Marion County Medical Center

Health Shorts

November 2008

Belly Aches Are Often Serious
    A persistent belly ache–severe enough to send you to the emergency center–may or may not be appendicitis. But in about 10 percent of cases, it’s a serious condition, according to one study.
    Appendicitis pain typically starts near the navel and moves to the lower right quadrant. A thorough evaluation by a physician is required for a diagnosis.
    In addition to the abdominal pain, symptoms that may indicate an emergency condition (not necessarily appendicitis) include fever, persistent vomiting, light headedness and fainting.
[SOURCE: Laurie Barclay and Penny Murata, “Evaluation of acute abdominal pain reviewed,” Medscape Medical News CME, April 18, 2008]

How Likely Is It Appendicitis?
    Persistent abdominal pain in an adult can have many possible causes. One study found that only 6 of 556 patients seen for abdominal pain at three family practice centers were diagnosed with appendicitis.
    Among children, on the other hand, studies have found that 10 to 25 percent of patients with abdominal pain had appendicitis.
[SOURCE: Mark H. Ebell, “Diagnosis of appendicitis: part I. History and examination,” American Family Physician, March 15, 2008]

Appendicitis: A Family Connection
    Heredity may be a predisposing factor in many cases of appendicitis. According to one study, a child with one or more relatives who had an appendectomy has a risk of appendicitis 10 times that of a child with no family history.
    The family connection can also be explained in part by environmental factors shared by a family: food habits, exposure to a particular bacterial infection and a genetic difference in bacterial resistance.
[SOURCE: Emre Ergul, “Importance of family history and genetics for the prediction of future appendicitis,” The Internet Journal of Surgery, June 28, 2007]

Lymphedema Is Common Problem
    Lymphedema, or swelling of an arm or leg because of accumulation of lymph fluids, can occur for a number of reasons. In the United States, the most common cause is breakdown of lymphatic circulation as a result of breast cancer or breast cancer treatment. Of about two million breast cancer survivors, 20 to 40 percent develop chronic lymphedema.
    Worldwide, 150 to 250 million people suffer from lymphedema because of lymph damage caused by the fungus, filariasis.
[SOURCE: Don R. Revis, Jr., M.D., “Lymphedema,” emedicine from WebMD, last updated March 18, 2008]

Weight Loss Reduces Lymphedema
    A small study of women with lymphedema or swelling of the arm related to breast cancer treatment found that weight loss was an effective way of reducing the swelling.
    Women who reduced their daily energy intake by 1,000 calories lost weight and reduced excess arm volume from 25 percent to 15 percent. Women in the control group saw no change in weight or arm size.
[SOURCE: David Douglas, “Dieting reduces arm lymphedema after breast cancer treatment,” Reuters Health, November 13, 2007]

Get Help for Your Cancer Questions
    To get help or support for any cancer-related problem, the National Cancer Institute offers an online chat service with an information specialist from 9 a.m. to 11 p.m. (EDT), Monday through Friday. Go to www.cancer.gov and click on LiveHelp.
    LiveHelp is confidential and does not provide medical advice.
    The National Cancer Institute website is a good source of information about cancer, clinical trials and organizations providing support and resources for cancer patients.
    You can also dial 1-800-4-CANCER (1-800-422-6237) or write to NCI Public Inquiries Office, Suite 3036A, 6116 Executive Boulevard, MSC8322, Bethesda, MD 20892-8322.
[SOURCE: National Cancer Institute, “Lymphedema (PDQ, Patient Version,” last modified July 1, 2008]

Many Patients’ Needs Non-Physical
    A survey of 103 Canadian women being treated for gynecological cancers found that 8 of the top 10 unmet supportive care needs reported were non-physical. These were: fear about the cancer returning, fear about the cancer spreading, uncertainty about the future, concern about the worries of loved ones, feelings of sadness, feeling down or depressed, anxiety and worry about lack of control over the results of treatment.
    The physical needs reported were lack of energy and not being able to do things previously done.
[SOURCE: Rose Steele and Margaret I. Fitch, “Supportive care needs of women with gynecologic cancer,” Cancer Nursing, September, 2008]

Support Therapy Improves QOL
    A follow-up study of metastatic breast cancer patients conducted by David Spiegel, M.D., and his colleagues from Stanford University found that participation in support groups
improved the quality of life of subjects even if it didn’t extend their lives.
    A 1989 study by Dr. Spiegel’s group found that subjects taking part in supportive group therapy lived 36.6 months compared to 18.9 months for those not getting group therapy. The second study, started in 1991, tracked patients for 10 years but failed to confirm the results of the first study. The subjects did, however, show lower levels of distress, anxiety and pain. A sub-group of patients with a very aggressive form of cancer did have a longer median survival than subjects given education literature alone.
[SOURCE: Michelle Brandt, “Support groups don’t extend survival of metastatic breast cancer patients, Stanford study finds,” Stanford University press release, July 23, 2007; D. Spiegel, et al, “Effects of psychosocial treatment on survival of patients with metastatic breast cancer,” Lancet, 2(1989);888-891]

Sex after Cancer? Not Always Good
    Many cancer patients report either short- or long-term changes in their sex life after treatment. Among women treated for breast and gynecological cancers, more than half report long-term changes in sexuality; even greater numbers of men treated for prostate cancer report long-term problems.
    These problems may result directly from surgery or radiation treatment (as in prostate cancer), from the effects of medication or from emotional issues related to changes in body image and self confidence. In nearly every case, a physician can provide help through medication or supportive therapy.
[SOURCE: National Cancer Institute, Life after Cancer Treatment, updated September 1, 2007]

Pre-Hospital Therapy Effective
    For patients suffering a heart attack, doctors have long known that quick action is essential to preventing long-term damage to the heart. Treatment options include 1) clot-dissolving medications, 2) angioplasty and 3) emergency bypass heart surgery.
    A University of Texas study [Journal of the American College of Cardiology, October, 2007] found the best results in patients given a half dose of clot dissolving medication in pre-hospital care in the ambulance followed by angioplasty at the hospital. About 70 percent of patients given this treatment had full restoration of blood flow following angioplasty, compared to only 22 percent of those who went to angioplasty without pre-hospital medication.
[SOURCE: University of Texas Health Science Center, “Treating heart attacks should begin in the ambulance, new study by UT-Houston cardiologists shows,” October 16, 2007; Richard W. Smalling, Journal of the American College of Cardiology, October, 2007]

Door to Balloon–90 Minutes Is Best
    Door to balloon time is the term used by doctors and hospitals for the time it takes to get a heart attack patient from the door of the emergency center to treatment with balloon angioplasty. Angioplasty is the preferred method of restoring blood flow to the heart for most heart attack patients with ST-segment elevation.
    American Heart Association and American College of Cardiology guidelines suggest a goal of 90 minutes or less, but fewer than half of hospitals meet that standard.
    One way of reducing door to balloon time is having emergency medical technicians perform an electrocardiogram on the way to the hospital. Time is also saved when an attending cardiologist is on site 24 hours a day or when emergency physicians (rather than a cardiologist) determine whether ST elevation is present and activate the heart catheterization team.
[SOURCE: Elizabeth H. Bradley, et al, “Strategies for reducing the door-to-balloon time in acute myocardial infarction,” NEJM, November 30, 2006]

Know Your Cardiology Terms
    A heart attack, also known as a myocardial infarction, occurs when blood flow to part of the heart becomes interrupted due to occlusion or blockage of one of the coronary arteries.
    Cardiac arrest occurs when the heart suddenly stops beating, either because of a heart attack or a cardiac arrhythmia (abnormal heart beat).
    Heart failure refers to a condition in which the pumping action of the heart is impaired. Heart failure, which may continue for years, is caused by a heart muscle that has been weakened, either by a heart attack or another cause such as uncontrolled hypertension.
[SOURCE: The Johns Hopkins White Papers, “Coronary Heart Disease,” 2008]

Prompt Treatment Prevents Damage
    A heart attack with ST-segment elevation (typically meaning a complete blockage of a coronary artery) can be treated effectively through reperfusion–restoring blood flow through medications, angioplasty or surgery. If treatment is delivered promptly–within an hour–25 percent of these heart attacks can be aborted, with little or no permanent damage to the heart.
    Even though the majority of patients do not receive such prompt treatment, about 10 percent of patients survive a heart attack without necrosis (death) of heart muscle.
[SOURCE: F.W. Verheugt, et al, “Aborted myocardial infarction: a new target for reperfusion therapy,” European Heart Journal 2006;27(8):901-904]

Health Shorts

November 2008

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