Esophageal Cancer

Esophageal cancer forms inside the esophagus, which is the muscular tube that carries food from the mouth to the stomach.  Esophageal cancer is not as common as some other cancers, such as breast, lung, and prostate cancer.  But the number of people with one particular type of esophageal cancer, called adenocarcinoma, has risen dramatically in the past few decades.  Adenocarcinoma is the most common type of esophageal cancer in the U.S.  Let's talk about more about it, including what symptoms you should be aware of.

What causes esophageal cancer?

Unfortunately, we don't know exactly what causes esophageal cancer.  It is thought that chronic irritation of the inner lining of the esophagus may contribute to causing changes in cells within the esophagus that can make them grow and divide out of control. 

Here are some of the things that cause irritation in the cells of the esophagus that appear to increase your risk of developing esophageal cancer:

• Smoking
• Having gastroesophageal reflux disease (GERD)
• Drinking alcohol
• Having Barrett's esophagus, which is the name given to precancerous changes in the esophagus
• Being obese
• A steady habit of drinking very hot liquids
• Not eating enough fruits and vegetables
• Having bile reflux (reflux of bile from the gall bladder)
• Having an esophageal sphincter that won't relax (called achalasia), which usually cause trouble swallowing
• A history of radiation treatment to the chest or upper abdomen

What are the symptoms of esophageal cancer?

• Weight loss without trying
• Difficulty swallowing
• Progressively worsening heartburn or indigestion
• Coughing or hoarseness
• Chest pain or pressure, or a burning sensation in the chest.

How is the diagnosis of esophageal cancer made?

• Barium swallow test - You swallow a liquid containing barium, then have X-rays. The barium will show the contour of your esophagus on the X-ray.
• Endoscopy or EGD - This involves your doctor putting a flexible lighted tube through your mouth and throat, into your esophagus. During the EGD, a biopsy can be done of any suspicious areas to send to the lab for testing. 
• CT scan of the chest - Can show the tissues in the esophagus.

What can you do to help reduce your risk of esophageal cancer?

• If you have been told that you have Barrett's esophagus, be sure to maintain follow up with your doctor and undergo screening tests when recommended.
• Quit smoking
• Avoid alcohol consumption or drink only in moderation
• Maintain a healthy weight. If you are overweight, talk with your doctor or one of our dieticians about strategies to help you lose weight.
• Eat more fruits and vegetables, aiming for a variety of colors.
• If you have GERD, follow your doctor's recommendations regarding treatment as well as lifestyle precautions you should take.

If you have any questions about esophageal cancer, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Sarcoidosis - Part II

Last week, we talked about sarcoidosis which is an inflammatory disease that can affect any organ in the body.  Let's continue our discussion today focusing on diagnosis, treatment, and possible complications.

How is the diagnosis of sarcoidosis made?

Diagnosing sarcoidosis can be difficult.  The disease often causes few or vague symptoms in early stages and the symptoms often mimic those of other diseases.  Your doctor will need to do a thorough physical examination to check all the areas that might be affected by sarcoidosis.

Your doctor will also usually recommend some tests to help make the diagnosis and to determine what body systems are involved and the extent or severity of involvement.  These tests include:

• Blood and urine tests
• Chest X-ray
• CT scan of your chest
• Pulmonary (lung) function tests
• Electrocardiogram
• Eye exam
• Biopsies - Usually from the lung, lymph node, or skin.
• MRI or PET scan - especially if there is suspicion of heart or central nervous system involvement

What are the possible complications of sarcoidosis?

Sarcoidosis often goes away without causing any complications, or responds well to treatment, but long-term problems can happen.  These complications can sometimes be life-threatening.  They include:

• Lungs - Permanent scarring with fibrosis in the lungs can make it difficult to breathe and can sometimes cause high blood pressure in the arteries within the lungs.
• Heart - Granulomas in the heart muscle can disrupt the electrical system of the heart, causing abnormal rhythms. They can also impair blood flow and normal heart function, which can cause congestive heart failure and even lead to death.
• Eyes - Inflammation within the eye can eventually cause blindness if not treated.
• Nervous system - Granulomas that form in the brain, nerves, or spinal cord can cause a variety of neurologic symptoms, the most common is facial paralysis on one side.
• Kidneys - Kidney stones, reduced kidney function, and rarely kidney failure can occur.

How is sarcoidosis treated?

Sarcoidosis cannot be cured, but it can be treated.  In many cases, it goes away completely without treatment.  Mild cases may not be treated at all.  If you have severe symptoms or extensive involvement, then treatment may include:

• Corticosteroids - These are powerful anti-inflammatory drugs that are usually the first line treatment for sarcoidosis. They may be taken by mouth, put on the skin in a cream, or put into the eye in drops. 
• Immune suppressants - Act to reduce inflammation.
• Hydroxychloroquine - Can help with skin lesions and elevated blood calcium levels.
• Certain other rheumatoid arthritis medications - Are sometimes used to treat sarcoidosis that has not responded to other treatment.

Ongoing monitoring by your doctor is very important in sarcoidosis, to determine if treatment is needed and monitor for treatment response and complications.

In rare cases, organ transplant may be considered if sarcoidosis has caused severe organ damage that cannot be treated with medication.

For more information about sarcoidosis, use this link:

Sarcoidosis - What Is Sarcoidosis? | NHLBI, NIH

If you have any questions about Sarcoidosis, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Sarcoidosis

Sarcoidosis is a disease in which there are tiny collections of inflammatory cells, called granulomas, that grow in the body.  They are most common in the lungs and lymph nodes, but can grow in any part of the body, including the eyes, heart, skin, and any other organ of the body.  Most people have never heard of it, or don't know much about it. 

What causes sarcoidosis?

We are not sure of the exact cause of sarcoidosis.  Experts believe that it is a result of the body's immune system reacting to an unknown substance.  There is probably a genetic predisposition that causes the body to form these granulomas in response to various substances that the immune system perceives as foreign, such as bacteria, viruses, dust, or chemicals.

There are some things that seem to increase your risk of developing sarcoidosis, including:

• Age - Most often occurs between age 20-60 years old
• Sex - Women are at slightly higher risk
• Race - People of African descent and Northern European descent have a higher incidence of sarcoidosis.  African Americans are more likely to have involvement of organs besides the lungs.
• Family history - You are at higher risk if a family member has had sarcoidosis.

What are the symptoms of sarcoidosis?

Symptoms can vary depending on what part of the body is affected.  The symptoms will sometimes develop gradually over several years but can sometimes appear suddenly.  Some people with sarcoidosis have no symptoms.  They may be found to have sarcoidosis after a chest X-ray that was done for an unrelated reason.  Here are some of the possible symptoms of sarcoidosis:

Lung Symptoms - Because the lungs are most often affected, common symptoms include:

• Persistent cough - usually dry
• Shortness of breath
• Wheezing
• Chest pain

General symptoms

• Fatigue
• Fever
• Swollen lymph nodes
• Weight loss
• Pain and swelling in joints

Skin symptoms

• Rash - Usually red or purple bumps on the shins or ankles
• Sores on the nose, cheeks, or ears - which can be disfiguring
• Variation in skin pigment with darker or lighter areas
• Growths under the skin - often around or under scars or tattoos

Heart symptoms

• Chest pain
• Fainting
• Irregular heartbeat
• Palpitations
• Swelling - usually in the legs

Eye symptoms

• Blurry vision
• Eye pain, burning, itching, or dryness
• Severe redness
• Light sensitivity

Next week, we will continue our discussion with more about diagnosis, treatment, and possible complications of sarcoidosis.

If you have any questions about Sarcoidosis, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Distracted Driving

The National Safety Council estimates that as many as 40,000 people died on U.S. roadways in 2016.  That was a 14% increase since 2014, the most dramatic 2-year increase in 53 years.  Every year in the U.S., at least 3,000 people die in crashes known to involve a distracted driver.  It's not just cell phones that cause distraction.  Let's talk about what we can all do to decrease distracted driving and save lives.

What is distracted driving?

Distracted driving is doing any other activity that takes the driver's attention away from driving.  We all think of cell phones as the cause but there are many things that can distract us, including: 

• Using a cell phone for talking or texting, even hands-free
• Using a navigation system or GPS
• Eating while driving
• Children crying or arguing in the back seat
• A heated argument or discussion with a passenger

There are three types of distracted driving.

• Visual - Taking your eye off the road
• Manual - Taking your hands off the steering wheel
• Cognitive - Taking your mind off driving

Sending a text causes all three!

Who is more at risk for distracted driving?

Young adults and teens are much more likely to drive distracted.  However, adults are also guilty of distracted driving more than you might think.

What can you do to prevent distracted driving?

As the driver:

• DO NOT multitask while driving!  Do not use your phone while driving for calls or texts.  Adjust your mirrors and seat before you drive.  Pull over to check on your crying baby.  Eat before or after you drive, not during.
• Consider trying an app designed to help you avoid cell phone distractions while driving.
• Pull over to make a call or send a text that you feel is important.

As the passenger:

• If you think the driver is distracted, speak up and ask them to focus on driving.
• Help the driver by assisting with navigation or monitoring their phone for them.
• Wait until after the drive is over to bring up topics that might be upsetting or cause an argument with the driver.

As a parent:

• Talk to your teen or young adult about the rules and responsibilities involved in driving.  Remind them that driving is a skill that requires their full attention.  Emphasize that cell phones should never be used while driving.
• Know your state's laws on distracted driving.  Many states have provisions in their distracted driving laws specifically for novice drivers.  Make sure you and your teen are aware of your state's penalties for distracted driving.  Remember that your own rules for your teen driver can be stricter than your state's law.
• Set consequences for distracted driving and stick to them.  The CDC has a Parent-Teen Driving Agreement that you can use to help set the rules and communicate them with your teenager. 
• Set a good example for your children even before they start driving by always paying attention to the road.  

For more information, use this link:

https://www.cdc.gov/transportationsafety/pdf/Distracted-Driving-Summary-Sheet-508.pdf

If you have any questions about distracted driving, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Diabetic Ketoacidosis - Part II

Last week, we talked about the serious complication of diabetes called diabetic ketoacidosis, or DKA.  We will continue our discussion today, focusing on how it is diagnosed and treated, along with ways to help prevent it.

How is the diagnosis of DKA made?

Your doctor will do blood and urine tests to make the diagnosis of DKA.  Sometimes additional tests will be done to determine what triggered the DKA or to determine how your body systems are functioning.

Although all of these tests are not necessary in every case, the tests can include:

• Blood sugar levels
• Ketone levels in blood and urine
• Acidity level of the blood
• Electrolyte levels in the blood
• Urinalysis
• Chest X-ray
• EKG - Shows the electrical activity of the heart

How is DKA treated?

• Fluid replacement, usually through an IV - Most patients with DKA are dehydrated, which could have been part of the trigger for developing DKA, or due to the high urination level and nausea and vomiting that can be symptoms of DKA.  Rehydration with fluid replacement can help to dilute the high blood sugar level and help relieve some of the symptoms of DKA.
• Insulin therapy - The underlying cause of DKA is too little insulin for the circumstance.  Insulin, usually given IV, will reverse the processes that cause DKA.  If your blood sugar goes down during treatment, but your blood is still too acidic, you will be given sugar in the IV along with the insulin, until the acid level improves.  
• Electrolyte replacement - When there is not enough insulin in the blood, this can result in lower levels of several electrolytes in the blood.  Replacing the electrolytes will help maintain normal function of your heart, as well as your muscles and nerves.  
• Treatment or evaluation of any underlying trigger - If the tests show a specific trigger for DKA, such as pneumonia or a kidney infection for example, then that would need to be treated with the appropriate medication.  If your doctor suspects the DKA was triggered by a heart attack, further heart tests would likely be recommended.

How can DKA be prevented?  

• Educate yourself and family members about DKA - Knowledge is power!
• Close management of your diabetes - Take all medications as directed by your doctor.  Follow up regularly. Make healthy eating and physical activity a routine part of your day.
• Monitor your blood sugar levels regularly - Check your blood sugar levels as recommended by your doctor.  Check blood sugar levels more often if you are sick or stressed.
• Adjust insulin dosage and other diabetic medications when needed - Talk with your doctor ahead of time to learn how to adjust the dosage of your diabetic medications, especially insulin, depending on activity level, what you eat, whether you are sick or stressed, etc.  When you feel ill or stressed, or have had a recent illness or injury, you should check your blood sugar often and adjust your insulin dosage as needed.
• Check your ketone levels - When you are ill or stressed, and especially if your blood sugar is above 240 mg/dl, you should use an over-the-counter urine ketone test kit every 4-6 hours until your blood sugar is consistently back to your target levels.  If your ketone level is moderate to high, contact your doctor right away, go to the emergency room, or call 911.  If your ketone levels are low, you may need to take more insulin to bring your blood sugar down.  Talk with your doctor for instructions.
• Be ready to act quickly when necessary - Learn where the closest emergency room is well before you need it.  Find out what health care facilities are covered by your insurance.  Know how to contact your doctor after hours.  Make sure your kids know how to call 911 in case you quickly become too ill to do so yourself.  If your blood sugar is high and ketones are moderate to high, you need to act quickly to seek emergency care.  It could save your life.

If you have any questions about Diabetic Ketoacidosis, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor