When Heartburn Paves Way for Cancer

Dan Gnagy sought his PCP’s advice when he started having difficulty swallowing. The 52-year old had experienced chronic reflux since his 20s, and thought he just needed adjustment to his medication.

But when the doctor peered into Mr. Gnagy’s throat, what he saw alarmed him, and he immediately referred him to thoracic surgeon Dr. Jeffrey Peters. After tests and a biopsy, the doctor’s initial diagnosis was confirmed: stage IV esophageal cancer. This week, we’re sharing Mr. Gnagy’s video account of his story, which originally published with Canandaigua Daily Messenger.

A Deadly Cancer

Esophageal cancer strikes only three percent of cancer victims but boasts the second highest death rate of all cancers—making it one of the deadliest in the U.S. Largely preventable through early detection and behavior modification, esophageal cancer is a disease that slowly targets older individuals—men in particular—who may have  experienced symptoms of reflux for years. As the giant cohort of Baby Boomers move into middle age, heartburn has now become a common condition, making esophageal cancer awareness all the more important.

What’s It Got to Do with Reflux?

Reflux is a condition where the muscle around the opening from the stomach to the esophagus becomes lax, allowing stomach acid to wash up into the esophagus ulcerating its delicate epithelial cells. Years of reflux can cause the esophagus to undergo enough changes to lead to precancerous conditions and even cancer.

Treatment is targeted at eliminating the corrosive effects of stomach acid by using antacids, proton pump inhibitors and lifestyle modification. URMC is one of just 13 U.S. surgery sites chosen to offer the LINX Reflux Management System, a ring of small, bead-sized magnets that mechanically prevents the backwash of acid into the esophagus. The force between the magnets strikes the just-right balance: Weak enough that it opens wide for swallowing, but strong enough that it tightens the faulty seal back up after food has passed down.

Because reflux affects one in 10 Americans and is a precursor to esophageal cancer, it’s important to treat it as aggressively and completely as possible in the beginning stages. Important interventions include eliminating risk factors like obesity, smoking and drinking.

Gnagy’s cancer is now being treated at the James P. Wilmot Cancer Center, and he has responded well. He makes the trek to Wilmot every two weeks for chemotherapy and has been told that his cancer is now inactive.

April has been designated Esophageal Cancer Awareness Month. To learn more about the disease and what you can do to prevent it visit the Esophageal Cancer Action Network.

An interview with Dan Gnagy  also appeared in the Messenger-Post News, here.

For more information about the LINX* heartburn ring being implanted at URMC, click here.

* Of note, Peters has served as a consultant to the device’s parent company, TORAX Medical, and received nominal compensation for sharing his clinical expertise at meetings over the past three years. You can hear from a patient who has enjoyed success with the device here.

Banning Big Soft-Drinks: Expert Says It Could Work

New York City Mayor Michael Bloomberg’s ban on soft drinks bigger than 16 ounces found more solid scientific footing last week, thanks to number of newly published clinical studies linking sugar-sweetened drinks to thicker waistlines.

The plan to can too-large soft drinks (passed by the city’s Board of Health in September) cracks down on the sale of super-sized sodas, sports and energy drinks, sweetened teas, coffees and fruit drinks containing less than 70 percent juice.

But will the move ultimately make for a healthier city? Or will it just disgruntle thirsty Americans? For some insight, we spoke to pediatric cardiologist Rae Ellen Kavey. Daily, she and her team help obese kids make the lifestyle changes needed to wrangle run-away blood pressure, unhealthy lipid levels, and more.

Scripts: The city’s ban demonizes soft drinks bigger than 16 ounces. Why are we quick to point a finger at soda?

Kavey: For starters, because there’s a huge amount of sugar in it. 16-ounce soft drinks can pack more than 50 grams – that’s about 13 cubes, if you’ve ever tossed one or two in a cup of tea. Somehow, because we’re drinking them, the calories tend to be under-appreciated. To make matters worse, they’re “empty” – they offer no nutritional merit to offset all that sugar.

What’s more, there’s a considerable amount of evidence – including three new articles out just last week in the New England Journal of Medicine – suggesting that by limiting sugary drinks, we can help individuals lose weight (or avoid becoming obese in the first place). And in clinical practice, among families we work with, we’ve absolutely witnessed this firsthand.  Limiting your primary beverages to fat-free milk, water, and – if you must – diet sodas, is a powerful starting point.

Scripts: Do you think the ban, if left in place, will make New Yorkers healthier?

Kavey: It just might. Whether or not it’s within the mayor’s purview to be making such decisions is certainly up for debate – but there is science behind this kind of approach. We have research showing that limiting access (say, removing soda vending machines from schools) can be an effective way of shaping healthier habits. It doesn’t have to be a perfect roadblock to work. It just has to deter folks.

In that sense, as a physician, I’m thrilled that the ban – and the flood of news surrounding it – is creating such a powerful educational moment. It’s opening our eyes to soda’s excessive sugar content. It’s spurring conversations around the issue of portion size. But it can’t stop there.

Scripts: What more needs to happen?

Kavey: I think that we need to make clear that this isn’t just about soda. It’s about a whole class of drinks that are, for all intents and purposes, flavored sugar-water.

Take sports drinks. High school athletes and weekend warriors have no need for electrolyte-charged drinks in their duffel bags. A water bottle is more than sufficient, unless you’re a high-performance athlete training several hours a day. And fruit juice? Many people feel almost virtuous sipping a glass of orange juice with breakfast, or giving their kids “100 percent” juice. But at the end of the day, juice is essentially just sugar-water too. It’s a way to consume far more sugar than you would if you enjoyed fruit in its natural state. Case in point, a cup of orange juice packs the calories of three to four medium oranges. Can you imagine consuming that many in one sitting? If you want to have your fruit, eat it in its whole form, the way it comes on the vine, the bush, or the tree. You’ll get some satiating fiber, that way.

Dr. Kavey was a member of both the NIH Obesity Task Force and the American Heart Association’s Pediatric Obesity Working Group, and is past Chair of the AHA’s Committee on Atherosclerosis, Hypertension and Obesity in Childhood. She divides her time between clinical pursuits, mainly in preventive cardiology and the Children’s Heart Center’s exercise lab, and expanding the division’s clinical research program.

To learn more about the Children’s Heart Center at URMC’s Golisano Children’s Hospital, click here.

Sugar Tipping Your Scales? Try a Sweet Substitute

Americans consume far too much sugar in their daily diets. That may be old news – but recently the American Heart Association and American Diabetes Association suggested that artificial sweeteners might be part of the solution for those of us with a wicked sweet tooth.

Non-nutritive sweeteners are products such as stevia, aspartame, acesulfame-K, neotame, saccharin or sucralose. Although no one is saying they’re a perfect alternative, artificial sweeteners do cut calories by curbing a high intake of regular table sugar.

In light of the obesity epidemic (and tempting seasonal treats like snow cones and ice cream) we asked Dr. Steven Cook, a childhood obesity expert at Golisano Children’s Hospital and member of the American Heart Association, to explain how to swap alternative sweeteners with the real thing.

Scripts: When should we consider using alternative sweeteners?

Cook: People can consider using products containing non-nutritive sweeteners in place of full-calorie products. For instance, grab a yogurt with low- or no-calorie sweetener instead of a full-calorie one. Be careful not to compensate for those saved calories, though. It’s a trick a lot of us play on ourselves far too often — drinking a diet soda now and then using that as an excuse to get a candy bar later.

Scripts: Should I give my children alternative sweeteners?

Cook: Actually, I recommend steering clear of very sweet foods, regardless of what kind of sweetener is used, as often as possible. We develop our eating habits and palate in childhood. When children eat more healthy whole foods, they’ll most likely turn to healthier foods as adults. Instead of sweetened foods, try to give kids naturally sweet foods, like apples and carrots. But some sweetened foods are OK. The key is everything in moderation.

Scripts: How much sugar in a day is OK?

Cook: The AHA recommends that women eat no more than 100 calories a day in sugar, and men, no more than 150. Take a look at your food labels and you’ll see what a challenge that can be — and why the AHA and the ADA are recommending non-nutritive sweeteners to get those sugar-calories down to an acceptable level.

Scripts: Is cutting down on sugar really going to make a difference in my weight and health?

Cook: Yes, especially if you’re significantly above the recommended 100 or 150 calories from sugar. Sugar is essentially empty calories. Your body isn’t likely to need sugar, and it’s been shown to contribute to cardiovascular disease in addition to obesity. We’ve seen incredible results from families who cut down or cut out sugar-sweetened beverages and switch to water and skim milk. It takes time to see the results on a scale, but if you stick to it, the benefits are life-long. But be careful: Just because a product has low sugar content, doesn’t mean it’s healthy. Read labels and aim to meet the daily recommendations of vegetables, fruits, whole grains, dairy and protein. For more information on a healthy diet, visit www.choosemyplate.gov.

Dr. Cook is an associate professor of ediatrics. To contact him, call the Strong Pediatric Practice at 275-2821 or visit http://www.urmc.rochester.edu/childrens-hospital/general-peds/index.cfm.

 

A Weighty Matter: Heavy Kids

Despite the inescapable buzz around America’s “obesity epidemic,” research has shown that too few parents accurately appreciate extra pounds on their own kids.

What’s more, our “screen society” – rife with iPads, Nintendo, HDTVs – has made it all too easy for youngsters to live their lives sitting down.

And to add one more ingredient to this toxic mix, consider kids’ media. TV and web commercials have found a surefire formula from promoting “junk food” – just show cool kids and cartoon characters happily noshing on the questionable eats. (Don’t believe it? Name the last time you saw a cartoon character – besides Bugs Bunny – happily munching on a vegetable.)

As these forces collide, what does it mean for the nation’s youth? For one thing, a growing burden on their developing hearts. Last week, the White House Community Leaders Briefing on Cardiovascular Health drew dozens of experts from the national health care community – including pediatric obesity expert Dr. Stephen Cook – to discuss legislation, regulations and initiatives that the Administration  is implementing to help improve our nation’s heart health.

Since you, our blog readers couldn’t attend, we want to loop you into the conversation by sharing some of our work with the Greater Rochester Obesity Collaborative (which has been selected as a national model for obesity prevention and treatment), plus results from two studies Dr. Cook recently was involved in (which point out why many parents don’t realize their children are obese, as well as how obesity rates have mushroomed over the past three decades).

In the clip below, you also can hear Dr. Cook discuss how modern media messaging is shaping our kids’ food preferences.

Mushrooming: Diabetes Rates Double in Just Three Decades

Startling new statistics published just weeks ago in the journal The Lancet suggest that nearly 350 million adults worldwide now have diabetes.

Still not fazed? Consider this: That count is more than double what it was in 1980.

And, while it’s clear that a now-global obesity epidemic is in large part fueling the phenomenon, there’s so much more at play – for instance, a little thing called genetics. Case in point: While more than 25 percent of the population is obese in more than two-thirds of all U.S. states, only about 8 percent of Americans are diabetic. So, clearly, while maintaining a healthy weight is a really important part of delaying or avoiding diabetes,  it’s not the whole story. (Just to shake things up some more, here’s another fact to chew on: As many as 20 percent of persons with type 2 diabetes are not overweight. You can read more popular diabetes myths here.)

To gain better insight into this often misunderstood disease – its various types, the causes and symptoms, and the heavy burden it places on persons living with it (from both fiscal and quality-of-life standpoints) – we spoke with URMC expert and endocrinologist Dr. Steve Wittlin.

In the clip below, he offers a crash course in diabetes.

Want to know more about the diabetes care available through URMC? Click here to learn about the spectrum of services offered by our team of endocrinologists, nurse practitioners, nutritionists, and nationally certified diabetes educators.