Tuesday, September 21, 2010

Breast Reconstruction?

This is something I think about, of course. Today I ran across a new report from Health News says:

Breast Reconstruction After Mastectomy: Now or Later?

The study finds more complications in women who get immediate reconstruction but need radiation later.

By Kathleen Doheny
HealthDay Reporter

MONDAY, Sept. 20 (HealthDay News) -- Two new studies may help breast cancer patients and their doctors make treatment decisions involving immediate breast reconstruction after mastectomy.

One study finds that about half of women who need radiation therapy after having had a mastectomy with immediate reconstruction develop complications that require additional surgery. Another study finds that chemotherapy does not affect complication rates after mastectomy and immediate reconstruction.

Both reports are published in the September issue of the Archives of Surgery.

The growing trend toward immediate reconstruction "has turned into a runaway train," said researcher Dr. Rodney Pommier, professor of surgery at Knight Cancer Institute, Oregon Health & Science University in Portland. Some women, he said, would be better off delaying it.

Pommier and his colleagues evaluated 302 women who had mastectomies; of these, 152 had reconstruction, including 131 immediately, and 100 had radiation after the mastectomy.

Among those 100 who needed radiation, complications occurred in 44 percent of those who had immediate reconstruction, but only in 7 percent of those who did not have immediate reconstruction.

Both scenarios -- having radiation after mastectomy and having reconstruction done immediately -- strongly predicted the risk of complications, Pommier's team found. Radiation tripled the risk, and immediate reconstruction increased the risk eightfold.

Implants had to be removed in 31 percent of patients who had radiation after mastectomy, compared to just 6 percent of those who did not have to have radiation, the researchers reported.

"We were surprised that one in three lost implants," he said. His team was also surprised at the complication rates overall. "I think it was known that complication rates [among those who need radiation] are fairly high, but I don't think they have been quantified," he noted.

The results, Pommier said, have changed his thinking. He now suggests that having a biopsy of the sentinel lymph node (the first to receive drainage from a tumor) before deciding whether to have immediate reconstruction would be wise. "If the sentinel node is negative, there is a low probability they would get radiation," he explained.

This biopsy is typically done at the start of the mastectomy, he said. But it can be done as a 30-minute outpatient procedure before the mastectomy is scheduled and before the reconstruction decision is made. In determining who will need radiation after mastectomy, doctors consider biopsy results as well as other factors, such as tumor size.

In the second study, researchers from the University of California, San Francisco, found that chemotherapy, either before or after the mastectomy and immediate reconstruction, had no bearing on complications and the need for more procedures.

Overall, 31 percent of 163 patients studied (some of whom received chemo, and some who did not) had a complication that required a return trip to the operating room. But the rate didn't differ based on whether the woman received chemo before surgery, after, or not at all.

The two new studies are putting some numbers behind what doctors have observed in patients, said Dr. Joanne Mortimer, director of the women's cancer program at City of Hope Comprehensive Cancer Center in Duarte, Calif., who reviewed the findings.

"I think they actually put in writing what physicians have appreciated clinically," she said.

While immediate reconstruction can help a woman cope psychologically, Mortimer said, sometimes it is not best in the long run if a woman needs radiation.

Since I've chosen not to have radiation, and hopefully don't require it in the future, much of this isn't pertinent to me, but it's certainly interesting! And I've learned that Medicare does cover reconstruction in the case of breast cancer, and also covers any procedure performed on the opposite breast for symmetry purposes. For example, in order to match the reconstructed breast, the opposite breast may require a breast lift or reduction. I could certainly go for a lift and even reduction on the other side!! especially a lift!! :o)

Another good excuse for dark chocolate!

World Alzheimer's Day

by Jean Carper

How are you celebrating World Alzheimer's Day today? Of course, it's hardly a celebration, since the idea is to focus on the awful fact that Alzheimer's is about to swamp us with the worst epidemic the world has ever seen--115 million cases, including 13.5 million Americans (up from 5.1 million today) by 2050, and the collapse of our health care system, according to the Alzheimer's Association, one of the organizers of this Day, on September 21.

One way to try to hold back this catastrophe, brought on by aging baby boomers, is spending more on research. The National Institutes of Health now antes up a paltry $527 million a year to study Alzheimer's, compared to $6.1 billion for cancer, $3 billion for HIV/AIDS, and $1.9 billion for heart disease. NIH should up Alzheimer's research money to at least $2 billion annually, say experts.

In the meantime, don't expect a cure anytime soon. The last big test of a miracle drug, costing hundreds of millions of dollars, actually made Alzheimer's worse.

After I accidentally discovered I carry a major gene (ApoE4) that triples my risk of developing Alzheimer's, I decided to find out everything I could do to delay or prevent the onset of the symptoms of memory loss and dementia. I read thousands of scientific papers and interviewed dozens of Alzheimer's researchers who were eager to tell me.

Scientists now know Alzheimer's is not a sudden brain catastrophe. Like heart disease and cancer, it is a chronic disease of aging that progresses slowly over 10 or more years, finally releasing its symptoms. That means you have years in which to fight off the disease, and one way to do it is by eating the right stuff.

Here are five things you want on and off your menu to help keep Alzheimer's out of your future.

Say yes to:

Fish: Around the world, people who eat fish every day are 40 percent less likely to develop dementia, according to a recent large study. Best: fatty fish, such as salmon and sardines. Such omega-3 fish fat improves the functioning of brain cells.

Curry: There's at least one likely reason why the people of India have one of the lowest rates of Alzheimer's— about one fourth the rate found in parts of Pennsylvania, for example. Curry is a staple in India, and it contains curcumin, found in the spice turmeric, which in animals blocks deposits of the toxic gunk beta amyloid, believed to be a cause of Alzheimer's.

Coffee and tea: Surprisingly, heavy coffee drinkers (three to five cups a day) in one study were 65 percent less apt to develop Alzheimer's. Some experts credit the caffeine and antioxidants in coffee. Both black and green tea are rich in chemicals that protect brain cells from damage.

Juices: Having a glass of any type of fruit or vegetable juice more than three times a week reduced the risk of Alzheimer's by 76 percent in a study at Vanderbilt University. Particularly beneficial to the brain, according to other research: apple juice, pomegranate juice and wild blueberry juice.

Fruits and vegetables: Scarfing up all kinds of fruits and vegetables is a potent way to keep your aging memory sharp. Eating veggies only three times a week cut memory decline 40 percent in a major study. Highest in brain-protecting antioxidants: raspberries, raisins, blueberries, artichokes, cranberries, dried plums (prunes), blackberries, garlic.

Say no to:

Meat: People who eat meat are 20 percent more likely than nonmeat eaters to develop dementia, says a recent worldwide study. Worst: processed bacon, hot dogs and cold cuts, which contain nitrites that can lead to nitrosamines that some scientists believe help induce Alzheimer's.

Animals fed diets with a lot of sugar get fat, have high cholesterol and ineffectual insulin and are slow to learn. Most alarming, high sugar causes brain damage from increased deposits of beta amyloid, a major cause of Alzheimer's. Worst: high fructose corn syrup, common in processed foods, including soft drinks.

Bad fats: Two villains are saturated animal fats and trans fats in processed foods. Animals fed diets of 10 percent saturated fat get dumb and dumber. According to a major study, older people who ate the most saturated fats doubled their odds of Alzheimer's; those who ate the most trans fats quadrupled Alzheimer's risk.

Extra calories: A high-calorie diet can lead to obesity, high blood pressure, fat around the middle and diabetes, upping Alzheimer's risk. Studies suggest that restricting calories reduces brain shrinkage and deposits of toxic brain proteins, both hallmarks of Alzheimer's.

Excessive alcohol: One drink a day, especially red wine, may help preserve memory. But "heavy drinking" for men and women—more than two drinks a day—doubled dementia odds, studies show. A monthly alcohol binge tripled dementia risk and passing out from alcohol at least twice in a year hiked dementia odds 10 times. Excessive alcohol is an unrecognized cause of much dementia, say experts.

Right now, your best bet for escaping Alzheimer's is to save yourself. And prominent Alzheimer's researchers have already figured out countless ways to do it. Here are 10 things they will be doing on World Alzheimer's Day--and do every day--and say you should do, too, to keep Alzheimer's out of your future.

1. Take a hike: Nothing beats walking for boosting memory and flooding your brain with chemicals that serve as "Miracle-Gro" to create bigger neurons. Take a brisk 30-minute walk, or three 10-minute sessions on a treadmill. A "nature" walk through a park also improves memory.

2. Eat an apple or two: Apples stimulate production of the neurotransmitter acetylcholine, which is what the Alzheimer's drug Aricept also does, say University of Massachusetts researchers. You get the same benefits from two eight-ounce glasses of apple juice.

3. Drink a few cups of coffee: "I try to drink five cups of coffee a day," says Gary Arendash at the Florida Alzheimer's Disease Research Center. He says the caffeine blocks build up of Alzheimer's brain toxins. In one study, drinking three to five cups of coffee a day cut Alzheimer's risk 65 percent.

4. Treat yourself to a little dark chocolate: It can boost blood circulation in your brain, lower blood pressure and inhibit stroke damage, all important in preventing Alzheimer's and other dementias. Be sure cocoa content is at least 70 percent. Even a half ounce of rich dark chocolate a day may be enough.

5. Surf the internet for an hour: Yes, a good Google search can stimulate an older brain and possibly improve thinking and memory. So can playing video games, and doing certain online brain games. For some that have been scientifically tested, check out www.positscience.com.

6. Do something new: Your brain cells are stimulated when you think of or do anything new. People who do novel mental activities reduce their risk of cognitive decline. Important: you must make a mental effort; breezing through crossword puzzles doesn't count.

7. Eat a cup of berries: If you want to make forgetful old lab animals "younger and smarter," just feed them blueberries, strawberries, raspberries, blackberries or cranberries, say Tufts University researchers. How much? At least a cup a day.

8. Take a multivitamin: It can slow brain aging, especially if it includes high antioxidants, such as C, E and alpha lipoic acid. Be sure to get 500 mcg B12, 800 mcg folic acid, 20 mg B6 a day--doses found to reduce brain shrinkage up to 50 percent in people with mild memory problems.

9. Have a Curry Meal: A constituent of curry spices known as curcumin blocks Alzheimer's-like brain damage and boosts memory in animal and lab tests. India, where curry is a staple, has a very low rate of Alzheimer's.

10. Get together with friends and family: Make it a point to yak it up today, the larger your circle of friends and family, the better. Extroverts with high "social engagement" have less cognitive failure as they age. Being married or having a significant other dramatically cuts your odds of developing Alzheimer's.

If we all do everything we can to save our own brains from Alzheimer's, we may one day actually be celebrating World Alzheimer's Day as a victory over this human tragedy.

Jean Carper is the author of "100 Simple ThingsYou Can Do To Prevent Alzheimer's and Age-Related Memory Loss." She has posted more than 200 scientific references to studies on slowing and preventing Alzheimer's on her blog www.jeancarper.com.

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