Precision Medicine: From Buzzword to Promise or Reality (Part II)

By Hui Xie-Zukauskas

Target_Precision Prevention_CPDHappy New Year to All! This article is the continuation (Part Two) of Precision Medicine mini-series, with a focus on Precision Prevention intended to help foster and improve your health in the new year.

So, let’s dive right in.

From Precision Medicine to Precision Prevention

Prevention and medicine work side-by-side, as ancient wisdom signifies “Prevention is better than cure.”

Similarly, precision medicine and precision prevention play a joint role in cancer outcome. While precision medicine is targeting the genetic characteristics and genetic changes of each patient’s cancer, precision prevention is aimed at changing an individual’s behavior.

Precision prevention requires a better understanding of the molecular pathways of a particular disease at a level of each individual, which involves mapping out genomic profile, identifying individual’s risk, behavioral, social and environmental interactions. Then tailored interventions can be strategized to modify individual’s physical and biological characteristics.

Impact on Cancer Prevention

Precision medicine, together with precision prevention, has certainly facilitated/improved cancer prevention whether you realize it or not, particularly in early detection.

Colonoscopy screening is a good example. Let me highlight the steps:

First, there is a guideline to identify people at a risk for colon cancer and/or who need to be screened – e.g. starting 40 years old if having a family history, or 50 years old without a family history.

Second, this test can detect a growth in the entire colon through imaging.

Finally, doctors can implement treatments immediately to prevent or slow down cancer progression, e.g. to surgically remove a benign growth (polyp) or premalignant lesion during the screening, or to start an aggressive therapy for a cancerous tumor.

As a result of such a cancer prevention strategy, colon cancer is highly preventable if caught in a precancerous stage.

Meanwhile, additional findings should be taken into consideration. Recent clinical studies found that 80% of people with colorectal cancer have no known family history of this disease, which suggests that other risk factors (environmental, diet or lifestyle) play a role in colon cancer development, and that current colon cancer screening recommendation (mainly based on age and family history) could miss many individuals at risk.
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So, next prospective is how to improve precision prevention. Advances in precision risk stratification has done so. To identify who may benefit from preventive measures or early aggressive treatment or alternative therapies, precision risk stratification can separate individuals at a high risk from those at a low risk through innovative technologies, genetic profiling and multiple risk factors reporting. In colon cancer prevention, while those at higher risk benefit from colonoscopy, people at a lower risk can get screened through sigmoidoscopy, a non-colonoscopy screening with clinical value in detecting advanced growth. Subsequently, precision risk stratification-based screening for colorectal cancer will also reduce healthcare cost stemming from unnecessary colonoscopy screening.

Immunoprevention presents other successful examples. It can be demonstrated by hepatitis B virus (HBV) vaccination and human papilloma virus (HPV) vaccination in preventing related cancers. Immunoprevention can also draw in patients carrying cancer predisposition genes.

In addition, precision prevention may imply identifying novel genomic biomarkers for cancer detection and prevention, applying predictive biomarkers, and analyzing gene-environmental interactions especially associated with modifiable risk factors to develop target preventive strategies.

Precision Prevention beyond Cancer 

Undoubtedly, precision medicine, along with precision prevention, is transforming cancer diagnostics and treatment to reduce cancer incidence, morbidity and mortality in the near future. And one day, the promise of precision prevention for Alzheimer’s disease, metabolic syndromes, or other chronic illnesses can lead us to a remarkable horizon.

Imagine – the beauty alongside benefit of precision nutrition blossoms in your plate of food. As the prevalence of obesity, prediabetes and diabetes increases, tailored nutritional approaches are needed to manage and prevent these conditions. Precision nutritional interventions can be achieved via analyzing and monitoring your dietary habits, food eating behaviors, physical activity, microbiota profile, along with deep phenotyping (i.e. precise and comprehensive analysis of abnormalities in physical and biochemical characteristics).

End Note with Key Numbers

Lifestyle factors (smoking, diet, sedentary, etc.) contribute to over 40% of cancers, and infections, to about 18% of cancers. Thus, many cancers are preventable by lifestyle modification, preventing infections, having balanced diet and regular exercise, and maintaining a healthy weight.

Remember: Prevention is not a sprint, nor a marathon; is a sustained life-long journey. Prevention is not done through virtual world, but achieved in a real world and requires actions. If precision prevention is aimed at changing individual behaviors, the power of control is within each of us.

Going into 2018, imagine a year with your best well-being!

 

Image credit: CanStockPhoto & CPD

 

 

Precision Medicine: From Buzzword to Promise or Reality (Part I)

By Hui Xie-Zukauskas

Target for Precision Med_CPDIn a cheering spirit of the season, an amazing gift for each of us, in a perspective of health and future healthcare, is Precision Medicine. Precision medicine is no longer just a buzzword, its remarkable ability to impact detection, treatment and prevention has extended beyond cancer, and advanced clinical care for cardiovascular diseases, neurological disorders, and other acute or chronic illnesses.

This is an exciting era that treating a disease is transformed from following standard guidelines or the conventional “one-size-fits-all” approach to tailoring of medical treatment to individual characteristics of each patient.

So, what does it mean to cancer treatment and cancer prevention? I’ll provide some remarkable findings for you.

First, Let’s Clarify Precision Medicine vs Personalized Medicine

According to NIH, precision medicine refers to the tailoring of medical treatment to the individual characteristics of each patient, i.e. to identify what approaches will be effective for which patients based on their genetic, environmental, and lifestyle factors.

Precision medicine and “personalized medicine” are interchangeable sometimes. However, the term “personalized medicine” tends to be misinterpreted or misunderstood as the practice that treatments are uniquely designed for each individual. This is not always the case with precision medicine, and I’ll elaborate upon it more in cancer treatment later to help you understand better, so read on.

How Can Precision Medicine Steer Cancer Treatment Precisely?

Cancer is essentially a genetic disease. Errors, defects and malfunctions in the sequence of DNA or changes in the ways how genes are regulated can overthrow a cell’s apparatus, triggering uncontrolled cell growth, and eventually, tumor development.

What’s more, chronic diseases and metabolic diseases such as diabetes, hypothyroidism, hyperthyroidism, adrenal sildenafil online no prescription dysfunction and other factors can surely result to female libido loss. 6. Nonetheless, they may be extremely high-priced that only those with severe cases should consider acupuncture, but at the same time, often you might get confused. viagra best prices is a great solution for those who experience degradation in the quality of their relationships as well. Frequently autoimmune disorders, since they remained unnamed but caused pain levitra 100mg pills as well as affecting other organs, were classed as rheumatism. Firstly just to clear up a canada tadalafil quick technical point. The cause of these changes can be lifestyle – such as smoking, environmental – such as exposure to toxins, and/or spontaneous – such as a result of mutations in genes or inherited genetic alterations. Furthermore, research findings show that the changes that occur in one person’s cancer may not occur in others who have the same type, and the same cancer-causing changes may be displayed in different types of cancer.

These genetic changes in cancer can be examined using extraordinary technologies such as DNA sequencing, genomic testing and tumor molecular profiling. Samples can be collected by biopsies from tumors or in some cases, circulating DNA from patients with premalignant lesions. Cancer molecular profiling can uncover patients’ genetic variations, transcriptomic or proteomic profiling, tumor metabolism and microenvironment, and tumor immunity.

Considerable evidence indicates that a specific sequence of acquired genomic events over many years characterizes the transition from a normal cell to invasive carcinoma, and that specific “driver” events, developed in a particular order, enable cells to progress from benign growth to a malignant cancer.

Traditionally, tumors from the same organ or anatomical site are treated as one tumor entity. With breakthrough advances in genomics and technology, molecular tumor profiling may identify cancer “drivers” that are shared among different cancer types, prompting an approach to target driver’s pathways across anatomical sites, and clinical trials (so-called umbrella trials) to test whether molecular alterations in one tumor entity can be extrapolated to all other cancers.

For example, an inflammatory signature proved to be shared by seven cancer types including breast, prostate, colon, gastric, pancreatic, oral and lung.  Karyopherin alpha 2, a protein that plays a vital role in causing cancer, is uniformly up-regulated across these cancer types. Hence, a cancer-related molecular inflammatory pattern may position this protein as a uniform marker for poor prognostic cancers. Alternatively, oncologists can use specific drugs that target this protein to stop cancer growth.

Take a look at traditional chemotherapy, it works by killing cells that multiply quickly whether they are normal or cancerous. Precision medicine works differently. Because cancer cells need specific proteins or cancer-causing genes to survive, grow and spread, targeted therapies are designed to go after specific cancer-causing genes or proteins, leading to stopping or slowing down cancer progression.

Collectively, precision medicine can improve diagnostics, treatment, early detection and prevention. The goal of precision cancer medicine is to identify which mutation that drives a tumor, and to target therapies on what and how cancer-causing genetic changes occur in a tumor, no matter where the tumor develops in the body.

 

Image credit: CanStockPhoto & CPD

Key Takeaways for CMS Oncology Care Model

By Hui Xie-Zukauskas

For cancer patients, living a life with and beyond cancer faces various challenges. Consider physical illness, emotional pain, financial cost, and psychological burden, etc.

Here is good news for those who are not aware of new cancer treatment program.

To improve cancer care and reduce the cost, Center for Medicare and Medicaid Services (CMS), particularly its Innovation Center (CMMI), developed Oncology Care Model, which are participated by over 190 health care providers and some insurance companies.

Oncology Care Model_CPDThis map shows the locations where oncology practice groups participate in Oncology Care Model. An interactive version that provides names of the practices or clinics is available on the CMMI site at this link.

This new five-year payment and practice reform initiative for cancer patients started July 1, 2016. Here are 5 key takeaways for cancer patients who use Medicare to receive chemotherapy:

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  1. You don’t need to do anything, just seek the treatment at the practice of your choice.
  2. It’s an episode based approach – an episode starts when your chemotherapy starts, and each one lasts six months. If you need more treatment at the end of six months, start a new episode.
  3. Your Medicare payment will be either the same or lowered.
  4. Have 24/7 access to an oncologist or specialist. A patient navigator will be a consistent point person for each patent to help with patient support throughout their care.
  5. Physicians are paid by two ways or parts, but receive federal reimbursement by quality of care and performance of service they provide.

The Oncology Care Model aims at enhancing patient experience, by providing comprehensive care planning, shared decision-making, regular assessments for pain, distress and quality of life, and palliative care consultation, just to name a few among many other benefits.

Overall, CMS hope to achieve better health outcomes for Medicare beneficiaries not only through better coordinated, high-quality care with electronic health records sharing between practices, but also by shifting the provider’s compensation from quantity of services to quality of outcomes.

 

Emerging New Evidence on Pancreatic Cancer Risks

By Hui Xie-Zukauskas

Risk_assessThis is a key topic on my editorial calendar this year due to the striking statistics of the increasing incidence and lethality of pancreatic cancer. For 2017, an estimated 53,670 people will be diagnosed with pancreatic cancer, and over 43,000 deaths resulting from it are expected in the U.S. alone (source: American Cancer Society).

Pancreatic cancer still has a very poor prognosis, with an overall survival of 5% over five years. The disease is remarkably aggressive, rarely diagnosed at an early stage, and difficult to treat due to its resistance to radiotherapy and chemotherapy. Therefore, the cancer’s cruelty creates a tremendous emotional burden for both patients and their loved ones. Even for survivors, the battles and treatments are brutal.

This does not mean we can do nothing.

To treat this horrible disease early and save more lives, identifying risk factors of pancreatic cancer and targeting high-risk people for effective screening are crucial. Therefore, steps to help prevent pancreatic cancer need everybody’s attention. A better understanding of the factors associated with pancreatic cancer can pinpoint preventive strategies to reduce its incidence.

Through literature review, I’ve compiled a list of risk factors for pancreatic cancer from research findings and emerging new evidence over the last 10 years. Here I share them with you in three categories.

First – Established risk factors

  1. Cigarette smoking: It is consistently associated with a two-fold increase in pancreatic cancer risk. Cancer-causing agents (i.e., carcinogens) existing in tobacco products cause DNA damage, which lead to abnormal cell growth.
  2. Obesity: Obesity produces an inflammatory state. Specifically, visceral obesity (i.e. belly fat) is linked to an increased risk for pancreatic and other cancers, independent of general obesity measured by body mass index (BMI).
  3. Chronic inflammatory conditions: such as chronic pancreatitis, liver cirrhosis.
  4. Diabetes: Particularly, type 2 diabetes is among a cluster of metabolic syndromes including hypertension, dyslipidemia, insulin resistance, and obesity.
  5. Age (55+): The risk of developing pancreatic cancer increases with age.
  6. Gender: Men are more likely to develop pancreatic cancer.
  7. Inherited genetic mutation: Genetic factors accounts for ~10% pancreatic cancer. 

Second – Emerging risk factors

  1. Environmental risk: Exposure to mutagenic nitrosamines, organ-chlorinated compounds, or heavy metals is involved in the initiating phase of pancreatic cancer.

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  2. Gut microbiota: The role of the microbiota in the development of pancreatic diseases is increasingly accepted. Gut bacteria translocation and small intestine bacterial overgrowth have been found in acute pancreatitis and chronic pancreatitis, respectively.
  3. Infection: Helicobacter pylori (H. pylori) infection.
  4. Ionizing radiation: Most relevant evidence comes from studies done on workers due to occupational exposure. 

Let me add a bit more on invisible microbiota. Imbalance in gut microbiota is also related to other risk factors for pancreatic cancer (such as smoking, diabetes, and obesity). Furthermore, oral microbiota change in periodontitis is associated with an increased risk of developing pancreatic cancer.

Third – Preventable or modifiable risk factors

  1. Sedentary behavior: Physical inactivity is directly and independently linked to multiple types of cancer.
  2. Smoking: Smoking is the biggest preventable cause of cancer.
  3. Excess alcohol intake
  4. Dietary factors: A diet high in red and processed meats, fat, calories, and fructose may increase cancer risk.  In contrast, a diet rich in whole wheat or whole grains, fiber, vegetables, and fruits is associated with reduced cancer risk.
  5. Obesity: Obesity is a significant risk factor for more than 10 types of cancer, severe morbidities, and premature death; it is also considered the major modifiable risk factor for multiple cancers and chronic diseases.

Each cancer is different. Sadly, pancreatic cancer has struck individuals who were healthy, non-smokers, athletes, or as young as age 30-40.

In summary

Fighting against pancreatic cancer starts with learning about its risk factors so as to save preventable deaths in the larger population.

Meanwhile, there is hope – thanks to advanced research and technology that deliver better treatments or promising therapeutic options. So, let’s also remember HOPE.

 

Image credit: http://fatfplatform.org/risk-assessment/

Floodwater May Be Muddy but Health Threats Are Clear

By Hui Xie-Zukauskas

Flood danger_chbdc.govt.nz w-CPDFirst of all, our hearts go out to the victims and people suffering from Hurricane Harvey.

What can we learn from this catastrophic storm – especially for residents living in flood-prone areas?

I address this question, because the danger of flooding is not just drowning. Health hazards under seemingly calm floodwater cannot be taken lightly, and they will persist, in some cases, for a long time.

Therefore, I’m going to highlight what health hazards come with flooding and how your preparedness can help avoid them.

Let’s start with – Types of Health Hazards and Risks

  1. Bacteria and infections: Bacteria can cause infectious diseases. Exposure to contaminated water (e.g. from pathogens, chemicals or wastes) can result in infection and put a risk for other health problems.
  2. Injury: Cuts and harm result from invisible sharp glass or metal fragments.
  3. Stress: Tension is overwhelming, from devastated loss, upset, anxiety, exhaustion and sleep deprivation, etc. Stress may progress to mental health problems such as post-traumatic stress disorder and depression. Inevitably, the emergency responders experience stress as well.
  4. Mosquitoes: Warm, stagnant water is their breeding bed, which increase the prevalence of mosquito-borne diseases such as Zika, West Nile and dengue.
  5. Mold: Mold from water-soaked homes/walls can be harmful because it not only causes allergic reactions but also may worsen other existing health problems.

Next, Strategies and Actions You Can Take (in acronym P.I.C.)

#1 Prepare and Plan prior to flood

The key to effective preparedness is to plan ahead, protect assets, and get everything ready. Never wait till the last minute then act. Here are things you can do:

For care of vulnerable populations

  • Make sure to take care of necessities for babies and pregnant women.
  • Have enough back-up medications for folks with chronic diseases or health problems, and ensure the medications kept in a safe, water- and heat-proof place (e.g. cooler). Likewise, watch over personal medical device safety.
  • Make sure elderly, fragile folks stay in a dependable home/facility. 

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  • Keep a prevention-mindset. Your health is your most valuable asset, as you cannot expect to take all your possessions with you.
  • Have your family’s emergency package/kit ready-to-go.
  • While securing some belongings is essential, it’s important to guard some critical documents such as insurance, health and immunization records.
  • If possible, consider getting the vaccine for TDAP – tetanus, diphtheria and pertussis in case of unforeseen injury.

#2 Implement during and post flood

  • Execute your plan, and ensure vital items at hand when evacuation.
  • Turn off power to avoid any incident from getting electrocuted.
  • Take good care of open wounds to prevent infection, esp. avoid direct contact in water.
  • Pay attention to folks in poor health, because they are at a great risk of heat-related death due to power outage and resultant lack of air conditioning.
  • Always make sure that your drinking water is safe.
  • Maintain hygiene and food safety. Discard any moldy, rotten or illness-risky foods.
  • When cleaning up floodwater, avoid injury. And clean everything in direct contact with water.
  • Clean mold thoroughly, but take caution to the cleaning chemicals because of their potential harm to your body. If necessary, ask for professional help.

#3 Communicate for management and support

Be informed. Follow the instructions or updates on mass flooding from federal or state government and communities. Keep your families and friends posted about your well-being. Support each other in every way possible. 

Final point:

To my knowledge, there is no direct evidence whether Hurricane Harvey is caused by climate change. However, as we all understand, global warming can add to warmer or hotter air, build up more humidity and more moisture, which will increase the intensity of hurricane and consequential damage. Hence, climate change does play a role in deadly storms or weather-related natural disasters.

So, let’s face the reality, take responsible actions to protect the earth and future generations.

 

Image credit: Chbdc.govt.nz and CPD

The Steep Price of Overlooking Prediabetes Risk Factors

By Hui Xie-Zukauskas

Stop Prediabetes_CPDWhen you have diabetes, self-managing this condition through a list of tasks can be very challenging in your daily life.

However, whether you live with or without diabetes, your days will be happier and your life, simpler, if you cut off or minimize, improve or prevent a few of 11 risk factors for prediabetes.

Prediabetes is a condition where blood glucose (blood sugar) levels are higher than normal, but not high enough to meet the criteria as diabetes. About 86 million of Americans adults have prediabetes, and 90 percent of people with the condition don’t know they have it, based on the CDC’s data.

So, it’s urgent to know your risk. Why? Because prediabetes may develop to type 2 diabetes, the progression can lead to several health consequences. Among these is an association of prediabetes with the development of cancer. Research reveals that prediabetes is significantly linked to an increased risk for cancer of stomach, liver, pancreas, colon, breast and endometrium.

Here I’ll help you learn 11 risk factors of prediabetes, which type 2 diabetes also shares.

  1. Overweight or obesity: Obesity is an epidemic, and of our greatest concern is that it has spread to our children. The fatty tissue makes the cells become less sensitive to glucose, leaving a higher level of sugar in the blood. One more note – overweight/obesity may cause insulin resistance, which is a condition where the cells do not respond to insulin properly; and to meet the body’s demand, the pancreatic beta cells produce more insulin to help cells absorb glucose from the blood stream. Excess insulin and insulin resistance are a hallmark of type 2 diabetes, and make weight loss more difficult.
  2. Abdominal obesity: Extra fat around your abdominal region is considered a risk. A waist size over 35 inches for women or over 40 inches for men may post a higher prevalence of prediabetes. “Belly fat” is associated with high blood pressure, hyperlipidemia, heart disease, stroke, and diabetes.
  3. “SAD” diet:Standard American Diet features high in sugar, fat, and red or processed meats, and excess carbohydrates. An inadequate diet can impair insulin sensitivity over time. Additionally, portion control is also a key player. To help manage, I’d suggest you start with a smaller-size plate, rather than a regular dinner plate.
  4.  Physical inactivity: If you are not physically active or regularly exercising, you may experience weight gain over time, and you’re more likely to develop prediabetes.
  5.  Long-term stress: Under stress, the body releases the hormone cortisol into the blood stream, raising blood glucose levels, which can cause diabetes.

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  6.  Metabolic syndrome: Metabolic syndrome is a group of three or more conditions that take place together and influence metabolism. When an impact of obesity, dyslipidemia (abnormal levels of “good” and “bad” cholesterol) and high blood pressure compounds, insulin resistance can occur.
  7.  Family history: Having an immediate family member or relative with type 2 diabetes considerably increases the risk of prediabetes.
  8.  Age: After the age of 45, the risk of prediabetes goes up, despite the fact that prediabetes can develop in anyone of any age. Aging alone contributes to decline in beta cell function of the pancreas. Aging could also let one easily get into inactivity, a poor diet, and a loss of muscle mass.
  9.  Ethnicity/Race: African-American, Native American, Hispanics, Asian-Americans and Pacific Islanders have a higher risk of developing prediabetes.
  10.  Gestational diabetes: Women who give birth to babies weighing over 9 pounds may be at a higher risk for prediabetes. Women previously diagnosed with gestational diabetes during pregnancy and their children have a higher risk too.
  11.  Polycystic ovary syndrome (PCOS): Women with PCOS are more susceptible to insulin resistance, thereby leading to prediabetes or type 2 diabetes.

Furthermore, activities contributing to chronic inflammation, such as tobacco smoking, excessive alcohol, and poor sleep quality, also post an increased risk of prediabetes and diabetes.

In the end, consider this price tag – The lowest cost of prediabetes or diabetes for individual health and our healthcare system is prevention, early detection, and timely treatment.

Nobody can control age, ethnicity, race or family history. But you can control those modifiable risk factors by changing lifestyle, especially having a balanced diet, exercise and healthy weight. Lifestyle modification can not only lower your risk of prediabetes or diabetes, but also that of cancer significantly.

 

Image credit: Clipart and CPD

Lifestyle Interventions in the Midst of Three Health Crises

By Hui Xie-Zukauskas Healthy Lifestyle in Right direction_CPD-Clipart combo

As a nation, we are facing three health crises: (1) Chronic diseases, (2) Obesity, and (3) Opioid epidemic.

The facts and figures below tell a sad story.

Impact of three health crises in the U.S. (estimated in 2016)

 

 

Morbidity

 

Mortality

% of All Death
Chronic diseases 25% of adults had two/more chronic health conditions. 595,690 deaths (cancer);  610,000~ deaths (heart disease) 48%
Obesity epidemic 36.5% of adults were obese; 35.6%, overweight. 300,000+ deaths (obesity attributable) 18%
Opioid overdose   59,000 – 60,000 deaths  

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Chronic diseases not only affect health and quality of life, they also add economical and social burdens. Specifically, about 86 percent of all health care spending goes towards treating individuals with one or more chronic conditions.

On the bright side, just eliminating three risk factors – poor diet, inactivity, and smoking – would prevent: 80% of heart disease and stroke, 80% of type 2 diabetes, and 40% of cancer, according to the Centers for Disease Control and Prevention (CDC).

It’s clear that poor lifestyle choices are key contributors in developing preventable chronic diseases such as cardiovascular disease, hypertension, diabetes, several types of cancer, and obesity. Lifestyle modification or intervention is not something new. However, it’s quite challenging to achieve and sustain success. So, here I will emphasize some key strategies and points you can use to fight these health crises personally.  

1. Keep a healthy diet. Intake a diet rich in vegetables, fruits, fish, beans, whole grains, nuts and other nutrients.

-          Reduce fats, sugar and salt in your diet, which may be packed as hidden ingredients in processed foods.

-          Reduce red meat, animal meats consumption too.

2. Participate in physical activity. Aim for a minimum of 150 minute exercise each week.

A combination of diet and exercise is effective in maintaining healthy weight. Take advantage of summer outdoor activities (e.g. swimming, walking, or playing at beach).

3. Quit or avoid addictive behavior such as tobacco, alcohol and illicit drug use.

-          Tobacco smoking takes more than 480,000 lives each year.

-          Rather than seeking substances as a mean for momentary pleasure, living a healthy lifestyle is an excellent regimen for meeting one’s physical, emotional, and social needs.

4. Maintain healthy weight. Weight control is about energy balance, i.e. Energy In = Energy Out. When energy intake exceeds energy expenditure, weight gain occurs.

-          Do eat good breakfast, and consume enough fibers and proteins.

-          Avoid emotional eating.

-          Yes, it’s not easy to make a big change. One step at a time. Don’t go it alone, lock arms for support and motivation.

5. Manage stress. There are many techniques to relieve stress, but the best ones are enjoyable, self-help ways that work for you.

-          Importantly, keep counting your blessings, because gratitude is a secret to happiness.

6. Get a good night’s sleep. Many people overlook this issue.

-          Lack of sleep for a long time may increase your risk of obesity, diabetes, and cardiovascular disease.

-          Sleep hygiene is essential to getting sound sleep (see previous article)

All of above healthy habits will effectively reduce triglyceride levels, cut blood sugar levels, minimize waist circumference, and lower blood pressure. As a result, most chronic conditions and obesity are preventable, and some can even be reversed.

So, go for a healthy, vibrant lifestyle!

 

Image credits: https://openclipart.org/; CPD

New on How Critical Your Sleep Is and How to Optimize It

By Hui Xie-Zukauskas

5 Sleeping babies_comboDo you toss and turn at night? Do you have difficulties in getting to sleep or staying asleep or both?

If the answer is “YES”, you are a part of the statistics as to an estimated 60 million adults in the US suffering from a sleep disorder. But, taking it lightly is risky.

Previously, I discussed about how sleep disorders may increase a risk to cancer by weakening or disrupting the immune functions and promoting inflammation (see CancerPreventionDaily.com). In this post, I’d like to share some intriguing updates emerged from a new perspective.

Notably, I’m also providing a “Sleep Regimen” in ROOM that is memorable and actionable for a better sleep.

First, let’s dive into recent interesting discovery on serious sleep disorder.

As you may know, sleep apnea is a serious sleep disorder with trouble breathing during sleep; in particular, a halt/stop to breathing may last 10 to 30 seconds and numerous episodes a night. So, it’s potentially life-threatening if left undiagnosed or untreated.

Sleep-disordered breathing, e.g. sleep apnea-hypopnea syndrome (SAHS), contributed to cancer development – based on the animal studies simulating SAHS’ characters, i.e. nocturnal irregular hypoxia (deprivation of oxygen to the tissue) and sleep breakup. Repetitive hypoxia and reoxygenation influenced tumor generation by fueling new blood vessel formation and cancer cell growth. Furthermore, human studies found that higher cancer incidence and mortality are observed in patients with severe sleep-disordered breathing.

Sleep disorders (varied from chronic insomnia to obstructive sleep apnea) have also been linked to many chronic conditions, such as stroke, heart failure, lung diseases, neurological disease, kidney disease, and depression, just to cite some, in both adults and pediatric populations.

Overall, insufficient/poor sleep can impact your health, happiness, safety, career, and quality of life.

Next, how to optimize your sleep

There are multiple ways to enhance the quality of your sleep, e.g. healthy lifestyle, exercise, stress-relief, pain management, etc. However, “sleep hygiene” is one of the top fundamentals, and you can gain direct benefit.
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That’s why I’d prefer a non-pharmacological management, and recommend specifically a “Sleep Regimen” in a simple, memorable ROOM to assist you optimize your sleep. Here is how it works.

R: Rest, Relax, and have a Ritual to unwind before your bedtime.

O: O=0 Zero distractions. Distractions range from electronic/mobile devices, TV/radio, bright lights, noises, air, plus Temperature (an important factor – not too hot or too cold), so eliminate or minimize them from your night environment.

O: O=0 Zero food or stimulant drinks, including alcohol, coffee, sugary drinks and/or stimulant medications. Limit water intake too. No meal intake 2 hours prior to your bedtime.

M: Mandate the time and mattress. It is critical to ensure your premier sleep time (7-8 hours per night); go to sleep at the same time and wake up at the same time every day, and stick with it even during the weekend. Remember: Invest a really good, comfortable mattress.

Let me recap it – Design or create and utilize the R.O.O.M. consistently.

In addition, find out the cause of your sleeping problem(s), and don’t rely on “sleeping pills”, unless drug intervention is absolutely necessary.

At the end, I wish you sleep like a baby, and smile like a baby too, for your well-being and vitality.

 

Image Credits: Oseias Ferreira at FreeImages.com;

Claire57100, Zinz25, Esudroff, PubicDomainPictures at Pixabay.com

Medication Adherence Is No Trivial Matter

By Hui Xie-Zukauskas

Med.Adherence n ProvidersPayers_CPDn2otherImagine you want that magic pill to lose weight or you just got the right drugs to effectively cure your illness, but in either case, you let the pills sit somewhere around your house… How would it help you?

Sadly, failure to take prescribed medications causes about 125,000 deaths annually, according to the CDC.

That’s why I talk about medication adherence and the consequences of non-adherence. Medication adherence implies that a patient takes the medication(s) prescribed by his/her doctor, following the dosage, time or frequency, duration and direction.

Issues on taking medications have been an age-old yet multifaceted challenge, which has some across-the-board consequences. Adherence is especially low among patients with chronic illnesses. And it often happens among elderly people too.

It may surprise you how significant this matter is. Let’s start with reasons for adherence.

Why should a patient take medications faithfully and rigorously?

Medication adherence and therapeutic satisfaction are profoundly tied together.

  1. Your adherence to correctly prescribed medication is essential to clinical-efficiency, cost-effectiveness and positive outcomes.
  2. Adherence to the right regime or course of therapy prevents the development of adverse drug events (ADEs) or adverse drug reactions (ADRs) in many ways.
  3. In the sphere of “cost”, if you try to reduce medication cost by taking it irregularly or delaying the refills, the full therapeutic pay off will not be achieved, and worst, a risk of declining health and increasing cost will transpire.
  4. Non-adherence can lead to hospital readmission, esp. in cases of critical health problems, and potentially affecting clinical quality improvement.
  5. Non-adherence is a $ Multi-Billion problem. “Between $100 and $300 billion of avoidable health care costs have been attributed to nonadherence in the US annually.” (Iuga & McGuire. Risk Manag Healthc Policy. 2014; 7:35-44)

It’s worthy to emphasize that many biological events in the body take place between drug dose and its response, including the release of the drug, absorption, distribution, metabolism, secretion and clearance. Plus, drug interactions with coexisting substances or factors could be severe or subtle. So, non-adherence to medication could result in some unanticipated incidents.

So, what are likely roots of non-adherence?

They can be divided into TWO categories: System (external) and Patients (internal)

Systems / External to Patients – just name a few

  • Discontinuity of care – esp. from hospitalization to subsequent discharge home when lacking a proper direction
  • Multiple changes in medication regimens
  • Inadequate education or instruction of drug use to patients
  • Lack of information on side effects of drugs and preventative measures
  • Drug design itself: e.g. formulation, packaging, inconvenience or high cost, etc.

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Patients / Internal Causes

  • Failure to fill the prescription at the start
  • Failure to refill the medications consistently
  • Forgetfulness – esp. in older people
  • Exhaustion of multiple medications
  • Discontinuity due to a side effect, fear of side effects, finance or misled information
  • Inappropriate use of medication
  • Intentional decision to not take the medication
  • Lack of understanding diseases or poor health literacy
  • Physical difficulties, esp. with swallowing big tablets or capsules, opening bottles or containers, or obtaining prescriptions.

Understandably, non-adherence may occur above all when a patient’s expectation for therapeutic benefits goes beyond the actual benefits, or when medication cost is greater than a patient anticipated.

If non-adherence is an issue for you, it’s time to reflect and deal with the root problem following the explorative list above. Surely it could be something outside it.

Finally – How can you stick to your medications?

Medical adherence is one of keys to better health care. Interventions to reinforce adherence from clinicians and allied health professionals need to be improved. On the other hand, I’d like to highlight what you can do to stay on your medication regimen and optimize your health.

10 Strategies & Tips for Medication Adherence

  1. Take a driver’s seat for your care. Before a drug prescription, talk with your physician to understand why the medication is needed and what benefits it produces. By making a mutual agreement or decision, it will enhance your adherence in the beginning.
  2. Counsel with a pharmacist at your local pharmacy if you have any concern or trouble with your drugs, and they are happy to help with adequate knowledge and advice. Bonus – it’s free of charge.
  3. Comply with the instruction. This is very important as mentioned earlier that drug dosing can impact your body in various ways. For example, some drugs need to be taken in the morning and others in the evening; some once a day, others four times a day; some with a full stomach, others with an empty one…
  4. Have a self-management system – i.e. use a pillbox, take the medication at the same time each day and ideally couple it with a specific daily task or routine, color-code different time points, refill the medications at the same time each week, and order your medications 7-10 days ahead… you got the idea. It’s practical and effective, esp. for older people who use multiple drugs or drugs that must be taken several times a day.
  5. Find a creative way to remind yourself. It could be a sign, a framed memo or a decorated item/box, or an alarm. And make sure it’s absolutely visible.
  6. Take advantage of technology. It could be a medication reminder app or a dedicated digital calendar. Most helpful, set the alarms, esp. smartphone reminders or some cell phones allow you to set multiple alarms a day.
  7. Reduce financial stress by trimming costs down. If your meds cost too much, consult with your pharmacist for a generic brand or current regimen adjustment. In addition, you can switch to a mail-order pharmacy, which certainly offers more savings.
  8. Get help and support from family members, care givers or doctors whenever necessary, e.g. reminder, refilling, or ideas.
  9. Change attitude and take control of your health. Concerns, denials or doubts are real, but none of them is the right solution to your illness. Find a motivation to take that pill, and it should be bigger than you.
  10. When you travel, make sure to take an extra 1-2 days of medications in case of a delayed schedule. Always keep your meds in your carry-on bag. On a similar note, if you’re dining out, take the required meds with you.

The Take-Home-Message:

#1  “Drugs don’t work in patients who don’t take them”. 

#2  Drugs don’t perform well in patients who don’t take them with a right dose, at a right time and in a right way.

#3  Medication adherence can maximize therapeutic benefits. Failure to do so causes considerable health, clinical and economic consequences.

 

Image Credits: Pharmaceuticalonline.com; Lifescript.com

 

Two Critical Matters in Colorectal Cancer Early Detection

By Hui Xie-Zukauskas

Time for cancer screening_Clipart library & CPDAccording to the American Cancer Society (ACS), an estimated 135,430 cases of colorectal cancer (CRC) will be diagnosed and an estimated 50,260 CRC deaths will occur in 2017 in the United States.

Zeroing in on the numbers: within the predicted colorectal cancer incidence, 71,420 will be men and 64,010 will be women, and deaths will be 27,150 among men and 23,110 among women. Consequently in cancer deaths, CRC is the second leading cause in men and the third leading cause in women among Americans. Worldwide, CRC is the third most common cancer.

These numbers make clear that CRC affects both men and women, in contrast to a myth that CRC is primarily a man’s cancer.

The good news is that most colon cancers are preventable! YES!

Yet, why are the statistics so large? Here are two areas many people often ignore or miss:

  •  Lack of adherence to the screening recommendation
  •  Delay in presenting symptoms to a physician/oncologist

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Let me weigh in a bit more on each of these issues.

Adherence to screening and the value of colonoscopy

Let’s start with ACS screening guidelines: “Starting at age 50, men and women at average risk for developing colorectal cancer should use one of the screening tests…” This is because about more than 90% of this disease is diagnosed after age 50. For individuals who have a 1st degree family member or relative with colon cancer, exams should start at an earlier age (e.g. ages 40).

One recommended screening test is colonoscopy, because it can not only detect cancers at their earliest, most treatable stages; it can also detect pre-cancerous polyps that can be removed during the exam before they become cancerous.

In reality, 50-60 percent of Americans who are recommended to get screened comply with the guidance. The lower screening rate might partially explain why only about 40 percent of colon cancers are diagnosed at an early stage (i.e. localized in colon or rectum).

Why should you go for a colonoscopy screening?

  1. You gain significant value. Your anxiety, fear, or even feelings of embarrassment may be understandable. However, consider this: Individuals undergo this exam of high quality under a comfortable, sedated condition, during which the entire colon and rectum are visualized by a qualified gastroenterologist. Pre-cancerous polyps can be found and removed safely. Can you see that this is a very valuable package of diagnosis and therapeutics for your colon health care? 
  2. You acquire rigorous clarity concerning your colon health. We want rigorous clarity in science, and surely, everyone wants thorough clarity when purchasing a house or insurance policy. It makes sense to seek rigorous clarity about a matter so critical to your health. If the result is normal, the colonoscopy should be repeated every 10 years up to the age of 75. If the test detects pre-cancerous polyps, the physician will recommend repeating the exam more frequently.
  3. You benefit from one of the most effective cancer prevention methods, and it is often covered by insurance.

Help your physician to help you by presenting any indications

In some cases, especially at an early stage, colon cancer may present no symptoms. Again, that’s why screening is vital to identify cancer early when prognosis and cure are optimistic.

Nevertheless, other folks may experience symptoms such as:

-          Blood in the stool or rectal bleeding

-          Abdominal pain or discomfort

-          Feeling the bowel incompletely empty, or bloating

-          Sudden changes in bowel habits (diarrhea, constipation, or oddly narrow stools)

-          Unexplained fatigue or weakness

-          Unexplained weight loss

Remember, nobody can read what’s on your mind or what’s going on in your life. If you don’t visit or communicate with your doctor, it’s likely he or she won’t know about your cramps or unexplained changes in your bowel movements.

So, devoting yourself to meeting screening guidelines is a key preventive measure, but another critical area is to counsel with your physician about possible warning signs.

In addition, an important step to preventing colorectal cancer is to know its risk factors. These factors can be categorized as:

-          Uncontrolled: age, colon polyps, family or personal history of cancer, esp. CRC

-          Pathological: obesity, diabetes, inflammatory bowel diseases

-          Controllable or Preventable: sedentary lifestyle, tobacco smoking, heavy alcohol consumption, diet with low-fiber but high-fat (esp. animal fats)

To conclude, for colorectal cancer early detection, as for all cancer risks:

#1 Cancer screening is your first crucial preventive step.

#2 Recognizing risk factors and warning signs is your second vital protective weapon.

Image credit: Clipart library & CPD