Examine Your Birthday Suit Yearly, Doc Says

A few blistering, lobster-red sunburns as a kid. Fair skin, light eyes, sprinkled with a hearty helping of freckles. A family history of melanoma.

When it comes to protecting your skin from cancer, you can’t be too safe. Each year there are more new cases of skin cancer than breast, prostate, lung and colon cancers combined, according to the American Center Society, with an estimated 76,690 new annual cases of invasive melanoma—a skin cancer related to UV exposure—diagnosed in the U.S. alone.

Luckily, skin cancer is almost always curable if caught early. But how can you discern between a normal, healthy mole and one that’s cause for concern? In the clip below (we’re re-sharing a favorite one from a couple years back, so please ignore the incorrect screening date at the end), you can hear URMC dermatologist Dr. Marc Brown discuss skin cancer, the importance of practicing “safe sun,” and some tips to help you identify suspicious moles (while wearing your birthday suit!) at home.

 

Free Skin Screenings May 11

What’s more, if you’re in Rochester, you can be proactive about your skin health this weekend by stopping by Strong Memorial Hospital’s Free Skin Cancer Screening Clinic between 8 a.m. and noon this Saturday, May 11. No registration is required; take the Silver Elevators to the 2^nd floor to find the Dermatology Suite. Each screening takes about five to ten minutes and offers a written report of findings. Information on skin cancer, including prevention tips, will be available.

“Sun damage is cumulative, so it includes exposures that can seem just a part of our daily lives such as walking the dog, mowing the lawn or a trip to the store,” Dr. Brown said. “Making a skin cancer screening part of your annual routine will not only make sure that you are identifying a current issue, but it’s a terrific way to uncover potential risk factors for the future.”

For more information about the free detection clinic, contact the Dermatology Department at (585) 275-3871.

Dr. Brown also recommends the following ways to protect your skin:

• Slather on sunscreen. The sun can damage your skin in as little as 15 minutes. Apply sunscreen, with SPF 30 or greater and both UVA and UVB protection, 15 to 20 minutes before you head outdoors. Don’t forget areas such as the back of your neck, top of your ears arms and legs, and scalp if you’ve lost some hair. Reapply every two hours—or sooner after swimming or actively sweating.
• Wear a hat and loose-fitting clothing.  A hat with a four-inch brim will shade more than 95 percent of the face, head, ears and neck. Wear light-weight clothes that cover your arms and legs.
• Avoid the most intense sunlight. Schedule outside activities for the early morning or late afternoon to keep out of the most intense sunlight between 10 a.m. and 3 p.m.
• Don’t tan indoors. Heading on vacation? Getting prepped for swimsuit season? Let’s bust  a relentless myth: Getting a base tan from a tanning bed or booth will NOT give protection from sun damage. In fact, it’s been linked to skin cancers.

This annual skin screening event is sponsored by the American Academy of Dermatology, Rochester Dermatologic Society, and URMC’s Department of Dermatology.

Dr. Brown specializes in the diagnosis, treatment and prevention of skin cancers. In addition to performing Mohs surgery on more than 1,200 patients a year, he also runs a multidisciplinary melanoma group practice.

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Would You Still Have a Voice If You Were Silenced? The Role of Health Care Proxies

From when the alarm blasts us awake until we drift off to sleep at night, the days are chock-full of choices—not only snap judgments, but those that require deeper thought. With the hundreds of decisions we face daily, who needs to sort through yet another one?

You do if you haven’t begun to consider how you’d like your medical care to proceed, in the event that you become ill or injured and are unable to then make or express your wishes.

For expert advice that might just save your loved ones a lot of heartache, we consulted Dr. Richard A. Demme, URMC associate professor of Medicine and Humanities.

Scripts: There seem to be several things people refer to when they talk about end-of-life planning—advance directives, living wills, and health proxies, to name a few. Can you provide a big-picture view here?

Demme: It certainly can feel a little confusing, which might contribute to the off-putting nature of this important subject. My own need to know more about end-of-life planning was sparked in my first week as an attending nephrologist, when a patient asked me for a lethal injection. That was over 20 years ago—I’ve been picking this stuff apart since. But thinking about this serious, somewhat tricky topic is essential.

The things you mention all fall under the same end-of-life planning umbrella. Advance directives, generally speaking, are instructions specifying how a person wants her health care to proceed should she become incapacitated and unable to communicate her wishes. A living will is an older type of directive outlining treatment instructions. For example, in an advance directive, you can choose to withhold certain life-support therapies, or ask for a trial period of treatment.

A health care proxy is a person who is supposed to interpret your wishes about health care decisions. The form appointing this person is also called a health care proxy. Proxies are broadly empowered in New York State, which means there’s more flexibility when doctors communicate with them than when referring to a printed document, which can’t talk back and clarify.

Scripts: So is end-of-life planning really for everyone? Kids, the young, the healthy?

Demme: If you’re over 18, you can and should name a health care proxy. There have been historical court cases—long, ugly battles—about which medical treatments should be continued for people in persistent vegetative states. Do you think a court would make a better decision for you than your own chosen proxy? Of course not. Your proxy, someone you trust to make decisions on your behalf, could ask to continue or stop treatments.

There are no fees or lawyers in appointing a proxy. Remember to choose wisely—not someone who’s consistently unavailable, or someone who just can’t live without you. Surprisingly, about 30 percent of people might not choose their spouse/partner to make their health care decisions. You need to count on your proxy to be able to know when to continue aggressive treatment, but also when to say Enough, now let’s concentrate on patient comfort. The hardest part about picking is figuring out who will make decisions according to your wishes, even if they personally would rather make a different choice.

Scripts: Some of the legal documentation asks that end-of-life decisions be put into words. How can we keep language broad enough to prevent potential confusion? We’ve heard that you don’t want to have been so specific with your wishes that you inadvertently complicate situations you couldn’t have anticipated. Are there good online resources you can point us to?

Demme: Try to avoid such popular boilerplate language as “extraordinary measures,” and “natural death.” Don’t say, “Do everything.” Due to the absence of agreed-upon medical definitions for these terms, sometimes we doctors are left with question marks hanging over our heads. Instead of unhelpful buzzwords, find precise language to help you articulate your message. You can write things like “If I am no longer able to recognize my family, and am not likely to recover, I would want treatments stopped.” Or, “I would prefer to try to eat by mouth, even if there is a risk of aspiration pneumonia.” But, it’s difficult to forecast all of the medical situations you might encounter, so it is more useful for physicians to know who you want us talking to when you can no longer tell us your wishes.

One excellent resource is this easy-to-use website (developed by a team of URMC medical students!) that fleshes out these topics a bit more fully and allows you to generate online, using their forms, some of the documentation we’re talking about now.

Scripts: So in summary, what’s the single action you’d recommend that readers take today?

Demme: You could probably guess, but here goes: Please consider appointing a health proxy—and don’t forget to communicate your health care wishes to him. Do it now.

Dr. Richard A. Demme has been a board certified nephrologist for over 20 years. He is a Fellow in the American College of Physicians. He chairs the URMC Ethics Committee, and is the co-director of the Division of Medical Humanities and Bioethics. His interests include ethical issues in transplantation, end-of-life care, medical decision making and informed consent, and the history of medicine.

Colorectal Cancer: Simple Screenings Save Lives

We’ll be blunt. Colorectal cancer is one of the most common cancers, and the second leading cause of cancer deaths in the United States. It will kill more than 50,000 Americans this year – more than die in car crashes.

But it doesn’t have to be so deadly. Ninety percent of colorectal cancers are completely curable, if diagnosed early, but the odds plummet to just 10 percent if tumors are found late. Many are; only about 30 percent of Americans over age 50 have had a simple colonoscopy.

The encouraging news about this lethal cancer is that a little education and adopting a few healthful habits can go a long way in conferring protection. Consider the expert advice below:

• When you turn 50, schedule your first colonoscopy screening and repeat it every five years. If your primary care physician doesn’t suggest it, you should. In this preventive scan, you’ll be sedated while a small, lighted endoscope inspects your colon and rectum for polyps – mushroom-like growths at risk for turning cancerous. If discovered during the scan, the polyps can be removed immediately, greatly diminishing your future risk.
  

  A polyp.

• Eat grilled meats in moderation, and avoid smoking and chewing tobacco. Whether inhaled or swallowed, carcinogens in charred or smoked meats, tobacco smoke and “chew” all eventually pass through the colon, where they can up your risk for cancer.
• Balance your diet between “red” and “green” foods. Over-indulgence in red meats (eating more than a pound a week) has been linked to increased risk for colon cancer; on the contrary, adding more green, leafy vegetables to your diet and reducing your intake of foods with high-carb, high-fat, high-cholesterol content, has been shown to reduce risk.
• Stay active. Incorporating more physical activity – walking a pet, taking the stairs over the elevators, cleaning your house – helps stimulate your body’s waste to keep moving along (the longer stool sits in your rectum or colon, the more time toxic chemicals have to leach out into the surrounding tissues).
• Maintain a healthy weight, and know your shape. Obese men and women are at greater risk for colon cancer; “apple” shapes, which gain weight around the waist and vital organs, tend to be at greater risk than “pear” shapes, which store fat in their thighs and hips.
• Learn the obvious symptoms. Through colorectal cancer is a notoriously “quiet” killer, in the later stages, it can give undeniable clues. If you experience bloody stools, diarrhea, cramping and unexplained weight loss, call your doctor immediately.

Put simply, colorectal screening can save your life. If all Americans were screened regularly, colorectal cancer deaths could be cut in half. March is Colorectal Cancer Awareness Month, so why not schedule your test today?

No health insurance? Learn how we can still help you get screened.

We originally published these tips last year, courtesy of Dr. John Monson, chief of the Division of Colorectal Surgery at URMC. His areas of expertise include minimally invasive technologies for colorectal cancer treatment, in addition to basic research exploring a broad range of cancer-related subjects.

For more information about colon cancer screening, talk to your primary care physician. You can also find doctor videos, patient stories, health facts and more on our colorectal cancer information site.

Breast Density: Radiologist Puts New Notification Law into Perspective

A healthy lifestyle means knowing a few things about your body – even if you’d rather ignore those facts. Weight, cholesterol readings, hormonal cycles, and osteoporosis risk are starting points for many women. Now you can add something else to the list – breast density.

Density refers to the amount of fibroglandular tissue (tissue besides fat or muscle, including milk ducts and lobules, connective tissue, etc.)  in the breast. On a mammogram (which looks like an x-ray to the untrained eye), dense tissue appears white and opaque, while the fatty tissue appears black.

The problem is that breast tumors or benign masses also appear white on the mammogram. So, for radiologists, searching for very small lesions in dense breasts is like looking for a snowman in a blizzard. Most women don’t know what type of tissue they have, and therefore don’t have enough information to start a conversation with their doctors.

A new law in New York changes everything. As of Jan. 19, 2013, providers are required to notify women if more than 50 percent of their breast tissue is dense. To learn more about why this is important, we spoke with Dr. Avice O’Connell, director of Women’s Imaging at the University of Rochester Medical Center and Highland Breast Imaging.

Scripts: It seems that many women might not realize that density is an issue in breast health. Is this true, in your experience?

O’Connell: Yes, absolutely. I see many women who are not familiar with their own breasts. They may not do monthly self-breast exams, and they often don’t ask questions during their routine mammograms. Awareness of breast density is low.  However, later, if women do find out that they have very dense tissue, they’ll say, ‘if I only had known this.’ The new law gives women more information – and in my opinion, more information is usually a good thing.

Scripts: Why do some people have dense breast tissue?

O’Connell: We’re not sure why some people have dense breasts. You can’t tell from the outside. In other words, it’s not related to a person’s size, age, or any other characteristic. We do know that density tends to ebb slightly with age (50s and post-menopause) – but only a mammogram can give us that information.

Scripts: Why is dense breast tissue a health hazard?

O’Connell: It’s a problem for two main reasons. First and foremost, small cancers can hide more easily in dense tissue. And simply having dense breasts slightly increases the risk of cancer.

The latter issue, however, is still being investigated and the risk is slight. In general we still have many questions about the impact of breast density on breast health. But from a practical standpoint as a radiologist who reviews thousands of films a year, I can say with certainty that detecting breast cancer in dense tissue is more difficult. A cancerous mass appears white and can be obscured by the white dense breast tissue and the spidery-looking fibrous glands surrounding it.

Scripts: Can you explain how the new law works — and why it’s important?

O’Connell: When a woman gets a routine, screening mammogram and we find no problems – other than dense breast tissue – she’ll receive a letter in a few days notifying her that her tissue is dense. The law’s intention is to boost awareness, not necessarily to prompt more testing. At that point, most healthy women with few or no risk factors for cancer will choose to do nothing. Radiologists are not required to make any recommendations on testing, either.

However, if you get one of those letters, we’re urging women to talk to their primary care physician or ob/gyn about their personal risk for breast cancer. Discuss family history, start of menstruation and early menopause (an early start and late finish are both risk factors), childbirth (if you’re older with your first pregnancy, that’s also a risk factor), and lifestyle habits such as overeating and excessive drinking. Based on an assessment of your personal risk for breast cancer, coupled with your dense breasts, your physician may recommend supplemental testing with a screening ultrasound or an MRI.

But this isn’t a simple decision, or a perfect solution. Sometimes an ultrasound opens a Pandora’s Box. Plus, additional testing takes time and money. The law doesn’t require insurance to cover screening breast ultrasounds, but most insurers have indicated they’ll pay for it with a physician’s referral.

Scripts: By ‘Pandora’s Box,’ you must mean that more information will cause needless worry for some women, correct?

O’Connell:  Yes. The main drawback is that the more ultrasounds we do, the greater likelihood of finding small, solid masses that need to be biopsied and followed up.  More than 90 percent of the time they will turn out to be benign. But an ultrasound provides a different view of the breast tissue, and studies show that ultrasounds will detect about three more cancers per thousand patients with an otherwise normal mammogram. And when cancer is detected earlier, it’s often more treatable. So, I like to say: “A little worry is better than a little cancer.”

Avice O’Connell, M.D., has practiced radiology for over 30 years in Rochester, New York. To contact Dr. O’Connell or to make an appointment at University Breast Imaging, please call 585-334-5519. Locations include 500 Red Creek Drive, Suite 130, in Henrietta; and Highland Breast Imaging at Highland Hospital, 1000 South Ave., Rochester

To learn more about good breast health and protective breast screening exams, watch Dr. O’Connell in this video clip, produced by URMC-based Peri-FACTS Academy, a multimedia continuing education program for OB/GYN healthcare providers.

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Considering LASIK? Here’s What to Expect

Some people who used to wear coke-bottle glasses are thrilled to have 20/20 vision after undergoing LASIK surgery – and doctors at URMC’s Flaum Eye Institute are making that dream possible for even more people. They’ve developed new technology that helps doctors predict how refractive surgery, such as LASIK, will affect a person’s eyesight.

Dr. Scott MacRae is a pioneer in refractive surgery, a procedure used to adjust the eye’s focusing ability by reshaping the cornea. MacRae helped develop the Rochester Nomogram, a complex formula that improves the success rate for LASIK– meaning fewer people need additional procedures to get the best vision possible. Currently, a remarkable 99.3 percent of MacRae’s patients see 20/20 or better after LASIK (laser in situ keratomileusis) surgery, and are able to toss aside their glasses and contact lenses.

Scripts: How does this new Nomogram help make LASIK surgery better?

MacRae: The Nomogram adjusts the way a laser interacts with eye tissue. Using it helps refractive surgeons reduce the chance that the patient’s eyes will be near-sighted or far-sighted after the procedure and potentially need additional care. It’s another tool for doctors to use to help their patients achieve 20/20 vision — or better.

Scripts:  Does LASIK surgery hurt or require a lengthy recovery?

MacRae:  No, the actual treatment is painless. Patients receive anesthetic drops to completely numb the eye. You may feel a light pressure sensation around your eye, and after the procedure is finished you will feel a sensation our patients describe as gritty, or like a lash in your eye, for a few hours. But most people experience very little pain. Doctors give you a prescription for pain relief if needed,  but most people need nothing more than Tylenol or Advil and a little rest.

Recovery can vary from one day to one week. The majority of people are back to normal activities a day or two after surgery, but it may take one or two months for your vision to fully stabilize. Although everyone is a little different, the vast majority of our LASIK patients are back to normal driving vision or better, the very next day. That’s one of the most exciting advantages of the LASIK procedure; clear vision comes in quickly. Initially, your vision might not be crisp and may fluctuate slightly. This is perfectly normal and should improve gradually day by day.

Scripts:  How do you select the best LASIK surgeon?

MacRae: It’s important to do your homework and ask plenty of questions. Indicators of a quality surgeon can include experience, great credentials, word of mouth referrals and willingness to work with a patient to resolve possible problems following a procedure. It’s important to trust your surgeon; if you don’t feel comfortable with them, find another one.  Some basic questions to ask:

• How many procedures have you performed?
• What is your complication rate, and how does this compare with national averages?
• What are your outcome statistics, and how do these compare with national averages?
• If a complication does occur, what is your specific policy regarding follow-up?  Is the surgeon available if complications do occur?

There are lots of different report cards for doctors to review.  I recommend you do your research, talk with your primary care doctor or other doctors until you know in your gut that you’ve chosen the right surgeon for you.

Scott MacRae, M.D., is one of the most experienced and respected refractive surgeons in the world, performing more than 15,000 procedures. He has more than 25 years of experience as a cornea specialist and 15 years of experience as a refractive surgeon.  He serves as director of the Refractive Surgery Center at the Flaum Eye Institute. For more information, call 585-273-2020.

Maintaining Balance on Icy Ground

Fresh fallen snow sure can be glorious, but for many, snow and ice trigger anxiety about getting around on slippery surfaces.

In fact, recent statistics from the World Health Organization reported that falls are the second leading cause of accidental or unintentional injury deaths worldwide. The National Safety Council estimates there are approximately 16,000 fatal falls each winter, and many more injuries resulting in lost work, pain and suffering.

To learn more about keeping your balance amidst snow and ice – and reducing risk for slips – we sat down with URMC physical therapist Tim O’Connor.

Scripts: Every winter, it seems more and more people are having difficulty maintaining their balance on snowy ground. Is it just our imagination?

O’Connor: No, it’s not. Studies have shown that, as we age, natural physiological changes indeed lead to reductions in strength, range of motion, reaction times and overall decreased balance. Healthy adults and younger persons may not notice the changes right away, but gradually, most people will see increased trouble navigating uneven and/or slippery terrain.

Scripts: Everyone loses muscle mass and coordination? That’s a bit depressing. Can anything be done to reduce one’s risk of falling?

O’Connor: No matter what age we are, we can all improve our balance. The best way to do this is by performing regular exercise that has both strengthening and cardiovascular components (anaerobic and aerobic exercise). Your motto should be “use it or lose it.” Fortunately, there are many fun and simple ways to practice balance, like walking, running, hiking, practicing yoga, Pilates, spinning, playing tennis, and much more.

Scripts: Some of the most fun winter sports – like skiing and snowboarding – seem rife with potential for serious spills.

O’Connor: It’s true, winter sports can result in serious injuries – but skiers and snowboarders often work on falling the correct way.  It does take practice – not only to learn proper techniques, but to recall and be able to apply those techniques in the split-second before you hit the ground. It is always better to prevent falls in the first place. However, if you’re primarily concerned with carefully navigating a mall or grocery store parking lot, we recommend the following safety tips:

• Wear proper footwear with sturdy soles to improve traction. Ice and snow grips to fasten on shoes are very effective.
• Don’t load yourself down with packages or bags that can cause your center of gravity to shift outside your base of support.
• Pay attention to the terrain. Chatting on a cell phone or running to catch a bus can distract you from an errant icy patch.
• Avoid an erect, stiff posture. Flatfooted, short, shuffling steps are best.

URMC’s Department of Physical Medicine and Rehabilitation also offers a training program for persons with a balance disorder (such as vestibular issues, neuropathy or history of falls). For more information on it, click here.

Tim O’Connor, P.T., D.P.T., has spent more than 10 years as a therapist in the inpatient acute rehab and outpatient clinics in URMC’s Department of Physical Medicine and Rehabilitation.

Brrr! Cold Weather Tips for Arthritis Sufferers

‘Tis the season of stress and colder weather. What’s an arthritis sufferer to do? Practicing moderation and common sense (beware of those icy patches when you’re rushing in and out of retail stores!) goes a long way.

But we also thought it was prudent to check in with orthopaedist Dr. Randy Rosier, who’s been treating people with osteoarthritis for nearly 30 years. Below, he offers tips on weather-related flare-ups, supplements, and stem-cell therapy. It’s important to note there are many types of arthritis (inflammation of the joints); in this post, we’re focusing on arthritis resulting from simple wear-and-tear, rather than from autoimmune disease or infection.

Q: Many people believe their symptoms worsen in cold weather, but we’ve also heard that’s just a myth.

Rosier:  I’ve got to say that I believe there’s some truth to it. Over and over, patients report that changes in the weather makes arthritis symptoms worse. This also applies to joint injuries and bone fractures. When it’s cold, our joints do get stiffer. Humidity and other dramatic swings in weather patterns seem to affect joints and mobility as well. My snow-bird patients tell me that when they go to the Southwest or Florida in the winter their symptoms get better. Although no one knows exactly how this works, I think it makes sense that milder climates ease arthritis.

Q: So, other than moving to the South, what other lifestyle changes can Rochesterians make, particularly if pain and stiffness is a daily struggle?

Rosier: Winter is still a great time to exercise. You need to keep moving and keep your weight under control, to keep arthritis symptoms in check. Regular activity also helps lubricate arthritic joints and diminish stiffness.

If you go outside, avoid spending prolonged periods in the cold. And don’t ignore your legs and hips when you’re dressing in layers! So often we think of wearing layers above the waist, but long underwear, socks, and heavier pants that protect your hips, knees, and ankles is equally important.

In terms of types of exercise, make sure it’s low-impact. Swimming is the best thing you can do if you suffer from arthritis. However, I realize that’s not always convenient for many people, so the next best thing is an indoor exercise bike or elliptical machine. You can work up a good sweat with either one, and they’re gentler on the joints than a treadmill.  I urge people with arthritis to avoid running, jumping jacks, squats and lunges. I’ve seen a recent trend where people with mild arthritis or joint discomfort are doing squats and lunges at exercise or zumba classes – and suddenly they’ve got damage to the knees.

Q: What about taking supplements for arthritis? Does science support certain over-the-counter remedies more than others?

Rosier: In general, the evidence supporting supplements for arthritis is weak and controversial. That said, however, I have patients who take glucosamine or fatty acids (omega 3s) and firmly believe it helps. Neither of those supplements will harm you, so I don’t discourage it. Keep in mind, though, that the science is not very strong in this area. The NIH did a large clinical trial testing glucosamine, and the results showed no significant benefit. See, the tricky thing about arthritis is that it’s such a variable disease. I have patients who experience mild symptoms over the course of 40 years and others who progress from almost nothing to severe joint destruction in a short period of time. Symptoms also come and go, from agonizing pain to almost no pain, so it’s difficult to decide whether supplements actually help.

Q: What about other medical interventions, short of surgery? Does anything really help?

Rosier: Yes, we can make several recommendations. Cortisone injections can help in some acute situations, as does ice or cold packs. Heating pads are better for chronic pain. Massage can alleviate symptoms by lessening stiffness. You can’t really massage the hip joints, but for knees, ankles, and shoulders, it can bring some relief. Acupuncture is a pain treatment, and it’s relatively harmless, but I haven’t had any rave reviews from my patients. Finally, a procedure called viscosupplementation, which is an injection of a lubricant similar to the native hyaluronic acid that is in joint fluid, may give relief of symptoms for several months.

Q: Since we’re in the middle of the holiday season, we wondered about some information that popped up on the Internet – that alcohol and caffeine tended to have a damaging or drying impact on cartilage. Is that true? Should we avoid peppermint lattes and the open bar at the office party?

A: Interesting topic, but there’s no convincing evidence to avoid alcohol or caffeine entirely. It’s okay in moderation, and obviously, with alcohol it’s important to limit your intake.  But, having said that, consider the flip side: A compound called resveratrol found in grapes and wine is an anti-inflammatory.  I’m not advocating drinking for those who don’t, but having some red wine with dinner or hors d’oevres won’t hurt and, who knows, it could help.

Q: Finally, what’s the latest news on the horizon in terms of treatment for arthritis?

Rosier: First, it’s important to emphasize that we’re talking about osteoarthritis – which stems from wear on the joints – and not other forms (e.g., rheumatoid, psoriatic, etc.). In that context, we’re writing grants to seeking funding for a clinical trial to test a known drug, Forteo, which has been shown in mice to prevent or retard deterioration of joint cartilage. Other things on the horizon involve stem-cell treatments. But I have to add a big dose of caution here: Patients should beware of clinics that claim to be able to cure arthritis by injecting stem cells into the joints, or enriching plasma with platelet injections. A lot of charlatans exist out there, and none of this is covered by insurers. At this point we don’t have any solid, peer-reviewed, stem-cell therapies to offer.  With further scientific research, however, these directions may hold some future promise.

One last note of caution: Many patients like to take over-the-counter pain relievers for arthritis. In the past we worried about the effects of anti-inflammatory medications on the stomach, but more recent concerns focus on their ability to raise blood pressure and harm the kidneys. We tell patients to limit the use of these medications to a week or two, when they’re experiencing a severe flare-up.

The URMC offers the most advanced arthritis care in the Rochester area, at Clinton Crossings, 4901 Lac de Ville Boulevard, Building D, Rochester, N.Y., 14618. To schedule an appointment call (585) 275-6321. Two new faculty members – Dr. Jennifer Paul and Dr. John Ginetti – are accepting patients. 

Gotta Go? Women of Every Age Can Improve Bladder Health

While there’s no shortage of advertisements touting products for “leaky pipes,” many women hesitate to broach the topic of bladder problems with their doctors. Some may dismiss the issue, believing that it’s a normal part of aging.

Certainly, urologists can tackle some of the issues women face, but the proximity of a woman’s bladder and urinary tract to her reproductive organs can complicate issues. Urogynecologists — specially trained physicians with expertise in both gynecology and urology — may be best equipped to address issues unique to women’s bladder health.

We sat down to discuss bladder health issues specific to women with urogynecologist Gunhilde Buchsbaum, M.D., who is hosting a free educational event for women on Nov. 14, “Maintaining Your Bladder Health.” (Please click here for details.)

Scripts:  When women think of the term “bladder health” they probably think mostly about incontinence. Are there other related issues they should be concerned about?

Buchsbaum:  Besides the common concern of incontinence, many women experience urinary tract infections, problems with frequent urination, and even bedwetting. Other concerns include painful bladder syndrome, bacterial cystitis, and bladder cancer.

It’s important for women to be aware of these problems, and to know they aren’t alone in facing them. So many women suffer in silence, either embarrassed by the problem or believing nothing can be done for it. In reality, there are many tools for evaluating and treating bladder problems, as well as steps women can take on their own to improve bladder health.

Scripts: What are some symptoms that might signal bladder problems?

Buchsbaum:  There are many things women can look for, some of which they might write off as normal, but may be worth investigating. Take urine leakage. It’s a common complaint of women. If you have this problem, you should tell your doctor. Don’t assume it’s something you just have to live with; there are many things that can be done to address it. Frequent or painful urination is another fairly common symptom, which may be a sign of infection or urethral stricture.

Other signs include blood in urine, which can indicate infection, kidney or bladder stones, or, in some cases, even bladder cancer. Without exception, if you find blood in your urine, you should consult your doctor. While it doesn’t necessarily mean there is a serious problem, if there is one, catching it early can make a big difference in identifying and treating a problem.

Scripts:  Issues with incontinence and that “gotta go” feeling seem so prevalent now. TV ads tout medications for it and women often crack jokes about it. Is it a normal part of a woman’s aging, especially if the woman has gone through childbirth? And is there really anything you can do to avoid it, or to treat it?

Buchsbaum: While it’s true that urinary incontinence becomes more common with age, it’s not a normal part of aging. There are steps women can take to help prevent it. These include doing pelvic floor exercises (think Kegel’s exercises); avoiding consumption of bladder irritants like caffeine, alcohol, and artificial sweeteners; and developing habits that will help with the urge to go to the bathroom.

When necessary, there are various treatment options depending on the type of incontinence and of the needs of the woman. For instance, stress incontinence – which occurs commonly with exercise, coughing, sneezing, or laughing – may be corrected with pelvic floor exercises, insertion of a device called a pessary to help control leakage, or surgical intervention.  Urge incontinence – a sudden and/or strong urge to urinate – can be treated with behavioral changes and, in some cases, medication or nerve stimulation techniques. Overflow incontinence – also known as urinary retention, when bladder is unable to fully empty – is usually treated with self-catheterization or, in certain cases, surgical intervention.

The bottom line is that there are very effective treatment options. Just ask.

Scripts:  What should women in their 20s know that might help them in their 30s, 40s and beyond? And if a woman is 50+, is it too late?

Buchsbaum: It is never too early and rarely too late for starting good bladder habits. Developing strong pelvic floor muscles (again, by performing Kegel’s excercises) is key for addressing stress and urge incontinence at all ages, but it’s best to start young, especially for women in childbearing years.  Limiting caffeine in your diet is a smart habit at any age.

Also, it is helpful for women to recognize symptoms of urinary tract infections (bladder) infections. These may vary from person to person and become less obvious in elderly women. For example, a young woman usually has the classic symptoms: urgency, frequency, and pain with urinating. An older woman may notice fatigue, confusion, low backache, or perhaps an increase in urinary incontinence. Women of all ages should know that incontinence is not normal.  Bladder leakage can get worse if not treated.

Scripts: What one thing do you recommend that a woman asks her doctor at her annual checkup with her primary care physician or gynecologist?

Buchsbaum: All women should ask about Kegel’s exercises, why they are important, and how to do them properly. They are perhaps the simplest step a woman can take to maintaining her bladder health.

Gunhilde Buchsbaum is a professor Obstetrics and Gynecology, professor of Urology, and director of urogynecology at URMC. She founded and directs the Pelvic Health and Continence Specialties practice at URMC’s Women’s Health Pavilion.

Final Gifts: Organ Donation Could Help Families Grieve

There’s no way around it: Funerals are hard. But when your loved one has made a final gift that can save lives and bring healing to other families, something positive can come out of the pain.

“There’s a great deal of support for organ donation in the Rochester community,” said Rob Kochik, executive director of Finger Lakes Donor Recovery Network (FLDRN), a division of URMC.

“Even so, we often find that some of the same people who are quick to express support at the idea of donation have not actually taken the step to officially register themselves. It’s probably because they haven’t spent much time considering their own potential to leave a legacy of hope.”

We spoke to Kochik to learn more about organ donation – and the incredible power one person can have to change lives. Read on.

Scripts: Not to downplay the very real struggle that grieving families face – we know time is the true healer of deep wounds – but is there any research showing that organ donation can help surviving family members make sense of their loss?

Kochik: There’s definitely evidence behind the idea. At FLDRN, we offer support to organ donors’ family members for a minimum of two years following their loved one’s gift. A number of these donor family members go a step further and serve on our FLDRN’s Donor Family Advisory Committee, giving us insight were incredibly grateful for. Who best to learn from than previous donors’ family members?

In a recent survey, family members told us they were motivated by the prospect that “something positive could come out of [their] loss,” that “someone else would have a better life,” and that, in a way, “[their] family member would live on.” This idea of paying life forward, and having something beautiful come out of their tragedy, is certainly compelling. It can be something encouraging to cling to in those first difficult days, months, even years.

Scripts: That’s a great way to describe it. But why do you think some people “never get around to” thinking about organ donation?

Kochik: Naturally, none of us likes to think about our loved ones dying, much less to consider our own death.

Even so, it’s inevitable that each of us will die at some point – so it’s really important that we make this very personal decision and share our wishes with our family members. When we make the choice ourselves, and document it, we spare our family members from being burdened with one more emotional decision at a time when they’ll likely be overwhelmed. We know this firsthand; family members of loved ones who’ve taken the time to elect to be (or not be) donors repeatedly tell us they are very much relieved that they didn’t t have to make this potentially exhausting decision.

Scripts: I bet many people don’t think of it from that angle, but it’s a fair point. On another note, though – can donor families and transplant recipients ever meet up?

Kochik: Great question. Transplant recipients often send thank you cards and letters to their donor’s family members; it’s one small way to express their appreciation for a very big gift – life. And in the other direction, donor family members often enjoy sharing some more information about their loved one with transplant recipients; it’s a way for them to see that their loved one’s story is being told, and they’re living on. Periodically, when both parties wish to meet in person, FLDRN helps coordinate that.

Scripts: What a special thing. Before we wrap up, tell us: Of all the myths that muddy the issue of organ donation, which one would you most like to see cleared up?

Kochik: Hands down, the most frequent reason people tell us they’ve not signed up to be a donor is because they’ve (wrongly) assumed that their age or medical condition would render them ineligible.

That couldn’t be further from the truth. The fact is, that there are absolutely no age restrictions to become an organ donor – and each donor’s medical condition is carefully evaluated at the time of donation. Everyone is encouraged to enroll in the registry, no matter their age or medical history.

Work at URMC? Join URMC’s Campaign 4 Life

URMC and Finger Lakes Donor Recovery Network are teaming up to launch the URMC Campaign 4 Life, a month-long initiative during October to raise awareness about organ donation and transplantation and to ask each URMC employee to take action by declaring their consent to be an organ donor by enrolling in the New York State Donate Life Registry. The goal of the campaign is for 65 percent of URMC employees – there are nearly 15,000 – to either simply confirm they are already registered OR to become a new registered donor by completing an enrollment form. Please click here to participate in the URMC Campaign 4 Life survey. It takes less than 30 seconds.

To learn more about organ donation and transplantation, please visit the Finger Lakes Donor Recovery Network website, or the Facebook page for the bLifeNY awareness campaign, developed by the URMC Division of Solid Organ Transplantation and Hepatobiliary Surgery. Or call FLDRN at (585) 272-4930.

Statistics Tell Story of Cancer and Aging

Quit smoking, eat a plant-based diet, exercise, and dodge environmental toxins. These are within our control in the quest to keep cancer at bay. And yet the unavoidable process of aging also makes us vulnerable – in fact, more than 50 percent of all cancers occur in people 65 and older.

Statistics shape a compelling need for doctors and scientists to focus on how aging transforms cancer care. The number of 65-year-olds who live to age 90, for example, has soared 400 percent since 1940, which explains why oncologists are seeing so many active, fit, older adults. And this population is only expected to grow, according to the U.S. Census.

Dr. Supriya Mohile, of the James P. Wilmot Cancer Center, is among the very few geriatric oncology specialists in the country. We spoke to her to learn more.

Q:  Much of cancer prevention seems to center on lifestyle choices. Can you discuss why age is actually the biggest concern?

Mohile: Absolutely. The simple fact remains that the single most important risk factor for cancer is age.  As life expectancy in the U.S. continues to rise, cancer in older adults is becoming increasingly common.  Recent data compiled by the American Cancer Society shows that 77 percent of all cancers are diagnosed in people over the age of 50.  Cancer-related deaths also occur far more often in people 65 and older.

Q:  What are some of the challenges in treating older cancer patients?

Mohile: As people age, they naturally develop co-existing conditions that make their cancer treatment more complex. We need better data on how to both manage and cure cancer in older patients.  We’re seeing very healthy people well into their 80s who’re still working, traveling, playing golf — and then they get cancer. Unfortunately, due to their advanced age, many of these patients aren’t adequately treated for their cancers. We’re trying to educate the thought-leaders in oncology of the need for hard data to address these unique situations.

Within the geriatric and oncology communities, we still don’t have standards of care for treating older patients. Yes, there are some overlaps in the (separate) care models for oncology and geriatrics. However, my colleagues and I advocate for a more collaborative approach that melds the fields and ultimately evaluates when the benefits of therapy outweigh the risks, given the underlying health status of the patient.

Q:   You have established the SOCARE (Specialized Oncology Care and Research for the Elderly) clinic, which runs at the Wilmot Cancer Center and Highland Hospital. Why did you believe it was important to have a clinic?

Mohile: My patients were my inspiration. One of the first people I treated after I arrived in Rochester had a very serious form of stomach cancer but was otherwise fit and healthy. It simply wasn’t appropriate to withhold aggressive treatment for him based solely on his age. On the other hand, if he had been faced with other significant health problems that we refer to as co-morbidities or disabilities, the likelihood of side effects from cancer treatment would’ve been greater. After carefully assessing him with tools used in both geriatrics and oncology, we decided on aggressive therapy – and now he’s living without evidence of disease and he’s back to enjoying a very active lifestyle.

SOCARE is one just three programs on the entire east coast, and one of the few in the country.  The overarching goals of the clinic are to help with decision-making for cancer treatment, as well as maintaining function and quality of life during treatment. The clinic offers a comprehensive assessment and multidisciplinary approach to older people with cancer. 

Q:  What unique services does the SOCARE clinic offer?

Mohile: We are trained to offer a complete geriatric assessment. This is a very comprehensive approach that helps us to look past a person’s chronological age. Instead, we evaluate physiological variables such as frailty, cognitive function, nutrition, psychological health, social support and other medical conditions such as heart disease or diabetes. Approximately 80 percent of our patients have co-morbidities that can influence treatment decisions.  

At the end of the complete geriatric assessment, we classify our patients into one of three “stages” of aging:  fit, vulnerable, and frail.  This system guides us in how aggressively we treat the cancer and how to predict the need for and sources of extra support during treatment.

Q: You mentioned earlier that we have few study results to inform treatment choices for older patients. So, the need for more education and research must be a priority, correct?

A:  Yes, we need to really accelerate our research. This includes enrolling elderly patients in available clinical trials and designing prospective trials specifically for the older population. We also need to promote collaboration between researchers in geriatric medicine, the biology of aging, translational research, and palliative care.

We see nuances every day that need to be addressed through research: From the seemingly fit person whose unseen medical problems might put him at risk for life-threatening toxicities, to the apparently frail person who could actually tolerate aggressive treatment. It’s critically important that oncologists learn to correctly assess elderly people. We’re proud that our studies and our educational seminars are beginning begin to fill this gap in knowledge. 

For more information about SOCARE, please call (585) 276-5652. To meet with one of our geriatric oncology specialists, call (585) 275-6124. To reach Dr. Mohile: (585) 275-5823.