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From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … http://www.LegacyEducators.org and click on “Cancer Information”

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JUNE IS MEN’S HEALTH MONTH!

(Please see video below and share with family and friends!)

While there are many types of cancers, Prostate Cancer, is one of the few that has a somewhat “predictable” blood indicator: the Prostate Specific Antigen (PSA). Please Note: only men have PROSTATE  – women do not have a prostate gland!

prostate normalSo what’s the fuss? Men – your brother, husband, uncle, boyfriend, grandpa, cousins, friends – are dying needlessly from this disease. Prostate cancer is the second leading of cause of death in men in the United States.

There are debates among medical professionals that we may be “over-treating” prostate cancer, leading to some clinics no longer testing for PSA.  However, that concern may be a bit premature, as over 27,000 men die annually from prostate cancer…still. African Americans/Black male are at greater risk and many are not being tested and many others do not know their number, or what it (PSA) means.

KNOW YOUR NUMBER!

KNOW YOUR PSA!

psa-adjusting

If you are an African American/Black male over 40 or other race over 50, someone in your family had prostate cancer, etc., you should know your number. Ask your doctor about it!

The prostate gland gets larger with age…so the PSA will increase. However, you should be referred to Urology if:

  • prostate abnormal1The PSA number is above age range specified above
  • The Digital Rectal Exam (DRE) is abnormal (lump felt, see pic above) – this occurs in ~20% of cases
  • The PSA number doubles or increase drastically from base line (therefore MUST know baseline)
  • Incidental abnormality on scan taken for other reasons

Now that you know more, speak with your physician to know what’s best for you. Tell your family and friends to do the sam – spread the word!)

Please watch this video and share!

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … http://www.LegacyEducators.org and click on “Cancer Information”

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It use to be that a cancer diagnosis lead to high mortality (death) rates and survivorship came at an extreme cost of post-surgical disfiguring features, neuropathy and other late effects from chemotherapy and radiation therapy as well.  With improved technology and clinical applications of (bench) research, many patients are surviving and doing much better than generation past. As survival continues to improve, quality of life, including fertility preservation has become increasing important to patients and their families.

fertility-preservation

Sperm Banking

I recently received my seasonal St. Jude magazine with the featured topic of preserving fertility. It was great to know that fertility preservation options are now being offered to children undergoing cancer treatments or those who are survivors.  Per their report, “…[it is] estimated that half of adolescent and young adult male cancer patients are at increased risk for infertility, with about 10% of female childhood cancer survivors having acute ovarian failure and an additional 15% entering menopause prematurely.”

fertility

Egg Harvesting

It was noted in their report, that St. Jude Children’s Research Hospital is currently the only hospital in the U.S. to cover the expense associated with harvesting and storing sperm and eggs until patients reach age 35. That policy eliminates one of the greatest barriers to fertility preservation for many childhood cancer patients:cost. This is GREAT news!

I remain and avid supporter of St. Judes Research Hospital!  Hope to be a visiting professor/clinician there one day. If you are looking for a charity to support, please consider St.Judes!

stjude1

 

 

Fertility Preservation for Young Women with Cancer

Fertility Preservation Options

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … http://www.LegacyEducators.org and click on “Cancer Information”

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Survivor – An individual is considered a cancer survivor from the time of diagnosis, through the balance of his or her life. Family members, friends, and caregivers are also impacted.

repairman with the tool on a white background. 3D image

Once cancer treatment is completed, patients transition from regular (daily, weekly, etc.,) healthcare provider’s attention, to follow-up regimen that is once every 3-4 months, twice/year or annually.  This may seem like an “unknown abyss” and some patient may even suffer a form of separation anxiety. What to do?

Patients are encouraged to become their own advocate. That includes, knowing follow-up guideline recommendations for your specific cancer. One size does not fit all! Ask your doctor to give you an idea of the follow-up plan for the next 2-5yrs…yes, you can ask for that. Many organization, including The National Comprehensive Cancer Network (NCCN) provides an update and recommendations annually regarding follow-up.

advocacyWhat does SELF-ADVOCACY mean for a cancer survivor? Well, for starters, here is a list of things you should discuss with your doctor at the end of treatment and during follow-up appointments (not all listed below will apply, but should be tailored to be cancer site specific).

  1. Late Effects/Long-Term Psychosocial and Physical Problems – what should I expect? What symptoms should be reported?
  2. Anthracycline-Induced Cardiac Toxicity – Not all chemotherapy affects the heart, but will the chemotherapy used for me affect me heart 20-30yrs down the road? What can be done to lower the risk?
  3. Anxiety and Depression – What symptoms should be looked for and what signs should be reported?
  4. Cognitive Function – What changes should I expect? Is “chemo-brain” real?
  5. Fatigue – Is it associated with treatment? How long will it last?
  6. Talk with your Oncologist and ask questions!

    Pain – What pain level should be tolerable? Can over-the-counter pain meds suffice? Which ones can be taken?

  7. Sexual Function (female/male) – If viagra does not work, are there other options for ED? What can be used to increase sexual desire in a woman?
  8. Sleep Disorders – how do  know if my sleeping problems are associated with past cancer treatment? Will the treatment be any different?
  9. Preventive Health
  10. Healthy Lifestyles
  11. Physical Activity – What is considered low, moderate and intense activity? Any examples? Are there limitations?
  12. Nutrition and Weight Management
  13. Supplement Use – Any specific type to avoid?
  14. Immunizations and Infections – Any immunization that should be avoided?

Self-advocacy is a lot of work! BUT, it is your life..take charge of it!

 

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … http://www.LegacyEducators.org and click on “Cancer Information”

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Seeking a second opinion is often exercised in many areas of life. It is often quoted that:

  • 70% of people consider a 2nd opinion for home improvement
  • 55% of people would consider a 2nd opinion on vehicle repairs.
  • What about Cancer diagnosis? How many get another opinion?

second-opinion-cartoonWhen it comes to cancer diagnosis and other serious chronic diseases, a second opinion is not only ok, it is recommended!

Your treating physicians should not mind, and in most cases, a good physician may even recommend that a second opinion be obtained. This recommendation is NOT a bad thing! As physicians, we are often very comfortable with our recommendations, but understand that there may be other ways of accomplishing what is best for you, the patient.

***Cancer is often a scary and frightening diagnosis! It is my recommendation to NEVER go to an appointment alone, if at all possible.***

PREPARING FOR A 2nd OPINION

Don’t wait too long after diagnosis – time is of the essence! Once you have completed your 1st set of appointments (or even during the process):

  • Tell your physicians that you would like to have a 2nd a opinion. They may recommend another hospital or physician and may assist with arranging an expedient 2nd opinion appointment. Alternatively, you may do this on your own, by seeking recommendations elsewhere/trusted sources
  • Sign release forms and/or gather all of your relevant medical records—including biopsy/pathogloy/test results, blood work, or any imaging test (CT scans, MRI, US, Mammograms, etc.,). This will prevent the need to repeat these exams – save time and money!
  • Create a list/time line of all the symptoms that lead to your diagnosis, if any was experienced
  • Write down and bring a list of all the medications you are currently taking (prescription and over the counter)
  • Write down and bring a list of all your questions. If you do not know what to ask, consider the things discussed at your first oncology appointment…AND please bring someone with you!

WHAT TO EXPECT

  •  The hospital/clinic may repeat their review of the pathology report to confirm the diagnosis
  • They will provide additional details about the type of cancer and its overall stage (a description of where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body)
  • Perspective from experts in different oncology disciplines, such as medical oncology, radiation oncology, and surgical oncology
  • Discussion treatment options (sometimes doctors may disagree with the original diagnosis or the previous proposed treatment plan – different chemotherapy, different radiation therapy approach, no chemotherapy or radiation, different type of surgery, etc.,)
  • The availability of clinical trials that you may want to consider
  • The favorite question most of my patient like to ask me – “What would you recommend if I was your…___(fill in the blank/relative)” … It never hurt to ask the same!

This is by no means an exhaustive list of recommendations in preparing for a 2nd opinion, but it is a start – for a blog *smile*.  Apply these recommendations to any other serious diagnosis. If possible, ask  questions before any surgeries or serious treatment. Oh, by the way, your research on the internet does not count as a second opinion!

Again, take someone with you on your appointments!

God’s speed!

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

 

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … http://www.LegacyEducators.org and click on “Cancer Information”

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It is often perpetuated that those with “high pigmentation” or darker complexion, will not and cannot get skin cancer. FALSE, FALSE, FALSE!

Melanoma on extremity

Melanoma on extremity

The Dark Skin/darker complexion that is seen is due to a substance in the skin called “melanin”, which after it spends time in the sun can become a defense mechanism.  Dark-skinned people have a higher concentration of melanin, which can offer a stronger defense/protection from the sun (sort of like a mild sun screen). HOWEVER, this does NOT mean darker skinned people are immune to skin cancer…not at all!

Skin cancer is the most common type of cancer in the United States. Ultraviolet (UV) radiation from the sun is the main cause of skin cancer. UV damage can also cause wrinkles and blotches or spots on your skin. The good news is that skin cancer can be prevented, and it can almost always be cured when it’s found and treated early.

The most common forms of skin cancer are basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma. Each of these has been linked to intermittent and/or chronic sun exposure. Tanning and sunburns are analogous to cigarettes in that just one can increase your risk of cancer, regardless of skin color.

melanomaBecause of this myth, skin cancer is often caught late in African Americans, resulting in a higher fatality (death) rate. An example such as melanoma, the deadliest form of skin cancer, recent studies showed that the 5 year survival rate was 59% in African Americans compared to 85% in Caucasians.

Among African Americans and others of African descent, Asians, Hawaiians, and Native Americans, melanomas are most likely to appear in the mouth, melanomas on the palms of the hands, soles of the feet and under the nails.

Take simple steps today to protect your skin. Here are some of the Skin Cancer Foundation Guidelines

  • Stay out of the sun between 10 a.m. and 4 p.m.
  • Use sunscreen with SPF 15 or higher. Put on sunscreen every 2 hours and after you swim or sweat.
  • Do not burn
  • Cover up with long sleeves and a hat.
  • Check your skin regularly for changes (If uncertain, take a photo with your trusted phone…and compare AND show your doc! See chart below)
  • See your physician every year for a professional skin exam

abcdes-of-melanoma-largeTell your family, friends, neighbors and colleagues while out at your backyard BBQ, pool or beach parties to protect themselves – dark skinned, light skinned and everything in between!

Dr. OZ discusses skin cancer…


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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

 

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … http://www.LegacyEducators.org and click on “Cancer Information”

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MANAGEMENT 

Keloids and hypertrophic scars are conditions that may require treatment if symptomatic. Pain, pruritus (itching), hyperhidrosis (sweating too much), functional impairment, and cosmetic disfigurement are examples of comorbidities. Although multiple medical and surgical therapies have been used for the treatment of keloids and hypertrophic scars, none of these treatments has been adequately evaluated in high-quality studies and there is no universally accepted treatment approach.

Patient evaluation and counseling — The evaluation of the patient with a symptomatic scar involves a detailed scar history, family history of keloids, and scar assessment. The scar location, size, contour, color, pliability, and presence of subjective symptoms such as pain and itching should be recorded. Baseline photographs may be useful for comparison after treatment completion.

Patients should let their physicians know their perception about the scar and subjective symptoms (your account of what you are feeling – pain, itching, shame, sensitivities, etc.,), as these will be documented as reasons for chosing a particular type of treatment and what expectations are from treatments.

Patients should know that there is a high recurrence risk associated with all treatment options and that repeated treatments or multiple treatment combinations may be necessary to achieve satisfactory results.

Post-Incisional/Surgery keloids

Post-Incisional/Surgery keloids

Goals of therapy — A frank discussion with your physician will determine the goals of therapy should be based on the patient’s complaints and desire for treatment. They may include one or more of the following:

  • Relief of symptoms (eg, pain, pruritus)
  • Reduction of the scar volume
  • Functional improvement
  • Cosmetic improvement

Patient AND Physician should accept their “pre-established” definition of success. For example, for conservative treatments volume reduction by 30% to 50%, symptom reduction by >50%, and may be acceptable after three to six treatments or after three to six months

Treatment options

An overall recommendation for the treatment of keloids based on size is first listed, followed by explanation of each treatment modality. Please note the “warnings” and possible side effects of each, especially as it pertains to Radiation Therapy (though highly effective, the long term side effects warrants consideration). Intralesional = injection of medication directly into the keloid

  • For linear or small hypertrophic scars resulting from surgery or trauma, silicone gel sheeting may be used as initial treatment. Pressure therapy, if feasible and tolerated by the patient, may be an alternative first-line treatment. Second-line therapies include intralesional corticosteroids, laser therapy, and surgical excision.
  • Keloid-of-chestFor minor keloids (<0.5 cm), intralesional corticosteroids is suggested as the first-line therapy. Silicone gel sheeting or pressure therapy may be used as adjunctive therapies. Second-line therapies include intralesional corticosteroids in combination with intralesional 5-FU, contact or intralesional cryotherapy, or laser therapy.
  • For major keloids (>0.5 cm), intralesional triamcinolone acetonide is the first-line therapy to control pruritus (itching) and pain, increase scar pliability, and reduce volume. Adjunctive (follow-up) treatments include intralesional 5-FU and contact or intralesional cryotherapy. For large earlobe keloids that cause considerable cosmetic disfigurement, the initial treatment is often surgical excision in combination with perioperative intralesional corticosteroids, compression, or radiation therapy.
  • For linear or small hypertrophic scars resulting from surgery or trauma, silicone gel sheeting may be used as initial treatment. Pressure therapy, if feasible and tolerated by the patient, may be an alternative first-line treatment. Second-line therapies include intralesional corticosteroids, laser therapy, and surgical excision

Description of each treatment modality

Intralesional corticosteroids (injection directly into the keloid) – Intralesional  triamcinolone acetonide is the most commonly used treatment for hypertrophic scars and keloids. Corticosteroids soften and flatten the scar. Treatment is usually repeated several times at four to six-week intervals, but the optimal concentration and number of treatments has not been determined.  Intralesional corticosteroid injections are painful. Other adverse effects include dermal atrophy, skin ulceration, hypo- or hyperpigmentation, and development of telangiectasias.

Intralesional 5-fluorouracil (5-FU is also used a chemotherapy agent to treat cancer) — Intralesional 5-fluorouracil (5-FU) has been used for scars that do not respond to intralesional corticosteroids.  Adverse effects of this treatment include pain and hyperpigmentation (darkening spots). Intralesional 5-FU can be used in combination with intralesional corticosteroids.

Silicone gel sheets — Silicone gel sheeting is frequently used for the treatment and prevention of hypertrophic scars and keloids. The mechanism by which silicone gel sheeting might exert an anti-scarring effect is unknown. Evidence showed that silicone gel sheeting may reduce the thickness and improve the appearance of hypertrophic scars and keloids.

Pressure therapy — Pressure therapy is usually performed with pressure garments, bandages, or special devices for certain locations such as the ear. A type of pressure earrings for earlobe keloids called Zimmer splints can be molded to the appropriate size and cosmetically altered to appear as earrings. Other devices using magnets with or without silicone sheeting have also been used as post-surgery adjuvant therapy for ear keloids.  Observational studies of patients with ear keloids have shown that custom-made pressure devices may be beneficial to reduce the risk of recurrence after surgical excision.

Cryotherapy (see video below) — Cryotherapy is most useful in combination with other treatments for keloids, although up to 50% of patients may respond to cryotherapy alone. A 10- to 30-second freeze-thaw cycle is used and can be repeated up to three times per treatment session. Treatment is repeated at intervals of four to six weeks until response occurs. The major side effects are pain and permanent hypo-pigmentation (lightening of the skin), the latter of which limits its use in patients with darker skin.

Intralesional cryotherapy is a newer technique that allows the focused destruction of keloid scar tissue with minimal surface damage. Delivery of liquid nitrogen to the scar tissue is performed under local anesthesia using a special cryosurgery needle probe. Treatments can be repeated at two- to three-week intervals. In contrast with conventional cryotherapy, postinflammatory hypopigmentation is infrequent after intralesional cryotherapy.

Laser therapy — Pulsed dye laser (PDL) and neodymium-yttrium-aluminum-garnet (Nd:YAG) laser treatment has been reported to be beneficial for hypertrophic scars and keloids. The underlying mechanism of laser therapy involves the destruction of small blood vessels, which leads to improved scar color, height, pliability, and texture.

Evidence from high-quality studies to support the use of lasers for the treatment of hypertrophic scars and keloids is limited. Therefore, the efficacy of laser treatment for hypertrophic scars remains uncertain.

Surgery/Excision — Surgical excision of hypertrophic scars and keloids may be indicated if conservative therapies alone are unsuccessful or unlikely to result in significant improvement. Surgical excision of keloids is associated with recurrence rates of up to 100%. (Surgery SHOULD be combined with other treatments). The combination of surgery with other types of treatments previously mentioned, may significantly lower the risk of recurrence:

  • Intralesional corticosteroids
  • Intralesional 5-fluorouracil (5-FU)
  • Cryotherapy
  • Radiation therapy– Brachytherapy or external beam radiotherapy administered after surgical excision appear to be highly effective in reducing keloid recurrence.

Radiation therapy after surgery — Several studies have found radiation therapy to be highly effective in reducing keloid recurrence when administered immediately after surgical excision.  A variety of techniques, doses, and schedules of radiation have been used in the treatment of keloids.

Treatment with superficial X-rays

Treatment with superficial X-rays

The control of keloids using postoperative radiation is illustrated by several studies with recurrent rates of 4% in 18months, 3% at 34 months,  another report of 1/45 pt recurring at 2yrs, and yet another study with use of brachytherapy that showed recurrence of 12% at 61 month follow-up. Radiation therapy may occasionally be indicated for lesions that are not amenable to resection.

Though these results are GREAT when compared to 50-100% likelihood of recurrence, please note: “Concerns regarding the potential long-term risks associated with the use of radiation therapy limit its utilization for these lesions. Several cases of malignancy that may have been associated with radiation therapy for keloids have been reported. Although causation cannot be confirmed in these cases, caution should still be used when prescribing adjuvant radiation therapy for keloids, particularly when treating younger patients.”

Combination treatments — Recalcitrant (hard to treat) keloids that do not respond to intralesional corticosteroids alone may be treated with a combination of intralesional triamcinolone acetonide and 5-FU.

Limited evidence from small retrospective studies supports the use of pulsed dye laser (PDL) or fractional ablative laser treatment in combination with postoperative intralesional triamcinolone.

SURGERY – Interview with patient

VERY GRAPHIC! Intralesional corticosteroids and cryotherapy

Patients are encouraged to discuss these treatment options with their primary care, and when indicated, a consultation with another specialty is highly encouraged!

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … http://www.LegacyEducators.org and click on “Cancer Information”

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Keloid associated w/ear piercing

Keloid associated w/ear piercing

“What is that behind your earlobe?” Are you brave enough to ask? What if that “thing” is located on other parts of the body? Can something be done to treat it? Will discuss over the next 2 weeks. First, let’s discuss what that abnormal growth actually is…

A keloid  is the formation of a type of scar tissue that can occur at the site of skin injury or previous trauma. The injury can be that of surgery, ear piercing, tattoos, trauma from shaving, etc., A hypertrophic scar looks similar to a keloid and are more common. However, hypertrophic scars do not get as big as keloids, and may fade with time – Keloids do not fade away!

  • Keloids are firm, rubbery lesions or shiny, fibrous nodules, and can vary from pink to the color of the patient’s flesh, or red to dark brown in color.
  • A keloid scar is benign (non-cancerous) and not contagious
  • Keloids can be associated with severe itchiness, pain, and changes in texture.

In severe cases, and depending on location, it can affect movement of skin. A large keloid in the skin over a joint may interfere with joint function. Unfortunately, keloids tend to grow and extend beyond the area of initial trauma and become unsightly and uncomfortable.

  • Keloids1Keloids are equally common in women and men, although more women developed them because of a greater degree of earlobe and body piercing among them.
  • Keloids are less common in children and the elderly.
  • People with darker skin are more likely to develop them, but keloids can occur in people of all skin types.
  • Keloid scars are seen 15 times more frequently in highly pigmented ethnic groups than in Caucasians.
Keloid-of-the-sternum-1

Keloid on chest from procedure

Doctors do not understand exactly why keloids form in certain people, or situations and not in others.
The best way to deal with a keloid is not to get one (really *smile*).

A person who has had a keloid should discuss with physicians before undergoing elective or cosmetic skin surgeries, or procedures such as piercing. When it comes to keloids, prevention is crucial, because current treatments leave a lot to be desired.

Next week – Keloid Treatments

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

 

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