Primary Care Treatment for Prostate Cancer Survivors

Posted Posted in Continuing Education, Elder Care, Nutrition, Seminars

By Barbara Boughton

cancer-390322_640A new guideline on health care for prostate cancer survivors from the American Society of Clinical Oncology (ASCO) shines a spotlight on the important role of primary care providers.

The new ASCO guideline, published in early February, endorses and adds to a guideline published in June, 2014 by the American Cancer Society. As well as providing guidance on follow up testing for prostate cancer survivors, the ASCO guideline emphasizes counseling about healthy lifestyle behaviors and interventions for the aftereffects of cancer treatment.

Clinicians are an important source for counseling about nutrition, exercise and healthy lifestyle as well as assessments for the late effects of prostate cancer treatment, the guidelines say. Clinicians should play an important part in talking to prostate cancer survivors about their lifestyle habits, and giving them advice about how to make changes. Increasingly, studies show that healthy eating and an active lifestyle can reduce the risk of prostate cancer recurrence. Clinicians should advise prostate cancer survivors to take these healthy lifestyle steps:

  • Achieve and maintain a healthy weight by limiting high calorie foods and drinks. Obesity is associated with worse health outcomes in prostate cancer, including a greater risk for recurrence and decreased survival.
  • Engage in exercise for at least 150 minutes per week, no matter what the survivor’s weight. Research shows that 3 or more hours per week of vigorous exercise is associated with a 61% reduction in prostate cancer-specific death among survivors. As well as discussing these benefits of physical activity with survivors, primary care providers should stress the advantages for quality of life.
  • Eat a diet that emphasizes micronutrient-rich and phytochemical-rich vegetables and fruits, whole grains, and low amounts of saturated fats. Such nutrition improves survival and decreases the risk for second cancers and chronic disease among all kinds of cancer survivors, according to the American Cancer Society.
  • Intake 600 IU of vitamin D per day and consume adequate, but not excessive, amounts of calcium (not to exceed 1200 mg per day). These recommendations are especially important for prostate cancer survivors receiving androgen deprivation therapy (ADT), since these treatments increase the risk of osteoporosis and fractures.

Most adults between ages 19 and 51 and older need 1000 to 1200 mg per day of calcium. Some, but not all studies on nutrition and prostate cancer risk, have indicated an increased risk for prostate cancer among those who had a high intake of calcium, particularly from dairy products. Calcium from supplements has not been associated with increased prostate cancer risk.

All cancer survivors should be given appropriate vaccines, based on age, season (flu), or travel plans. Primary care providers should also counsel prostate cancer survivors to avoid or limit alcohol, since excessive alcohol can affect cancer risk. Clinicians should also assess prostate cancer survivors for tobacco use and provide or refer survivors to cessation counseling.

Bowel dysfunction can occur in prostate cancer survivors as a result of radiation, although bowel symptoms are more common during treatment than after it. Prostate cancer survivors with bowel problems affecting nutrient absorption should be referred to a registered dietitian.

Prostate cancer survivors are also at risk for anemia, cardiovascular disease and diabetes from ADT, and should be regularly assessed for these conditions, and if present, treated. Thirty percent of prostate cancer survivors also experience distress associated with their cancer diagnosis, including increased anxiety and depressive disorders. Ongoing assessment and treatment by primary care providers or referrals to psychologists, psychiatrists and/or social workers are important to minimize cancer-related distress. Treatment for cancer-related anxiety or depression can also minimize the effects of these conditions on survivors’ quality of life.

INR offers Seminars such as His Health/Her Health – Medical Challenges in Mid Life. To learn more about the seminars, click here.webinarsSeminars-CTA

The Power Of Sleep

Posted Posted in Continuing Education, Homestudy

By Dr. Mary O’Brien MD

When you’re scrambling to meet the countless demands in life, cutting back on sleep might seem like the only answer. Although you realize that getting a good night’s sleep is important, you might not realize the vital role sleep plays in our physical and emotional health. Not getting enough shuteye can have serious and even devastating consequences.

baby-303068_640Unfortunately, sleep problems are quite common, and over 60% of Americans report having trouble getting to sleep or staying asleep at least a few nights a week. More troubling is the fact that over 40% of American adults report daytime sleepiness severe enough, at least a few days each month, to interfere with their daily activities.

During sleep, the brain is preparing itself for the next day—and even forming new neural pathways that help with learning, memory, and problem-solving. For teenagers and children, deep sleep actually stimulates the production of growth hormone which supports normal growth and development.

Sleep is also important in maintaining a healthy functioning heart, blood vessels, kidneys, and immune system. Emotional well-being—especially during times of stress—is also tied to getting enough sleep. The ability to react to stress without mood swings and undue anger, as well as the ability to get along with others, is affected by whether or not one gets enough sleep.

Lack of sleep causes not only fatigue, but also a wide range of health problems and disease. Chronic sleep deficiency can causes immune system dysfunction, making it difficult to fight infections. Insomnia can also lead to problematic changes in the endocrine system, which may exacerbate diseases such as diabetes. And sleep problems can lead to abnormalities in the central nervous system and cardiovascular system. Children and adults who don’t get enough sleep, for instance, are at increased risk for a host of emotional ailments, including depression, mood swings, impulsivity, and anxiety.

Below are just a few of the health problems that can result from lack of sleep:

  • Obesity
  • Kidney disease
  • Hypertension
  • Stroke
  • Depression
  • Chronic Pain

Many people think they can function well even with sleep deficits. But scientific research reveals that the opposite is true. After just several nights of not getting enough sleep—with a loss of 1 to 2 hours of sleep per night—your ability to function declines as much as if you hadn’t slept for a day or two.

Research has also shown that people who don’t get enough sleep take longer to finish tasks, have a slower reaction time, and are more likely to make mistakes. They also have difficulty making decisions, are less creative than those who get enough sleep, have a hard time controlling emotions and behavior, and suffer declines in their problem-solving abilities. So not only does lack of sleep compromise alertness and physical health, it can also reduce productivity at work and decrease one’s ability to weather life’s stresses.

When sleep is compromised, the body’s ability to heal, repair, and restore itself can be impaired. Blood pressure fluctuations, adrenaline production, and hormone synthesis are affected —and impede our ability to bounce back from the physical stresses of normal life. When sleep deficits persist for an extended length of time, these disruptions in normal bodily function can push a vulnerable organ system from health into disease.

The bottom line is that we live in a sleep deprived world. Sleep is good for your mind, body, and spirit. In the words of Homer — “There is a time for many words, and there is also a time for sleep.”

Homestudy

Knee Pain

Posted Posted in Continuing Education, Homestudy, Pain

Knee PainBy Rajinder Hullon, MD, JD

Knee pain is one of the most common complaints seen in outpatient medical-treatment centers. This disorder affects 20 percent of our population and is the fifth most common health complaint, accounting for millions of doctor visits each year.

Physicians treat knee pain more frequently these days for a number of reasons. Better health care options and availability have resulted in people living longer. Because the knee joint is one of the key weight-bearing joints in the body, it is subject to more wear and tear with age. Older people are more likely to suffer from some degree of knee pain.

The nationwide problem with obesity has also contributed to the increasing frequency of knee complaints. More stress is placed upon the knee joint the heavier a person is. At some point, the knee joint will be unable to support this stress, and surgical intervention may be required.

Preventing Knee Injuries

As everyone knows, an ounce of prevention is worth a pound of cure. In the case of the knee joint, the American Academy of Orthopedic Surgeons and the American Orthopedic Society for Sports Medicine offer these suggestions to avoid pain or injury:

  • Stay in shape. Good general conditioning helps control or prevent knee pain, particularly patello-femoral pain. Overweight individuals may need to lose weight to prevent excessive stress on the knees. Doctors recommend a 5-minute warm-up before running or beginning any other exercise.
  • Stretch. Stretching is a good warm-up technique before and after any exercise. When performed in the prone (face down) position, it helps maintain the flexibility of the ligaments, muscles, and tendons within the knee joint.
  • Increase training gradually. Work up gradually and avoid sudden changes in the intensity of exercise.
  • Use proper running gear. Running shoes should have good shock absorption and quality construction. Be sure shoes fit properly and are in good condition. If you have flat feet, you may need shoe inserts. Running shoes should be replaced every 3-4 months if used consistently.
  • Use proper running form. Lean forward and keep the knees bent. Also, try to run on a clear, smooth, and reasonably soft surface. Never run straight down a steep hill. Walk down it, or run in a zig-zag pattern.

Since there can be many different causes for such pain, the clinician must take great care to make an accurate diagnosis in order to ensure proper medical and/or surgical treatment.

Many knee pain cases also involve overuse or injury from sporting activities. In these situations, individuals should be aware of the importance of warm-up exercises and, and if pain arises, the need to seek early treatment to avoid permanent or disabling knee injury.

Of course, if you experience knee pain, the best thing you can do is see a doctor, and remember that if you’ve been diligent about exercise for a long time, a week off for rest and recovery might be the best thing you can do, whether you’ve come down with an injury or not.

INR (Institute for Natural Resources) offers continuing educations courses that cover many medical conditions including knee pain.

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Tea: From Social to Medicinal Beverage

Posted Posted in Continuing Education, Homestudy, Nutrition

teaBy Rajinder Hullon, MD, JD

Tea is the most popular beverage in the world as well as one of the healthiest.

The history of tea is fascinating and offers great insight into the history of our world.

Ever since tea was first discovered in China, it has traveled the world, conquering the thirsts of virtually every country on the planet.

According to Chinese mythology, the origins of tea date back to a day in 2737 BC. Emperor Shen Nung was sitting beneath a tree while his servant boiled drinking water. When a leaf dropped into the water, Shen Nung, a scholar and herbalist, decided to taste the brew. The tree was the Camellia sinensis.

For several hundred years, people drank tea because of its herbal medicinal qualities. By the time of the Western Zhou Dynasty, tea was used as a religious offering. During the Han Dynasty (202 BC – 220 AD), tea plants were quite limited and only royalty and the rich drank tea not only for their health but also for the taste. As more tea plants were discovered during the Tang Dynasty (618 – 907), tea drinking became more common among lower classes and the Chinese government supported planting of tea plants and even the building of tea shops so everyone could enjoy tea.

Also during the Tang Dynasty, tea spread to Japan by Japanese priests studying in China. Similar to the Chinese adoption of tea, tea was first consumed by priests and the rich for its medicinal properties. Tea is often associated with Zen Buddhism in Japan because priests drank tea to stay awake and meditate. Soon, the Buddhists developed the Japanese Tea Ceremony for sharing tea in a sacred, spiritual manner. The Emperor of Japan enjoyed tea very much and imported tea seeds from China to be planted in Japan, making tea available to more people.

After obtaining coffee seedlings, Holland, England, and France were able to trade coffee and broke the monopoly exercised by the Arabs. Soon coffee trees were growing in the colonies of India, Java, and the West Indies. Coffee became one of the world’s most profitable export crops in the 18th century. Since then, coffee has been cultivated in many tropical locales and has especially prospered in South America. Today 50 percent of the world’s coffee is from Brazil, 25 percent from other Latin American countries, and nearly 20 percent from Africa.

Tea finally arrived in England during the 17th century when King Charles II married a Portuguese princess, Catherine of Braganza. The Queen made tea the drink of royalty and soon tea became a popular import to Britain via the East India Company. Afternoon tea or tea parties became a common way for aristocratic society to drink tea. Though tea was regularly imported to Britain, the taxes were so high that smugglers would get and sell tea illegally for those that could not afford it. In attempts to turn profits during the tea smuggling period, the East India Company began exporting the tea to America. The American tea was also taxed heavily and contributed to the cause of the Boston Tea Party.

Our Homestudy Course , The Mysteries of Coffee and Tea, explores the origins of coffee and tea and both the positive and negative effects that it can have on the human body. Some research also suggests that caffeine may impact cholesterol levels, the menstrual cycle and even dental health. Caffeine may also lower risk for some cancers. Some people are more sensitive to caffeine than others. Even one cup of coffee may affect their sleep duration and quality, while others can get plenty of shut-eye even after downing several lattés. So whatever is your choice, grab a cup and get ready to study!

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Understanding Alzheimer’s Disease

Posted Posted in Brain Science, Continuing Education, Elder Care, Homestudy

alzheimersBy Dr. Mary O’Brien MD

Dr. Alois Alzheimer, a German neuropathologist, was the first identify and name Alzheimer’s Disease in 1906.  He had been treating a middle-aged woman who exhibited symptoms of memory loss and disorientation.  Five years later, the patient died after symptoms of dementia and suffering hallucinations.   The manifestations and course of the disease were so unusual that Dr. Alzheimer was unable to classify the disease into any existing category.  Postmortem examination of the brain revealed microscopic and macroscopic lesions and distortions, including neurofibrillary tangles and neuritic plaques.

Although it has been more than a century since the disease was identified, it has been only within the last four decades that it has received recognition.  In the past, symptoms were attributed to the “senility” of old age and victims were cared for at home.  The problems of dementia were gradually recognized as an issue associated with the older population, but the nature of the disease and how to treat it were still a mystery.  In the 1970s, researchers determined that people with Alzheimer’s disease had a neurochemical deficiency. This enabled them to study the disease in more detail and separate patients with Alzheimer’s disease from those with dementia of normal aging.

Researchers and scientist are conducting studies to learn more about plaques, tangles, and other biological features of Alzheimer’s disease. There have been great dvances in brain imaging techniques which allow researchers to see the development and spread of abnormal amyloid and tau proteins in the living brain, as well as changes in brain structure and function. Scientists are also exploring the very earliest steps in the disease process by studying changes in the brain and body fluids that can be detected years before Alzheimer’s symptoms appear. The findings from these studies will help in understanding the causes of Alzheimer’s and make diagnosis easier.

One of the great mysteries of Alzheimer’s disease is why it largely strikes older adults. Research on normal brain aging is shedding light on this question. For example, scientists are learning how age-related changes in the brain may harm neurons and contribute to Alzheimer’s damage. These age-related changes include atrophy (shrinking) of certain parts of the brain, inflammation, production of unstable molecules called free radicals, and mitochondrial dysfunction (a breakdown of energy production within a cell).

INR offers continuing educations courses that will present the elements of pathology, medical treatment, and care of victims of this progressive disease. It is hoped that the continued research into the causes of Alzheimer’s disease will provide some of the necessary information about the prevention and treatment of this relentless and socially damaging disease.

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Sources: www.nia.nih.gov/alzheimers