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I’ve signed up for Heart Day! Now what?

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According to the CDC, heart disease accounts for 1 in every 4 deaths in the U.S. making it the leading cause of death for both men and women in the nation. Preventative medicine can help you catch health issues before they become life threatening. RMC’s Early Detection Connection series aims to provide screenings to our community to help keep you out of emergent care and improve your health awareness. 

So now, you have booked an appointment for Heart Day. We are so excited to see you there! Make sure you are fasting for 12 hours prior to your appointment, and arrive 15 minutes before your scheduled time. Here is an overview of the tests that you will complete during your visit:

EKG

An EKG, or an electrocardiogram test, normally takes around 3 minutes to complete. While lying down, electrodes will be placed on your chest, arms, and legs. The machine will read the electric signals that travel through your heart, and will display the results on a computer monitor and/or printed out on paper.

Please note that the EKG only records the electricity in your body but does not send any into your body so there is little to no risk of having an EKG done.

Lipid Profile

A lipid profile can also be known as a lipid panel, cholesterol panel, or lipid test. This test measures the lipids in your blood to measure total cholesterol, low-density lipoprotein cholesterol (LDL), very low-density lipoprotein cholesterol (VLDL), High-density lipoprotein cholesterol (HDL) , and triglycerides.

These different types of lipids can show if you are at risk of cardiovascular disease or other cholesterol related issues. 

Blood Pressure Screening

You most likely have had your blood pressure taken at a routine doctor’s visit. An inflatable cuff is wrapped around your arm, then a healthcare professional will inflate the cuff to tighten around your arm, and measure your blood pressure.

If you are above 40 years in age or at risk for high blood pressure. (If you have diabetes, smoke, are overweight, or have kidney failure.) You should get your blood pressure checked every year.

Complete Metabolic Profile

This blood test measures 14 different substances in your blood. Glucose, calcium, sodium, albumin, ALP (alkaline phosphatase) ALT (alanine transaminase), and AST (aspartate aminotransferase). Like the lipid profile, abnormal levels of these substances can be an indicator of major health issues.

C-Protein

A c-protein or C-Reactive Protein Test is the last of the blood tests on our list. A high c-protein level can mean inflammation somewhere in your body. While it does not show where in the body the inflammation is occurring, it is still an extremely useful tool for doctors to see a more complete picture of your overall health. Increased c-protein is normally found in patients after a trauma like a heart attack or in a response to a bacterial infection.

Along with all of these tests, you’ll also receive a Heart Day t-shirt courtesy of RMC Foundation.

This Heart Day, know that as you take control of your health with early prevention, our team at RMC will be with you every step of the way!

The Silence of Cervical Cancer, Why Screenings Save Lives

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According to the CDC, every women is at risk for cervical cancer. The cervix connects the vagina to the upper part of the uterus. “[The cervix] kind of looks like a donut with a donut hole in the middle.” Says Dr. Ricky Patel, an OBGYN at RMC. Dr. Patel and Dr. Ford joined us for our RMC Physician Check-Up to answer some of our most asked questions about cervical cancer.

What can I do to prevent cervical cancer?

Not smoking is the first thing recommended by CDC to prevent most forms of cancers, and cervical cancer is no different. (Here is a resource if you want help quitting cigarettes.) Also, use condoms when having intercourse and limit the amount of partners you have to prevent getting HPV. “Usually HPV is very silent. You won’t know if you have it. There are some that cause cancer, and there are some that cause genital warts. It’s all part of the same HPV family.”

HPV is the human papillomavirus, and it is the most commonly transmitted infection in the United States. A vaccine is available for both men and women with a typical age window of 13-26 to receive it. “At age 27 or above you should talk with your doctor to see if you would qualify to get it given the risk factors you’ve had and potential exposure to HPV that you’ve had.”

“Screening very important.” Dr. Patel stated. Cervical cancer is found through pap smears and HPV tests, but has little to no symptoms on its own. Pap smears can find abnormalities through an annual exam. “When you turn 21, that’s when we usually start screening.” After your first visit, you still need to come for annual check-ups but pap smears can sometimes be every 3 years instead. “That’s something you should talk to your doctor about.” Dr. Patel informed us.

Are there any signs or symptoms for cervical cancer?

Cervical cancer that is advanced can cause bleeding after sex, or abnormal discharge. “These can be signs of things that are benign as well.” Dr. Patel urges us again to speak with a doctor if you are concerned, because cervical cancer early on is often silent. Many people have no signs or symptoms of cervical cancer so be sure you are getting regular screenings.

What happens during a pap test/pap smear?

A pap test will look for cell changes on the cervix that might become cervical cancer as well as HPV and some other gynecologic cancers. In order to swab the cervix, a few things will happen:

  • The patient will lie back and place their feet into foot rests or stirrups.
  • A doctor will insert a tool called a speculum into the vagina to hold the vaginal walls open.
  • The doctor will brush a thin, long swab over the cervix.
  • The cells will then be placed on a petri dish and sent off for testing.

“The process is a little uncomfortable unfortunately.” Say Dr. Patel “But it should only last just a couple of minutes.”

My test came back abnormal, now what?

“An abnormal pap smear does not always mean cancer.” Dr. Rachel Ford states. Thankfully, cervical cancer is rare, and an abnormal screening could indicate HPV or precancers. “This should not effect you ability to get pregnant.” Dr. Ford continued. “5% of pregnancies’ will be complicated by either an abnormal pap smear or positive HPV.”

Just like anyone else with HPV, pregnant women can experience genital warts or abnormal cell changes on the cervix. It is imperative that you keep up with your screenings to prevent these changes from becoming cancerous. Some of the abnormalities found during pregnancies can wait until a later date, and the pregnancy can go on as normal or possibly more closely monitored depending on the situation. “If you are diagnosed with an invasive cancer, you will most likely be referred to a gynecologist-oncologist on what to do during the pregnancy.”

Procedures that follow an abnormal pap smear.

There a few different things that can happen after results of a pap smear come back as abnormal. A repeat pap smear may be take place as well as a colposcopy, a biopsy of the cervix. “This is usually done in the office. It is well tolerated by most patients.” The biopsy is sent to be looked at for cancer and precancerous lesions.

Other procedures include LEEP procedures, which removed cells and tissue from the lower genital tract, and a cone biopsy, a small operation to remove a piece of tissue from the cervix. Dr. Ford explains that “These are all things that can be both diagnostic and therapeutic for anyone with precancerous lesions.”

Get Screened for Cervical Cancer

Use our physician finder to locate one of our premiere women’s health specialists for your annual visit. For more information on cervical cancer, check out Dr. Ford and Dr. Patel’s Physician Check-Ups!

All About the Thyroid

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The thyroid is a butterfly shaped gland in the front of neck that affects your entire body. The hormones your thyroid gland makes are secreted into the blood and carried into tissues throughout you body. These hormones keep your organs in working order, like telling the body when to use energy.

The thyroid works in tandem with your pituitary glad that sits below your brain, in the middle of head. When there is an imbalance of TSH (thyroid stimulating hormone) this gland will adjust the amount throughout the bloodstream to help get the body back to normal. With so many functions relying on this gland to function properly, it is incredibly important to know when something might be going wrong and what you can do to stay healthy.

Thyroid Disease and Symptoms

Anyone regardless of age or gender can be affected by thyroid disease, but some conditions, like diabetes, can cause someone to be at more risk than others. There are myriad of symptoms that could indicate a problem with the thyroid, as well as several different hormone disorders. Thyroid disease is just the general term for these disorders which can include hypothyroidism, graves disease, thyroiditis and more.

If any of these symptoms apply to you, consider speaking with your healthcare provider at your next check up about your thyroid health.

Overactive Thyroid Symptoms

  • Anxiety
  • Trouble Sleeping
  • Losing Weight
  • Enlarged thyroid
  • Muscle weakness
  • Irregular periods or no longer having a menstrual cycle
  • Sensitive to heat
  • Vision problems or eye irratation

Underactive Thyroid Symptoms

  • Feeling tired/fatigued
  • Weight Gain
  • Trouble with memory/forgetfulness
  • Heavy and/or frequent menstrual periods
  • Changes in hair being dry and coarse
  • A hoarse voice
  • Having an intolerance to cold temperatures

Hypothyroidism in Pregnancy

It is normal to experience slight changes to the thyroid during pregnancy due to hormonal changes. The human chorionic gonadotropin hormone (HCG) can cause a lower level of TSH in the first trimester, but should return to normal for the remainder of the pregnancy. While uncommon, the thyroid glad can also increase in size during pregnancy.

Around 0.2% of patients who are pregnant develop a form of hyperthyroidism called Graves’ disease. This can cause severe morning sickness puts a mother more at risk for pre-eclampsia and early labor if inadequately treated. Luckily, anti-thyroid medications are available if needed, but mild hyperthyroidism cases are just closely monitored. Anti-thyroid medications can also help your infant to not develop fetal hyperthyroidism, and do not prevent you from breastfeeding your baby.

Post-partum thyroiditis can develop in the first few months after delivery, and Graves’ disease can worsen during this period. Normally a higher dosage of anti-thyroid medications and close monitoring of thyroid function is required at this time.

Healthy Habits to Adopt

While it is not entirely possible to prevent thyroid disease, there are habits to help you feel your best after receiving a positive thyroid test.

  • Take your medication as directed by your physician
  • Exercise regularly after consulting with your doctor
  • Watching your diet or following any nutrition plans provided by your healthcare professional
  • Getting a full nights sleep
  • Keeping up with tests an check-ups as needed

If you have a family history of thyroid disease, or have questions about symptoms you are experiencing, talk to one our family physicians or endocrinologists here at RMC.

Sources:

https://my.clevelandclinic.org/health/diseases/8541-thyroid-disease

January is Thyroid Awareness Month

https://www.cdc.gov/cancer/thyroid/index.htm

https://www.thyroid.org/hyperthyroidism-in-pregnancy/

The Struggle of Quitting Cigarettes

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In the United States, an estimated 14% of adults currently smoke cigarettes, and is the leading cause of preventable death and disease. Smoking takes over 480,000 lives per year and creates monstrous medical bills for smokers and their caregivers totaling to $225 billion dollars when combined. Even without any medical costs, the average pack-a-day smoker spends $2,292 a year on the habit. With so many health and financial benefits at stake, why is it hard to quit smoking?

Why is quitting cigarettes difficult?

If you have ever attempted to quit smoking, you have most likely asked yourself, “Why is this so difficult?” The culprit in the addictive nature of cigarettes is nicotine. Nicotine causes an increase in adrenaline which can make you feel great while using it, but you slowly become dependent on it to feel normal. According to the National Institute on Drug Abuse, people often report feeling sick when trying to quit smoking. 

The addiction to cigarettes has set in and it is incredibly tough to get through the day without smoking or vaping. A smoking habit for most is associated with multiple facets of their day; talking with coworkers on a smoke break, having coffee, or after finishing their lunch. Not only is breaking the habit of routine hard, but the stress of change can cause someone to feel the urge to smoke. However, this task is not impossible with over 2 million smokers a year successfully quitting.

I want to quit. Where do I start?

There are many ways to start your health journey, but one recommendation by the CDC is to speak with a healthcare provider about medication. The absence of nicotine can affect your mood and even your sleep schedule so getting some help from a patch, lozenge, or gum can help with urges to smoke and can help you be more successful with quitting. Discuss with your doctor about any complications you may be having and if they have any recommendations for quitting.

Keeping cigarettes out of sight is essential, but the smell of cigarettes often stays long after it’s been extinguished. Try to wash clothes and surfaces that smell like smoke so it does not trigger the urge. When getting rid of your cigarettes or after smoking the last in that pack, throw away ashtrays and lighters from your home and car. Getting rid of your personal items attached to smoking is a big step, but it will be tempting to repurchase them and cigarettes if you go to places that sell them.

When shopping, try to avoid places that sell cigarettes like convenience stores, and avoid designated smoking areas. If you cannot avoid a place that sells tobacco products, prepare yourself beforehand and decide that you are not going to buy cigarettes. When shopping online you may be on email lists for tobacco companies, but you can unsubscribe. Ask to be taken off any physical mailing lists and opt out of texts they send you. 

While you are telling tobacco companies that you are quitting, make sure to also tell your friends and family to create a support group. Social situations can tempt you to smoke, but it’s not always desired or practical to avoid them. Ask friends who still smoke if they would not smoke around you or offer you cigarettes in support of your efforts, and engage in activities that can take your mind off the cravings like talking with a friend, going to the movies, or taking a walk. 

I have decided to quit, and I’m struggling.

While there are wonderful tips and tricks to help the urges and cravings, they are not entirely avoidable. The cravings can sometimes feel crippling and our natural response is to fight or give. Are those the only two options? According to the CDC, there is a third option: riding the wave. 

The good news about urges is that they are temporary. If you don’t fight it or give in you can simply let it pass, but there are some things to tell yourself that can make it a bit easier to resist that temptation. Using cigarettes as a reward on a particularly bad day can led to picking up that habit again. Instead of treating yourself with a cigarette because you “deserve it” due to enduring stress, tell yourself that you deserve a break to relax from the day. It can feel easy to have a cigarette now to manage the craving, but with each cigarette it becomes increasingly difficult to stay on the health journey you are on. Choosing to ride the wave now makes quitting easier down the road.

While riding the wave it can be easier to have something that substitutes cigarettes. Currently, the NIH states there is not enough data to support that vaping will help you quit smoking. In teens that started vaping, research supports that they are more likely to use other tobacco products later in life. Some safe substitutes are cinnamon sticks, stress balls, doodling, and toothpicks. Try different methods even before you officially quit to see which one you like most. Some smokers even admit that they take a straw and pretend to smoke to trick themselves in situations where it was hard to break the habit, like riding in the car alone.

I am worried about my lung health.

Despite quitting, you have done some damage to your lungs and other organs by smoking. Remember to speak all concerns to your healthcare provider and follow up if you are not seeing improvement in your lung function even after quitting. Some symptoms you should reach out to your provider about are:

  • Shortness of breath
  • Tightness or pain in the chest
  • Thickening or lump in any part of the body
  • Hoarseness or a cough that does not go away
  • A hard time swallowing

If you are in the Anniston, Oxford, or Jacksonville area you can make an appointment with one of our family doctors who can help assess your health situation. Sometimes your primary care doctor will refer you to a specialist called a pulmonologist who can help if you are experiencing chronic breathing problems like a cough that persists for weeks. Some health insurances require that you get a referral, but others you can look in your insurance’s database and schedule an appointment with a pulmonologist that is in your network.

Regardless out the route you go about quitting, your quality of life can dramatically improve by choosing to not smoke. The CDC reports that almost 10 years can be added to your life expectancy, significant reduction in chances for cardiovascular disease, and lower chances of reproductive issues can all be attributed to quitting smoking. Protect yourself and those around you from tobacco smoke by choosing to quit today.

The Different Faces of Diabetes

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Today, one in three adults in the US is pre-diabetic, and eight out of ten of those don’t even know it. Don’t be one of them. Know your facts and know your body, so you can protect yourself from developing or worsening long-term chronic disease.

So what is diabetes? In short, it is a condition that causes an inability to produce and regulate insulin throughout the body. Insulin is a hormone produced in the pancreas and secreted into the blood. There, it binds glucose molecules that have been absorbed into the blood through the digestive system. The insulin then carries those molecules to cells throughout the body, so it can be used or stored as fuel. When those cells eventually have too much dietary fat stored over time, they become resistant to insulin.  This is known as insulin resistance, which leaves glucose to stay in the bloodstream, putting you at risk for high blood pressure, kidney disease, neuropathy and other chronic conditions.

To rebalance insulin and blood sugar levels in the body, it may take both lifestyle changes and medication to address the production and uptake of insulin in the body.

What is pre-diabetes?

Pre-diabetes is a condition where your blood sugar levels are higher than normal but not high enough to be diagnosed with type 2 diabetes. If you are diagnosed with pre-diabetes, the good news is that you can introduce lifestyle changes to reverse and reduce your risk for developing type 2 diabetes.

Talk to a nutritionist or lifestyle coach today to make a plan that’s right for you. Living with pre-diabetes doesn’t have to be a burden. It can kick start the lifestyle changes you’ve always thought about, so you can live with peace of mind in your new daily habits. These changes should include more exercise and more balanced meals.

What is type 1 diabetes?

Type 1 diabetes is a thought to be an autoimmune condition, which causes the body to attack its own cells. In this case, your beta cells, which produce the insulin hormone in your pancreas. You can be tested for type 1 with a simple blood test. If you think you may have type 1, ask your doctor to test for antibodies and ketones, which are indicators.

This type is typically diagnosed in children, teens and young adults but can be diagnosed at any age. It’s thought to be genetically linked and is not directly triggered by lifestyle or diet. Because type 1 cannot be reversed by diet and lifestyle changes, patients will have to manage their blood sugar levels with daily insulin and medication.

Type 1 symptoms can develop over a short period of time and can be severe, so do not hesitate to see your doctor if you think you’ve developed symptoms.

What is type 2 diabetes?

Type 2 diabetes is the most common form of diabetes with around 90-95% of people with the condition having type 2. Most commonly diagnosed in adults, it can develop over several years due to insulin resistance.

Insulin resistance happens when too much blood sugar enters the bloodstream over a period of time. After a while, the pancreas can not produce enough insulin to manage the blood sugar. According to the CDC it isn’t clear what exactly causes insulin resistance, but contributing factors are family history of diabetes, being overweight and being inactive.

It is possible to combat insulin resistance with diet and exercise. Ideally, you want to move and be active before you are diagnosed with diabetes. Physical activity can make you more sensitive to insulin, and of course help you with weight loss. Some other lifestyle changes like avoiding high blood sugar, reducing stress, and getting enough sleep can help your body fight insulin resistance.

What is gestational diabetes?

While less common, 2-10% of pregnancies in the United States, gestational diabetes can develop in pregnant women that do not presently have diabetes. Like type 2 diabetes, insulin resistance is the cause of gestational diabetes. All pregnant women have some form of insulin resistance during late pregnancy, but some women have insulin resistance prior to becoming pregnant. This increases their chances for gestational diabetes.

Gestational diabetes does not present itself in symptoms, so it is important to discuss your family history and risk factors with your doctor. Just like type and type 2 diabetes, you will need tests to know for sure if you have it. If you are diagnosed for gestational diabetes, be sure to go to all prenatal appointments, follow your treatment plan and ask your physician what exercises are safe for you to perform.

What are the signs?

  • Urinate (pee) a lot, often at night
  • Are very thirsty
  • Lose weight without trying
  • Are very hungry
  • Have blurry vision
  • Have numb or tingling hands or feet
  • Feel very tired
  • Have very dry skin
  • Have sores that heal slowly
  • Have more infections than usual

Where should I go to get tested?

Blood work for diabetes testing can be done by a primary care physician or an endocrinologist and can include:

  • A1C Test
  • Fasting Blood Sugar Test
  • Glucose Tolerance Test
  • Random Blood Sugar Test
  • Glucose Screening Test

 All of these tests involve a blood test, but be sure to ask your physician about what each test entails. A fasting blood sugar test requires you not to eat prior to coming in, and glucose tolerance/glucose screening tests both involve drinking a liquid and testing your blood 1-3 hours after consumption. 

I’ve been Diagnosed  with Diabetes, now what?

Being diagnosed with any type of diabetes can be scary, but it doesn’t have to be. Your doctor will come up with a treatment plan, and there are several self checks you can perform to ensure you’re meeting your treatment goals. Every day you should be checking your blood sugar, checking your feet for cuts, redness, swelling, sores, or other changes to the skin or nails, taking your prescribed medication (even if you feel fine,) getting 30 minutes of physical activity a day, and eating healthy food to help your blood sugar stay in your target range.

Be sure to ask your doctor how often you should be in for check-ups, and schedule another appointment if you are having trouble meeting your treatment goals. 

Parkinson’s Physical Therapy: Think BIG and LOUD!

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People with Parkinson’s Disease may have trouble with daily life activities like getting dressed, moving around their home, and sometimes communicating. Their movements may become slower (bradykinesia) and smaller (hypokinesia) with both “large” and “small” motor tasks. There may be a disconnect to how they think, move, and movement that is considered normal can feel “too big,” and there can be an absence of once subconscious movement like arms swinging while walking. This sentiment carries over to speech as well with many people having trouble speaking at a volume that others can understand.

What is LSVT Global ™ ?

LSVT or Lee Silverman Voice Technique is a type of therapy for Parkinson’s Disease. LSVT Global ™ is a group dedicated to developing treatments that impact the lives of people with Parkinson’s Disease. This program was pioneered by the Chief Scientific Officer and Co-Founder of LSVT Global ™, Dr. Lorraine Ramig. There are over 19,000 speech pathologists and 16,000 physical and occupational therapist trained in LSVT LOUD ™ and LSVT BIG ™. RMC is proud to have both LOUD and BIG Certified Clinicians.

What is LSVT BIG ™?

“LSVT BIG is for people with Parkinson’s of any stage.” Says Emilee Hollingsworth, a physical therapist assistant at RMC. “We work on functional tasks with them that they have difficulty doing at home like getting dressed, cooking something, or getting out of bed.”

The physical therapy program is designed to help patients think BIG in regards to their movements. One on one sessions are tailored to meet an individual’s needs and goals. While LSVT BIG ™ is newer than LSVT LOUD ™, research has shown that patients who completed the program showed improvements on the Unified Parkinson’s Disease Rating Scale. This scale is what doctors use to measure the progression of Parkinson’s disease.

During the 4 week program, patients will complete one-hour sessions for four days a week. There are also daily exercises you will complete at home. “These are called max daily exercises and you do the exercises two times a day. You can progress them so they are more difficult.” These sessions train people to increase the amplitude (size) of their movements, but with a holistic approach and also takes other symptoms into account like emotional and cognitive changes.

Treatment often consists of repetitive exercises, because Parkinson’s disease makes it difficult to make these bigger movements in day to day life. Emilee Hollingsworth talks about how they can help a patient with the movement of getting in and out of their car. “We can break those movements down into each physical component of that movement. Lifting your foot into your car, spinning to sit fully in the seat, and closing the door.” BIG’s main goal is to provide a treatment that leaves the patient confident and ready to lead a more independent and active life, which can be achieved through the month long course alongside the daily exercises and tune-up sessions.

What is LSVT LOUD ™?

Like LSVT BIG ™, LSVT LOUD™ is a four week program for four days of the week. The goal of this program is for patients to be able to communicate with others around them using their voice. Parkinson’s Disease can rob those with it of the volume of their voice, and normal speech can feel like shouting. LOUD retrains the brain’s mismatch of thinking that a patient is speaking at normal level when they actually are not.

Research has shown that patients who complete this therapy have improved loudness and have more variation of pitch in their speaking. While not the main focus, other improvements have been recorded like changes in swallowing, speech related brain changes, better articulation, and improved facial expressions while talking. This is achieved through three key strategies LSVT LOUD ™ is built on: target, mode, and calibration.

Target encompasses vocal loudness or amplitude which is consistent with the most effective strategies for neuroplasticity and learning. Mode is intensive dosage and effort treatment. This is tailored to everyone’s individual goals, and encourages patients to achieve more by working harder through one-on-one sessions. Calibration is the recognition that the new, louder voice the patient’s hear is a normal speaking voice, because at first it will feel uncomfortable, like shouting.

When and How can someone sign up for this therapy?

Brittany Shiflett, a physical therapist at RMC, explains, “There are five stages of Parkinson’s, and the earlier you can get into the program the better, because the earlier the diagnoses, the quicker you can treat, and the more manageable your symptoms can be. However, it is never too late to start the program. Most of our patients have been stage one or two, but the program is designed to help those even at stage 5.” As long as the patient is able to come to the Tyler Center and perform the exercises to the best of their ability, this therapy is for them.

Because of the frequent visits this intense therapy has, a caregiver may want to help the patient make travel arrangements for these appointments before therapy begins. BIG and LOUD are both treatments that are not intended to vary from the schedule of an hour a day and four days a week. Patients should speak with a physician before beginning the program. “You have to have a physician referral. Ideally, it should specify LSVT BIG or LSVT LOUD to get in. Just know that it can come from any doctor. It doesn’t have to be their neurologist. It can come from a family physician even.” Hollingsworth says. Which is wonderful news for some who may have infrequent visits to their neurologist.

“Because of the LSVT BIG Program, I’m able to walk without my cane now and do more things I like to do. I would recommend the program to anyone. The staff made it that much better.” Aaron O’Dell, a participant in the LSVT program.

“It works.” Angie, a physical therapist assistant at RMC, says when asked what people should know about the program. “I’ve seen it work. I have seen patients come in with very slow, small movements and leave at the end of their four week program talking louder and moving bigger and telling us that their family members have seen the changes. They don’t have to have help putting their clothes on anymore and they can get in and out of their car without somebody standing beside them. It works. It’s amazing.”

Here are some helpful resources for those interested in learning more:

www.parkinsonalabama.com Alabama Parkinson’s Association- local resources for those in Alabama

www.lsvtglobal.com for info on LSVT BIG and LOUD

www.michaeljfox.org Michael J. Fox Foundation for Parkinson’s Research

www.parkinson.org The Parkinson’s Foundation 

www.adpaparkinson.org American Parkinson’s Foundation

Diagnosed with Breast Cancer: The Next Steps

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Every 2 minutes a woman is diagnosed with breast cancer and around 2,650 cases are men will be diagnosed in a year. After a woman has had a mammogram and/or breast MRI and an abnormality is found a biopsy will be done of the breast tissue. From there a doctor will determine if it is breast cancer. 

After receiving a diagnosis

Your doctor will be determining how far the cancer has spread, and a team of doctors will plan a path of treatment for you. “There are about 5 different specialists,” Dr. Paul of RMC Radiation/Oncology says, “the radiologist who does the mammogram, the pathologist who looks at the sample to see if it’s cancer, the surgeon who does the surgery, then the radiation oncologist, which is myself, and then the chemotherapy team.” 

All of these specialists come together for what is called a tumor board. This is where each specialist gather each week at RMC to discuss your cancer case “to ensure nothing is missed,” Dr. Paul explains.

What kind of treatment will I need for my breast cancer?

There are several different cancer treatments as well as several different factors to what treatment your physician may recommend. Some factors include: age, cancer stage, and other health problems. Your overall feelings about the treatment are also taken into account when your doctor comes up with your treatment plan. Some treatments include:

  • Chemotherapy
  • Hormone Treatment
  • Surgery (mastectomy and lumpectomy)
  • Radiation Treatment
  • Targeted therapy

Dr. Paul, spoke on the history of these treatments and says “30 years ago we would have just done a mastectomy. Which is a very aggressive, very effective surgery where we remove the entire breast.” Dr. Paul further explains a study that involved 3 different sets of breast cancer patients; those who received a full mastectomy, those who received a lumpectomy, and those who received both a lumpectomy and radiation. “The group that received the lumpectomy, the tiny surgery, had the cancer return.” However, those who received a lumpectomy plus radiation and those who received a mastectomy had virtually the same results. Though some may still need a mastectomy, there is always a range of options to consider based on your specific conditions. 

What side effects will I get from my treatments?

This varies greatly by what treatment you receive along with other factors like age, cancer stage, other health conditions, etc. Several treatments are also used in tandem with others; chemotherapy can be used before and after surgery or is not needed at all. 

Chemotherapy

Loss of appetite, nausea, vomiting, diarrhea, mouth sores, hair loss, changes in nails, easy bruising or bleeding, fatigue, changes in menstrual cycle, and increased chance of infections.

Hormone Therapy

It is important to know there are several different drugs and therapies that can be used during hormone therapy. Always speak with your physician about the side effects of your prescribed medication.

  • Selective estrogen receptor modular (SERM) side effects can include hot flashes and vaginal dryness. More rare side effects are uterine cancer, blood clots, and stroke.
  • Selective estrogen receptor degrader (SERD) side effects can include hot flashes, headache, mild nausea, bone pain, and injection site pain.
  • Aromatase inhibitors can cause muscle pain, join pain, joint stiffness, and bone thinning.
  • Ovarian suppression can involve surgery or prescription drugs which all have the possible symptoms of hot flashes, night sweats, vaginal dryness, and mood swings.

Surgery

Along with the mastectomy and lumpectomy, there are some surgeries such as removing nearby lymph nodes that may produce soreness. 

Radiation

 External radiation and intracavity radiation brachytherapy are two types of radiation that can produce side effects such as redness, bruising, breast pain, infection, damage to fatty tissue in breast, fatigue, fluid collecting in the breast, and in rare cases weakness of the ribs, and fracture of the ribs.

Targeted Drug Therapy

There are several different types of drugs that researchers have developed to fight cancer cells. Because each individual drug has their own side effects, you should consult each medication’s website for a list of side effects, and as always speak with your physician about the expectations of your treatment.

What kind of questions should I ask my physician?

Treatment plans, life expectancy, side effects, and more can leave cancer patients reeling for answers. Limited time with a physician and the emotional toll that it takes to receive life altering news can make it impossible to remember everything you would like to ask your treatment team when you come in for an appointment. “Write it down.” Says Dr. Paul when talking about how patients and caretakers can manage all the questions that will come when they are not around someone you can ask.

What is the stage of my cancer? 

Stage 1 to 4 of breast cancer means different things for different patients. “There are some breast cancers that have spread which cannot be cured.” Dr. Paul when speaking about Stage 4 breast cancer. Thankfully, the most common stage of breast cancer is the localized stage where a Breast MRI or mammogram will show cancer cell growth in the milk ducts. This is why getting regular screenings is incredibly important.

What type of breast cancer do I have?

Types of cancer that have remained in the milk duct and not spread to the breast tissue is called non-invasive cancer or Ductal carcinoma. Invasive breast cancer has special types of cancer like triple-negative breast cancer and inflammatory breast cancer. Less common types of breast cancer include paget disease of the breast, angiosarcoma, and phyllodes. Each one of these cancers will need their own unique approach to treatment, and you should ask about what your cancer diagnosis entails.

What does my treatment involve?

“When talking about radiation, you will come in 5 days a week for 4 to 6 weeks.” Dr. Paul says. So asking the question of how often you need to come in for treatment is essential. Having a support person at your appointment as well that can help remember all this information to relay to your support team at home will make it easier to plan transportation to treatment visits. Dr. Paul reiterates the importance of the family during treatment, “The family can change the environment, where the patient is living, to be more biologically effective and at the same time more emotionally effective.”

Is this treatment safe/effective?

A common question that Dr. Paul says gets from patients is, “Would you treat your mother or someone in your family with this?” A cancer diagnosis can be scary and not knowing what a treatment will do to your body can be equally as terrifying. “You can always ask, ‘Where is the data?’” There are wonderful resources like the American Cancer Society and the National Cancer Care Network that have factual information on cancer and cancer treatments, so you never have to be in the dark about your health.

Listen to a Radiation Oncologist talk about Breast Cancer

Mentioned throughout this blog, Dr. Arun Paul sat down with Kristin Fillingim from RMC Marketing to speak on the full picture of breast cancer as a part of RMC’s Weekly Check-Up series. This series allows the community to ask a physician of the week questions related to their specialty. Click below to hear Dr. Paul’s answers to COVID vaccination in breast cancer patient questions, what a healthy environment for a cancer patient looks like, and how far breast cancer treatments have come in the last 30 years.