Health for Self Newsletter

Prostate can be found just below the bladder.  Your urethra is a tube-like structure that runs from your bladder, through the middle of the prostate, and down the middle of the  penis.  Your urethra carries urine and semen through the penis and to the outside world.

The main purpose of the prostate is to provide the seminal fluid to the man’s sperm prior to ejaculation.  The seminal fluid provides nurishment for the sperm.  The prostate also has the ability to contract in order to push the semen out of the penis further.

Some pathologies that can attack the prostate gland are prostate cancer and benign prostatic hyperplasia (BPH).  Prostate cancer is currently tracked by the changing levels of PSA. However, there is currently some debate on how to manage changing levels of PSA values.

BPH is what is known as an enlarged prostate.  BPH is not a cancerous process but can cause difficulties for everyday activities.  Because the urethra passes in the middle of the prostate and BPH occurs in the middle of the prostate, complaints regarding urination and the feeling of incomplete urine release are common.

Always speak to your physician if you have any concern regarding your prostate.

The lungs make up the respiratory system which consists of a right and  left lung.  The right lung is divided into three lobes and the left has two lobs (a third theoretical lobe known as the lingula exists).  When you take a breath, your diaphragm contracts and moves downward, causing a negative pressure to occur inside of your lungs.  This negative pressure allows air to move into your lungs.  You do not actually suck air into your lungs, air rushes into your lungs due to the pressure being lower inside of your lungs.

The air enters your mouth or nose and travels down into the trachea, into the bronchi, and eventually into the alveoli. The alveoli are the small sac like structures that are found at the lungs smallest level.

Once air (oxygen) is in your lungs, it is then exchange for carbon dioxide. Carbon dioxide is a waste product of the cells that form your entire body.  The oxygen moves into your blood and carbon dioxide moves out of your blood into your lungs.  When you exhale, you are letting out all your carbon dioxide waste. This exhange takes place at the alveoli.

The heart is a simple pump that drives blood throughout your body to other organs and tissues.   Heart disease is the leading cause of death among adults in the United States.  Those who are at the highest risk for heart disease include individuals with a strong family history, high cholesterol, high blood pressure (hypertension), diabetes, a history of smoking, and peripheral vascular disease.   Any combination of these factors will place a person at a very high risk for heart disease.

Coronary artery disease (heart disease) occurs when plagues form in your coronary arteries.  These plaques can cause two things.  One, they can cause blockages in the flow of blood to your heart muscle.  Two, the plaques can rupture causing either a stroke or cause a thrombus to form which will lead to blockage of blood to your heart tissue (an acute myocardial infarction or heart attack.

In order to prevent heart disease, people should make a strong effort to reduce all the risks listed above. Risk such as high cholesterol and high blood pressure can be reduced with a healthy diet and exercise for the most part.   A low weight and a healthy lifestyle can certainly reduce the risk of getting type II diabetes which will further decrease the risk for heart disease.

As always, consult your physician in regards to any questions you have regarding heart disease and a change in diet and exercise.

Swine flu (swine influenza, pig flu) is a variety of influenza virus that usually infects pigs. Swine flu typically is spread from pig to pig.  However, the swine flu becomes dangerous when it spreads from pigs to humans and then from one human to another.  Humans who have been infected with the swine flu tend to present with symptoms that are similar to the typical influenza virus such as fever, chills, sore throat, aches andpains, and weakness.

The current swine flu outbreak is a new strain of influenza A virus with the subtype of H1N1.  It has raised alarms simply because of the fact we have no vaccinations prepared to combat this particular strain.  However, it does seem the this strain of swine flu is not necessary very aggressive and deadly.  Yet, caution must still be taken.

Prevention:
The swine flu, just like any other influenza virus, spreads via water droplets that are released during sneezing or coughing.  Thus, in order to prevent the spread of swine flu, the same precautions need to be taken as used to prevent any influezna virus.  People should cover their mouths during coughing or sneezing, wash your hands with soap or alcohol-based hand rub, and disinfect surfaces such as counter or table tops and door knows.

If you began to come down with flu-like symptoms such as fever, cough, chills, or aches, you should immediately contact a physician and avoid using public transportation or going out in public places.

Acai berries grow in the Amazon rainforest located in Brazil. The acai berry is considered beneficial due to its large amount of free-radical antioxidants. Many claims are made regarding the acai berries’ ability to improve the immune system, improve digestion, fight aging, protect against coronary artery disease, fight cancer, and even cause weight loss. Numerous media outlets, such as ABC news, Oprah, and CBS news, have all promoted the benefits of this magical berry. However, many of these claims have not been proven scientifically in a controlled study.

In fact, there is a very limited number of published medical papers on the actual benefit of the acai berry. Even nutrition specialists of the Mayo clinic cannot provide actual medical studies supporting the above claims.

In study published in the Journal of Agricultural and Food Chemistry, the authors compared the antioxidant potency of certain fruit drinks distributed in the United States. The study compared pomegranate juice, red wine, berry fruit juices (which includes black cherry, blueberry, concord grapes, cranberry), apple juice, bottled teas, and the acai berry juice. One measure used to compare the juices is the Oxygen Radical Absorbing Capacity (ORAC) which measures the juices ability to absorb free radicals. The highest to lowest ORACs are as follows: Concord Grape Jucie > Red Wine > Pomengranate Juice > Acai Juice > Cranberry Juice. 

Click here to see all the values.

In a comparison of the various juices’ abilities to inhibit LDL oxidation (LDL is a leading part of the mechanism that causes heart disease), pomegranate juice had the highest values at 97.1 +/- 0.0 (for peroxides) and 97.2 +/- 0.7 (malondialdehyde). Wheras the acai berry juice had values at 29.2 +/- 15.5 (for peroxides) and 20.4 +/- 6.7 (malondialdehyde). Overall, the study found pomegrante juice to have the most potent antioxidant abilities followed by red wine and grape juice.

Not to say drinking acai juice is not beneficial, but more extensive studies are needed to validate all of the claims found in the media. At this point, these claims of acai being a new “super food” by such individuals as Oprah and Dr. Perricone are simply not supported. Only the juice manufactures are benefiting (the acai berry spoils within 24 hours from being picked, thus, you cannot get the actual berry in food stores, only as juices at this point).

Nonetheless, all diets should be high in fruits and vegetables, regardless of which one you prefer. Nonetheless, an individual should not put all of their hopes into just one magical berry.

If you have visited your cardiologist or a good primary care physician recently, they may have suggestioned you take a fish oil supplement. Fish oil, or Omega-3 fatty acids to be specific in this case, has been shown to reduce the incidence of cardiovascular disease. Though it may sound counterintuitive to take an oil to prevent heart disease (but then again so is spending a trillion dollars to reduce our national debt - but thats for another post), omega-3 fatty acids have the ability to reduce the formation of plaque found in your coronary arteries.

The presence of plaque in the coronary arteries places you at risk for a heart attack (myocardial infarction). The american heart assocation guidlines have recommended at least two servings of fish per week. However, fish oil supplements are available over the counter. Currently, the only FDA approved fish oil is Lovaza. Lovaza is considered the best because it is FDA approved which means it is certainly pure. You have to be careful with purchasing over the counter (OTC) supplements from an uknown brand because of the risk of contaminents (ask your physician what brand he/she recommends) Additional information can be found at the Mayo Clinic site. Or, you can click here or here to read recent scientific studies on fish oil.

Fish oil can be taken to prevent such cardiac events such as death, heart disease, heart attack, and stroke. In cases of patients with increased triglycerides, even greater levels of fish oil are usually used.

Be sure to ask your physician before taking any supplements.

This part 3 of 3 in the Breast Cancer Series.

Treatment of breast cancer includes the input of surgeons, pathologists, oncologists and radiologists.

Atypical Ductal Hyperplasia

Treatment for such a diagnosis usually requires a lumpectomy to ensure no cancerous cells are present.  After the lumpectomy, the patient must decide with their physician if they will take Tamoxifen. Tamoxifen is an estrogen blocker that has been shown to reduce the risk of breast cancer in patients who took the drug for five years as demonstrated by the Breast Cancer Prevention Trial.  The risks/side effects include vaginal dryness, hot-flashes, blood clots, and an increased risk of cervical cancer that is easily detected and removed.

Lobular Carcinoma in Situ
A diagnosis of LCIS is usually treated with observation after biopsy.  However, tamoxifen has been shown to decrease the risk of developing breast cancer  who were on the drug for 5 years as well.  Even mastectomy in patients who are at an increased risk for breast cancer (BRCA1 and BRCA2 gene mutations) is considered too invasive in patients with this diagnosis.

Ductal Carcinoma in Situ
First step in treatment will be a lumpectomy which should the only surgical treatment needed if the mass is small, has clean margins, and the DCIS cells are a non-aggressive type (non-comedo).  Lumpectomy and radiation is another option in order to reduce the chance of the DCIS recurring.  Radiation is more often used for larger tumors or more aggressive forms of DCIS.  A third choice of treatment is lumpectomy and tamoxifen. Again, tamoxifen has been shown to reduce the chance of recurrence of DCIS after lumpectomy.  Finally, mastectomy will usually be considered in candidates who have a large tumor of DCIS, multiple areas that contain DCIS cells, the lumpectomy has negative margins (cancer located at the periphery of the removed tissue), or you are at an increased risk for breast cancer (BRCA1 and/or BRCA2 gene mutation carrier)

Invasive/Infiltrating Carcinomas
In these cases, mastectomy is usually the standard treatment.  However, a sentinel lymph node biopsy is recommended in most cases.  A sentinel lymph node biopsy entails the first drainage lymph node to be removed in order to determine if it has cancerous cells.  If it does contain cancerous cells, then an axillary lymph node dissection will be required (you lymph nodes located in your armpit will have to be removed).  If the sentinel lymph node biopsy is negative, you do not need such an invasive procedure.  After mastectomy, most patients will under go radiation, chemotherapy, and also tamoxifen for 5 years.

Though the diagnosis if breast cancer is terrifying, it is a very treatable disease if caught in time. Thus, the importance of yearly mammograms cannot be stressed enough.

Of course, you should always speak to your physician if you have any questions regarding breast cancer.

This is the second post in a series of 3 regarding the topic of breast cancer.   In the first post of the series we discussed the basic anatomy and benign diseases of the breast.  This post will discuss the malignant breast diseases.

Over 200,000 new cases of breast cancer will be discovered this year with nearly 40,000 women dying from the disease.  Nearly 1 in 8 women will be diagnosed with some form of breast cancer in their lifetime.  Breast cancer is the leading cause of death for women in their forties and the second most common cause of death in women overall - second to lung cancer.

Lobular Carcinoma in Situ (LCIS):

This cancer arises from the lobular and terminal ducts of the breast that were mentioned in our anatomy review. Previously, LCIS was thought to not be a true cancer but a precursor for future breast cancer.  However, LCIS is now thought to be the beginnings of a more invasive breast cancer.  Patients with LCIS need to have it removed as these women will have a 10x increased risk for getting an invasive cancer.  However, some physicians suggest getting annual mammograms to watch the disease to see if it will progress.  Some physicians suggest taking Tamoxifen (we will discuss more in the next post) which is a selective estrogen receptor modulator and is though to reduce the risk of future cancer.

Ductal Carcinoma in Situ (DCIS):

This cancer is thought to arise from malignant epithelial cells within the milk ducts of the breast system (see first post), but this is not an invasive process. Ductal carcinoma in situ is not a malignant disease but localized within the milk duct. Thus, DCIS itself is not life threatening. However, if DCIS is not removed, it can progress into a more invasive disease. In 70% of DCIS cases, the cancer cells are positive for estrogen receptor.  In 50% of cases of DCIS, the cancer cells are Her2/neu positive as well.  These markers are important for how the cancer will be treated.  Currently, most women are treated with breast-conserving treatment (such as a lumpectomy).  Most women will be at risk for a recurrence of DCIS or an invasive tumor.  Thus, in some cases, women will opt for bilateral mastectomies to lower their risk for a recurrence.

Invasive Lobular Carcinoma and Invasive Ductal Carcinoma:

Invasive breast cancers are described as invading into the breast tissue and ducts.  In these cases, the cancer cells can spread to your lymph nodes and metastasize throughout the body.  Invasive ductal carcinoma is the most common malignant breast cancer and will often be found on mammogram or felt as a lump in the breast.  About 10% of cases of breast cancer are invasive lobular carciomas. This cancer can present as a mass that can felt within the breast, but not always.  In either cases, these invasive cancers are obviously worse due to their potential to metastasize or spread throughout the body.

The third post in this series will review treatments of these diseases.

This post is the first in a set of three posts covering the topic of breast cancer.  The first post will deal with the basic anatomy of the breast and also benign (or non-cancerous) processes that occur in the breast. The second post will deal with malignant diseases of the breast.  The series will conclude with current treatments for breast cancer.

Basic Breast Anatomy:

The breast lies between the second and sixth rib, with tissue extending to the axilla (scientific name for the armpit). The breast lies on top of the chest muscles known as the pectoralis major and pectoralis minor.  The breast contains fat tissue, connective tissue, lymphatics, nerves, and blood vessels.  The blood supply  to the breast is through the internal mammary artery and lateral thoracic arteries.  The lymphatics of the breast drain to the axilla in 97% of cases.  This is an important fact in regards to malignancy (will be discussed furth in the second post of this series).  The long thoracic nerve is important as it provides nerve impulses to the serratus anterior and subscapularis muscles.  This is a very important nerve in breast surgery, as if the long thoracic nerve is damaged, it can cause a winged scapula (droopy shoulder blad) and a weakend shoulder.

The breast is also composed of what are known as ducts and lobule structures.  The tunnel-like structures that lead toward the nipple are “ducts.”  The round structures that branch off the ducts are known as “lobules.”

 Benign Diseases:

Most masses of the breast are either discovered during routine screening, such as mammogram screenings, or felt by the individual as a mass or lump in the breast.  Microcalcifications are most frequently seen on mammograms as abnormalities.  Cysts can also present as abnormal findings during exams.

Cysts:  These are cavities that are often fluid filled and develop in about 7% of women.  The easiest way to analyze a cyst is to take a needle and draw out the fluid within the cysts.  If the fluid is bloody, the cyst is solid, or the cyst recurs quickly, then a biopsy is most likely warranted to further evaluate the cyst.  If the fluid is clear and the cyst does not occur again, it is probably a benign process.

Fibroadenoma: These are the most common cause of a mass found in women 25 years of age and younger.  Though it is very rare to for a fibroadenoma to be malignant, it is still necessary to perform a biopsy in these masses, regardless of the patient’s age.  Biopsy can be performed using a needle to obtain some tissue, or the entire mass can be removed during a minor surgical procedure.  Usually, nearly 60% of these masses will decrease in size and 35% will not change in size at all.

Fat Necrosis:  Typically occur after a surgical procedure or trauma to the breast.  They occur if bleeding into the breast tissue occurs.  A round, firm mass will form in the breast as the bloody area heals.  This is typically a benign process but further analysis is needed to ensure a malignant process is not occuring.

Mondor Disease:   Due to inflammation of the veins found in the breast tissue close to the skin.  Women will tend to have pain in the breast and even some dimpling of the skin.  In these cases, a mammogram is recommended.  The disease will usually go away with time.  However, if the pain and inflammation persists, removal of the vein can be performed.

Next Post: Malignant Disease of the Breast

The tragic death of Natasha Richardson has sparked much conversation regarding head injury and how such a seemingless innocent fall could have been fatal.  Natasha Richardson died from what is categorized as an epidural hematoma.  An epidural hematoma is a type of head trauma that is an emergency and needs to be treated immediately, usually, with a craniotomy and evacuation of the blood surrounding the brain.

How does an epidural bleed cause death? 

Your brain is housed in a skull that is immobile.  There is a space between your brain and your skull called the epidural space.  There is an artery that runs in the area of the temple below the skull bone called the middle meningeal artery.  The area around the temple is thinner than the rest of the skull, thus, it is most susceptible to fractures.  When fractures or trauma to that temporal area do occur, the artery can be damaged, causing it to bleed.  Epidural bleeds are quite     dangerous as they have an unique  presentation.

Because a space does exist between the brain and the skull, when the fracture and damage to the vessel does occur, it takes a little bit of time before that potential space can fill with blood.  However, once that potential space is filled it blood, the increased intracranial pressure will began to push on the brain - leading to death if the blood within the space is not evacuated.

Sadly, Natasha Richards presented in such a fashion.  After the fall, Natasha Richardson seemed fine (at this point the artery was injured and blood was filling the potential space); she returned to her hotel room where she quickly became ill and was rushed to a hospital (at this point the intracranial pressure was increased to such a level that it was pushing on the brain most likely causing a headache, nausea, and eventually loss of consciousness.)

How to prevent such traumatic head injury? 

Helmets.  All individuals participating in contact sports or high speed activities, such as skiing, biking, etc, should wear a helmet in order to protect their heads from any traumatic injuries.