Healthoughts

take one camera and call me in the morning
Despite the recent availability of a pill-sized video camera patients can swallow, USC physicians say that the time-tested colonoscopy procedure remains the gold standard for diagnosing problems of the colon.


Robert W. Beart Jr., M.D., the Charles W. and Carolyn Costello Chair and the Audrey Skirball-Kenis Chair, both in colorectal diseases, explains that colonoscopy is a way to visually examine the colon and rectum, using a camera mounted at the tip of a long, flexible, tubular instrument. It is used to diagnose colon and rectum problems and to perform biopsies and remove colon polyps.


The swallowable camera—a tool that has come into medical use in the last two years—is useful for videotaping the small intestine, but it was never designed to image the colon.


“The camera is small and its battery runs out in the two to four hours that it takes to get to the colon. Further, there is no control over what the mini-camera shows as it passes through the body. It simply transmits images of whatever is in front of it,” he says. Colonoscopy, on the other hand, permits the physician to re-scan areas of interest and provides a good deal of control. The two approaches complement each other, though, Beart says.
“When you have patients who have symptoms you don’t understand, such as bleeding, you can look at what might be causing it from below, to a certain extent. But the camera is a new tool that provides a way to visualize the unexplored middle of the intestine that is beyond the limit of colonoscopy. It obviates the need for exploratory surgery.”

pain in the gut
Infection with the Helicobacter pylori (H. pylori) bacterium is thought to play a leading role in causing peptic ulcers.
“The majority of the world’s population is infected with H. pylori, but most people do not get ulcers. The reasons for that probably have to do with the virulence of an individual strain and the host’s genetic and environmental factors,” says Loren A. Laine, M.D., professor of gastroenterology and liver diseases.


Laine says that a peptic ulcer is a hole or sore on the lining of the stomach or duodenum and that as many as one in 10 people may acquire an ulcer in their lifetimes. Even so, the infection can be cured with a two-week course of antibiotics and antacid medication.


Laine says that the most common symptom of an ulcer is upper abdominal pain. In more serious cases, severe symptoms may include vomiting blood, black stool and dizziness or lightheadedness associated with blood loss.
He notes that although many ulcers heal without treatment, ulcers are potentially serious health problems that may need attention from a physician.


Additionally, while H. pylori is the main cause of ulcers, use of non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen or naproxen can cause ulcers by interfering with the stomach’s ability to protect itself from gastric acid. These ulcers typically heal when those medications are stopped.

whitening strikes
Products designed to whiten teeth generally are safe and effective, but USC dentists emphasize that even in the best of circumstances, the effects are temporary.


Harold Slavkin, D.D.S., dean of the USC School of Dentistry, says that whitening processes use hypochlorite or peroxide-based compounds to remove stains and alter the surface chemistry of the enamel to make it more reflective and therefore brighter.


Whitening agents, which do not harm or strip away any of the enamel, are typically applied to the teeth via gels or adhesive strips that stay in contact with the teeth for as long as 30 minutes per treatment.


How the chemicals are delivered—whether at home or in the dentist’s office, with or without ultraviolet light or laser light to accelerate the process—is largely irrelevant because the underlying chemistry is essentially the same.
Still, the amount of whitening is highly variable, depending on the concentration of the solution, the chemical agent used, the frequency with which it is applied and the duration it remains in contact with the tooth, Slavkin says. He warns that routinely exceeding the recommended treatment can damage and weaken the tooth enamel.


“It’s important that people understand that tooth whitening is not permanent. Depending on a person’s lifestyle habits, the treatment will need to be repeated,” Slavkin says.


In the best circumstances, a treatment can remain effective for up to two years, but people who routinely smoke or drink coffee may see effects last only three to four weeks, he says.


Slavkin says tooth whitening is safe, although as many as 10 percent of the people who try it will experience tooth sensitivity or pain. “The discomfort usually goes away in a few hours, but anyone who experiences that should stop immediately and contact their physician or dentist for guidance.”

self improvement
First, women are told to check their breasts every month to detect any breast cancer early. Then, studies say that self-exams don’t save lives. Which is right?


Well, maybe both.


“When a woman finds a tumor through self-exam, the disease has been there for a while,” says Jennifer Dizon, M.D., assistant professor of obstetrics and gynecology at the Keck School of Medicine. “We do know that monthly breast self-exams do not improve outcomes in a large group of breast cancer patients.”


The American Cancer Society and many physicians continue to recommend that women age 20 and older keep doing the exam because it is one component of a complete cancer-detection regimen.


Women should become familiar with the bumps and ridges that are normal in their tissue. They should watch for any growth in the lumps, but if they examine themselves too often, they are less likely to notice gradual enlargement over time.


“It’s important to know your own breasts,” Dizon says. “But it’s also important to do the exams no more than once a month, and at about the same day in your cycle—after the end of menstruation.”


Besides self-exams, women over age 20 should have a physician perform a clinical breast exam at least every three years. Women age 40 and older should get a mammogram every 12 months and a clinical breast exam yearly. Feeling no changes in the breasts is no reason to skip mammograms.


Those with a strong family history of breast cancer are urged to perform regular self-exams and talk to their doctor about starting screenings at an earlier age.


For more on self-exams, visit the Susan G. Komen Foundation Web site at www.komen.org/bse.