Healthoughts

Healthoughts compiled by Sarah Huoh and Alicia Di Rado

Illustrations by Diane Bigda.

guiding light

People know they should get their cars serviced every 10,000 miles and change the batteries in their smoke detectors once a year.

However, health screenings, particularly for colorectal cancer, do not necessarily follow a standard timeline; individualized guidelines should be set up to determine when to be checked.

According to Heinz-Josef Lenz, M.D., associate director of the gastrointestinal oncology program at USC/Norris Comprehensive Cancer Center, the general recommendation is to have a baseline colonoscopy at age 50 and thereafter every three to five years.

But certain factors may warrant an earlier or a more frequent check, including a family history of colorectal cancer, irritable bowel syndrome, polyps, high consumption of red meat, a low-fiber diet or obesity.

“If there is any family history of colorectal cancer, we usually recommend a colonoscopy at the age 10 years younger than the youngest family member was diagnosed,” Lenz says. “If there is a general disposition to cancer, a shorter interval is recommended, usually every one to two years.”

While a colonoscopy remains the gold standard of screening for colorectal cancer, Lenz says that two new options are being investigated. One is a virtual colonoscopy that is based on a computed tomography, or CT, scan; the other is a test for abnormal DNA in a stool sample.

For now, though, Lenz says the colonoscopy remains the best option.

As far as the ease and comfort of the test is concerned, Lenz explains, “Usually patients get some anesthesia for the colonoscopy. It is usually done quite quickly and most patients have no problems.”

In addition to screenings, Lenz advises regular exercise, limited alcohol consumption, and a diet with less red meat and more white meat, fish, soy or tofu for decreased colorectal cancer risk.

 

eat your heart out

As people age, a particularly spicy meal can bring on chest pain. So the fear becomes: Is it indigestion or a heart attack?

It is often easy to confuse symptoms of indigestion, esophageal problems, acid reflux disease, muscle spasms or pneumonia and other lung problems with those of a heart attack, according to cardiologist Alex Durairaj, M.D., assistant professor of clinical medicine at the Keck School of Medicine of USC.

“The nerves on the inside of the body are not as accurate as the nerves on your skin,” says Durairaj. “The brain sometimes misinterprets esophageal pain as cardiac pain, for example.”

There are symptoms that are more indicative of a cardiac event, he says, for example, a feeling of heavy pressure in the chest and a tightening sensation extending into the left arm or throat. Associated symptoms also may be breathing difficulty, sweating or palpitations.

Durairaj cautions that if the pain persists after 15 minutes, seek medical help immediately, either by calling 911 or going to the emergency room. Heart attacks treated within the first hour offer the best outlook for saving heart function and minimizing damage.

At the emergency room, patients should volunteer information about their own risk factors such as smoking, diabetes, hypertension or family history of heart disease, so the physician can determine the likelihood of a heart attack and what tests to administer.

Often, gastrointestinal medicines administered to the patient result in diminished pain.

“The GI medicine can sometimes reduce heart attack pain or has a placebo effect,” he says. Even if the pain is thought to be gastrointestinal in nature, patients should follow up with a cardiologist to discuss personal heart disease risk, determine if any danger exists and decide what steps to take to control it.

 

main squeeze

Knowing your ejection fraction will not help you balance the checkbook, but it could help protect you against sudden cardiac death.

Cardiac electrophysiologist Leslie A. Saxon, M.D., professor of medicine at the Keck School of Medicine of USC, says an ejection fraction is the percentage of blood squeezed out of the left ventricle with each heartbeat.

“Everyone should know their ejection fraction, just like they know their cholesterol level, blood pressure and other measures of cardiovascular health,” Saxon says.

With each heartbeat, oxygen-rich blood is pumped or ejected out of the heart’s left ventricle, the biggest and most muscular of the heart’s four chambers. Using non-invasive imaging such as an echocardiogram, physicians can measure how well the left ventricle is working. For example, an ejection fraction of 50 percent means the left ventricle expels half its blood volume each time it contracts.  

A healthy ejection fraction is 50 percent or higher; lower ejection fractions may mean cardiomyopathy—a malfunction of the ventricle that saps the muscle’s pumping ability. Cardiomyopathy may cause sudden cardiac death.

“Sudden cardiac death is responsible for about a thousand deaths in this country every day,” Saxon says. “Research shows that 95 percent of people who experience cardiac arrest die, often before they can reach an emergency room. But with an implantable defibrillator, sudden death could actually be prevented in 98 percent of cases.”

Implantable cardioverter defibrillators (ICDs) interrupt cardiac arrest by monitoring the heart’s rhythm and delivering an electrical shock when a life-threatening arrhythmia is detected. Saxon notes that research studies completed in the past year show that many patients with heart failure will have improved survival with an ICD. The federal government recently expanded Medicare coverage to include patients who have never had a heart attack, but who have a serious heart condition and would benefit from an ICD.

 

lotta liver

Deep within the body is an organ that may suffer obesity’s effects in silence. That organ is the liver.

The liver may fall victim to fatty liver disease, a condition in which fat builds up in the liver cells and causes injury and inflammation over time.

A person with fatty liver usually feels fine and shows no outward signs of a problem until the disease is advanced and the liver is significantly damaged.

“It is extremely common, since we have an obesity epidemic,” says gastroenterologist Shelly Lu, M.D., professor of medicine at the Keck School of Medicine of USC.

Physicians know that certain conditions put a person at risk for fatty liver disease. These include obesity, diabetes and hyperlipidemia—elevated levels of lipid molecules such as cholesterol and triglycerides in the blood. Insulin resistance is common, too. Yet 10 to 20 percent of people with fatty liver disease do not have these risk factors, she notes.

Sometimes, the only hint of fatty liver comes from routine blood tests, which may show high liver-enzyme levels. The liver also might feel enlarged during a physical exam.

About 10 to 25 percent of Americans have fat in their liver but no signs of inflammation or injury, according to the National Institute of Diabetes and Digestive and Kidney Diseases. Another 2 to 5 percent of Americans have damage or inflammation, a condition known as non-alcoholic steatohepatitis, or NASH.

“Most fatty liver patients have a benign disease course, but NASH patients can progress to fibrosis and cirrhosis,” Lu says. Cirrhosis, an irreversible hardening of liver tissue, may result in liver failure.

No drugs are currently approved to treat fatty liver disease, but several are under study. To both prevent and treat fatty liver disease, Lu encourages overweight patients to take pounds off sensibly through exercise and diet. Crash diets hold their own danger, since rapid weight loss can also lead to fatty liver.