and mammograms are for early diagnosis of cervical and breast cancers. Once the gastroenterologist performs the colonoscopy, if any lesions are found, a biopsy will be taken right there. The biopsy goes to the pathology lab, and if the results turn out to be consistent with malignancy, then the surgeon, oncologist and radiation oncologist will become involved. The primary treatment for any patient that has been diagnosed with colon cancer is surgery. But adequate staging needs to be done first. This includes a CAT scan of the abdomen, pelvis and most of the time, chest. Routine blood work, including determination of carcinoembriogenic antigen (CEA) is mandatory. Most patients will have early stage disease and will be referred to the surgeon, who will perform either laparoscopic or conventional (open laparotomy) resection of the tumor. The surgeon will remove lymph nodes around the tumor as well. This is a very important step for an accurate diagnosis and staging of the patient. The involvement of lymph nodes will usually indicate a more advanced staging and the need for further therapy, in addition to surgery. Depending on the characteristics of the tumor and the extent of the disease, the surgeon may need to perform a colostomy at the time of surgery. Thankfully, most patients will not need such a procedure. Once the surgery is performed, the specimen will be sent for pathology evaluation, and usually within a week, the results will become available. That is when the patient will see the medical oncologist. For the most part, when I see a new patient with colon cancer, they have already had surgery and they are coming to discuss

the pathology results. We will then review the size of the tumor, the aggressiveness of the tumor, and very importantly, the involvement of the lymph nodes. If the lymph nodes are not involved, the patient will have stage one or two colon cancer and no further treatment will be needed. Therefore, the treatment is completed with surgery and the patient now goes onto surveillance, which means physical examination and blood work every three to six months and a colonoscopy within a year. If the colonoscopy is clear, then they will have another test in two years, three years, and every five years thereafter. Someone with a history of colon cancer has a high risk of developing a second colon cancer later in life. Having colon cancer will imply that the patient will be under surveillance for a long time. Most of the patients with early stage disease have a very good prognosis and will not relapse. Patients with involved lymph nodes (stage III disease) at the time of surgery, have a different outlook. If only a few lymph nodes are involved, the prognosis is better. For these patients, the standard treatment is preventive (or adjuvant) chemotherapy, which is given every other week for about four to six months to prevent the reoccurrence of cancer at a later time. A patient with stage three colon cancer that has surgery and adjuvant chemotherapy usually has a cure rate of about 65%. However, there will be some patients, particularly those with multiple lymph nodes involved, or large tumors, or those who presented with intestinal obstruction or perforation, in which the prognosis will be fairly worse. After the chemotherapy is completed, these patients will need intense surveillance for the next five years. This includes multiple physical exams, imaging and endoscopies studies. The less fortunate patients are those with stage four disease, or metastatic disease. This means that the tumor has gone beyond the lymph nodes. It could be one spot on the liver, or multiple spots on the liver, lungs, or spots in other places. Those patients are treated with chemotherapy and for most of them, the treatment is palliative. This means we cannot cure it, but we can try to improve their quality of life and survival. With newer technologies and treatment strategies, we have made significant progress, although there is much work to be done and we are far from curing most of the patients. nowadays, a standard patient

with stage four have an average survival rate of about 30 months. When I say average, I mean 50% of the patients will live longer and 50% less that the average number. It is not unusual to see patients in daily practice that are currently living four, five, six years, and beyond. Without therapy, they would not live that long. Before we had the drugs that are available today, the average survival was only six to nine months. We are going in the right direction, but we are not there yet. The newer drugs are less toxic and more effective. There are some patients with stage four colon cancer that are curable with aggressive treatments. Those are patients with small or limited number of metastatic lesions that can be surgically removed. In some patients with limited metastatic disease, surgery is not possible due to the anatomic location of the lesions or because the patient is not a good surgical candidate. Those patients can benefit from newer techniques in radiation therapy such as CyberKnife. There are other modalities, including radio frequency ablation or trans-arterialchemo-embolization (TACE) of liver lesions that are used for selected patients. The abovementioned treatments can offer cure or extended (prolonged) survival and improved quality of life to some patients with metastatic disease. In the field of medical oncology, the more exciting developments are in molecular biology and genetics of cancer. Targeted therapy is now available for the treatment of patients with metastatic disease. These drugs are better tolerated and do not generally affect the good cells of the body. In other works, the blood counts will not usually be affected, and the patients will not lose their hair while being treated with these drugs. There are several well-recognized targets in patients with colon cancer. A very common mutation in patients with colon cancer is called, KRAS, or Kirsten rat sarcoma viral oncogene homolog. In patients with a non-mutated KRAS (wild type), we can use a medication that targets the Epidermal Growth Factor Receptor (EGFR) with little toxicity and very good success for long-term survival. Another popular drug that we use in combination with various chemotherapy regimens is called Bevazucimab ( Avastin), that targets VEGF, or Vascular Endothelial Growth Factor . This particular drug targets the mechanism for which a tumor can spread by creating microscopic

blood vessels and communicate with the patient’s own circulation. newer technologies will allow us to “personalize” the treatment of colon cancer. In other words, in today’s world, if a patient comes to our practice with stage III or IV colon cancer, we base our assessment and treatment recommendations on statistics and clinical trials on similar patients, but we cannot tell that particular patient what his or her own risk of developing metastasis and long-term survival or cure rates are. We are hoping that, in the upcoming years we will have tests that will give us information about the genetic content of an individual tumor and its potential behavior, hence allowing us to determine what the prognosis will be for that particular individual, as well as the potential benefit of different chemotherapy drugs, and what targeted therapies will be more adequate. The way I envision we will practice oncology in the future is that when a patient comes to see me, I will be able tell: this is what you have, these are the targets, and these are the right drugs for your particular problem. We are getting there, just not yet. For some patients with malignant diseases this is already happening today. It is not uncommon to see patients in our daily practices enjoying prolonged survivals with good quality of life, even with stage IV disease. There are medications out there to treat cancer that patients are using the same way they use their cholesterol or antihypertensive pills. There are multiple newer anticancer medications in oral forms. We currently have pills approve for use in patients with breast cancer, leukemia, lung cancer, kidney cancer, gastrointestinal malignancies, melanoma, and there are many others in clinical trials. My message to our patients is not to give up and to keep on fighting. You never know when the next discovery applying to your particular disease will come around and change your prognosis and life expectancy dramatically. Over the past decade, tremendous advances have been made and we now can give hope to many patients that only few years back didn’t have any. A cancer fighter and survivor will stimulate and influence the life of many others around. Every step given by the patients, families, researchers, and medical providers will count towards this marathon race that is the fight against cancer. For additional information regarding Dr. Caldera or Hematology Oncology Associates, you can visit the website at www.hoapb.com.

MARCH ISSUE â&#x20AC;˘ 2012 11

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Healthy Kids of Jupiter and The Whistling Moon Travelers Erica Whyman

Jupiter, FL--- Healthy Kids of Jupiter, a community based awareness and education initiative with the ultimate goal of preventing obesity in our community, hosted a fun-filled family event on Saturday February 11th. Wylders Waterfront Bar and Grill, overlooking the Intercoastal, served as the perfect location to enjoy the day. The adults enjoyed live music by the very talented band, The Whistling Moon Travelers, while the kids were entertained by balloon benders, tattoo artists, fun give-aways and prizes. The Whistling Moon Travelers set the mood by performing a mix of Loxahatchee River Blues, lockabilly, and Country-influ-

enced Rock. The band which has been performing together for six years performs to support local charitable causes; they donate their fees to the cause as well as encourage additional fundraising efforts. The two groups, Healthy Kids of Jupiter and The Whistling Moon Travelers make a perfect match, serving the charitable and admirable causes of our community. To learn more about the Healthy Kids of Jupiter or check out upcoming events visit their website www.healthykidsofjupiter.org. The Whistling Moon Travelers consider Harry & The natives" in Hobe Sound their home base, but you can learn about future performance at www.myspace.com/thewhistlingmoontravelers or check out their face book page.

the Whistling moon travelers: lynn mullings: Lead Vocals (Mom and Lynn and her husband own armory MMa training facilities in Jupiter and Wellington), ray beane: Keyboard (Physical Therapist at Jupiter Medical Center), mark brooks: Bass (Land Surveyor), bud vereen: drums (Pharmacist), tom Kelly: guitar (airline Pilot), Nancy Kelly: Vocals, not pictured (Mom and art Teacher). Band Members Not at Event: Tom Larkin: Full Time Bass Player (Physicians Assistant and Lt. Col. In the Army Reserves)

Hematology Oncology Associates We specialize in all areas of Medical Oncology, benign and malignant blood disease, and coagulation disorders More than 35 years of experience in Palm Beach County Fully bilingual practice with 3 offices (Wellington/Loxahatchee, Lake Worth, Boynton Beach) and inpatient coverage for Palms West Hospital, Wellington Regional Medical Center, JFK Medical Center, and Bethesda Memorial Hospital.

3450 Lantana road Suite 100 Lake Worth, FL 33462

561-965-1864

Eight Board Certified Hematologist Oncologists and 1 ARNP roger D. rosenstock, M.D. Surendra K. Sirpal, M.D. William L. Sternheim, M.D. Eduardo A. Garcia, M.D. Arunachalam thenappan, M.D. Humberto J. caldera, M.D. Miguel Araneo, M.D. Jose A. ortega, M.D. Jessica D. Portu, ArnP

2300 S. congress Avenue Suite 103 Boynton Beach, FL 33426

561-732-2440

12993 Southern Blvd. Suite B Loxahatchee, FL 33470

561-793-0106

12 MARCH ISSUE

• 2012

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A Visit To The Doctor should I just do what the patient actually came into my office for: which is chestpains. I soon come to a decision in a split second (which I am used to) and opted for the latter. The EKG turned out normal, the examination was normal too but the patient had all the signs and symptoms of angina or impaired blood flow to the heart that causes chest pain. After a thorough explanation, the patient is in complete disbelief, stating “I have no chest pains now, so I should be fine!”. After much explaining I convinced the patient. Shekhar V. Sharma, M.D. Board Certified in Internal Medicine

am writing this article to give readers an understanding of patient doctor interactions within an examination room. Many a time a patient walks into my office (an unscheduled walk in) with chest pains. In the exam room the patient states that he is “doing fine”.

The patient is a smoker with a history of non-compliance with his medication. Apparently, he is not a fan of physicians, is an unhealthy eater and begins to tell me what tests he would like for me to order, as he is up-to-date on his online medical knowledge. He states that he is only interested in having an exam, EKG (electro cardiogram) and blood work, but nothing more. Furthermore, he also wants me to take care of all of his other issues in this visit. For a brief moment I think: “Should I tackle all this patient’s problems in this visit?” or,

I convinced the patient to get a stress test done. My staff has to call his insurance company to get an approval for various tests to be done as well as a referral to another specialist / imaging center ASAP. I then have to think of other dangerous health issues in the patient that could have caused the chest pain. Could this patient have had a clot in the lungs? If so, does this patient have clots in the legs? Is this pain related to a gastric issue? In the meantime, my staff is put on hold by the insurance company of which denies the stress test for reasons unknown to me at that time. Later, I found out that this insurance company sent a letter to the patient that the physician did not supply enough information to get the stress test approved.

For most insurance companies it has always been a matter of saving money and appeasing the patient by blaming ‘The Doctor’. The patient now walks out of our office blaming our staff for something that is in the hands of his insurance company. The next day the patient had another episode of chest pains and goes to the emergency room. The ER admits the patient and the cost incurred by the insurance company for this hospital visit amounts to ten times more than an outpatient office work up. In the next examination room is seated another patient who has come in with severe fatigue that she has had for a certain period of time. Fatigue is a symptom that should be taken seriously and not be simply brushed aside. I immediately have to think of all the various causes for this symptom. I decided to run some labs and an EKG. The EKG is to rule out cardiac arrhythmia. Labs are done to rule out anemia, hypothyroidism, diabetes mellitus etc. At this time, I have to use my clinical chess mind to make the right moves to come to proper diagnosis. Patients often tell the staff that their problem can be analyzed in ten minutes. How can a good doctor examine a patient, do the necessary tests, make the required referrals, prescribe the right medications, check the patient’s medical history, allergies, medications all in ten minutes. That is an impossible feat. In the meantime, other patients have to wait.

They may have simple issues or complex issues and I will never know that until I see them in the examination room. The entire day goes on in this manner where some patients have to wait longer due to the complexity of the problems that arise in the examination room. Physician patient encounters are not like appointments you may have with an attorney or your beautician. The encounters are complex in nature and time cannot be an issue. As an experienced physician I have to reiterate that practicing good medicine is like a game of chess, and then thinking through a complex maze and finally hitting the mark is not as easy as it may sometimes seem. To all my patients out there who have come to me with complex issues to solve, I appreciate your patience and understanding.

Dr. Sharma is a board certified internist that has been in practice for the past 19 years. His office is accepting new patients: palomino park, 3347 State road 7 Suite 200 Wellington, Fl 33449 and for an appointment please call

(561) 795-9087 Dr. Sharma's office in belle glade is at 1200 South main Street, Suite 100 (opposite the old glades general Hospital). He will be seeing patients at this location along with his nurse practitioner grace vanDyk. He is currently accepting new patients and the office accepts most insurances.

Call

561-996-7742 for an appointment.

PalM Beach PriMary care aSSOciaTeS, iNc. State of the Art Office Building with Imaging Center,

Shekhar Sharma M.D. Grace VanDyk A.R.N.P.

Medicare patients accepted

Southern Blvd.

MEDICARE, BLUE CROSS BLUE SHIELD, HEALTH CARE DISTRICT AND MOST MAJOR INSURANCES ACCEPTED On Staff: At Palms West Hospital, Wellington Regional Medical Center

Palomino Park

PALM BEACH PRIMARY CARE ASSOCIATES

Lake Worth Rd.

Florida’s Turnpke

The Mall at Wellington Green

State Road 7 (441)

Forest Hill Blvd.

9 AM - 5 PM MONDAY - FRIDAY SAME DAY APPOINTMENTS AVAILABLE 24 HOUR SERVICE AVAILABLE

SPECIALIZING IN: • Diagnosis of Complex Illnesses • Cholesterol Management • Diabetes • Cardiac Care • EKG/24 Hour Heart Monitoring/Spirometry • Hypertension • Geriatric Concerns • Osteoporosis ACCEPTING NEW PATIENTS

3347 State Road 7 Suite 200 Wellington, FL 33449

1200 South Main Street Suite 101 Belle Glade FL 33430

Tel: (561) 795-9087 • Fax: (561) 753-8730

Tel: (561) 996-7742 • Fax: (561) 753-8730

MARCH ISSUE • 2012

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Colorectal Cancer

Medical Community Business Networking By Deborah Lynn Photos of Gregory Dillard, Grapeseeker

alms West Chamber of Commerce held a medical networking event at Diagnostic Centers of America in Wellington on February 23. As Palms West Chamber of Commerce just recently merged with Lake Worth Chamber of Commerce, they are currently working out the details. This will be a very exciting time as they expand their forces to make one exceptional union.

Srinivas Kaza, M.D. Graduate of St. George University School of Medicine. After completing an intership and residency at the Brooklyn Hospital Center—Cornell University, Dr. Kaza went on to complete a fellowship and serve as clinical instructor at University of Texas Southwestern Medical Center. Dr. Kaza has practiced in the community since 2008.

olon cancer is cancer of the large intestine which occupies the last 135-150cm of the lower digestive system and rectal cancer is cancer of the last several inches of the colon. Together, colorectal cancer is the 2nd leading cause of cancer related deaths in the United States with approximately 60,000 deaths per year. Each year, more than 150,000 new cases are diagnosed, and as a result, great strides have been made in prevention, prophylaxis, early detection, and cure. The development of colorectal cancer is a process that takes between 10 and 15 years; usually starting as adenomatous polyp. A colorectal polyp is a projecting mass that originates from the mucosa (the innermost lining of the colon). Therefore, any colonic polyp should be either completely excised or biopsied to assess the malignant potential and determine the need for further action.

risk Factors: • Age greater than 60 • Diet high in red or processed meats • Colorectal polyps • Personal or family history of cancer • Smoking • Obesity

Signs and Symptoms: • Fatigue secondary to anemia • Pain • nausea • Early satiety • Diarrhea/blood in the stool • Weight loss • Mucous rectal discharge • Urgency

Diagnosis: Colonoscopy is the gold standard for diagnosis. If diagnosed with colon cancer, additional tests such as CT scans, MRI’s, and blood tests may be required for preliminary staging.

Staging and treatment: Stage 0- very early, inner most lining of intestine; can usually be treated by colonoscopy Stage I- inner layers of colon; need surgery Stage II- spreads to the muscle wall; surgery +/- chemotherapy Stage III- spreads to lymph nodes; surgery + chemotherapy. Radiation is given before and/or after surgery for rectal cancer Stage IV- spreads to other organs; not curable (surgery and chemotherapy/radiation for palliation only)

Surgery: The surgery performed would depend on the location of the tumor, usually requiring removal of that segment of the colon and the associated lymph nodes. Surgery may be performed laparoscopically/robotically, which involves 4-5 small incisions or through an open incision in some cases that cannot be done through laparoscopy.

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prevention/Screening: Death rates have been decreasing over the last 15 years mainly due to increased awareness and screenings. All men and women over the age of 50 should have a screening colonoscopy and every 10 years thereafter. Patients with increased risk factors or that are found to have polyps will need more frequent colonoscopies.

prognosis: Colon cancer in many cases is curable if caught early. The earlier the stage of the cancer at time of detection, the better the prognosis for the patient, thus stressing the importance of screening colonoscopies.

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14 MARCH ISSUE

• 2012

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Colorectal Screening Dr. cathia rene

Cathia Rene, MD recently joined the Gastroenterology practice of Eisenman and Eisenman, M.D (Lake Worth, FL) in January of 2010. Prior to her coming to the West Palm Beach area of Florida she served as Clinical Assistant Professor in the Gastroenterology, Hepatology and Nutrition, at the University of Florida (Gainesville, FL). During her tenure, she helped to found the Pelvic Floor Program at the University of Florida, a multi-disciplinary program of surgeons, gastroenterologists and therapists, focused on diagnosing and treating pelvic floor pathology. Dr. Rene received her MD from Brown University (Providence, RI) in 2001. She then went on to Boston University Medical Center where she completed her residency in Internal Medicine, 2004. She spent a year as an Attending in Internal Medicine at Brockton Hospital (Massachusetts). Dr. Rene went to the University of Florida as a Gastroenterology / Hepatology as a fellow in July 2005 and completed her training in June 2008. During her fellowship she completed the Advanced Postgraduate Program in Clinical Investigation as well as served as the Chief Fellow in GI. Her areas of focus in Gastroenterology have been Motility and Pelvic Floor Pathology. Dr. Rene spends her time outside the office traveling internationally, reading, and running.

s a Gastroenterologist, one of the major parts of my practice is colorectal cancer (CRC) screening. One of the main reasons why it is such a health issue, is that it is the third leading cancer in the United States. We have 1.2 million cases a year and 600,000 deaths that occurred in 2008. CRC is the third most commonly diagnosed cancer in males and the second in females.

One of the things that I’m proud to say, is that colorectal cancer is decreasing in the United States because of what we have done as a field with colon cancer screening. In the United States, both the incidence and mortality have been slowly, but steadily decreasing. In the United States, CRC incidence rates have declined about 2 to 3 percent per year over the last 15 years. Incidence rates in most other western countries have been stable or increased slightly during this period. We get approximately 140,000 new cases of CRC cancer a year. About 100,000 are colon and the remainder are rectal cancers. About 50,000 Americans die of colorectal cancer a year. Therefore it is still a significant number, and there are still strides that can be made in the arena of

screening or directing patients who are eligible to screening. As with many other cancers there is a genetic component to colorectal cancer, some of these include age, a history of inflammatory bowel disease (Crohn’s Disease or Ulcerative Colitis), a family history of colorectal cancer, inherited syndromes, racial and ethnic backgrounds.

The lifestyle factors which patients have control over include: alcohol, obesity, and the most carcinogenic of all, tobacco product use. There are individuals who have a significantly strong history of CRC in their families. The most obvious red flag for these patients is a history of colorectal in a family member under the age of 40. This signals the Gastroenterologist that there may be a genetic syn-

drome at play that predisposes this family to cancer at ages sometimes as young as 20. In that instance, we recommend those people to get screened sooner and more often. As a rule, every patient should start at or 10 years prior to the youngest person in the family with CRC. Individuals should alert their primary care doctors or Gastroenterologist if they see these patterns emerge in their family. There are also some new recommendations from the American College of Gastroenterology and the American Society for Gastrointestinal Endoscopy that CRC screening begin at age 45 in African Americans and that colonoscopy is the preferred screening test. CRCs occur at a younger age and there is a higher frequency of CRC under age 50 in African Americans. In addition the mortality rate is 20 % higher then their Caucasian counterparts. The genetic disorders that are associated with the highest risk of developing CRC include Familial Adenomatous Polyposis Syndrome and Lynch Syndrome. Individuals and families with this pattern of genetic inheritance will certainly develop colorectal cancer in their 30s and 40s, requiring total colectomy. These individuals should begin screening in their teens. These syndromes only account for 5% of colorectal cancer.

Nation's Joke Surplus in Danger of Hitting Lowest Level Since Great Depression

By David Fagin Writer, producer, musician

White House - Washington, D.C. At eight-thirty this morning, Cathy Goodwin, Secretary of Comedy under the Obama Administration, called an emergency press conference and issued a stern warning: "Let this be a wake up call to all Americans. The report I have before me shows that, due to the overwhelming number of people trying to be funny on an hourly basis on social media sites such as Twitter and Facebook, and the non-stop texting of bad jokes and insults between friends, the national Joke Surplus is at its lowest level since the Great Depression. So low, in fact, that if we, as a nation, continue to try and "out-funny" one another, every second of every day, we will be completely humorless by the fall of 2013 and China will surpass us as the funniest nation on the planet." Special agent, Carl Rutherford, has been working undercover in

the Comedy dept. for the past several years under the name, "Dane Cook." He states, "As an experiment, Miss Goodwin suggested I infiltrate the comedy field and be as unfunny as possible, in an effort to see, firsthand, how desperate people really are for laughter. We had no idea how successful the operation would become. I ended up filling arenas, being offered movie roles, doing cable specials, etc. All without the assistance of a single, valid punch line. If anyone has experienced the horror of this situation up close, it's me." As shocking as Miss Goodwin's and Mr. Rutherford's statements are, to some, the joke shortage has been a long time coming. Robert Hedges, founder of the watchdog group P.F.A.F.T (People for a Funny Tomorrow) says his organization has been monitoring our tweets and status updates for the past several years. "The cracks in the armor are already beginning to show," he states. "According to our research, in the past six months alone, over eight-hundred thousand up-and-coming comedians and aspiring late-night television show writers have combined to post approximately twenty-two million unfunny tweets. Add to that the drab and totally mediocre comments of several million out of work writers - including the three million or so, self-deprecat-

ing office workers who feel they should've been writers - and I think you can see the problem." As to the possible cause or causes of this dire situation, Mr. Hedges stated, "Preliminary data seems to point to the fact that we're a nation that's become too politically correct. We're simply running out of things to make fun of. Right now, we outsource over eighty-eight percent of our jokes from countries like Poland, Mexico, and the Middle East. One report last november showed that, as a direct result of U.S. Aid in education, the average I.Q. in Poland has risen twenty points in the past two years. And, because we're constantly looking for cheap labor south of the border, Mexico's unemployment rate has fallen twelve percent. You don't have to be a rocket scientist to understand there's simply nothing funny about a smart Polish guy or a Mexican with a job." Mr. Hedges goes on to say, "Add to that the fact that, within the next year or two, almost every state in the Middle East will have a sane, non cross-dressing, democratic leader, and you're talking about a serious shortage of material. It's simple math. Take that shortage of material, combine it with the insatiable appetite of each of us to outdo ourselves with a post funnier than the last,

and you can see how dangerous the situation is. We're running on fumes as it is, thus, if we don't start firing Mexicans again and treating Blacks and Jews like we used to, we could be facing the greatest comedic recession since the Great Depression." Jason Fein, an out of work, yet, according to his mother, "very funny" writer states, "Last night I watched this crap-ass sitcom on the CW and, for the life of me, no matter how hard I tried, I couldn't think of anything funny to say. It's scary." Our ability to laugh; the instinctual need for it. It's one of the most vital parts of the human spirit. It keeps us calm in times of trouble. Relaxes us in moments of stress. Just a simple, little chuckle, here and there, throughout the workday, is enough to give all of us the strength we need to make it through another week. Yet, unless each of us acts now, and stops trying to be the coolest thing since sliced bread, we will no doubt lose that laughter which we all so easily take for granted. none of us want to imagine a world in which you pay two hundred dollars to see Louis C.K. doing "knock-knock" jokes or God-forbid, a real-life Dane Cook. For the sake of our kids, let's all just try and "cool it" out there and leave the jokes to the professionals.

There are several modalities used to facilitate screening. The most common and well known modality is the colonoscopy. Colonoscopy allows direct visualization of the colonic mucosa and the ability to biopsy or excise polyps thereby preventing colorectal cancers and deaths. The other modalities include flexible sigmoidoscopy (flex-sig), virtual colonoscopy, barium enemas, fecal occult blood testing and stool DnA testing for colorectal disease. The radiographic and stool based modalities are limited in that they do not offer the ability to remove polyps or early cancerous lesions once detected. If these tests are found to be positive, the patient will ultimately require a colonoscopy. In conclusion, colon cancer is one of the more common cancers that plaque our nation today, but there have been great strides made in screening and decreasing the number of individuals who suffer from this disease. As a gastroenterologist, I encourage all patients who have risk factors or who are of a screening age to talk with their health care providers to initiate screening. For additional information regarding colon cancer screening, call 561-753-7487, or visit the Eisenman & Eisenman website at www.eisenmans.com

Toxins Afloat in Shark Fin Soup?

hark fins contain high levels of a neurotoxin called BMAA, which is linked to neurodegenerative diseases in humans such as Alzheimer's and Lou Gehrig's disease (amyotrophic lateral sclerosis), according to a new study. The findings suggest that people who eat shark fin soup and shark cartilage pills may be at significant risk for these diseases, the University of Miami researchers warned. The scientists tested seven shark species -- blacknose, blacktip, bonnethead, bull, great hammerhead, lemon and nurse -- in waters throughout South Florida. "The concentrations of BMAA in the samples are a cause for concern, not only in shark fin soup, but also in dietary supplements and other forms ingested by humans," study co-author Deborah Mash, director of the University of Miami Brain Endowment Bank, said in a university news release. The new study was published in the journal Marine Drugs.

WWW.GLOBALHEALTHTRIBUnE.COM

Upcoming Medical Events and Fundraisers for March 2012 marCH 10

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Molly’s House Angel Run A 5K, 10K, and 2K walk. All proceeds benefit Molly’s House Adopt-A-Family program. Flagler Park in Stuart. Entry fees are $20-$35. For additional information, contact Samantha at 772-223-6650, or go to www.mollyshouse.org.

Walk to Defeat ALS Palm Beaches Walk. Carlin Park, Jupiter. For additional information, call 1-888-9255257, or go to www.walktodefeatals.org.

Florida's Blood Centers Location: Lake Worth Branch 3123 Lake Worth Road Lake Worth, FL 33461 Time: 07:30 AM - 02:30 PM

marCH 12 Bethesda Hospital Foundation. 11th Bethesda Day at Hunters Run. Hunters Run Golf Course, Boynton Beach. The cost to play 18 holes is $235; cost to play 9 holes is $165 and the reception only is $95. For additional information, call 561-737-7733, ext. 85600. Crohn’s and Colitis Foundation 22nd Annual Book of Hope Luncheon featuring Elizabeth Smart. Boca Raton Resort and Club. Tickets are $125. For additional information, contact Michelle Klein at the CCFA Florida Chapter at 561-218-2929 or by e-mail at mklein@ccfa.org.

marCH 26 MorseLife Foundation 21st Annual Golf Classic with Bruce Fleisher. PGA national, Palm Beach Gardens. Golf entry fee is $395. For more information, call 561-242-4661, or e-mail louisd@morselife.org. Florida's Blood Centers Location: Royal Palm 1224 Royal Palm Beach blvd.,Unit 26 Royal Palm Beach, FL 33411 Time: 10:00 AM - 04:00 PM

marCH 31 Boys and Girls Clubs of Palm Beach County Barefoot on the Beach 2012. The Breakers, Palm Beach. For information, call 561-683-3287.

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Florida's Blood Centers Location: Royal Palm 1224 Royal Palm Beach blvd.,Unit 26 Royal Palm Beach, FL 33411 Time: 07:30 AM - 02:30 PM

Alzheimer’s Community Care Casino Royale, License to Thrill! The Breakers, Palm Beach. For additional information, call 561-683-2700, or e-mail info@alzcare.org.

If you would like to add a medical event or fundraiser to our Upcoming Events section, please e-mail your information to info@globalhealthtribune.com. This is a free section.

Exercise in Pregnancy Safe for Baby, Study Finds

xercising at moderate or -- for very active women -- even high intensity during pregnancy won't hurt your baby's health, a new study finds. Researchers monitored healthy women in their third trimester before and after 30 minutes on a treadmill and found no problems with measures of fetal well-being, including heart rate and blood flow. The results were similar whether or not the women exercised on a regular basis. "Healthy pregnant women who exercise should be encouraged to continue, and if a woman is pregnant and is not an exerciser, she should be encouraged to start a moderate exercise program," said study coauthor Dr. Linda Szymanski, an assistant

professor in the division of maternalfetal medicine at Johns Hopkins University in Baltimore. The findings are in line with the recommendation of the U.S. Department of Health and Human Services that healthy pregnant women get at least two and a half hours of medium-intensity aerobic exercise a week even if they did not exercise before becoming pregnant. Exercise improves heart health and may reduce the risk of complications during pregnancy, such as developing high blood pressure and diabetes. However, research indicates that women tend to exercise less when pregnant, and most fall short of the government guidelines.

Srinivas Kaza, M.D., FACS • Robotic SuRgeRy • geneRal SuRgeRy • coloRectal SuRgeRy • advanced lapaRoScopic SuRgeRy

Office 561-439-1500 | Fax 561-439-9902 142 JFK Drive, Atlantis, FL 33462 12989 Southern Blvd. suite 202 Loxahatchee, FL 33470

MARCH ISSUE • 2012

Palm Beach Gastroenterology Consultants, LLC

Krishna Tripuraneni M.D., M.B.A.

Vikram Tarugu M.D

Call Us Today If You Suffer From Any Of The Following: Abdominal Pain Bleeding Chest Pain Cirrhosis of the Liver Colitis Constipation Diarrhea

Pancreatis Stomach and Duodenal Ulcer Ulcerative Colitis Reflux Disease Hemochromatosis Hemorrhoids Hepatitis

Digestive Diseases Stats Dysphagia Gallstones Gastroesophageal Jaundice Lactose Intolerance Liver Disease Nervous Stomach

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At Palm Beach Surgery Center we provide a safe and friendly enviroment, with a highly qualified and dedicated staff. A variety of procedures such as colonoscopy, endoscopy, gastroplications, ERCP, Liver Biopsy, 24 PH Monitoring/BRAVO can be done at our facility thus avoiding the need for hospitalization.