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Strengthening the gluteus medius can be a key step in injury prevention.

Runners often hurt. Knees, feet, hips… Minor aches and pains and the threat of a serious, disabling injury plague runners of all ages and at all levels. “We see runners all the time who have had occasional discomfort in a knee,” says physical therapist John Fulton of Armonk Physical Therapy and Sports Training. “They take a couple of logical steps—scale back their runs, try icing, stretching, maybe new shoes—but the knee doesn’t improve and sometimes gets worse. The problem may be that the root cause of their discomfort is injury or weakness in the gluteus medius and the pain won’t be alleviated until that is corrected.”

Three gluteal muscles make up the buttocks. When walking or running, the gluteus maximus, the largest of the gluteal muscles, moves the hips and thighs. The gluteus medius, a broad muscle located on the outer surface of the pelvis, and the gluteus minimus, the smallest of the three, act as abductors, meaning they move the leg away from the body. They also stabilize the pelvis when the runner’s foot hits the ground.

“There is more than one way in which the gluteus medius can cause problems for a runner,” says Mr. Fulton. “It can become inflamed causing pain in the hip or it can develop small contractures that shorten the muscle and make it less flexible, sending pain down the outside of the leg to the knee, shin and ankle.”

The gluteus medius causes further problems for the runner when it becomes weak or fatigued. “We’ve learned that some of the most common running injuries can be traced to weakness in the gluteus medius,” says Mr. Fulton. “Problems like patellofemoral pain syndrome, also known as ‘runner’s knee,’ iliotibial band syndrome, Achilles tendonitis, and lower back pain can be triggered by an inadequately functioning gluteus medius. When the gluteus medius isn’t providing proper stabilization, muscles that weren’t designed for that task pick up the slack, eventually causing discomfort that compels the runner to adjust his or her stride, leading to poor mechanics and vulnerability to a wide range of injuries.”

Strengthening the gluteus medius can improve a runner’s performance and, even more important, is key to preventing injury. Mr. Fulton makes the following recommendations:

  • Cross train: Athletes who work the same muscles repeatedly and intensely, for example, those who limit their workouts to running, suffer more injuries than those who regularly swap a run for, say, a bike ride or a swim. Cross-training gives the muscles a chance to recover and relieves the strain of using them over and over in the same way.
  • Strengthen: A physical therapist or professional trainer can assess the state of your gluteus medius and suggest a strengthening regimen that takes into account your individual circumstances. Exercises that may be used include squats, particularly single-leg squats, lunges, side-lying hip abduction, single-leg dead lifts, and the clam shell.
  • Take it easy: A program to strengthen a weak muscle or muscle group should be undertaken gradually to avoid injury.

“We find that many injuries to the pelvis and lower limbs can be treated by strengthening the gluteus medius,” says Mr. Fulton. “And doing so will not only help prevent further injuries, improved pelvic stabilization will enable proper gait and improve performance. Strengthening the butt is one of the most important things a runner can do.”

John Fulton, PT, takes great pride in restoring athletes to optimum physical condition and getting them back in the game as soon as possible. Armonk Physical Therapy and Sports Training provides personalized, integrative, and skilled one-on-one physical therapy services. www.armonkptst.com

The post Runners: Ready, Set, Strengthen Your Butt appeared first on A Woman's Health - Women Magazine.

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Go green and reap the benefits of these nutritious foods.

Our culture tends to “super-size” everything, especially food—often to the detriment of our health. But superfoods, or foods that are considered nutrient dense, actually are super: They pack a strong nutritional punch and can give your health a jumpstart.

Go Green

While many foods provide a complex range of nutrients, supergreens are considered one of the best sources of nutrition available. The supermarket is full of greens—kale, chard, spinach, lettuce—but the term supergreen typically refers to a small group of greens from the algae and cereal grass families.

Algae are one of the most primitive life forms on the planet. Micro-algae such as spirulina and chlorella have been shown to contain high levels of chlorophyll and protein.

Cereal grasses are the young grasses of common grain plants. Wheatgrass and barley grass are cereal grasses that are high in chlorophyll and protein and a range of other nutrients.

Those who tout the benefits of supergreens are most often referring to spirulina, chlorella, wheatgrass, and barley grass. But you don’t have to be a health nut to reap the benefits of these nutritious foods.

Why Supergreens?

The research on supergreens is wide and varied. Some proponents make bold claims that supergreens are the magic bullet for health. Opponents say that supergreens provide no more benefit than your average supermarket spinach. The truth likely lies somewhere in the middle.

Supergreens are packed with a wide array of vitamins, minerals, proteins, and enzymes that are easily absorbed by the body. They contain high levels of chlorophyll and antioxidants. Because of their highly concentrated nutrient profile, supergreens are believed to help boost the immune system, reduce inflammation, detoxify the body, and promote healthy digestion.

Some studies have indicated that supergreens may help regulate cholesterol as well as reduce the symptoms of arthritis. The key ingredient to these health benefits appears to be the chlorophyll, which helps to lower the pH balance of the body, thereby making the body more alkaline and reducing the acidity that is associated with health problems such as arthritis.

The antioxidants in supergreens are a line of defense against free radicals, which contribute to disease and aging. The enzymes offered by the supergreens appear to aid digestion.

Without a degree in science or nutrition or an understanding of antioxidants, enzymes, and chlorophyll, here are some of the benefits that people who consume supergreens report: increased energy, reduced cravings for sweets, and an overall sense of clarity and wellbeing.

Down the Hatch

But who wants to eat algae or grass? Though nutritional powerhouses, the idea of downing these greens is unappetizing for many new to the idea. The good news is that adding these foods to your diet is actually quite easy, and because they’re so nutritionally dense, a little bit goes a long way.

Many people drink a small one-ounce shot of fresh wheatgrass juice, typically available at local juice bars. However, for those who don’t like the strong taste of green juice, there are other options.

Algae and cereal grasses are available in powdered and tablet form, and in fact, they are often sold as a combination of many different supergreens. The green powder can be stirred into water, juice, or even mixed with a smoothie. Be sure to check labels on these products carefully to ensure that they contain the supergreens you’re looking for and do not include any extra ingredients and fillers that may not provide any health benefits.

Supergreens are whole foods, but they are most often consumed as a supplement to a balanced diet. Supergreens may not be a magic bullet, but they can provide a benefit by providing missing nutrients.

The post What’s so Super about Super Greens? appeared first on A Woman's Health - Women Magazine.

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By Paulette Lambert, RD, CDE
Director of Nutrition, California Health & Longevity Institute

We are hearing a lot about the potential benefits of a plant-based diet; even former president Bill Clinton attributes his weight loss and improved health to this increasingly popular way of eating. But what exactly is included in a plant-based diet?

What is a plant-based diet?

There are two major food sources in our diet: plants and animals. A plant-based diet includes more volume of food from plants than animal sources. This type of diet includes grains (especially whole grains), beans, lentils, fruits, and vegetables—but it is not necessarily strictly vegetarian. In fact, a plant-based diet can include a whole range of eating styles, from a vegan approach (excluding all animal products, including dairy) to a diet that is largely based on plants but does include some animal protein.

Are there health benefits to eating a plant-based diet?
There is sound medical evidence that a plant-based diet contributes to longevity and good health. A balanced, varied plant-based diet is protective:

  • It’s high in fiber.
  • It provides adequate protein for growth and repair.
  • It’s high in antioxidants that are critical to neutralizing free radicals that cause aging and chronic disease, including cancer.
  • It’s high in vitamins and minerals.
  • It’s low in saturated fat that promotes heart disease.

Also, plants have much lower caloric concentration than animal protein overall, which allows for more food volume without excessive weight gain.

The China Study, a 20-year comprehensive study of nutrition conducted by Cornell and Oxford Universities and the Chinese Academy of Preventive Medicine, describes how the typical standard american diet, which has become very high in animal protein and unhealthy fats and low in fiber, promotes substantially more chronic disease and obesity than a more plant-based, whole-foods diet. The study further illustrates the fact that much of the world lives on a plant-based diet, consuming only small amounts of animal protein due to cost and availability, with much less chronic disease and obesity than the United States.

Dean Ornish, MD, founder and president of the nonprofit Preventive Medicine Research Institute in Sausalito, California, has conducted long-term research that shows that a totally plant-based vegetarian diet along with exercise and stress management can actually reverse heart disease. A plant-based diet protects the body from cancer-causing agents and decreases the inflammation that is responsible for heart disease, stroke, and diabetes. Simply stated, a diet high in animal protein increases inflammation that can contribute to chronic diseases, whereas a plant-based diet actually lowers inflammation.

How far should we go?

So, do we need to fully embrace veganism or vegetarianism to reap the benefits of a plant-based diet? The answer, for many of us, is no—but we can all benefit from transforming our daily diet to one that is primarily plant-based.

As a first step in this direction, take some time to look closely at your plate when you sit down for your next meal. At least half of your plate should be filled with vegetables and/or fruit, and a quarter of your plate should be filled with whole grains. The remaining quarter should be filled with either a lean animal protein, such as fish or chicken, or a plant-based protein such as beans or lentils. When considering serving sizes of animal protein at dinnertime, aim for 3- to 4-ounce servings for women and children and 5- to 6-ounce servings for men. Better yet, try to include five to seven meals per week with no animal protein, substituting plant-based proteins instead.

A few great plant-based protein meal choices include beans and rice topped with salsa; a bean burrito made with a whole-grain, low-fat tortilla; whole-grain bread topped with natural peanut butter; and high-protein pasta tossed with fresh tomatoes, garlic, and basil. At every meal and snack, think of ways to include plant sources of food.

For those who wish to become vegan or vegetarian, ease into increasing plant-based protein in your diet and decreasing animal protein. Be aware that eliminating animal protein while continuing to consume processed food or “junk food” will not improve overall health. Try to focus on eating whole foods, not processed food, to ensure that you see optimal benefits from a plant-based diet. For those who eliminate animal products entirely, it is important to supplement with vitamin B-12, the only nutrient not available in a plant-based diet.

Eating a primarily or completely plant-based diet may be one of the best and most practical ways to improve your health and well-being. While we can all benefit from making even small changes and moving in this direction, some health conditions may require a more aggressive dietary approach. So the next time you are tempted to reach for another helping of chicken or beef, try more salad, green beans, and fruit instead, and change your plate for a healthier you.

Recipes for a Plant-Based Diet

Roasted vegetables are a great way to incorporate a wide variety of vegetable servings into your diet in interesting and diverse ways. Included here are three variations of the Wellness Kitchen’s favorite roasted veggies to demonstrate how easy it is to incorporate a more plant-based diet into your life.

Roasted Cauliflower

1 large head cauliflower
1 tablespoon olive oil
1 teaspoon sea salt
½ teaspoon black pepper
2 tablespoons grated Parmesan cheese

Preheat oven to 350°. Break cauliflower into bite-size florets, removing and discarding core. Place florets in a baking dish. Add olive oil, salt, and pepper and toss well. Roast for 35 minutes until cauliflower is golden and tender. Sprinkle with Parmesan and roast for an additional 5 minutes.

Makes 4 servings
Nutritional information per serving: calories 85; calorie equivalent: 1 vegetable, 0.5 fat

Roasted Green Beans with Pine Nuts

1 pound green beans
1 tablespoon olive oil
1 teaspoon sea salt
½ teaspoon black pepper
2 tablespoons pine nuts

Preheat oven to 350°. Spread green beans on a baking sheet in a single layer. Drizzle with olive oil, salt, and pepper and toss well. Sprinkle with pine nuts and roast until tender and lightly browned, about 20 minutes.

Makes 4 servings
Nutritional information per serving: calories 60; calorie
equivalent: 1 vegetable

Roasted Brussels Sprouts

1 tablespoon olive oil
2 tablespoons honey
2 tablespoons lemon juice
1 tablespoon fresh thyme
½ teaspoon sea salt
¼ teaspoon black pepper
2 pounds Brussels sprouts, cut in half lengthwise

Preheat oven to 350°. In a small bowl, whisk together oil, honey, lemon juice, thyme, salt, and pepper. In a large bowl, combine Brussels sprouts with dressing mixture. Spread on a baking sheet in a single layer. Roast for 30 to 35 minutes until golden and tender.

Makes 6 servings
Nutritional information per serving: calories 75; calorie
equivalent: 2 vegetables

Paulette Lambert RD, CDE, is director of nutrition for California Health & Longevity Institute, located within Four Seasons Hotel Westlake Village (www.chli.com). With more than 27 years of private practice after an extensive clinical education, Lambert has wide-ranging experience in clinical nutrition and the development of individualized dietary plans.

The post A Plant-Based Diet Offers Great Benefits appeared first on A Woman's Health - Women Magazine.

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Minimize pollution exposure for maximum fitness benefit.

It’s a classic catch-22: you want to do something good for yourself by going for a run, but do the benefits outweigh the risks of exercising in heavily polluted air?

Aerobic exercise is indeed one of the cornerstones of health, but it turns out that aerobic activity and pollution really don’t mix. If you live in a heavily polluted urban area or travel frequently to such places, you may want to rethink your exercise regimen so that you can reap the maximum benefits with minimum harm to your lungs.

Why Air Pollution and Exercise Don’t Mix

Air pollution is never a good thing, but it becomes even more harmful when mixed with exercise. Exercising in polluted areas increases our exposure to air pollutants. During aerobic activity, we breathe more deeply and rapidly than we do when we’re at rest. As a result, we inhale 10 to 20 times more air during exercise, which means that we’re inhaling more pollutants into our lungs.

Further exacerbating the situation is the way we breathe. During exercise, we tend to breathe through our mouth, which means we bypass the filtering system of the nose. The result? A dangerous cocktail of pollutants delivered straight to the lungs.

Exercise and Air Pollution: The Results

There is more than theory at work here; there is hard data to indicate that exercising in polluted conditions can be harmful. Researchers at the University of Brisbane in Australia conducted a review of pollution studies worldwide and found that individuals exposed to low concentrations of pollutants during exercise experienced the same amount of lung damage as individuals exposed to high concentrations of pollutants during periods of rest.[1]

Air pollution can irritate the upper respiratory tract and reduce the oxygen transport capacity of the blood. Continued exposure to air pollution has been linked to significant damage to the small airways of the lungs, an increased risk of heart attacks and strokes as well as increased risk of death from lung cancer and cardiovascular disease.[2]

Understanding Pollution

You don’t need a degree in science or environmental studies to understand the harmful effects of pollution. The most common air pollutants are carbon monoxide, sulfur oxides, nitrogen oxides, ozone, peroxyacetyl nitrate, aerosols, soot, dust, and smoke. You may also hear the term particulate matter (sometimes called particulates) which refers to a mixture of tiny specks of soot, dust, and aerosols that are suspended in the air.

Our main exposure is to ozone, which is a colorless gas that comprises 95 percent of smog. Ozone is produced when sunlight triggers a chemical reaction between oxygen and the pollution emitted from cars, refineries, power plants, and other sources. Concentrations of ozone are highest on sunny afternoons with little or no wind and on during inversions, when pollution can be trapped in valleys and basins.

Symptoms of Exposure

Exposure to pollution can cause a variety of symptoms:

  • Aggravates the respiratory system
  • Coughing
  • Chest pain
  • Irritated throat
  • Eye irritation
  • Headache
  • Dizziness
  • Nausea
  • Long-term exposure can reduce lung function, making breathing shallow and uncomfortable.

Exercise Alternatives

If you live in a heavily polluted area, you don’t have to give up your exercise regimen—you just have to exercise a little common sense. To reduce your exposure, follow these guidelines:

  • Avoid exercising outdoors during rush hour, when pollution levels are highest
  • Avoid exercising outdoors in the late afternoon when ozone levels are often highest due to sunny, windless conditions
  • Avoid heavily congested areas of traffic
  • Exercise early in the morning as far away from traffic as possible
  • Exercise during windy conditions
  • Avoid the combination of heat, humidity, and pollution
  • Check local pollution alerts and plan your exercise accordingly
  • Vary your routine by exercising indoors on occasion—the effects of pollution can be cumulative
  • Pay attention to seasonal variations in pollution—ozone is lowest during the winter and highest in late summer and early fall
  • If you must exercise in a heavily polluted area, decrease the time and duration of your exercise—instead of running for one hour, walk for a half hour.

Exercising in pollution is still less harmful than smoking cigarettes. In other words, exercise in pollution may be better than no exercise at all; however, the data shows that there are negative effects. Don’t forego your exercise plan, but do exercise caution. An indoor treadmill might be your best friend on heavy pollution days.

References:

[1] Sharman JE, Cockcroft JR, Coombes JS. Cardiovascular implications of exposure to traffic air pollution during exercise. QJM: An International Journal of Medicine. 2004; 97(10): 637-643.

[2] Miller KA, Siscovick DS, Sheppard L, et al. Long-term exposure to air pollution and incidence of cardiovascular events in women. New England Journal of Medicine. 2007; 356: 447-458.

The post Exercise and Pollution appeared first on A Woman's Health - Women Magazine.

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If I asked you about the leading cause of deaths for adults in the United States, what would you say? Many people lean towards cancer, hearing about it often in the news or as plot lines in their favorite television dramas. The true deadly culprit, however, is heart disease. Heart disease causes 1 in 7 deaths in the United States killing more than 360,000 Americans per year. With these high odds against us, it’s no wonder that millions of Americans take prescribed medications to lower their risk of heart disease. Medications, though, come with their own set of risks, and many high-risk factors for heart disease can be treated without the use of prescription drugs. We want to encourage you to learn more about your potential risk of heart disease and ways that you can reduce it naturally.

What Are the Risk Factors for Heart Disease?

Heart disease risk factors can be divided by those you can control and those you can’t. Age, gender, race, your family’s medical history, and any previous heart attacks or strokes you may have experienced can all increase your risk for heart disease in the future, and these are the risk factors that you have no control over. On the other hand, there are risk factors that you can actively work to reduce in order to protect yourself from heart disease. The three main controllable risk factors for heart disease are high blood pressure, high cholesterol, and prediabetes or diabetes.

What Is High Blood Pressure?

High blood pressure occurs when the pressure of your blood is consistently too high against your blood vessel walls. Last year, the American Heart Association and the American College of Cardiology lowered the healthy blood pressure standards; these new guidelines diagnose 46% of American adults with high blood pressure or hypertension. Untreated high blood pressure can take its toll on the heart and blood vessels, making them work harder and ultimately become less efficient.

How Can You Lower High Blood Pressure?

To fight high blood pressure and reduce a patient’s risk for heart disease, doctors often prescribe diuretics. Diuretics help to reduce the amount of both salt and water in the body, thereby lessening some of the built-up pressure in the blood vessels. As an ancillary medication, doctors may also prescribe an ACE Inhibitor to someone with high blood pressure to prevent the person’s blood vessels from narrowing. Unfortunately for some patients, ACE Inhibitors may cause angioedema, or swelling of bodily tissue. This condition can be fatal if throat tissue begins to swell.

Luckily, there are ways to treat high blood pressure without the need for medications. The Dietary Approaches to Stop Hypertension (DASH) eating plan has been endorsed by the National Heart, Lung, and Blood Institute (NHLBI), The Mayo Clinic, and the American Heart Association to reduce high blood pressure. The NHLBI went as far as to fund three clinical research trials around the diet in order to determine its true health potentials. During the studies, participants following the DASH diet had lower blood pressure results than those on a typical American diet with or without added fruits and vegetables. The DASH diet encourages people to eat foods low in sodium, saturated fats, and trans fats while consuming foods high in potassium, calcium, magnesium, fiber, and protein. Recommended foods on the DASH diet include whole grains, nuts, broccoli, carrots, kale and lean meats.

What Is High Cholesterol?

There are two main types of cholesterol that play a role in heart health. High-density lipoproteins (HDL) are considered “good” cholesterol and actually lower your risk for coronary heart disease and stroke, whereas low-density lipoproteins (LDL) are often referred to as “bad” cholesterol. This “bad” cholesterol can cause plaque to build up in your arteries causing them to harden; this is a condition called atherosclerosis. When this plaque builds up in your arteries, you have a higher chance of suffering from a heart attack or stroke when either a blood clot forms on the plaque or a piece of plaque breaks off and clogs your artery.

How Can You Lower High Cholesterol?

There are two main types of medications prescribed to lower high cholesterol. The first is statins which have been shown to lower LDL levels. Statins have also been shown to cause side effects like muscle damage, liver damage, memory issues, and increased blood sugar levels associated with type 2 diabetes.

Patients with high cholesterol may also be prescribed a blood thinner to prevent blood clots or keep existing blood clots from growing larger over time. Blood thinners can save your life, but again, no medication comes without a risk. If, for example, you cut yourself or become injured while taking blood thinners, your thinned blood will have difficulty clotting which could result in severe, life-threatening bleeding. For this reason, many blood thinners have an antidote to reverse the medication’s effects in the case of an emergency. However, popular anticoagulants like the blood thinner Pradaxa have faced thousands of patient complaints and lawsuits due to severe or fatal incidents caused by the medication’s lack of an antidote.

Before you risk your health and well-being to prescription medications and their adverse side effects to treat high cholesterol, consider changing your diet. Research published by the Harvard Medical School recommends a diet change to lower your LDL. Studies suggest limiting your intake of trans fats and saturated fats, as well as refined sugars and grains. Consider eating foods high in fiber and polyunsaturated fats to lower your LDL, foods that contain plant sterols and stanols to reduce the amount of cholesterol your body absorbs. Here is a list of 11 foods that the Harvard Medical School recommends adding to your diet to fight high cholesterol.

 What Is Prediabetes and How Is It Related to Diabetes?

 Prediabetes is diagnosed in patients whose blood sugar levels are higher than the healthy standard, but not high enough to be considered diabetic. However, if not treated, prediabetes can become type 2 diabetes. Diabetics are actually 2 to 4 time more likely to develop heart disease than those without it. Adults with diabetes are also more likely to suffer from high blood pressure and high cholesterol.

How To Treat Prediabetes and Diabetes?

Unlike the other two high-risk factors we looked at, diabetes can’t be treated by diet alone. Diabetics need insulin regularly, frequent monitoring of blood glucose levels, and in some cases, supporting medications.

Again, even with these auxiliary medications, we see severe adverse side effects. For example, the drug Invokana is used by patients with type 2 diabetes to block glucose from being absorbed by the body. This can be especially helpful for patients who struggle to maintain lower blood glucose levels. Unfortunately, patients taking Invokana have also experienced serious side effects such as lower body amputation, diabetic ketoacidosis, kidney failure, acute pancreatitis, and cardiovascular issues.

Despite the necessary treatments and monitoring, there are foods that diabetics and pre-diabetics can utilize to avoid blood sugar spikes and avoid taking medications like Invokana. Many diabetics and pre-diabetics have been encouraged to reference the glycemic index when meal planning to maintain healthy blood sugar levels. Pre-diabetics are also encouraged by experts to avoid processed, fatty, or canned foods.

How Can You Celebrate Heart Month?

 Everyday Americans are suffering from heart disease and adverse drug side effects when in reality, a healthy lifestyle change could be the preventative measure needed to avoid both. February is American Heart Month, and we want to encourage Americans to be proactive with their heart health. Challenge yourself and your loved ones to make new heart-healthy traditions in the kitchen this February! A nutritious diet full of healthy fats, fruits and vegetables could be the first step in reducing your risk for heart disease and creating a lifestyle to keep your family happy and healthy for years to come.

Caitlin Hoff <choff@consumersafety.org

The post Could You Be At Risk Of Heart Disease? appeared first on A Woman's Health - Women Magazine.

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Spring is here and summer is just around the corner. As our outdoor activity and sun exposure begins to increase we need to remind ourselves about the risks of skin cancer. What is the balance between spending time outdoors enjoying all that summer has to offer and avoiding sun damage? Simply put – just follow these rules to staying sun safe and then enjoy the season! The key to finding that balance is acknowledging a few basic facts that should guide our time outside.

First, it is a myth that exposure to ultraviolet (UV) rays is justifiable in the name of vitamin D metabolism. The fact is we can get appropriate and healthy vitamin D through 15 minutes of direct sun exposure over the surface area of our hands.

Second, the incidence of skin cancer (cumulative sun exposure being the biggest risk factor) is on the rise. Basal and squamous cell carcinoma are now more common than all other cancers combined. They can be life threatening but are more commonly quality-of-life threatening—capable of destroying and deforming our skin if left untreated. If you have fair skin and live long enough, you are likely to get one of these cancer types.

The key to living fully under the sun is to be smart. Be outdoors and be “sunsensical” at the same time. That means moderation and common sense. To that end here are five key lessons to live by.

Say No Tanning Beds.
Tanning beds are to skin cancer what cigarettes are to lung cancer. A recent study estimated that regular use of tanning beds increased the risk of melanoma by 75 percent. Tanning beds deliver radiation— varying degrees of UVA and UVB rays, depending on the machine. Both forms of radiation cause skin cancer (and premature aging). Avoid them.

Say Yes to Sunscreen.
Put sunscreen on your body every day. Don’t forget your scalp and under your bathing suit. There is no evidence that one brand or product is better than another at preventing skin cancer. The best sunscreen out there is the one you will actually wear. If it is too expensive, too greasy, or too fragrant, you won’t wear it.

Like most over-the-counter products, not all sunscreens are created equal. Some sunscreens provide higher sun protection, whereas others contain ingredients that are better suited for children’s skin. The key is choosing a sunscreen that will provide the best sun protection for all family members and combine sunscreen use with other sun-smart behaviors.

Ultimately, the best type of sunscreen is the one you will use again and again. Just be sure to choose one that offers broad-spectrum protection, has a sun protection factor (SPF) of 30 or greater, and is water resistant. An SPF of 30 blocks 97 percent of the sun’s rays. SPFs higher than 30 blocks slightly more of the sun’s rays, but no sunscreen can block 100 percent. It is important to note that even if you are wearing a high-SPF sunscreen, it should be reapplied approximately every two hours when outdoors and after swimming or sweating.

Are chemicals in sunscreens dangerous? Parabens, triethanolamine, and para-aminobenzoic acid (PABA)—all have been shown in mice studies to have some adverse effects. The risk in humans is unclear, however, and the risk of direct and cumulative UV exposure far outweighs the unclear and very small risks associated with the use of any sunscreen. Please wear it.

Benefit from Early Detection.
Examine your own skin every month on your birthday for an extra 10 minutes in the shower. A wound that bleeds with minimal trauma (like toweling), a wound that won’t heal over the course of a few weeks, a skin lesion that grows larger—all are signs of skin cancer. Additionally, any brown or black spot on the skin that is changing (shape, color, or size) is a red flag. Change is the most sensitive indicator of something you should have checked. At least once a year, have your skin checked by a dermatologist or primary care doctor.

Don’t Cut Corners on Treatment.
If you’re diagnosed with skin cancer, treat it right the first time. Be your own advocate, ask questions, and make sure you are treated by an expert in the removal of skin cancer (certified by the American College of Mohs Surgery) and an expert in reconstructive surgery (board certification by the American Board of Plastic Surgery or the American Board of Facial Plastic and Reconstructive Surgery).

You Can Be Sun Safe and Still Look Great!
For a variety of reasons, our society sees pale skin as less attractive than tan skin. As a board-certified plastic and cosmetic surgeon, I understand and appreciate the importance of cosmetics and looking attractive, youthful, and rejuvenated. But the reward has to justify the risk. Radiating your skin to look temporarily better is not worth the increased risk of cancer that prolonged and repeated intense sun exposure carries. If you feel more attractive with a tan complexion, keep in mind that there are several very effective and very safe spray-tanning options on the market today that do not increase the risk of cancer and that give fantastic cosmetic results.

Skin Cancer Fast Facts & Tips – Who is at Risk?
Skin Cancer DOES NOT Discriminate
o 1 out of 5 Americans will get skin cancer and although melanoma incidence is higher in caucasians, the 5-year survival rates for African Americans (78%) is significantly low¬er than that of caucasians (92%).1,2
o 65% of those with skin of color feel they are not at risk for skin cancer.3
o 62% of African Americans have never worn sunscreen.4
o Only 17% of those with skin of color have had a skin check by a dermatologist.5

Play by The Rules!
1. Seek shade from 10 am to 2 pm
2. Reapply sunscreen every 2 hours
3. Wear the right amount of sun¬screen (1 oz.)
4. Get annual skin checks

Know The ABC’s of Melanoma
If Any Mole Shows Signs of One of the Following, It Should Be Examined Promptly:
A. Asymmetry When half of the more or lesion does not match the other
B. Border Irregular, scalloped or poorly defined, uneven edges.
C. Color Varied from one area to another; shades of tan and brown, black; sometimes white, red or blue.
D. Diameter Larger than 6mm as a rule (diameter of a pencil eraser)
E. Evolution/ Elevated Melanomas usually change in size, shape, or color over a short period of time. Ordinary moles stay the same size, shape, and color for many years.

Top 10 Safety Tips for Outdoor Enthusiasts
1. Thirty minutes before going outdoors, apply a broad spec¬trum (UVA and UVB) sunscreen with an SPF of 30 or higher.
2. Use a ping-pong-ball-sized amount of sunscreen (1 ounce) to cover your entire body.
3. Cover your lips with a sun protective lip balm that contains an SPF of 30 or higher.
4. Check expiration date on your sunscreen and remember that if you are using sunscreen properly, it should not last more than one season.
5. Seek shade whenever possible.
6. Wear a broad-brimmed hat (preferably at least 2 inches with a back flap) instead of a baseball cap to help protect your face, ears, and neck.
7. Protect your eyes with UV-protective sunglasses.
8. Wear sun protective clothing (for example, tightly woven cotton) including long pants and long-sleeved shirts as often as possible.
9. Completely coat all exposed areas of your face and body. Don’t forget the ears, neck, nose, shoulders, and the backs of your hands, arms, and legs.
10. Re-apply every two hours–even on a cloudy, overcast, or cool day. If you are going to be swimming, make sure to re-apply as soon as you get out of the water.

References
1. American Academy of Dermatology.
2. Wu XC, et al. Racial and ethnic variations in incidence and survival of cutaneous melanoma in the United States, 1999-2006. J Am Acad Dermatol 2011;65:S26-37.
3. Kim M, et al. Perception of skin cancer risk by those with ethnic skin. Arch Dermatol 2009;145:207-8.
4. Pichon LC, et al. Sun-protection behaviors among African Americans. Am J Prev Med 2010;38:288 –95
5. Imahiyerobo-Ip J, et al. Skin cancer awareness in communities of color. J Am Acad Dermatol 2011;64:198-200.
6. Imahiyerobo-Ip J, et al. Skin cancer awareness in communities of color. J Am Acad Dermatol

The post Goodbye Winter, Hello Summer! The Sun Safety Tips You Need to Know appeared first on A Woman's Health - Women Magazine.

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Like most other 30-somethings across the country, Alisa Rouse pulls her smartphone from her pocket dozens of times a day, to check email, text friends, and call family. But also to log her symptoms as they occur: headaches, fatigue, itching, pain, and more.

Alisa lives with polycythemia vera (PV), a rare disease that causes the body to produce too many red blood cells, which in turn thickens the blood. This thickening causes the uncomfortable symptoms of PV. Diagnosed at the age of 16, Alisa has likely had the condition since birth—a rarity, since most patients develop PV later in life.

People with PV undergo regular blood draws to keep their number of red blood cells closer to normal. They also sometimes need to take medications to suppress blood-cell production. Alisa has to go to the doctor’s regularly for blood tests, to make sure her treatments are keeping her disease as manageable as possible.

For years, she tried to track her symptoms and understand when they occurred in relation to her treatments, but found the process overwhelming. She tried a homemade spreadsheet, which required her to remember everything she had felt during the day when she was at home at her computer in the evening. Using a paper calendar posed the same problem, especially when she was feeling sick for days on end.

Finally, in late summer of 2017, a website called Voices of MPN, developed by Incyte Corporation, launched an online program called the PV Tracker Tool. The program allows Alisa to log her symptoms in real time from her phone, tracks changes in her blood counts over the weeks and months, and graphs all this information together in easy-to-read printouts for her doctor. The two can then sit down to review the feedback from the program to determine whether her current treatment schedule needs tweaking to keep her symptoms under control.

“As simple as the program is, it really covers what we patients need,” says Alisa. “And since most of the people with PV are older, simple is going to be the best thing for them,” she adds.

PV isn’t the first disease to get phone-based tracker app. Another example, called MyRA, has been available for patients with rheumatoid arthritis since 2013. Rheumatoid arthritis is an autoimmune disease that causes inflammation and pain in the joints, often affecting people’s ability to perform even simple tasks of daily living, like getting dressed or cooking dinner.

Developed by Crescendo Bioscience, which manufactures a blood test to measure rheumatoid arthritis disease activity, the app is free for patients to use. It lets them record where in the body they feel pain throughout the day, using an animated human figure on their phone’s touchscreen. It also lets them rate how that pain is affecting their ability to perform a range of activities, on a four-point scale from “easy” to “no way.” The app then generates summary reports on demand that patients can forward to their doctors. Patients can even discuss results and share solutions in a MyRA social community on theRAConnection.com – a leading social community and educational resource for individuals with inflammatory arthritis.

In this era of smartphones, fitness trackers, and instant communication, the time is right for technology to make greater inroads into patient care across all areas of medicine, explains Leslie Saxon, MD, executive director of the University of Southern California Center for Body Computing. “Many of the tools, software, and sensors we can use are already out there, and we can port them to medicine,” she says.

Feeling Better, Living Longer

Studies of simple yet useful technologies to improve patient care are starting to show that they can do more than make patients’ lives easier—they can also make them longer.

For example, in the summer of 2017, results from a clinical trial[1] showed that using a web-based system to let patients report their symptoms in real time during chemotherapy for advanced cancer improved their survival by as much as some new anti-cancer drugs.

In that clinical trial, researchers split more than 750 patients into one of two groups. One group had their symptoms managed in the standard fashion: by reporting them at regular visits to the clinic, and calling the doctor’s office if they had any concerns.

The other group was taught to use the online system that collected information continuously during treatment for 12 common symptoms of chemotherapy. When a patient reported a symptom that was severe or seemed to be getting worse over time, the system generated an alert that prompted a nurse to call the patient, instead of vice versa.

The researchers had expected the reporting system to help patients feel better during treatment. But at the end of the study, they also found that those using web-based reporting lived an average of 5 months longer.

“If this were a drug that had a survival advantage of this magnitude, it would be priced at $100,000, and we would ask how…we get this into our practice,” said Harold Burstein, MD, of the Dana-Farber Cancer Institute in Boston, speaking about the results at the 2017 American Society of Clinical Oncology annual meeting.

The research team could not pinpoint exactly why survival improved with online symptom reporting. Possibly, by providing better symptom management, online reporting may have helped patients tolerate chemotherapy for longer.

The advantage could also be due to potentially dangerous side effects of chemotherapy being caught early. “That’s key to getting better outcomes” [in medicine in general]—picking stuff up early,” comments Dr. Saxon.

Sharing Cancer Experiences and Expertise

Today, social media allows people to share every aspect of their lives online, almost instantly. Websites allow people to rent out their homes, cars, and more to perfect strangers. The comfort that people feel with reaching out to others online has likely never been greater.

Several years ago, Tony Blau, M.D., then a hematologist at the University of Washington, tapped into this trend for a clinical trial he was working on, treating women with an advanced, aggressive type of breast cancer that had spread throughout their bodies.

As part of the trial, the researchers performed genetic sequencing of every participant’s tumors. They uploaded this genetic information to the cloud, all de-identified to protect patient privacy. Experts from around the world were then invited to look through the reams of data and suggest potential, individualized treatments for the women.

“It was very heartening that the experts would really try to help, and when they couldn’t, they’d refer on to others around the world who could,” remembers Dr. Blau.

Inspired by the experience, he had started to think about how to expand the project when he himself was diagnosed with cancer. In April 2015, Dr. Blau became a patient with multiple myeloma, a type of blood cancer.

The good news for Dr. Blau was that multiple myeloma “is an area where there’s been really breathtaking progress in treatments over the last 20 years,” he says. The bad news, he adds, is that “no one really understands how best to apply those treatments in any given patient.”

Dr. Blau decided to use himself as a test case for a new web portal for cancer patients, undergoing the same in-depth gene sequencing as the women in his breast-cancer trial and putting his genetic and treatment information online at his new project’s website, all4cure.com.

All4cure features three interlocking communities. One is the patients, who put all their information about treatments they’ve undergone—and responses to their treatments—online, again de-identified to protect their privacy.

The second is a team of myeloma experts from clinics around the world, who answer questions from patients and their doctors as requested and review the information patients post online. The third comprises researchers who are looking for myeloma patients to join clinical trials of promising new treatments.

Like on Facebook or Instagram, patients can read and post a comment on other participants’ dashboards, sharing information they’ve gleaned from their cancer experience with others who might benefit.

“Everyone can see what everyone else is doing…so if I as a patient do something that seems to work well for me, then other people can be immediately aware of it,” explains Dr. Blau. “And if an expert has a suggestion for one patient, every other patient who’s facing that same issue could benefit immediately from that same suggestion,” he adds.

All4cure launched in March 2017, and while still in the proof-of-concept phase, has over 150 registered patients, with complete treatment dashboards for almost 80. The project has also signed up almost 30 participating clinical experts and more than 20 researchers.

“We’re still early on, but we’ve proven that people are willing to engage in this way, and we have a number of examples where people have unambiguously benefitted from their participation,” explains Dr. Blau. These examples include a patient who found that his myeloma has a rare genetic mutation that could be targeted with a drug more commonly used in melanoma, a type of skin cancer.

Throughout his career, Dr. Blau has noticed that patients want their experiences to help others with cancer whenever possible. When women in the breast-cancer trial that inspired All4cure were asked why they were participating, “their top motivations were that they hoped they could find something that would benefit them, and that their experience with cancer might be of benefit to others. Those were equally strong motivations,” he remembers.

Fostering Engagement

Technology will not solve all of the problems encountered in the complexity of modern medicine. Some recent studies have shown disappointing results for high-tech solutions designed to help patients remember to take their medications[2], or to manage their heart failure[3], for example.

Dr. Saxon thinks that these are early days and that patients will become more engaged with health technology as they see the benefits, including feeling in control of their own health care and having a more equal relationship with their doctors.

For example, everyone at her center who gets implanted with a pacemaker automatically receives wireless monitoring of their device that sends early warnings of potential issues with the heart’s rhythm both to Dr. Saxon and the patient, “and we can intervene earlier,” she explains.

Research has shown that this type of continuous monitoring saves lives compared with standard follow-up visits at a doctor’s office, she adds, “and patients like the surety and confidence of knowing that we’re constantly monitoring them.”

Her team is now building software to layer on top of this monitoring system, which her patients are comfortable and familiar with, to let them track signs of other conditions common in patients who receive a pacemaker, such as heart failure and diabetes.

“When we allow patients to see their own results, whether it’s their blood glucose monitored continuously and wirelessly, or their blood pressure numbers…they tend to get more engaged in their care,” she says.

“And I think the more engaged you are in your own health care—the more you have a dog in the fight—the more you tend to partner with your care providers and the more your outcomes are improved,” she concludes.

References
[1] Basch E, Deal AM, Dueck AC, et al. Overall Survival Results of a Trial Assessing Patient-Reported Outcomes for Symptom Monitoring During Routine Cancer Treatment. Journal of the American Medical Association. 2017;318(2):197-198.
[2] Choudhry NK, Krumme AA, Ercole PM, et al. Effect of Reminder Devices on Medication Adherence: The REMIND Randomized Clinical Trial. JAMA Internal Medicine. 2017;177(5):624-631. JAMA Intern Med. 2017 May 1;177(5):624-631.
[3] Ong MK, Romano PS, Edgington S, et al. Effectiveness of Remote Patient Monitoring After Discharge of Hospitalized Patients With Heart Failure: The Better Effectiveness After Transition — Heart Failure (BEAT-HF) Randomized Clinical Trial. JAMA Internal Medicine. 2016;176(3):310-8.

The post New Technologies Connecting Patients to Solutions appeared first on A Woman's Health - Women Magazine.

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Dr. Gottlieb is shifting the agency’s focus in significant ways.

  • The FDA said it would now update policies to help developers gain approval of treatments targeting specific gene mutations that can spur tumors. Makers of cancer drugs are increasingly using genomics to develop precision cancer medicines, compared to the traditional manner of identifying cancers by the affected body part, such as the lung, breast or kidney.
  • The FDA will expand the accelerated-approval program for lifesaving medications with the goal to conditionally approve an experimental drug if it shows increased survival in early trials for a small number of patients. The advantage here is focusing on results from small clinical trials and interim study, instead of waiting for more traditional clinical trial findings. Drug developers can then seek rapid conditional approval for treatments for cancer-based on evidence that a drug is likely to extend patient survival. Later trials once a drug is on the market are necessary to prove the survival benefit.
  • A new FDA and Centers for Medicare & Medicaid Services (CMS) Parallel Review Program was implemented this year to speed access to innovative diagnostics, so doctors are better able to deliver the best quality care and patients have access to these state-of-the-art tests.

These combined efforts appear to be bearing fruit as evidenced by the recent FDA approval of the F1CDx next-generation sequencing (NGS)-based test that detects mutations in 324 genes in any solid cancer. In a truly collaborative effort between the FDA and CMS, the latter proposed coverage of the F1CDx test under the new FDA and CMS Parallel Review Program will facilitate earlier access to the F1CDx test for Medicare beneficiaries.

The F1CDx is a first of its kind extensive test that provides information on a number of different genetic mutations that may help in the clinical management of patients with cancer.

Commissioner Gottlieb summed up the new regulatory partnership this way: “By leveraging two policy efforts aimed at expediting access to promising new technologies, we’ve been able to bring patients faster access to a breakthrough diagnostic that can help doctors tailor cancer treatments to improve medical outcomes and potentially reduce health care costs.”

The FDA’s Breakthrough Device Program and Parallel Review with CMS allowed developers to win approval for this novel diagnostic and secure an immediate proposed Medicare coverage – thereby providing access to patients in need must faster than before.

Reference:

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm587273.htm

The post Trump Administration FDA Slated to Bring Novel Cancer Treatments to Market Quicker and More Efficiently appeared first on A Woman's Health - Women Magazine.

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Bladder cancer is the fourth most common new cancer in men and the tenth in women. About 70,000 individuals will be diagnosed with bladder cancer this year.

What should you know about bladder cancer?

It can happen to you.

  • The most common sign is blood in the urine, but other urinary symptoms (frequency, urgency, and burning pain) can also be signs of the disease.
  • Women are more likely to have the disease diagnosed later than men (and thus have the worse disease and a higher mortality rate) because most primary care and OB/GYN physicians don’t think about the possibility and often inappropriately treat women for months with antibiotics for a presumed urinary tract infection or with drugs for cystitis.
  • Smoking and permanent hair dyes are known risk factors.
  • Reconstructive options that can preserve the uterus and the ovaries and internal pouches or neo-bladders are available for women who are diagnosed with advanced forms of the disease.
  • The disease is very rare in women under the age of 40 who are nonsmokers.

Can people be screened for bladder cancer?

Yes, people can be screened, but it is appropriate only if there is unexplained blood in the urine or other bladder symptoms that don’t go away as expected.

Bladder cancer does tend to run in families, but it is not passed on as some traits are, suggesting this may be more related to similar exposure to cancer-causing agents rather than strict genetics. The highest-risk group for this disease consists of women with visible, painless blood in the urine who are over the age of 50 and who happen to have smoked for 20 or more years. In these cases an X-ray test (such as a computed tomography [CT] urogram or an intravenous pyelogram [IVP]) would be appropriate together with a scoping procedure called cystoscopy, which involves looking directly into the bladder. A urine Pap test—also known as a urine cytology—is an important part of the evaluation, but a normal cytology does not rule out bladder cancer. If all these tests are negative, however, the chance of unsuspected bladder cancer is well under 1 percent.

How does bladder cancer develop?
Nearly 80 percent of bladder cancers remain within the bladder lining or mucosa. This type of bladder cancer is called superficial bladder cancer, or carcinoma in situ (CIS), and often comes back after treatment.

In invasive cases, the cancer extends through the bladder wall and may grow into bones and other organs, including lymph nodes, reproductive organs, lungs, liver, and the pelvis.

What are the symptoms of bladder cancer?

The most common symptoms of bladder cancer include:

  • Blood in the urine (making the urine slightly rusty to deep red)
  • Pain during urination
  • Frequent urination or feeling the need to urinate without being able to

Having these symptoms does not necessarily mean a person has bladder cancer. Infections, benign tumors, bladder stones, or other problems also can cause these symptoms. Anyone with these symptoms should see a doctor so that the problem can be caught early.

How is bladder cancer diagnosed?
If a patient has symptoms that suggest bladder cancer, the doctor will give the patient a complete physical exam and order lab tests. The person may have one or more of the following procedures.

Physical exam. The doctor feels the abdomen and the pelvis for tumors. The physical exam may include a rectal or vaginal exam.

Urine tests. The laboratory checks the urine for blood, cancer cells, and other signs of disease. The most common urine test for bladder cancer is a urine cytology, similar to a Pap test.

Intravenous pyelogram. During an IVP, the doctor injects dye into a blood vessel. The dye collects in the urine, making the bladder and the kidneys show up on X-rays.

Cystoscopy. The doctor uses a thin, lighted tube called a cystoscope to look directly into the bladder. The doctor inserts the cystoscope through the urethra to examine the lining of the bladder. The patient may need anesthesia for this procedure.

The doctor can remove samples of tissue with the cystoscope. A pathologist then examines the tissue under a microscope. The removal of tissue to look for cancer cells is called a biopsy. In many cases, a biopsy is the only sure way to tell whether cancer is present. For a small number of patients, the doctor removes the entire cancerous area during the biopsy. For these patients, bladder cancer is diagnosed and treated in a single procedure.

How is bladder cancer staged?
If bladder cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has invaded the bladder wall, whether the disease has spread, and, if so, to what parts of the body. In a sense, it is a measure of the depth and the extent of the disease.

The doctor may determine the stage of bladder cancer at the time of diagnosis, or the patient may need to undergo further testing. Such tests may include imaging tests—CT scan, magnetic resonance imaging (MRI), sonogram, IVP, bone scan, or chest X-ray. Sometimes staging is not complete until the patient has surgery.

The following are the main features of each stage of the disease.

Stage 0. Cancer cells are found only on the surface of the inner lining of the bladder; this stage is known as superficial cancer. One particularly aggressive form is the surface-spreading case of high-grade cancer called carcinoma in situ.

Stage I. Cancer cells are found deep in the inner lining of the bladder but not in the muscle of the bladder. While technically invasive, this stage is still considered superficial bladder cancer because it can be removed through cystoscopic surgery.

Stage II. Cancer cells have spread to the muscle of the bladder.

Stage III. Cancer cells have spread through the muscular wall of the bladder to the layer of tissue surrounding the bladder. At this stage, the cancer may also have spread to the reproductive organs.

Stage IV. Cancer extends to the abdomen or pelvis. At this stage, the cancer may have also spread to the lymph nodes and even as far away as the lungs.

How do doctors rate the aggressiveness of bladder cancer?
In addition to knowing the extent of the disease, it is important to know whether the disease has intrinsic aggressive potential. Under the microscope, the pathologist can usually determine this by looking at the individual cancer cells. Bladder cancer has traditionally been graded on a 3- to 4-point scale, where grade 1 signifies a less aggressive (low-grade) cancer, grade 2 is intermediate, and grades 3 to 4 signify a highly aggressive (high-grade) cancer.

The grade of the cancer is probably the single most important predictor of prognosis for superficial bladder cancers. Unfortunately, by the time the cancers have reached Stages II to IV, the grade is less important because almost all of them are of the high-grade type. By definition, CIS is always high-grade.

How is bladder cancer treated?
Treatments for bladder cancer include surgery, radiation therapy, chemotherapy, and immunological therapy.

Surgery. Surgery is a common treatment for bladder cancer. The type of surgery depends largely on the stage and the grade of the tumor.

  • Transurethral resection. The doctor may treat early-stage (superficial) bladder cancer with transurethral resection (TUR). During TUR, a cystoscope is inserted into the bladder through the urethra. A small wire loop on the end is used to remove the cancerous area and to burn away any remaining cancer cells with an electric current.
  • Radical cystectomy. For invasive bladder cancer (and when superficial cancer involves a large part of the bladder), the most common type of surgery is radical cystectomy, during which the entire bladder, the nearby lymph nodes, part of the urethra, and the nearby organs that may contain cancer cells—all are removed. In men, the prostate, seminal vesicles, and part of the vas deferens are removed. In women, the uterus, ovaries, fallopian tubes, and part of the vagina are often removed. If the entire bladder is removed, the patient may undergo another procedure to create a pouch to hold urine. Occasionally, small, localized, muscle-invasive bladder cancers can be removed, sparing the remaining normal bladder in a procedure referred to as partial cystectomy.

When bladder cancer has spread beyond the bladder, the goal of surgery is often not to remove the cancer itself but to relieve the symptoms of the disease. Additional forms of therapy are then used to treat the cancer.

Precision Cancer Medicine The purpose of precision cancer medicine is not to categorize or classify cancers solely by site of origin, but to define the genomic alterations in the cancers DNA that is driving that specific cancer. Precision cancer medicine utilizes molecular diagnostic testing, including DNA sequencing, to identify cancer-driving abnormalities in a cancer’s genome. Once a genetic abnormality is identified, a specific targeted therapy can be designed to attack a specific mutation or other cancer-related change in the DNA programming of the cancer cells. Precision cancer medicine uses targeted drugs and immunotherapies engineered to directly attack the cancer cells with specific abnormalities, leaving normal cells largely unharmed.

Keytruda (pembrolizumab) is a precision cancer immunotherapy that helps to restore the body’s immune system in fighting cancer. It creates its anti-cancer effects by blocking a specific protein used by cancer cells called PD-1 and PD-L1, to escape an attack by the immune system. Once PD-L1 is blocked, cells of the immune system are able to identify cancer cells as a threat and initiate an attack to destroy the cancer.  There are several PD-1 and PD-L1 inhibitors that work in bladder cancer and they are collectively referred to as “checkpoint inhibitors”.

  • Keytruda
  • Imfinzi (durvalumab)
  • Tecentriq (atezolizumab)
  • Bavencio (avelumab)
  • Opdivo (nivolumab)

A clinical study that compared the Keytruda to standard chemotherapy in recurrent bladder cancer that had recurred or progressed following platinum-based chemotherapy demonstrated improved outcomes with the checkpoint inhibitor.

Patients who expressed higher levels of the PD-L1 protein have been demonstrated to experience a greater anti-cancer response than those who expressed lower PD-L1 levels.

Immunotherapy uses the body’s natural ability (immune system) to fight cancer and is used for the treatment of superficial bladder cancer following TUR and for the treatment of more advanced cancers.  For superficial bladder cancer immunotherapy can be used within a few weeks of TUR surgical removal of the cancer.

  • Bacillus Calmette-Guerin (BCG). This is the most common form of immunotherapy. BCG solution contains live, weakened bacteria related to cow tuberculosis that stimulate the immune system to kill cancer cells in the bladder. The bladder is filled with the solution through a catheter and left for about two hours. Patients generally undergo this treatment once a week for about six weeks.
  • Interferon. This is another form of biologic therapy, which involves the administration of large amounts of a synthetic protein normally made by the body to activate and energize the immune system. Recent studies suggest that a combination of BCG plus interferon may be particularly active against aggressive or refractory superficial bladder cancer, especially CIS.

Radiation therapy. Also called radiotherapy, this technique uses high-energy rays to kill cancer cells in one specific area. Radiation therapy can also be used to shrink a tumor before surgery to make it easier to remove, or, after surgery, to kill any cancer cells that may have been left behind.

  • External radiation. This is usually done at least several days per week on an outpatient basis for several weeks. The high-energy rays are concentrated on the cancerous area from outside the body.
  • Internal radiation. This is done by placing a small container of a radioactive substance into the bladder through the urethra or through an incision in the abdomen and requires a hospital stay. Once the implant is removed, no radioactivity is left in the body.

Chemotherapy. Chemotherapy uses drugs to kill cancer cells. A single drug or a combination of drugs may be used.

For patients with superficial bladder cancer, intravesical (inside the bladder) chemotherapy may be used after TUR. A catheter (tube) is placed through the urethra and into the bladder and used to fill the bladder with liquid forms of the drug(s) used. The drugs are left in the bladder for several hours. This treatment is usually done once a week for several weeks and can then be continued once or several times a month for up to a year.

For cancer that has spread to other parts of the body, chemotherapy drugs may be given intravenously (through a vein that carries the drugs throughout the body). The drugs are usually given in cycles so that a recovery period follows every treatment period. Occasionally, chemotherapy is also given before bladder surgery (cystectomy) as a means to facilitate surgery by reducing the tumor bulk. This is known as neoadjuvant therapy and has demonstrated survival benefits for many patients needing a radical cystectomy.

Learn About Bladder Cancer at CancerConnect.com

The post What You Should Know About Bladder Cancer appeared first on A Woman's Health - Women Magazine.

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The Trump administration’s first year offered some early hints and lasting intent about definitively pro-patient reforms designed to cut the red tape at the Food and Drug Administration and bring life-prolonging medications to patients faster than before. Echoing this objective, the President’s appointed head of the FDA Dr. Scott Gottlieb has called for an expedited approvals process for new drugs.

Dr. Gottlieb is shifting the agency’s focus in significant ways.

  • The FDA said it would now update policies to help developers gain approval of treatments targeting specific gene mutations that can spur tumors. Makers of cancer drugs are increasingly using genomics to develop precision cancer medicines, compared to the traditional manner of identifying cancers by the affected body part, such as the lung, breast or kidney.
  • The FDA will expand the accelerated-approval program for lifesaving medications with the goal to conditionally approve an experimental drug if it shows increased survival in early trials for a small number of patients. The advantage here is focusing on results from small clinical trials and interim study, instead of waiting for more traditional clinical trial findings. Drug developers can then seek rapid conditional approval for treatments for cancer based on evidence that a drug is likely to extend patient survival. Later trials once a drug is on the market are necessary to prove the survival benefit.
  • A new FDA and Centers for Medicare & Medicaid Services (CMS) Parallel Review Program was implemented this year to speed access to innovative diagnostics, so doctors are better able to deliver the best quality care and patients have access to these state-of-the-art tests.

These combined efforts appear to be bearing fruit as evidenced by the recent FDA approval of the F1CDx next generation sequencing (NGS)-based test that detects mutations in 324 genes in any solid cancer. In a truly collaborative effort between the FDA and CMS, the latter proposed coverage of the F1CDx test under the new FDA and CMS Parallel Review Program will facilitate earlier access to the F1CDx test for Medicare beneficiaries.

The F1CDx is a first of its kind extensive test that provides information on a number of different genetic mutations that may help in the clinical management of patients with cancer.

Commissioner Gottlieb summed up the new regulatory partnership this way: “By leveraging two policy efforts aimed at expediting access to promising new technologies, we’ve been able to bring patients faster access to a breakthrough diagnostic that can help doctors tailor cancer treatments to improve medical outcomes and potentially reduce health care costs.”

The FDA’s Breakthrough Device Program and Parallel Review with CMS allowed developers to win approval for this novel diagnostic and secure an immediate proposed Medicare coverage – thereby providing access to patients in need must faster than before.

Reference:

https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm587273.htm

The post Trump Administration FDA Slated to Bring Novel Cancer Treatments to Market Quicker and More Efficiently appeared first on A Woman's Health - Women Magazine.

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