eHealth Newsletter – May

Fastest Car, Fastest Athlete…Fastest Growing Cancer in the US?

by Anne S. Boyd, MD, FAAFP, FACSM

You might know the fastest car or even the fastest athlete, but did you know that melanoma is the most common and the most rapidly growing cancer in the United States? Imagine you’re sitting in a room of 50 people. Now, look around…the person sitting next to you could be that one-in-50 Americans at risk for developing melanoma in their lifetime…or, it could be you.

May is National Skin Cancer Detection and Prevention month, but there’s another reason I chose this topic for the newsletter. Recently, a particularly reluctant patient was coaxed by her husband to come in for a routine physical. I found a new mole that she’d never noticed or would have been able to see. I removed it, sent it for biopsy and the report came back as a malignant melanoma. Her longevity and lifetime changed in that one instant.

In its early stages, melanoma can be successfully removed and monitored by regular skin screenings. In fact, survival rates can exceed 90 to 95 percent. However, in its most advanced stages, melanoma can be deadly as few treatment options exist. Survival rates drop to less than 20 percent when melanoma has spread to other organs.

Early detection is the key!!! That’s why a careful monthly self exam is so important. Remember, this includes close inspection of any moles including those in the hairline, behind your ears, between your toes, under your nails, around the genital areas and even within the mouth. Wherever there is skin, there is a potential for melanoma. If you can’t see or reach areas to be examined, ask a partner or utilize mirrors. If there is a family or personal history, a regular skin exam every 6 to 12 months by a trained medical professional is recommended.

“How do I know what I am looking for?” Well…like your mama’ told you…use your ABC’s. Actually, when it comes to distinguishing between benign or malignant moles use your ABCD and sometimes E’s:

• Asymmetry. Benign lesions generally have a round, symmetric border (if you folded one in half, the 2 halves would match). Melanomas are often asymmetric.
• Borders. Benign lesions have regular borders while melanomas are often irregular and less well defined.
• Color. Benign lesions are uniform in color, while melanomas often have various colors within one lesion.
• Diameter. Most benign lesions are < 6mm (the size of a pencil eraser).
• Evolution. Benign lesions tend to remain unchanged for prolonged periods of time.

How do you protect yourself and help prevent melanoma? We know that genetics is one risk factor and, at least for now, we can’t influence genetics. However, there are several things we can all do to reduce the risk of this ever increasing, deadly disease:

• Use sunscreen daily and repeatedly. Sunscreen should block both UVA and UVB rays and should be at least SPF 30. Regardless of any product claims, there is no sunscreen that lasts all day. And don’t forget your ears, hands, feet and scalp.
• Wear protective clothing. Sleeves, pants, wide-brimmed hats and sunglasses.
• Avoid unnecessary exposure to natural light, particularly from 10am-4pm.
• Avoid tanning salons; there is no occasion worth the risk.

To learn about this insidious form of cancer, read our latest blog, Melanoma—Just the Facts!

As for our ‘reluctant’ melanoma patient, you’ll be happy to know that she is now doing well. She has had a second, wider excision of her melanoma and, fortunately, it was detected early enough, when it was still superficial and localized. She will be fine. And both she and I are exceedingly glad she came in for her executive physical.

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Mediterranean-Style Dieting: It really is too good to be true!

by Sabrina Zaslov, MS, RD, CDE

Ah, the Mediterranean… sunny climate, amazing blue sea, stunning beaches, and now also famous for its extremely healthy diet. While there may be no such thing as an “official” Mediterranean diet, consuming a Mediterranean-style diet has been linked to lower risks of coronary artery disease, stroke, diabetes, metabolic syndrome, certain cancers, as well as better eye health and an increased lifespan.

What makes this diet so beneficial? A major factor may be its influence on inflammation and oxidative stress which both tend to be the root of chronic disease and, as recent research is showing, cognitive disorders.

A study done at the University of Miami Miller School of Medicine found that people whose diets followed a Mediterranean-style eating pattern had lower white matter hyperintensity volume, indicating less brain damage. For those of us without a neurology degree, white matter hyperintensities can indicate small-vessel damage in the brain foreshadowing an increased risk of dementia and a faster decline in cognitive performance.

While it might be nice to move to the Mediterranean and simply adapt their diet, here are some practical tips for eating “Mediterranean-Style” right at home.
The primary diet is plant-based:

• 7-10 servings a day of fruits and vegetables
• Whole grains such as whole wheat, oats, brown rice, quinoa, & barley (nothing processed)
• Protein sources such as fish, nuts, beans and legumes
• Snack on nuts and seeds daily

Rules to live by (whatever your diet):

• Don’t overdo alcohol
• Replace saturated fats such as butter and animal fats with olive oil, avocado & almonds
• Use herbs & spices instead of salt to flavor foods
• Limit red meat to no more than a few times a month and consume in ‘petite’ portions
• Eat fish at least 2-3 times a week

Remember, individual components of the Mediterranean-style diet are healthy, but it’s the entire dietary pattern which has been associated with decreased chronic disease risk and overall better health.

However, if you aren’t ready or willing to fully adopt the Mediterranean-style diet pattern, try starting here:

• Include fruits and vegetables at each meal
• Substitute processed grains with whole grains
• Decrease consumption of saturated fats

The benefit of the diet comes from not only what you are eating, but what you are NOT eating.

Buon Appetito!

 

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An Alternative to Sleeping Pills: Cognitive Behavioral Treatment for Insomnia (CBTI)

by Derek Loewy, PhD, DABSM, CBSM
Insomnia Program Director
Integrative Insomnia & Sleep Health Center

We’ve all lived through the occasional bad night’s sleep. Such intermittent bouts of insomnia are often due to some short-term malady like a head cold or acute stress. Perhaps the culprit is an external nuisance like a snoring bed-partner or a disruptive family pet roaming the bed. For most of us, a poor night’s sleep is a transient thing and not a big deal. Not so for a large segment of the population. It’s estimated that up to 10% of adults suffer with severe insomnia, meaning that for them it occurs most nights of the week. The condition is deemed chronic if it persists for at least three months. In reality, most chronic insomniacs have dealt with their sleep problem for years!

Insomnia is defined as any of the following: difficulty with falling asleep, difficulty staying asleep, waking up too early in the morning, or waking up feeling unrefreshed. Research has shown that chronic sleeplessness is more than a mere annoyance. Insomnia has been associated with decreased quality of life, increased risk for hypertension and heart attack, increased risk for accidents, and increased risk for the development of psychiatric illness, most notably depression.

A comprehensive review of available scientific evidence on insomnia treatment led the National Institute of Mental Health, in 2005, to conclude that only two validated treatments existed for the effective management of chronic insomnia:

(1) Benzodiazepine hypnotic medications, such as Ambien and Lunesta, and
(2) Cognitive Behavioral Therapy for Insomnia (CBTI).

Sleep medications, both prescription and over-the-counter, constitute the most widely employed form of insomnia intervention.

In a recent, widely popularized, yet controversial, study published by a renowned San Diego sleep physician, Daniel Kripke, the safety of sleep medication use was seriously called into question. (See Dr. Lee Rice’s article on the subject, Sleeping Pills and Early Death.) The study found that sleep medication use, even for brief durations, was associated with significantly greater risk of premature death and elevated cancer risk. While the study did not demonstrate a causal connection between hypnotic use and mortality, the findings rekindled concern felt by many healthcare providers and insomnia sufferers alike about the long-term use of hypnotic drugs.

By contrast, CBTI is a treatment intervention with origins in behavioral and cognitive psychology, hence the name “cognitive-behavioral”. CBTI is a constellation of validated treatment strategies aimed at improving sleep through non-pharmacological means.

The first step in CBTI is to conduct a functional analysis of the problem by identifying all active contributing factors. Medically-based causes are treated through medical channels. CBTI then addresses the remaining so called “primary” insomnia factors which include such things as conditioned arousal at night, circadian rhythm disturbance, sleep fragmentation, problematic sleep-wake behaviors, and anxiety-provoking thoughts and beliefs about sleep. This subset of perpetuating factors is remarkably common among most insomnia sufferers and consequently can be addressed through a structured program that is deliverable in individual or small group formats. The typical CBTI program is comprised of a number of weekly or bi-monthly treatment sessions conducted over the course of 5 to 8 weeks.

Controlled, randomized studies on the efficacy of CBTI versus hypnotic drugs have shown that after about six weeks of therapy both groups show improvement and to about the same extent. Long term follow-up (1 year post-treatment) data however consistently show that only the CBTI-treated patients retain their treatment gains.

It is believed that CBTI yields longer lasting sleep improvement because, unlike sleep medication, CBTI targets the causes of insomnia not just its symptoms. The drawbacks to CBTI are that it takes longer to “kick in” than does a sleeping pill and, as with any lifestyle change program, success is largely dependent on the patient’s level of commitment and follow through with the treatment recommendations. One of CBTI’s biggest strengths is that it has no known side effects!

Dr. Derek Loewy is the Director of the Insomnia Program at The Integrative Insomnia & Sleep Health in San Diego. He is a licensed clinical psychologist and board-certified sleep specialist and certified behavioral sleep specialist. Dr. Loewy earned his doctoral degree at the University of Ottawa, Canada in 1996 and completed his sleep medicine fellowship at the Stanford Sleep Disorders Center in 2001 where he co-founded the Stanford Insomnia Program.