In case you missed it, March was National Colorectal Awareness Month. This is a reminder to doctors and patients to consider routine testing for colon cancer prevention. Last year 145,000 people in the U.S. were diagnosed with colon cancer and sadly, about 66,000 died for this disease. This is especially sad, because colorectal cancer is a preventable disease.

     Colon cancer usually does not produce early symptoms, so the only good strategy for catching it early is routine testing. Doctors call routine testing in patients with no symptoms "screening." Several tests are available for colon cancer screening, but colonoscopy is considered the best. It is not perfect, but it does examine the entire colon and is more accurate than other methods like x-rays, flexible sigmoidoscopy (a shorter colon scope that evaluates only the left half of the colon) and stool guaiac testing (testing for microscopic blood in the stool).

     All adults are at risk for colon cancer-even if there are no symptoms and no family history of cancer. About 6% of the population over 50 will eventually develop colon cancer. It is the second most common cause of cancer death in the U.S. The risk is higher in older individuals, in African Americans, and in those with a family history of colon cancer. Because everyone is at risk and because there are usually no symptoms, the American Cancer Society recommends a routine screening colonoscopy every 10 years starting at age 50. African Americans should start at age 45, and those with a close relative with colon cancer should start at age 40 or when 10 years younger than their relative's age at first diagnosis.

     Patients having colonoscopy are usually surprised by how easy it is. During the procedure a flexible fiber-optic scope is placed in the rectum. This allows your physician to see and evaluate the lining of the entire colon. A small I.V. is used to provide sedation so patients experience little discomfort and usually don't remember the test afterwards. Fortunately this test does not need to be repeated very often. "Alarm" symptoms such as blood in the stool, persistent diarrhea or constipation, and changes in the caliber (diameter) of stool should prompt a doctor's visit, but in the absence of new symptoms colonoscopy only needs to be performed every 10 years. Of course no one enjoys colonoscopy but it is a small price to pay to avoid the trauma and risk of colon cancer.

     Robert D. Schmidt, MD
     Gastroenterology
     NPHO Member

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     Despite increased awareness, heart disease remains the number one killer in America, and claims over half of the lives lost annually in Oklahoma.

     In the last few years, coronary artery calcium scoring has emerging as a way to detect early changes in the heart that could eventually lead to a heart attack. This test is a specialized CAT scan of the heart looking specifically for calcium in the coronary arteries. These arteries supply the heart with blood. Calcium does not normally appear in the coronary arteries, and its presence suggests atherosclerosis, which eventually causes narrowing in the coronary arteries, leading to a heart attack.

     Early in the process the coronary arteries can compensate for this atherosclerosis, but eventually the arteries are overwhelmed, and blockages begin to form. Thus, the mere presence of calcium does not mean a blockage is present, but the more calcium present in the arteries, the greater the likelihood blockages exist.

     The test is non-invasive and takes about five to ten minutes to complete. Results should be received in about one week. The results are based on the amount and extent of calcium present in your coronary arteries. Your score is then compared to other people of the same age and sex. Bases on that comparison you are then given a percentile rank, and placed in a low, medium, or high-risk group for possible future cardiac events.

     In most studies a score of zero is associated with a very low (less than 1%) risk of heart attack over the next five years. A high-risk score can be associated with a fifteen-fold increase in the chances of having a heart attack.

     A doctor's referral is not necessary to have this test. If your test is "positive" or particularly if it is high risk, you should discuss the results with your doctor. A treadmill stress test may be indicated. At a minimum, controlling cardiovascular risk factors such as high blood pressure, high cholesterol, diabetes mellitus, and smoking, are in order. Although it is currently being studied, the value of following your treatment with serial testing presently unknown. If you already have a diagnosis of coronary artery disease there is very little reason to have this test.

     Currently calcium scoring CAT scans are available, by appointment, at the Norman Regional Healthplex. The cost is $______, and the scan is not usually covered by most medical insurance policies.

     Jeffrey Crook, MD
     Cardiovascular Diseases
     NPHO Member

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     There is a general misconception that heart disease is a man's disease. The fact is that cardiovascular disease is the number one killer of women. If you are a woman, you are more likely to have heart disease in your lifetime than breast cancer. According to the American Heart Association (AHA), cardiovascular-related diseases such as heart attacks, strokes and heart failure cause 500,000 women lives a year. Put in another away, cardiovascular-related diseases claim more women's lives than the next top five causes of death combined, including cancer.

     Heart Disease Risk Factors:
     Heart disease risk factors are the same for men and women. Risk factors we cannot modify include age, heredity, and a previous history of heart disease. Men tend to have heart disease at an earlier age, but females catch up to males after menopause.

     Risk factors which can be modified include: tobacco smoke, high blood pressure, high blood cholesterol, physical inactivity, obesity and diabetes mellitus. The lifestyle modifications to reduce your risk factors (even if you don't yet have heart disease) are the keys to improve your overall health. Physical inactivity, obesity and diabetes mellitus go hand-in-hand. Persons with increased fat around the belt line are more likely to have high blood pressure, high cholesterol and diabetes.

     Symptoms of Heart Disease:
     The symptoms of a heart attack in women may not be the classic chest pain as experienced in men. Instead, chest-pain equivalents such as chest pressure, shortness of breath, generalized weakness, and nausea and other non-specific symptoms could be signs of a heart attack.

     Early symptoms of heart disease include a change in stamina, early fatigue, shortness of breath with activities, chest pressure and/or chest pain with pain in the neck, jaw and arms.

     Test and Treatment:
     Heart disease diagnosis and treatment have made rapid advancements. Many different treatment options are now available locally to your physician. Options range from simple laboratory tests, stress tests, and "heart scans," to more high-tech treatments such as cardiac catheterization, angioplasty, stents and "bypass open heart surgery". However, it is important to remember that the most important part of diagnosing and treating heart disease may be time spent discussing your symptoms and concerns with your physician.

     If you are a woman or care for one, don't miss heart disease symptoms. Your physician is the key to identifying and managing risks and treating heart disease. If you have additional questions about your risks, you need to contact your personal physician. Additional information can also be found on the web at www.americanheart.org.

     Michael Villano, M.D., F.A.C.C.
     Dr. Villano is a staff cardiologist at Norman Regional Hospital.

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     If you saw the movie The Lady Killers, you probably laughed at the plight of the character " Mountain Girl" and her boyfriend who met at an Irritable Bowel Syndrome retreat for singles. Unfortunately, irritable bowel syndrome is not really a laughing matter. Rather, it is a common, often painful disorder of the intestinal tract. It affects millions of people and accounts for millions of doctor visits every year. Irritable bowel syndrome is also known by several other names, including IBS, spastic colon, and functional bowel disease. IBS is different from colitis, ulcerative colitis, and inflammatory bowel disease.

     IBS is a motility disorder. This means that the normal rhythmic action of the intestinal tract is disrupted. The activity may be increased or decreased, and it may be uncoordinated and spastic. The symptoms of IBS correspond to this activity. Patients may experience cramps, diarrhea, and mucous in the stools with increased activity. Sufferers may also experience alternating symptoms if activity is uncoordinated.

     The cause of irritable bowel syndrome is unknown. Most patients notice that symptoms may be triggered by stress; however, many spells have no obvious correlation with stress. Likewise, certain foods seem to trigger spells in certain patients, but no single food will predictably trigger symptoms in IBS patients. High fiber diets may improve symptoms and most physicians recommend high fiber diets for their IBS patients.

     No specific test exists to make a diagnosis of irritable bowel syndrome. The diagnosis of IBS is a diagnosis of exclusion. This means that other diseases of the intestinal tract must be ruled out before a diagnosis of IBS can be confirmed. Usually this can be done with a few simple tests and does not normally require a great deal of evaluation. Typically a basic medical history, physical exam, and a handful of blood and urine tests are sufficient, but based on individual circumstances your doctor may order x-rays, CAT scans, or ultrasound exams.

     IBS affects both men and women, but women get irritable bowel syndrome more often. It can occur in children but is more common adults. Usually symptoms occur only intermittently-spells may occur days or years apart. The severity of symptoms is variable as well. Symptoms may be mild and barely noticeable or they may be severe and incapacitating.

     Treatment for irritable bowel syndrome is usually very effective. Although there is no cure, many treatment modalities may be helpful. High fiber diets are often useful. Stress reduction through exercise, meditation and relaxation training is often useful. A wide variety of medications are also sometimes helpful including antispasmodics, stool softeners, antidepressants, and anti-diarrhea medications.

     Although IBS can be a significant nuisance, it can be successfully treated and controlled. It does not usually worsen over time and does not cause any injury to your intestinal tract. If you have symptoms of IBS that are severe enough to affect your life, you should see your local doctor for evaluation.

     Stephen E. Connery, MD
     Board Certified Family Practitioner
     NPHO Member

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     It is estimated that approximately 1,000,000 basal cell carcinomas and squamous cell carcinomas will be newly diagnosed in the United States this year. Approximately 60,000 melanomas will be newly diagnosed, with the rate of all skin cancers increasing yearly. In order of severity the melanomas are at the top of the list. These are cancers that occur from the pigment producing cells of the skin called melanosomes. Next in line is the squamous cell carcinoma that occurs from the cells of the mid layer of the epidermis. The epidermis is the top layer of the skin. Both of these cancers can become metastatic and spread through the body and both can be potentially fatal. The third cancer, basal cell carcinoma, occurs from the very bottom layer cells of the epidermis. Basal cell cancers, although destructive and dangerous, are rarely metastatic.

     Sun exposure and ultraviolet light from tanning beds increase the incidence of all 3 of these skin cancers. Sunburn causes the most trouble. Protection from the sun should be routine and can be easily accomplished with sunscreens and clothing. The sun protective factor of a sunscreen, called the SPF, is listed on the containers of sunscreens. A sunscreen of 15 or above is the best protection against the ultraviolet light that causes most of the problems with skin cancer. The same two bands of ultraviolet light that are involved in producing skin cancer, as well as producing tanning. These are ultraviolet A and ultraviolet B. The sun protective factor tells you only how much ultraviolet B protection you are getting and does not list the ultraviolet A protection, as there is no official measurement for that. Complete sunblocks block both UVA and UVB and are available. Clothing that covers the skin and hats that shade the ears and face are also very effective protecting against UVA damage.

     When skin cancer does occur the most common treatment is surgical removal of the cancer. In some cases, radiation or freezing is used, and in early cancers there is a topical cream that can be effective. Treatment is available and successful for all 3 of the common skin cancers, however, prevention by protection with sunscreens and clothing and avoiding intentional exposure to tanning booths, is obviously the best approach.

     The American Academy of Dermatology recommends that each person see a dermatologist yearly for examination to discover any skin cancers or other problems with the skin at the earliest possible stage. The earlier the cancer is discovered and treated, the better the likelihood of complete cure as an outcome. Dermatologists believe you should have dun in the sun, but have the good sense to protect yourself while doing so.

     Joel E. Holloway, M.D., Board Certified Dermatologist, Fellow of the American Academy of Dermatology and the American Society of Dermatologic Surgeons. He is in private practice of dermatology in Norman with a special interest in skin surgery and cancer of the skin.

     Member, Norman Physician Hospital Organization

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     Dr. Gailen D. Marshall Jr., director of the Division of Clinical Immunology and Allergy at the University of Mississippi Medical Center, says that vaccines were the Number One advancement in Medicine in the past 100 years. At the beginning of the last century (1900) the average life span in the U.S. was 47 years. By the end of the 20th century it was 77 years. This 30-year life expectancy improvement is primarily due to vaccination.

     Most vaccines are aimed at children, increasing the lifespan by increasing childhood survival. Every year newer and more effective vaccines with fewer side effects are being developed. Great strides in conquering infectious disease common only a few decades ago are being made. While antibiotics to fight infections are failing more often, newer vaccine to prevent infections are significantly improving the health of our children as well as adults.

     Childhood immunization begins shortly after birth with the first Hepatitis B vaccine, and are followed at 2, 4, 6 months with DTaP (Diphtheria, Tetanus, Whooping Cough), Polio, Hemophilus Influenza, Hepatitis B, and Pneumococcal vaccines. Later at 12-15 months Chicken Pox, Hemophilus Influenza (booster), and MMR (Measles, Mumps, Rubella-German Measles) are given. At age 2 years the Hepatitis A series of two is started. Then again just before school age DTaP, Polio, and MMR booster doses are given. All but the Pneumococcal vaccines are required in Oklahoma for school. While not a school requirement, the Pneumococcal vaccine is very important because it help prevent Pneumococcus, a major cause of both ear infection and meningitis (infection of the brain and spinal cord). And we must not forget the annual Flu Vaccine. Exemptions to all these vaccines can be given but only under very stringent circumstances. Failure to vaccinate places children and his/her contacts at significant frisk. Vaccination not only protects the individual who receives the vaccine but by preventing disease in the vaccine it also protects his/her contacts. This is particularly obvious with the rubella portion of the MMR vaccine, which has been shown to protect the pregnant woman and her unborn baby from getting the German Measles, which is almost always fatal to the baby.

     Several newer vaccines have been approved by the FDA recently. These include a new version of the RotoVirus Vaccine (to prevent the viral cause of vomiting and diarrhea in infants), Tdap a special formulation of the DTaP vaccine given to adolescents over age 11, and a vaccine to prevent Meningococcal disease (Menactra), which can be rapidly fatal especially in adolescents, and college students who are particularly at risk. A vaccine still in the approval stage has been developed against the Human Papilloma Virus (a known cause of cervical cancer in women).

     All of these vaccines have not only been proven to be effective in preventing disease but they are also very safe. Side effects can and do occur but are generally mild and include fever and soreness or redness at the site of vaccination. The controversies that have cropped up regarding autism, inflammatory bowel disease, and neurological illness have been extensively studied and proven to be merely coincidental, not causal. The consequences of not immunizing children could prove devastating. In today's world with instant communication and almost instant long distant travel disease can spread very rapidly. In countries where Mumps vaccine was discontinued the incidences of Mumps increased rapidly. Small pox has been successfully eliminated form the entire world by vaccination and now only exists in very small quantities in several laboratories including the lab at the Center for Disease Control in Atlanta, Georgia. While there has been some concern about terrorists obtaining some of this virus and causing outbreaks, this is only theoretical. Polio is basically gone from the USA and with the use of the killed virus injectable vaccine there is no longer the threat of vaccine induced Polio. However wild Polio Virus still exists in several third world countries and can easily be reintroduced in to the United States by visitors from these countries.

     The America Academy of Pediatrics and The American Committee on Immunization Practices as well as the American Medical Association fully endorsed the use of these vaccines. To not vaccinate you child, in my opinion is not only dangerous but also irresponsible and negligent. All of these vaccines are available at your pediatrician's office and the County Health Department and are usually covered by your insurance program or the Vaccine for Children Program.

     For more information about the use and side effects of vaccines you can contact your doctor, the Health Department or a reputable internet site such as www.cdc.com.

     Richard A. Carlson, M.D.
     Pediatrician
     NPHO Member

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