Scanning the prostate before a Don’t give yourself a...
1
8 – MARCH 2017 HEALTH CONNECTION Scanning the prostate before a biopsy In the 1985 comedy “Movers & Shak- ers,” writer Herb Derman (Charles Grodin) gets a checkup from his doctor (Sandy Ward) that leaves the audience wondering just what medical school the guy went to: “Your prostate is boggy,” says the physician. Turns out that vague description isn’t much more precise than what’s ac- tually touted as the best way to diagno- sis prostate cancer. When PSA (pros- tate-specific antigen) readings are above normal and a digital rectal exam indicates possible prostate changes, the combo often leads to a multi-sample bi- opsy, a tough procedure, to check for cancerous cells. Even now, when active surveillance (a PSA test every six months and track- ing symptoms) or watchful waiting (less-aggressive tracking) is the smart move, 1 million prostate biopsies are done in the U.S. annually. From that number, only about 161,360 new cases of prostate cancer are identified. Since up to 40 percent of those biop- sies trigger complications ranging from soreness to infection to acute urin- ary retention, you’d think there’d be an- other way to successfully diagnose prostate cancer. There may be, because we’re learning how to minimize diag- nostic difficulties. A new British study offers great news: If men with suspected prostate cancer are given a multiparametric MRI (MP-MRI), doctors can determine who should have a biopsy and who can adopt a watch-and-wait plan. (The scan correctly ID’d 93 percent of aggressive cancers as opposed to the standard bi- opsy finding only 48 percent!) If you’re scheduled for a biopsy, ask your doc about getting the MP-MRI scan first. Big news on lower epinephrine auto-injector prices The band Berlin hit the charts with “Take My Breath Away” in 1986, a year before the first epinephrine auto-injec- tor was approved by the Food and Drug Administration. That device was a game-changer, protecting people at risk for life-threatening anaphylactic reactions, which actually do take your breath away by causing a swollen throat and tongue, respiratory distress, edema and low blood pressure. They can happen from contact with an aller- gen such as peanuts, insect bites or chemicals, like latex. In 2007, Mylan acquired the right to sell EpiPen, the brand-name epineph- rine auto-injector. Since 2007, the price for a two-pack went from $93.88 to $608.61. NBC news reports that it costs Mylan about $35! Thankfully, you can lower the cost. However, to obtain a lower-priced, ge- neric EpiPen your doctor must write you a prescription for an “epinephrine auto-injector,” NOT “EpiPen.” Also, not all discount coupons deliver what they imply (up to 75 percent off), so ask what your rate will be, and know that Mylan’s My EpiPen Savings Card has restric- tions. So, what discounts are available? CVS offers a generic two-pack for un- der $100; discount coupons are avail- able online from national drugstore chains and places like GoodRx.com. Just Google “EpiPen discounts.” For the brand version: Walgreens, RiteAid and others offer EpiPen two-packs for around $200. Then there’s Auvi-Q. The EpiPen alternative hits shelves this month -- free to folks with commercial insurance or with no insurance in households earning less than $100,000. Will insurers and pharmacy benefit managers go along with the plan? We’ll see. And there’s Mylan’s discount: a two-pack for $300. Perpetual munchies As Murphy (the narc) says in “Cheech and Chong’s Up in Smoke” (1978): “Ingestion of marijuana from smoking invariably produces not only severe hunger pains, but ... [a] porten- tous appetite ... manifesting itself in a total uncontrollable frenzy of eating quite a lot.” Well, research now shows that the typical high-fat, sugar-packed Ameri- can diet creates similar impulses by overstimulating your body’s endocan- nabinoid system. This system is needed for appetite regulation (and other stuff), and it’s made up of lipid-signal- ing molecules called endocannabinoids that essentially are the body’s natural cannabis. In fact, these molecules acti- vate the same receptors in your brain and body that THC, the active compo- nent of marijuana, does. According to the study in Physiology & Behavior, mice fed a typical Ameri- can diet, loaded with fat and sugar, ate larger meals, took in more calories and did so more rapidly than mice fed a low- fat, low-sugar diet. But don’t take the mice’s word for it. One medication that blocked the brain’s endocannabinoid receptors ef- fectively prevented the munchies that high-fat, high-sugar foods trigger. It was approved for use as a weight-con- trol drug in Europe, but had to be pulled off shelves because it caused severe psychiatric side effects. The Food and Drug Administration in the U.S. never did approve it. However, the researchers who did the recent mice experiments say they can prevent those side effects, so one day you might be able to turn off your endocannabinoid-triggered munchies and watch your compulsion to overeat go up in smoke! Be prepared to dish up a winning meal When it comes to creating a team that delivers a full menu of talents, the Cleveland Cavaliers’ acquisition of 6- foot-7 Kyle Korver didn’t quite fit the bill. “We still got a couple more things we need to do. We got to get a point guard,” said LeBron James. Seems when you try to prepackage a champi- onship, you have to make sure all the power positions (backing up LeBron, Kyrie Irving and Kevin Love) are filled with top-grade talent. In the same way, you want to make sure you’re dishing up meals that deliv- er the full menu of nutrients it takes to have a winning breakfast/lunch/dinner. Unfortunately, in 2014, Americans spent nearly $14 billion on frozen pre- pared foods, many of which would be better off benched. A recent study explains why many folks rely on high-fat, high-sodium, cal- orie-packed, sugar-laced, prepackaged, frozen meals: 57 percent say that quick prep -- meals both parents and children can zap -- is the attraction. Also, parents often are more confident in prepared food than in their own cooking, and they think they’re cutting costs (which is not usually true). To deliver championship meals, try these tricks: » Learn a few great recipes. Go to www.doctoroz.com for quick and easy recipes and 30-minute meals. Cook- once, serve-twice meals -- like soups, stews and casseroles -- reduce cooking time and costs. » Don’t ditch quick-to-fix frozen veggies. They’re nutrition-filled (but, no buttery, sauced-up versions!). » Supplement prepared meals with fresh produce. If you do dish up a pre- pared meal, make a fresh salad and add some walnuts or steamed veggies to go with it. GETTY IMAGES According to the study in Physiology & Behavior, mice fed a typical American diet, loaded with fat and sugar, ate larger meals, took in more calories and did so more rapidly than mice fed a low-fat, low-sugar diet. Continued on Next Page GETTY IMAGES/ISTOCKPHOTO One study found that having high levels of stress over an average of 10 years was linked to a 27 percent higher risk of coronary heart disease. Don’t give yourself a heart attack There’s a reason the song “Stressed Out,” by Twenty One Pilots, struck a chord with listeners last year, topping the charts and getting over 800 million music video views. The chorus is nos- talgic: “Wish we could turn back time to the good old days/when our momma sang us to sleep, but now we’re stressed out.” And that stress response can put your heart in jeopardy. One study found that having high levels of stress over an average of 10 years was linked to a 27 percent higher risk of coronary heart disease. It also found that psychological interventions that reduce your stress response are associated with a 27 per- cent decrease in coronary heart dis- ease. So, how does stress harm the heart, and what can you do about it? It’s all between your ears. The part of your brain that’s responsible for proc- essing emotions is called the amygdala. Recent research has found that your stress response can fire up amygdala activity, which in turn cranks up your bone marrow. You end up with overpro- duction of white blood cells, which then causes arterial inflammation. That’s one way stress can lead to cardiovascu- lar diseases like high blood pressure, heart attack and stroke. The good news is that understanding this soon may lead to more effective ways to prevent heart disease. In the meantime, we already know a pretty ef- fective way to reduce your stress re- sponse, calm your amygdala and spare your heart, not to mention your brain and relationships: mindful meditation. Go to www.sharecare.com for instruc- tions. Pregnancy and opioid addiction Alicia Keyes craved root-beer floats while pregnant with her second child, Genesis; Victoria Beckham was mar- malade-crazed while carrying daugh- ter Harper; and Blake Lively had to have pumpkin ice cream when expect- ing Ines. As cravings go, they’re not good nutrition choices. But it could be far worse. For an ever-increasing number of pregnant women, cravings are for opioids such as heroin and the prescrip- tion painkillers fentanyl, oxycodone and hydrocodone. According to a new report from the Substance Abuse and Mental Health Administration, drug use among pregnant women in the U.S. has increased dramatically. And about 21,000 pregnant women ages 15 to 44 have misused opioids in the past month. Those women are putting their fetus at risk for placental abruption, preterm labor and death. And 70 to 95 percent of those women’s newborns suffer with- drawal or neonatal abstinence syn- drome (NAS), low birthweight and res- piratory complications, and they risk future brain dysfunction. According to an Australian study, by seventh grade more than a third of children with NAS fail to meet test standards in reading, writing, math, spelling and/or gram- mar. Pregnant woman experiencing ad- diction need quality pre- and postnatal care! According to the American Soci- ety of Addiction Medicine, “Pregnant women who are physically dependent on opioids should receive treatment us- ing methadone or buprenorphine ... rather than withdrawal management or abstinence.” The National Alliance of Advocates for Buprenorphine Treat- ment can help you find a doc (www.naabt.org), as can www.samhsa.gov. This as a health is- sue, not a moral failing, and we should support and help these women and their babies. Looking out for early Alzheimer’s symptoms: S.A.G.E. advice If you’re concerned about dementia or Alzheimer’s disease, either for a fam- ily member or yourself, we’re here with some sage advice. Consider the words of Thomas Jefferson: “I find that the harder I work, the more luck I seem to have.” So if you put some effort into learn- ing about early detection of Alzheim- er’s and other forms of dementia, you just might get lucky too. Early detec- tion allows doctors to slow or even sometimes halt dementia’s progress. Our sage advice? Try the at-home screening test developed by research- ers at Ohio State University called the Self-Administered Gerocognitive Ex- am, or S.A.G.E. This simple test (Google “OSU S.A.G.E.” to download) takes only 10-15 minutes to complete and was designed to detect early signs of cognitive im- pairment. Dr. Mike’s Cleveland Clinic and its Wellness Institute use S.A.G.E. to help decide if you’re a candidate for its brain wellness shared medical ap- pointment program or need neurologic treatment from its Neurologic Insti- tute. Another early sign of Alzheimer’s: your nose. The part of the brain that controls smell often is affected in the early stages of the disease. So if you no- tice that you’re having trouble picking up fragrances or odors, talk to your doc- tor. Whatever your age, family history or cognitive powers, remember that staying engaged and curious, socializ- ing with family and friends, getting 10,000 steps a day or the equivalent, do- ing “speed of processing” games like brainHQ’s Double Decision, and stick- ing with brain-healthy nutrition, like the DASH and Mediterranean diets, helps protect your brain. Mehmet Oz, M.D. is host of “The Dr. Oz Show,” and Mike Roizen, M.D. is Chief Wellness Officer and Chair of Well- ness Institute at Cleveland Clinic. To live your healthiest, tune into “The Dr. Oz Show” or visit www.sharecare.com. GETTY IMAGES In 2014, Americans spent nearly $14 billion on frozen prepared foods, many of which would be better off benched. HEALTH CONNECTION MARCH 2017 – 9
Transcript of Scanning the prostate before a Don’t give yourself a...
8 – MARCH 2017 HEALTH CONNECT ION
Scanning the prostate before abiopsy
In the 1985 comedy “Movers & Shak-ers,” writer Herb Derman (CharlesGrodin) gets a checkup from his doctor(Sandy Ward) that leaves the audiencewondering just what medical school theguy went to: “Your prostate is boggy,”says the physician.
Turns out that vague descriptionisn’t much more precise than what’s ac-tually touted as the best way to diagno-sis prostate cancer. When PSA (pros-tate-specific antigen) readings areabove normal and a digital rectal examindicates possible prostate changes, thecombo often leads to a multi-sample bi-opsy, a tough procedure, to check forcancerous cells.
Even now, when active surveillance(a PSA test every six months and track-ing symptoms) or watchful waiting(less-aggressive tracking) is the smartmove, 1 million prostate biopsies aredone in the U.S. annually. From thatnumber, only about 161,360 new cases ofprostate cancer are identified.
Since up to 40 percent of those biop-sies trigger complications rangingfrom soreness to infection to acute urin-ary retention, you’d think there’d be an-other way to successfully diagnoseprostate cancer. There may be, becausewe’re learning how to minimize diag-nostic difficulties.
A new British study offers greatnews: If men with suspected prostatecancer are given a multiparametricMRI (MP-MRI), doctors can determinewho should have a biopsy and who canadopt a watch-and-wait plan. (The scancorrectly ID’d 93 percent of aggressivecancers as opposed to the standard bi-opsy finding only 48 percent!) If you’rescheduled for a biopsy, ask your docabout getting the MP-MRI scan first.
Big news on lower epinephrineauto-injector prices
The band Berlin hit the charts with“Take My Breath Away” in 1986, a yearbefore the first epinephrine auto-injec-tor was approved by the Food and DrugAdministration. That device was agame-changer, protecting people atrisk for life-threatening anaphylacticreactions, which actually do take yourbreath away by causing a swollenthroat and tongue, respiratory distress,edema and low blood pressure. Theycan happen from contact with an aller-gen such as peanuts, insect bites orchemicals, like latex.
In 2007, Mylan acquired the right tosell EpiPen, the brand-name epineph-rine auto-injector. Since 2007, the pricefor a two-pack went from $93.88 to$608.61. NBC news reports that it costsMylan about $35!
Thankfully, you can lower the cost.However, to obtain a lower-priced, ge-neric EpiPen your doctor must writeyou a prescription for an “epinephrineauto-injector,” NOT “EpiPen.” Also, notall discount coupons deliver what they
imply (up to 75 percent off), so ask whatyour rate will be, and know that Mylan’sMy EpiPen Savings Card has restric-tions.
So, what discounts are available?CVS offers a generic two-pack for un-der $100; discount coupons are avail-able online from national drugstorechains and places like GoodRx.com.Just Google “EpiPen discounts.” Forthe brand version: Walgreens, RiteAidand others offer EpiPen two-packs foraround $200. Then there’s Auvi-Q. TheEpiPen alternative hits shelves thismonth -- free to folks with commercialinsurance or with no insurance inhouseholds earning less than $100,000.Will insurers and pharmacy benefitmanagers go along with the plan? We’llsee. And there’s Mylan’s discount: atwo-pack for $300.
Perpetual munchies
As Murphy (the narc) says in“Cheech and Chong’s Up in Smoke”(1978): “Ingestion of marijuana fromsmoking invariably produces not onlysevere hunger pains, but ... [a] porten-tous appetite ... manifesting itself in atotal uncontrollable frenzy of eatingquite a lot.”
Well, research now shows that thetypical high-fat, sugar-packed Ameri-can diet creates similar impulses byoverstimulating your body’s endocan-nabinoid system. This system is neededfor appetite regulation (and otherstuff), and it’s made up of lipid-signal-ing molecules called endocannabinoids
that essentially are the body’s naturalcannabis. In fact, these molecules acti-vate the same receptors in your brainand body that THC, the active compo-nent of marijuana, does.
According to the study in Physiology& Behavior, mice fed a typical Ameri-can diet, loaded with fat and sugar, atelarger meals, took in more calories anddid so more rapidly than mice fed a low-fat, low-sugar diet. But don’t take themice’s word for it.
One medication that blocked thebrain’s endocannabinoid receptors ef-fectively prevented the munchies thathigh-fat, high-sugar foods trigger. Itwas approved for use as a weight-con-trol drug in Europe, but had to be pulledoff shelves because it caused severepsychiatric side effects. The Food andDrug Administration in the U.S. neverdid approve it.
However, the researchers who didthe recent mice experiments say theycan prevent those side effects, so oneday you might be able to turn off yourendocannabinoid-triggered munchiesand watch your compulsion to overeatgo up in smoke!
Be prepared to dish up awinning meal
When it comes to creating a teamthat delivers a full menu of talents, theCleveland Cavaliers’ acquisition of 6-foot-7 Kyle Korver didn’t quite fit thebill. “We still got a couple more thingswe need to do. We got to get a pointguard,” said LeBron James. Seems
when you try to prepackage a champi-onship, you have to make sure all thepower positions (backing up LeBron,Kyrie Irving and Kevin Love) are filledwith top-grade talent.
In the same way, you want to makesure you’re dishing up meals that deliv-er the full menu of nutrients it takes tohave a winning breakfast/lunch/dinner.Unfortunately, in 2014, Americansspent nearly $14 billion on frozen pre-pared foods, many of which would bebetter off benched.
A recent study explains why manyfolks rely on high-fat, high-sodium, cal-orie-packed, sugar-laced, prepackaged,frozen meals: 57 percent say that quickprep -- meals both parents and childrencan zap -- is the attraction. Also, parentsoften are more confident in preparedfood than in their own cooking, and theythink they’re cutting costs (which is notusually true). To deliver championshipmeals, try these tricks:
» Learn a few great recipes. Go towww.doctoroz.com for quick and easyrecipes and 30-minute meals. Cook-once, serve-twice meals -- like soups,stews and casseroles -- reduce cookingtime and costs.
» Don’t ditch quick-to-fix frozenveggies. They’re nutrition-filled (but,no buttery, sauced-up versions!).
» Supplement prepared meals withfresh produce. If you do dish up a pre-pared meal, make a fresh salad and addsome walnuts or steamed veggies to gowith it.
GETTY IMAGES
According to the study in Physiology & Behavior, mice fed a typical American diet, loaded with fat and sugar, ate larger meals, took in morecalories and did so more rapidly than mice fed a low-fat, low-sugar diet.
Continued on Next Page
GETTY IMAGES/ISTOCKPHOTO
One study found that having high levels of stress over an average of 10 years was linked toa 27 percent higher risk of coronary heart disease.
Don’t give yourself a heartattack
There’s a reason the song “StressedOut,” by Twenty One Pilots, struck achord with listeners last year, toppingthe charts and getting over 800 millionmusic video views. The chorus is nos-talgic: “Wish we could turn back time tothe good old days/when our mommasang us to sleep, but now we’re stressedout.” And that stress response can putyour heart in jeopardy. One study foundthat having high levels of stress over anaverage of 10 years was linked to a 27percent higher risk of coronary heartdisease. It also found that psychologicalinterventions that reduce your stressresponse are associated with a 27 per-cent decrease in coronary heart dis-ease. So, how does stress harm theheart, and what can you do about it?
It’s all between your ears. The part ofyour brain that’s responsible for proc-essing emotions is called the amygdala.Recent research has found that yourstress response can fire up amygdalaactivity, which in turn cranks up yourbone marrow. You end up with overpro-duction of white blood cells, which thencauses arterial inflammation. That’sone way stress can lead to cardiovascu-lar diseases like high blood pressure,heart attack and stroke.
The good news is that understandingthis soon may lead to more effectiveways to prevent heart disease. In themeantime, we already know a pretty ef-fective way to reduce your stress re-sponse, calm your amygdala and spareyour heart, not to mention your brainand relationships: mindful meditation.Go to www.sharecare.com for instruc-tions.
Pregnancy and opioidaddiction
Alicia Keyes craved root-beer floatswhile pregnant with her second child,Genesis; Victoria Beckham was mar-malade-crazed while carrying daugh-ter Harper; and Blake Lively had tohave pumpkin ice cream when expect-ing Ines. As cravings go, they’re notgood nutrition choices.
But it could be far worse.For an ever-increasing number of
pregnant women, cravings are foropioids such as heroin and the prescrip-tion painkillers fentanyl, oxycodoneand hydrocodone. According to a newreport from the Substance Abuse andMental Health Administration, druguse among pregnant women in the U.S.has increased dramatically. And about21,000 pregnant women ages 15 to 44have misused opioids in the past month.
Those women are putting their fetusat risk for placental abruption, pretermlabor and death. And 70 to 95 percent ofthose women’s newborns suffer with-drawal or neonatal abstinence syn-drome (NAS), low birthweight and res-piratory complications, and they riskfuture brain dysfunction. According toan Australian study, by seventh grade
more than a third of children with NASfail to meet test standards in reading,writing, math, spelling and/or gram-mar.
Pregnant woman experiencing ad-diction need quality pre- and postnatalcare! According to the American Soci-ety of Addiction Medicine, “Pregnantwomen who are physically dependenton opioids should receive treatment us-ing methadone or buprenorphine ...rather than withdrawal management orabstinence.” The National Alliance ofAdvocates for Buprenorphine Treat-ment can help you find a doc(www.naabt.org), as canwww.samhsa.gov. This as a health is-sue, not a moral failing, and we shouldsupport and help these women and theirbabies.
Looking out for earlyAlzheimer’s symptoms:S.A.G.E. advice
If you’re concerned about dementiaor Alzheimer’s disease, either for a fam-ily member or yourself, we’re here withsome sage advice. Consider the wordsof Thomas Jefferson: “I find that theharder I work, the more luck I seem tohave.”
So if you put some effort into learn-ing about early detection of Alzheim-er’s and other forms of dementia, youjust might get lucky too. Early detec-tion allows doctors to slow or evensometimes halt dementia’s progress.
Our sage advice? Try the at-homescreening test developed by research-ers at Ohio State University called theSelf-Administered Gerocognitive Ex-am, or S.A.G.E.
This simple test (Google “OSUS.A.G.E.” to download) takes only 10-15minutes to complete and was designedto detect early signs of cognitive im-pairment. Dr. Mike’s Cleveland Clinicand its Wellness Institute use S.A.G.E.to help decide if you’re a candidate forits brain wellness shared medical ap-pointment program or need neurologictreatment from its Neurologic Insti-tute. Another early sign of Alzheimer’s:your nose. The part of the brain thatcontrols smell often is affected in theearly stages of the disease. So if you no-tice that you’re having trouble pickingup fragrances or odors, talk to your doc-tor.
Whatever your age, family historyor cognitive powers, remember thatstaying engaged and curious, socializ-ing with family and friends, getting10,000 steps a day or the equivalent, do-ing “speed of processing” games likebrainHQ’s Double Decision, and stick-ing with brain-healthy nutrition, likethe DASH and Mediterranean diets,helps protect your brain.
Mehmet Oz, M.D. is host of “The Dr.Oz Show,” and Mike Roizen, M.D. isChief Wellness Officer and Chair of Well-ness Institute at Cleveland Clinic. Tolive your healthiest, tune into “The Dr.Oz Show” or visit www.sharecare.com.
GETTY IMAGES
In 2014, Americans spent nearly $14 billion on frozen prepared foods, many of which wouldbe better off benched.
HEALTH CONNECT ION MARCH 2017 – 9
