Healthy Lifestyle Extended Survival After Colon Cancer Diagnosis

An interesting read about the importance of a healthy lifestyle while fighting colon cancer.
— Dr. Dale

From Healthy Lifestyle Extended Survival After Colon Cancer Diagnosis

Patients with stage III colon cancer who maintained a healthy lifestyle during and after treatment had a 42% reduced risk for death and a trend for a lower chance of recurrence compared with patients with less healthy lifestyles, according to the results of a study (abstract 10006) presented during a press conference ahead of the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting.

The definition of healthy lifestyle was based on guidelines called “Nutrition and Physical Activity Guidelines for Cancer Survivors” released by the American Cancer Society; the guidelines include recommendations for maintaining a healthy body weight; engaging in physical activity; and eating a diet high in whole grains, vegetables, and fruits, and low in red or processed meats, with only moderate alcohol intake.

“Individuals often seek information on what they can do to lower risk of cancer recurrence, including changes to lifestyle,” said Erin Van Blarigan, ScD, assistant professor of epidemiology and biostatistics at the University of California, San Francisco, during the press conference. “The American Cancer Society released guidelines based on scientific studies but it is not known if patients who followed these guidelines actually lived longer.”

The prospective study included 992 patients with stage III colon cancer enrolled in an adjuvant chemotherapy trial from 1999 to 2001. Patients were enrolled within 8 weeks of surgery and received 6 months of adjuvant chemotherapy. The trial assessed lifestyle twice using validated surveys. Patients were assigned a score from 0 to 6 (0 = no healthy behaviors) that measured the degree to which their lifestyle matched the American Cancer Society guidelines.

With a median follow-up of 7 years, there were 335 cancer recurrences and 299 deaths. Compared with 26% of patients with the least healthy lifestyle (score 0–1), the 9% of patients with the healthiest lifestyle (score 5–6) had a 42% lower risk for death (hazard ratio [HR], 0.58; 95% CI, 0.34–0.99; P = .01 for trend). They also had a trend toward improved disease-free survival (HR, 0.69; 95% CI, 0.45–1.06; P = .03 for trend).

Alcohol consumption is included in the guidelines for cancer prevention, but not cancer survivors. When alcohol was included in the lifestyle score, the adjusted HRs for patients with 6–8 points compared with 0–2 points were 0.49 for overall survival (P = .002 for trend), 0.58 for disease-free survival (P = .01 for trend), and 0.64 for recurrence-free survival (P = .05 for trend).

Commenting on the results of the study, ASCO President Daniel F. Hayes, MD, said, “It should be emphasized that the authors are not suggesting that a healthy lifestyle alone should be considered a substitute for standard chemotherapy and other treatments for colon cancer, which have dramatically improved survival. Rather, patients with colon cancer should be optimistic, and they should eat a healthy diet and exercise regularly, which may not only keep them healthier, but may also further decrease the chances of the cancer coming back.”

More that 1 in 5 U.S. adults are infected with cancer-causing HPV, CDC report says

Important information reported by the CDC.
— Dr. Dale

From More that 1 in 5 U.S. adults are infected with cancer-causing HPV, CDC report says 

During a recent two-year period, almost 23 percent of U.S. adults ages 18 to 59 had a type of genital human papillomavirus (HPV) that put them at high risk of certain cancers, according to a Centers for Disease Control and Prevention report published Thursday.

That percentage jumped to more than 42 percent during 2013 to 2014 if any type of genital HPV was included, the CDC found. In both groups, prevalence was higher in men than in women.

“We tend to overlook the fact that 20 percent of us are carrying the virus that can cause cancer,” said Geraldine McQuillan, lead author of the report and a senior infectious-disease epidemiologist in the Division of Health and Nutrition Examination Surveys at the CDC's National Center for Health Statistics. “People really need to realize that this is a serious concern.”

This is the first data CDC has compiled on HPV rates among men. Its previous research among teen girls and women looked at far fewer strains of the virus and included a younger, narrower age range — and, perhaps because of that, found a lower prevalence of high-risk HPV.

“What we know is that cervical cancer rates have remained relatively stable, but that being said, HPV-related cancer rates have been increasing,” said Lois Ramondetta, a professor of gynecologic oncology at the University of Texas MD Anderson Cancer Center. HPV has been linked to throat, tonsil, anal, vaginal and penile cancers as well as cervical cancer. The HPV vaccine can protect people from infection.

HPV is the most common sexually transmitted disease in the United States. The CDC estimates that nearly 80 million people are infected and that about 14 million new infections occur annually among teenagers and adults. Most of these go away on their own, typically without even causing symptoms, but some HPV strains can lead to genital warts and cancer. Each year, 31,000 men and women are diagnosed with cancers caused by HPV — which, in most cases, would have been preventable with the HPV vaccine, according to the CDC.

The CDC recommends HPV vaccinations for youths ages 11 to 12 so that they are protected before potential exposure to the virus through sexual contact. Vaccination rates have been increasing, but they still lag for boys and girls.

Lingering misconceptions and fears are among the reasons for the lower use of HPV vaccination, said Electra Paskett, a cancer control researcher at Ohio State University's Comprehensive Cancer Center. Some people still think vaccination encourages youth to become promiscuous. “The way [the vaccine] was introduced in Australia and the United Kingdom was as a cancer vaccine, which is truly what it is. It is a cancer vaccine,” Paskett said.

The CDC report also addresses oral HPV infections. From 2011 to 2014, their prevalence was 7 percent among those aged 18 to 69, it found. As with genital HPV, rates were higher for men than women overall and in all racial and ethnic groups. The same disparities also were found among those groups: Asians had the lowest rates and blacks had the highest rates.

Learn the ABCs of Viral Hepatitis

May is Hepatitis Awareness Month - a month dedicated to raising awareness and learning more about the virus.
— Dr. Dale

From Learn the ABCs of Viral Hepatitis

Learn the ABCs of Viral Hepatitis

For Hepatitis Awareness Month and national Hepatitis Testing Day on May 19th, learn more about the different types of viral hepatitis. Find out if you should get tested or vaccinated by taking a quick, online Hepatitis Risk Assessment.

May is Hepatitis Awareness Month. In the United States, the most common types of viral hepatitis are hepatitis A, hepatitis B, and hepatitis C. While each can produce similar symptoms, each hepatitis virus affects the liver differently, has different routes of transmission, and has different populations that are commonly affected.

CDC developed an online Hepatitis Risk Assessment to help people find out if they should get tested or vaccinated for viral hepatitis. The assessment, which takes only five minutes, will provide personalized testing and vaccination recommendations for hepatitis A, hepatitis B, and hepatitis C.

Hepatitis A

Hepatitis A is a highly contagious liver infection that can range from a mild illness lasting a few weeks to a severe illness lasting several months. The hepatitis A virus is usually spread when a person ingests the virus from contact with objects, food, or drinks contaminated by feces or stool from an infected person. Hepatitis A can be easily prevented with a safe and effective vaccine, which is recommended for all children at one year of age and for adults who may be at risk.

Hepatitis A is common in many parts of the world, and many new cases of hepatitis A in the United States have occurred from international travelers eating or drinking contaminated food or water. CDC recommends, therefore, that travelers to countries where hepatitis A is common get vaccinated in advance of travel. Even if travel is restricted to resort destinations, it is still possible to get infected with the hepatitis A virus.

Hepatitis B

Hepatitis B is a liver disease that results from infection with the hepatitis B virus. For some people, especially those infected as infants, the infection leads to a chronic or lifelong illness. The hepatitis B virus is spread primarily when blood, semen, or certain other body fluids from a person infected enters the body of someone who is not infected. The virus can be spread through sexual transmission and through contact with blood, such as sharing injection drug equipment. The hepatitis B virus can also be passed from an infected woman to her baby at birth, if her baby does not receive the hepatitis B vaccine. As a result the hepatitis B vaccine is recommended for all infants at birth and anyone else at increased risk.

Hepatitis B is common in many parts of the world, including Asia, the Pacific Islands and Africa. Unfortunately, many people got infected before the hepatitis B vaccine was widely available. That’s why CDC recommends anyone born in areas where hepatitis B is common, or whose parents were born in these regions, get tested for hepatitis B.

Hepatitis C

Hepatitis C is a liver disease that results from infection with the hepatitis C virus. Most people who become infected with the virus go on to develop a chronic infection that causes serious liver problems. The hepatitis C virus is usually spread when blood from a person infected enters the body of someone who is not infected. Today, most people become infected with hepatitis C by sharing needles, syringes, or any other equipment to inject drugs. In fact, rates of new infections have been on the rise in young people who inject drugs in recent years. While rare, hepatitis C can be transmitted sexually, as well as from an infected women to her baby. . In the past, hepatitis C was spread through blood transfusions and organ transplants. However, widespread screening of the blood supply began in 1990 and the hepatitis C virus was virtually eliminated from the blood supply by 1992.

People born from 1945-1965, or baby boomers, are five times more likely to have hepatitis C. Unfortunately, the reason that baby boomers have high rates of hepatitis C is not completely understood. Most baby boomers are believed to have become infected in the 1960s, 1970s and 1980s when transmission of hepatitis C was the highest. CDC recommends anyone born from 1945-1965, as well as anyone else at risk, get tested for hepatitis C.

Find out if you should get tested or vaccinated for viral hepatitis by taking CDC’s quick online Hepatitis Risk Assessment.

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Does Meditation Really Help With Depression And Anxiety

For us to be my physically healthy, we must focus on our mental health.
— Dr. Dale

From Does Meditation Really Help With Depression And Anxiety?

The Question: I experience depression and anxiety. Will meditation really help me? 

The Answer: Depression and anxiety can make everyday life very challenging. And research suggests that healthy lifestyle habits like meditation may help with some of its symptoms. 

Case in point: A small study published earlier this year in the journal Psychiatry Research. Researchers randomized 70 adult participants with generalized anxiety disorder into two groups. One group received mindfulness-based stress reduction as a technique to cope. The other group, acting as the control, did not receive any sort of meditation training.

The scientists found that participants who learned the mindfulness techniques showed much lower levels of a specific biomarker for stress in the body. This could suggest meditation can not only help how someone feels over time, but also may leave an impression on a cellular level. 

This potentially corroborates a large body of meditation research that suggests the practice is a wunderkind for mental health issues. But it’s important to note that previous research outcomes also had its flaws. Some early studies lacked a control group. Other research potentially fell victim to “expectancy bias,” which is when participants expected meditation to work and thus reported feeling better after the experiment. 

The recent Psychiatry Research study took all of this into account, which is why it seems promising. To solve for bias, the researchers said the study was simply about stress reduction without mentioning a meditation component. Mindfulness was introduced later on, and only to some of the participants. This is so researchers could separate out meditation as an active component, according to Elizabeth Hoge, the study’s lead author and associate professor of psychiatry at Georgetown University. 

So, recent research shows it works. But how do you do it?

It all comes down to your thoughts, according to Hoge. Start by sitting in a quiet room and try to focus on your breath. Thoughts will inevitably pop up but the key is to not push them away or give up.

For example, if you are meditating and start to ruminate on a major work mistake or an unfounded fear, notice what’s happening but don’t get frustrated. The thoughts won’t disappear but you will learn to create distance from them, Hoge said.

“Mindfulness meditation is based on the idea of paying attention one’s own inner experience, whether that’s thoughts or sensations or emotions,” she told HuffPost. “Anything that passes through the mind is the internal stimuli that you’re paying attention to.”

Ideally, with enough practice, you’ll learn to create space between negative thoughts and your reactions. 

“See them as distinct objects from yourself,” Hoge said. “As in, ‘My thoughts are not myself.’ That allows a layer of separation so that the person has a little bit more freedom in how to respond to the thoughts or how to cope with them.” 

There is a slight catch

The practice does have some really great mental health perks. But if you truly suffer from anxiety and depression, meditation is likely something you should consider as part of a larger form of treatment like therapy, according to Chloe Carmichael, a clinical psychologist based in New York City.

Carmichael, who specializes in treating anxiety and depression, was a yoga instructor before she became a mental health professional. She uses a blend of mindfulness meditation and psychology tools to treat her clients.

“When you just sit there and follow your breath, that is a mindfulness meditation. It’s one of the early steps of learning how to follow our thoughts,” Carmichael said. “Once you have mindful awareness of what your thoughts are, you’re able to observe them without reacting to them.”

Depression has a tendency to make people think they’re worthless and then they tend to ruminate on that negative idea. People who have anxiety are prone to excessive worrying. Meditation can be a tool to help observe those thoughts, but medical support can provide the methods that help replace those thoughts altogether, according to Carmichael. 

“That’s one of the cornerstones of cognitive behavioral therapy: To analyze someone’s automatic thoughts,” she said. “So they work together really well ― psychology and mindfulness meditation.” 

Ultimately, implementing mindfulness into anxiety or depression treatment can have a very positive impact, according to Sharon Salzburg, a meditation teacher and author of Real Happiness: The Power of Meditation: A 28 Day Program

“You try different things to relieve suffering,” she said. “You can celebrate whatever method, or combo of methods, [that] help.” 

Just a little something to meditate on.

How Elite New Yorkers Are Preparing Their Skin for Summer, According to Gwyneth Paltrow-Approved Dermatologist Dr. Robery Anolik

Top recommended treatments to get you ready for summer.
— Dr. Dale

From How Elite New Yorkers Are Preparing Their Skin for Summer, According to Gwyneth Paltrow-Approved Dermatologist Dr. Robery Anolik 

With summer just around the corner, it's time to prepare your skin for the season. It's a busy time of year for dermatologist Dr. Robert Anolik, a protégé of Dr. Fredric Brandt. Here, Dr. Anolik, who counts Gwyneth Paltrow as a fan, offers a guide to the three treatments you need right now, his number one tip for beautiful skin, and the latest product he is excited about.

Do you see more patients coming in this time of year?

Yes, my schedule can be a bit hectic in the spring and summer! Once the temperature rises on the East Coast, all my patients want to book an appointment at the same time to get themselves ready for summer in the Hamptons, tropical vacations, etc... I have patients saying that they want to be able to wear tank tops, shorter skirts, and bathing suits this summer but they have age spots, dull skin, love handles, and wrinkles. So, they come in to ask how I can help them.

So, what are your top recommendations for your patients that come in with those requests?

I would say that Coolsculpting, Botox, and lasers for getting rid of sunspots would be the top three pre-summer treatments I recommend for my clients.

The end of winter or early spring is an optimal time for Coolsculpting because it takes about 3-12 weeks to see the results. Some of my patients even start a series of treatments in the fall so that they can do it a few times before beach season.

In the summer we have a greater tendency to squint because of the bright sunlight. This accentuates the appearance of deep lines and folds between the eyebrows and the crow's feet. So, you should invest in a great pair of sunglasses! But for improvement of those lines, Botox is the most popular treatment in my office. As far as sunspots are concerned, if last year's sun damage is still visible on your skin, you'll likely look very damaged once this summer hits. Brown spots develop over time from sun exposure and can often be eliminated with specific lasers, like Ruby, Yag, and Alexandrite. These are specific to pigment particles that make the spots appear. Eliminating them just before summer will make your skin look more even and youthful. It will also prevent them from getting darker. When I treat them, it's advisable not to get too much sun in the few weeks following to avoid complications. And in the summer, when many of my patients are on the beaches or golf courses in the Hamptons, it's best to do this before summer.

I always thought it was a no-no to get any laser treatments before summer because it would leave skin vulnerable to more sun damage. Is that not true?

Let me say this, and I say this to all my patients in New York City. You can do any beauty treatment any time of year. Remember, in places like Miami and Los Angeles it's summer every day, and patients undergo cosmetic dermatology procedures all year round. That said, what's important is to understand that if it requires some level of downtime, meaning pinkness on the skin surface, sun should be avoided in the days or weeks following the procedure because there is a risk that the patient will burn or tan. My patients who undergo laser resurfacing in the summer understand this and simply wear regular sunscreen and do their normal activities. BUT if a patient in the summer - or winter for that matter is heading off on a vacation - they are advised not to sit at a pool or on the beach or a golf course in the time following treatment. The time-period depends on the treatment, but can range from days to weeks depending on the intensity.

Is there an area that we are neglecting that we need to pay better attention to?

The neck and décolleté. People forget to put sunscreen on these areas and when I laser the skin, I always look for issues here.

I think we are all well versed in Botox by now but Coolsculpting is relatively new. Can you explain what it is? 

Coolsculpting is perfect for trouble spots like love handles and lower abdomen fat that form because of genetic tendencies to store fat there. It reduces the fat layer. It relies on the fact that adipocytes, the cells in our body that hold fat under the skin surface, are sensitive to cold temperatures. After safe exposure, many of the cells shut down and go away permanently over the course of about 12 weeks. Your body simply metabolizes the fat that is released from the cells the way we typically metabolize fat released from the cells as part of normal metabolism. It is not suited to treat obesity, but it is wonderful for a non-surgical approach to reduce the bulges of fat that bother us, like love handles.

The variety of different lasers out there is dizzying! Which ones are best for treating those pesky brown spots from the sun, and how painful is the treatment?

Lasers including Ruby, Yag, and Alexandrite are best to target brown spots. They deliver a wavelength of light and when the correct wavelength is used, the light beam bounces off a target structure. The absorption creates heat that only affects the target and nothing else, making the treatments specific. When the laser passes over the sunspot and delivers the laser light it produces a snapping sensation on the skin. That's it. People do not need to numb for this procedure.

Of course, no-one wants to be hiding out at home for weeks after a getting something done, and I’m sure your celebrity clients can’t afford to miss a day! What’s the downtime?

There is no downtime after Coolsculpting. People go right back to their normal activities, including the gym. The treated area tends to be numb and tingly for a few weeks after treatment.  Uncommonly patients can develop soreness to the treatment site and this tends to come on in the few days after treatment and go away after another few days. With Botox, most of my patients have no downtime. If anything is visible, it's usually a brief period of minutes to hours of pinkness at the needle injection sites. Less commonly people can develop a bruise, and usually this is small. Fortunately, in rare instances where a bruise is particularly noticeable, instead of waiting the days for it to resolve, I have a trick using a pulsed dye laser that can eliminate bruises more quickly. It's an easy laser treatment and very helpful for my patients who are on TV or models before photo shoots in the days after treatment. When treating sunspots with laser therapy, I do expect a scab to form at the treatment site. The duration of the scab depends on the location. For example, a scab might persist 4-7 days on the face and up to 2 weeks on the chest. 

Are there any new products you are really excited for?

Juvederm Vollure XC was just released in March and I am thrilled! Many are just learning about it. It's the first hyaluronic acid filler FDA-approved for moderate to severe wrinkles and folds that lasts up to 18 months. Before this product, these sorts of fillers (hyaluronic acid) for wrinkles and folds have not exceeded durations of one year so 18 months is remarkable! It is a particularly smooth filler, and has a very natural, subtle appearance. 

What is your best skincare advice for the spring/summer?

Sunscreen! This is true for all seasons, BUT reapplication is so important in spring and summer if outdoors for more than two hours. Sunscreen reapplication of an SPF30 or higher product every 2-3 hours will give you good protection. Despite our guidance, some people will seek out summer sun to get color. It's just such an awful thing to do to the skin, since it leads to skin aging and skin cancer. In fact, an astonishing 90 percent of aging that we see on our skin is from the sun.

Any other advice to help protect us from the sun’s harmful rays?

I love sun protective clothing. It works. Sun-exposed areas need sunscreen but clothing-covered areas do not, as long as it's truly opaque. If wearing a light or mesh shirt in intense sun, you are not protected. If it's a high-quality UPF product, you are likely fine without sunscreen on the areas covered. If in a high-intensity sun environment like the Caribbean, why risk it. Put the sunscreen on everywhere, and wear sun protective clothing. Also, I have recommended Heliocare to many of my patients. It can be protective against the sun as well.

The Mother's Day Bliss Package

This year, celebrate Mom (or treat yourself) with our exclusive Mother’s Day promotion!
— Dr. Dale
mother_s_day.jpg

This Mother's Day, give Mom the gift of beauty with our aesthetic division's

Mother's Day Bliss Package!

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•25 Units of Botox

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Email us at chelsie@aestheticbodysolutions.co to reserve your Mother's Day Bliss Package!

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Probiotics and IBS

Read about how probiotics can be effective in IBS.
— Dr. Dale

From Probiotics and IBS 

Irritable bowel syndrome (IBS) is a chronic gastrointestinal condition that is prevalent in anywhere between 8 and 22 percent of the population. Associated symptoms include abdominal pain, flatulence, changes in bowel habits and bloating, in the absence of organic intestinal disease.

The cause of IBS has not yet been determined. Genetic predisposition, environmental factors such as infections and psychologic stress, and disorders of colonic digestion absorption and microbial fermentation may be involved in the etiology of the disease.

Microbiota and IBS

It is of interest that the fecal microbiome is obviously abnormal in IBS, with respect to the proportion of facultative organisms, and the reduction in the number of bifidobacteria and lactobacilli.

In some cases, this is caused by bacterial infections, and antibiotics may be useful because they are able to wipe out the disrupting bacterial strains. On the other hand, antibiotics are also the most common cause of this type of microbiome disturbance.

Disruption of the microflora leads to abnormalities in many functions that they perform in the human gut.

Probiotics in IBS

Probiotics are microbes that are ingested in the appropriate numbers in order to bring about health-related effects on the body beyond their nutritive value. These are live organisms and have been studied in many conditions affecting the gastrointestinal tract, such as Clostridium difficile colitis, antibiotic-associated diarrhea, and inflammatory bowel disease.  Many studies have now shown that their use is associated with better outcomes in irritable bowel syndrome.

Other applications in which probiotics have been of clinical benefit include necrotizing enterocolitis, traveler’s diarrhea, antibiotic-associated diarrhea and pouchitis, which is inflammation of a restorative ileal pouch. Probiotics are not a panacea for all inflammatory bowel conditions because they are ineffective in inflammatory bowel disease and Crohn’s disease.

In IBS, probiotics are found to be effective in the general sense, but the available evidence is heterogeneous. Some studies have used single and others multiple probiotics. There is a general improvement in IBS symptoms, but overall, the efficacy is usually confined to one symptom. Research on IBS and probiotics has been confounded by the differences between the parameters used from study to study in terms of dose, strains, duration, formulation, study design, and other treatments used.

Mechanisms of probiotic action

It is now understood that the mucous membrane and microbiome of the intestine are one physiological unit which is of great importance in maintaining intestinal homeostasis, modulating immune responses, and regulating mucosal immunity as well as cytokine production. The benefits brought about by probiotics is best understood in the context of dysbiosis-induced metabolic and inflammatory changes, and include:

  • Inhibition of the growth of pathogenic bacteria
  • Suppression of pathogen binding via their effects on adhesins
  • Improvement of the quality of the epithelial barrier in the gut
  • Enhanced host immune activity: some Lactobacillus species enhance immune function, by activation of dendritic cells (DC) which present antigen to the T cells of the innate immune system to produce cell activation and recruitment. This changes the cytokine pattern of the enteric mucosa. They may also be used to deliver other biologically active drugs to the intestine.
  • Colonic transit time is also affected by probiotic use in IBS with bloating as a prominent symptom.

Changes in the lumen include:

  • Reduced production of gas with fewer Clostridia and Veillonella
  • Increased consumption of nutrient substrates in the colon with SCFA production
  • Better colon motility, perhaps due to SCFA-induced peristalsis or fluid absorption
  • Less bile acid absorption in IBS with diarrhea due to bacterial deconjugation, with a lower load of bile salts to the colon, resulting in less damage to the mucosa
  • L. acidophilus leads to the overexpression of opioid and cannabinoid receptors which results in suppression of visceral hypersensitivity that occurs with disrupted gut microflora

Some of these effects are probably mediated by short chain fatty acids, which acidify the pH and result in bactericidal protein production. One of them is butyrate, which is a nutritive substrate for colonic enterocytes and improves the integrity of the mucosa. They may correct bowel motility problems, and also inhibit epithelial apoptosis.

Commonly used probiotics

One of the most studied probiotics in IBS treatment is Bifidobacterium infantis, which produces reductions in the levels of several pro-inflammatory chemicals such as TNF-α, gamma-interferon, and IL-6. It may also increase tryptophan levels which can suppress abnormal nervous signaling in the gut.

Other species that have been considered in this area and which produce similar effects on the pro-inflammatory (IL-12) and anti-inflammatory (IL-10) cytokine balance include the following strains of Lactobacillus:

  • L. plantarum 299v
  • L. rhamnosus LGG
  • L. reuteri
  • L. acidophilus
  • L. casei

There are also Bifidobacterium strains such as:

  • B. infantis
  • B. lactis
  • B. brevis

Another role for probiotics is to act as vehicles for targeted anti-inflammatory therapy at required areas in the gut, such as the use of Lactococcus lactis with the recombinant IL-10 secreting gene, which acted in a manner like that of corticosteroids.

The use of probiotics such as Lactobacilli and Bifidobacteria is safe unless the patient is immunosuppressed, and the dose given is large, or they are used following intestinal resection.

7 steps to making your health your No. 1 priority

Here’s to becoming a healthier version of yourself.
— Dr. Dale

From 7 steps to making your health your No. 1 priority

If you’re like many of us, you make well-intentioned health and fitness resolutions — perhaps on Jan. 1 — only to break them days or weeks later. We asked Betsy Mendel, a Los Angeles personal trainer and author of “Move a Muscle. Change a Mood,” for tips to help get back on track when we lose our way. Here’s what she had to say:

Instead of resolutions, let’s talk about commitments. Commitment involves an actual action plan. Really making a commitment and holding yourself accountable is critical. Personally I don’t make resolutions. I am committed to being my best, feeling and looking my best, all year round.

Here are six simple steps for accomplishing this:

1. Don’t try to change everything at once. Pick one thing and stick to it.

It seems like we try to change everything at once — our weight, our relationship, our career, our family and our finances — rather than prioritize. But it is completely unrealistic. In fact, sometimes the more we try to do, the less able we are to make any of these changes, and everything suffers.

So the first step is to prioritize. Make a list of everything you want to change. Then take time to really look at your list. Think about how each item on the list affects the other, and which makes the most sense to start with. Arrange them in order of importance. Now look at the first thing on your list and set a tangible and achievable goal you know you can attain. For instance, you could say “I want to lose 10 pounds by summer.” Look at this commitment each and every day. You are now on the pathway to success, taking one small step at a time.

2. Aim to create a positive new habit, not just a result. 

Focus on the new behavior you want to achieve, not the outcome. Let’s go back to that goal of losing 10 pounds by summer. There are two ways to obtain this goal: Cleaning up your diet, and exercise, just getting up and moving. That’s more effective that just focusing on the scale.

3. Change your environment.

This will change depending upon your goal. But if you want to lose weight and get healthier, you know that you need to stock your kitchen and pantry with healthy, wholesome foods that you will actually eat. Go through your kitchen, pantry and cabinet. Look at each item, one by one and put them into three groups: Foods that are healthy, foods that you’re not sure about, and foods that are unhealthy. The first group contains fruits, vegetables, lean meats and so on. Use your smart phone or computer to look up foods you’re not sure about, and decide whether they go into the healthy or unhealthy category. And you know what do to with the third group of food: Take unopened, non-perishables to the food pantry, and the rest goes in the garbage.

4. Recognize that small changes add up. 

Park your car so you have to walk a little farther rather than wasting time hunting for “the perfect spot.” Take the stairs instead of the elevator. Think of each step as a calorie burned. Ditch the diet drinks and drink water instead. (There have been so many studies and reports that show that diet drinks actually make us hungrier.) Create an exercise plan you can commit to four days a week.

5. When you slip, get back on track quickly.

There are times when we will make choices that we know are not good for us. We grab that super sugary dessert or skip a few days of our workout. One of the hardest things to do is to forgive ourselves and move back into our best behaviors as soon as possible. You don’t need to overcompensate to try to undo the damage that was done. This only makes getting back on track harder. Just get back into your healthy routine. Get back to your small changes, back to your positive behaviors and right back to achieving that outcome.

6. Schedule your new habits into your life.

Now, how do we make sure we follow through? First, we need to remember we are talking about a commitment. A commitment to ourselves. Commitments are not meant to be taken lightly. They are how we can truly judge ourselves. Are we strong enough to make a commitment and follow through? Of course we are, if we make and use the realistic plan we’ve outlined. But it’s not automatic. We are trying to changing behaviors that we’ve had possibly for decades. I suggest you use daily reminders to stay on track. Take your calendar or your smart phone and note all the positive behaviors you are committing to for the day. Maybe it’s wake up earlier to work out, or make a healthy smoothie, or walk a mile during your lunch break. Do this every day.

Your thoughts become your words, your words become your actions, your actions become your habits, your habits become your character. Add some positive thinking in this entire process, and your character becomes your destiny. And your destiny is plain and simple: Lose those 10 pounds, or whatever your goal was. If you follow through, you’ll find that achieving your goal was one of the easiest things you ever did because you did it through small, achievable steps.

7. Repeat.

Use this process over and over again to achieve all the goals you laid out at the very beginning. Step-by-step, day-by-day, you will live your commitments and see the strength of your true character.

The bottom line is there’s no secret sauce, no quick fix.

Commitment to good habits is the “magic bullet.”

 

Learning to Live With Ulcerative Colitis

An interesting read about living with Ulcerative Colitis.
— Dr. Dale

From Learning to Live With Ulcerative Colitis 

When I first wrote about living with ulcerative colitis (UC), I was very optimistic, as I typically am. I had just been released from the hospital and was on a heavy dose of steroids to control my symptoms and inflammation. I was a rookie. I didn’t know what was to come, but I was just so happy to get back to my normal life and be free.

What I didn’t know was that three years later, I still won’t have found freedom from my disease. Three years. Three years of pain, various medications, steroids, colonoscopies, blood labs, tests, trips to Mass General, desperate calls to my doctor.

One of the worst parts about UC, IMO, is the uncertainty of it. No one knows the cause, how your body will react to certain medications, when or why a flare will occur, a cure. Not being able to understand why this is happening makes things more difficult for one reason: on top of all the physical symptoms, it makes me feel guilty. Am I doing something wrong? Should I be taking different vitamins? Spending my money on acupuncture? Should I stop eating gluten? Should I stop drinking alcohol? Should I stop having a life?

I don’t know. No one knows. So, I just keep living, day after day, unsure of when I’m going to be bedridden in the fetal position again.

Despite my struggle with UC, I consider myself truly blessed. I know that God would not put so hard a burden on me that He knew I could not handle. I count the positives in my life, and understand I could have been dealt far greater problems. I am strong, in every sense of the word. My parents instilled that strength and confidence in me, yet they worry about my health more than I do. I accept things as they are. I accept that I have UC, and that I have to wake up and take several pills every day, even though I hate medication. I accept that despite being in my mid-20s I have annual colonoscopies. I accept that I have to get bi-monthly blood labs to be sure my medicine isn’t affecting my liver. I accept that I often have to pretend I am okay because I can’t continuously cancel plans, or miss big-moments. But what I forget sometimes is that this isn’t normal. I forget that other people, besides me, care about me and I need to manage that. UC has become such a part of who I am, that when people ask me if I’m feeling okay, it takes me by surprise to remember that I’m very sick.

Since my rookie year, I’ve learned a few things:

· People react differently to different medications – one person’s side effects may be completely different than yours

· Don’t consider what you read online as fact

· Sometimes you’re going to cry and it’s okay

· People LOVE to complain. Keep counting your blessings rather than joining their pity  parties

· Vegetables aren’t always good for you. Eat them sparingly

· Cinnamon is an anti-inflammatory. Add it to your coffee

· Baby wipes are not just for babies

· Tylenol is okay, not ibuprofen

· Invest in a heating pad, it is magical

· Drink more water than you want to

· Going for a short, slow walk can help pain. If you’re too sick for a short walk, go to the ER

The past three years I have been on and off steroids, which is terrible to be on and off of for that long. I consider steroids the devil’s drug. They work immediately, but have terrible side effects. Along with steroids, I started with a Level One medication, an aminosalicylate, which stopped working for me after a year. I moved onto a Level Two medication, an immunosuppressant, which has also now stopped working. I’m moving up and onto the final Level of medications: biologics. This medication is not a pill, it is an infusion, I am out of pill-options.

My goal going into this new medication is to find the freedom that three years ago I thought would come as soon as I was released from the hospital: remission. If I don’t find myself in remission, the last step for me is surgery. I’m not afraid of my UC, nor am I afraid of what it may bring. A friend of mine who had the surgery explained it well, she told me that you lose one year, but get the rest of your life back.

Like everything else around my disease, I’m unsure. I’m unsure about what the future will hold for me, but I do know that it will be nothing less than great. The rest of my life is a blank slate, and I intend to overfill it with love, family, friends, and uber-happy moments. I don’t have much space allotted in my future for sitting on the couch with my heating pad. So, we shall see where this next year takes me, I’m aiming for freedom.

Nearly half of adults in US infected with HPV

An interesting read about adults in the U.S. with HPV
— Dr. Dale

From Nearly half of adults in US infected with HPV

If you currently are sexually active, have been sexually active in the past or have sex in the future, there's an extremely high chance that at some point before your sex life is over you will have been infected with the human papillomavirus (HPV), a sexually transmitted infection that is linked to several cancers. Just this month, the National Center for Health Statistics announced that it found that 45.2 percent of men and 39.9 percent of women 18 to 59 years in age were infected with genital HPV during 2013 to 2014.

Even more alarming, the center found that during the same time period 25.1 percent of men and 20.4 percent of women were exposed to high-risk genital HPV, which result in about 31,000 cases of cancereach year.

A viral infection, HPV is the most common sexually transmitted infection and can be spread between partners through anal, vaginal, or oral sex, and even through close skin-to-skin touching. The center's latest figures are a reminder that nearly everyone who is sexually active becomes infected with HPV during some point in their lives, according to the federal Centers for Disease Control and Prevention (which includes the NCHS).

"HPV is very common; up to 80 percent of sexually active people have been exposed at some point in their lives," says Summer Dewdney, MD, a gynecologic oncologist at Rush University Medical Center. "But the vast majority never develop any symptoms, and the body's immune system can usually clear HPV on its own within two years."

HPV causes nearly all cervical and oral cancers

But other times, the infection does not clear up. And since there is no cure for HPV, the virus puts people at risk for potentially serious problems—such as cancer and genital warts—down the road. Every year, more than 27,000 women and men are affected by the following cancers linked to HPV:

  • Anal cancer
  • Cervical cancer
  • Oropharyngeal cancer, which includes oral cancer and throat cancer
  • Penile cancer
  • Vaginal cancer
  • Vulvar cancer

Almost all of the more than 11,000 cases of cervical cancers diagnosed in the U.S. each year are caused by HPV. While oral cancers used to be attributed mainly to tobacco and alcohol, now 72 percent of oral cancers (particularly in young men) are caused by HPV.

"There has been significant change in the last decade. The HPV-associated oropharyngeal cancer has reached epidemic proportions," says Kerstin Stenson, MD, a head and neck cancer surgeon at Rush.

"By 2020, HPV is projected to cause more oropharyngeal cancers than cervical cancers in the U.S.," adds Karen Lui, MD, a pediatrician at Rush

Protect yourself with HPV vaccine ...

The doctors recommend taking precautions to prevent HPV infection and catch infections that do occur before they become major health problems. "We have a vaccine for cancer," Dewdney says. "Use it!"

Two vaccines, Cervarix and Gardasil, are available to protect against the types of HPV that cause the most cervical cancers, as well as anal cancers in men. A doctor can administer the vaccine in three shots over a six-month period.

  • Gardasil is recommended for girls and women between ages 9 and 26
  • Cervarix is recommended for girls who are 9 years of age, plus women of any age who have not previously been vaccinated and have not previously been diagnosed with cervical cancer.
  • The HPV vaccine is also recommended for boys, starting at age 11. 

"If you aren't eligible but your children are the right ages, consider taking them to be vaccinated," Dewdney says. "But the important thing to know is that even if you were not vaccinated as a child, you can still get the vaccine up to age 26."

... get regular pap tests and dental exams ...

Additionally, Lui recommends annual PAP tests for women starting at 21 years of age—whether they've been vaccinated or not. Pap tests enable doctors to detect abnormalities—changes on the cells on a woman's cervix—and take action before cervical cancer develops. "Screening is the best way to catch HPV-related cancers early," Liu says.

"Once you turn 30, we recommend pap smears every five years as long as you have HPV testing with your Pap and the results are negative," Dewdney says. "In addition, any bleeding with intercourse should be evaluated by a gynecologist."

According to the American Cancer Society, between 60 and 80 percent of women in the United States with newly diagnosed invasive cervical cancer have not had a Pap test in the past five years. And, even more alarming, many of these women have never had the exam.

Stenson stresses the importance of regular visits to the dentist. "Dentists play a key role in detecting oral cancer," she says. "You might not see a primary care physician even once a year, but most people see their dentist twice a year. Having regular dental visits can help catch cancers early to help ensure the best outcome."

... also, practice safe sex

Studies have shown that women who have many sexual partners increase their risk of developing HPV and their risk of cervical cancer. 

"If you are sexually active, use a condom every time you have sex," Dewdney says. "Unprotected sex leaves you at risk for contracting sexually transmitted diseases that can increase your risk of getting HPV and greatly increase your chances of developing precancerous changes of the cervix."

While condoms help to lower the risk of developing HPV-related diseases, including cervical cancer, be aware that HPV can infect areas that are not covered by a condom, so condoms may not fully protect against HPV. That's why it's essential get the HPV vaccine in addition to using condoms.

Though studies have shown that using a condom properly and consistently—meaning every single time you have sex—can reduce HPV transmission, any area of the penis not covered by the condom can be infected by the virus.

"While the infection is most commonly passed by vaginal or anal sex, you can also transmit it during oral sex and skin-to-skin contact, and in those cases a condom isn't going to protect you at all," Lui says. "That's where the vaccine can help safeguard you."

Protect your children 'for the rest of their lives'

Due to controversy about vaccinating young people against a sexually transmitted infection and parental concerns about possible long-term effects of these relatively new vaccines, many children, teens and young adults aren't getting vaccinated, leaving them vulnerable to future HPV infection.

Lui encourages kids and parents to have an ongoing, open conversation about their wishes when it comes to being vaccinated.

"It's hard for some kids to admit to their parents that they're sexually active or are considering it," says Lui. "But it's important to be honest with your parents and tell them that you want to protect yourself."

Also, research has shown that getting the HPV vaccine does not encourage kids to become sexually active or start having sex at a younger age—a common concern cited by parents.

"Parents need to understand that just because their kids want the HPV vaccine, it doesn't mean they're promiscuous, or even that they plan to start having sex right away," Liu says. "They're talking about doing something now that can help keep them safe for the rest of their lives—and as parents, that's all we really want for our children."