Lung Cancer Screening

It’s the number-one cancer killer of both men and women.  Almost 160,000 Americans died in 2016 from this cancer, and it accounts for over 25% of all cancer deaths in the USA.

We have no effective chemotherapy treatment for most cases of this cancer.  Once it spreads, it cannot be cured.

The most effective treatment for this cancer is surgery, but the vast majority of cases have no symptoms until the tumor is advanced.

Until recently we had NO way to screen for this cancer.

This is, of course, lung cancer.  One of the most feared and most difficult to treat tumors in humans, it usually spreads to the bone, the liver, the adrenal glands and the brain.  It is strongly associated with smoking and with second-hand smoke exposure, as well as with some occupational exposures like to radiation, asbestos and radon gas.

After years of research and the development of new less-costly and less-harmful technology, we finally have an effective tool for lung cancer screening.

In 2015 Medicare approved the use of low-dose CT scanning for screening for lung cancer in certain patients.  Most private insurers and Medicaid also cover this screening test although you should check whether your carrier offers this test.

Who is at risk for lung cancer and eligible to be screened?

  • Age 55-77, both men and women
  • NO signs or symptoms of lung cancer like a chronic cough, fevers, night sweats, coughing up bloody phlegm, or unexplained weight loss
  • Current smoker or quit smoking within the last 15 years
  • At least 30 pack-years of smoking history (an average of 1 pack per day for 30 years, 1 ½ pack per day for 20 years, or 2 packs per day for 15 years, for example)

It’s not a one-and-done screen though.  Like mammography, low-dose CT for lung cancer screening needs to be performed every year.  Often there are tiny nodules found on screening that may be scars, may be evidence of old infections, or may be very early lung cancers.  These need to be followed over time to make sure they are not changing and that no new spots develop.

One other important thing to realize is that although the screening CT is covered by Medicare at no cost sharing (like mammograms, Pap tests and bone density tests), any follow up done because of an abnormality WILL have an associated cost based on deductibles and copays.

It is also important to know that an abnormal screening scan produces a LOT of anxiety.  It’s very hard to hear that you have a 1/8-inch spot in your upper left lung, which is too small to biopsy or to scan in any other way, so we’re going to leave it alone and repeat the scan in 6 months.  Wait, what?!  What am I going to do for the next 180 days and nights until it’s time to scan again?  Wait, and worry, unfortunately.

If you meet the criteria above and are interested in being screened for lung cancer, make an appointment to talk to your doctor about it.  This should happen at a well visit so if you haven’t had your physical in over a year you should definitely call and schedule it.

Lung cancer kills more Americans than any other cancer.  It is difficult to diagnose early enough to be able to treat it effectively.  Low-dose CT scanning is the best tool for lung cancer screening we’ve ever had.

PS – If you meet the criteria to be screened for lung cancer and you are still smoking, you need to cut down and quit.  Today.  I know that goes without saying, but I just needed to say it anyway.

QUESTION: Do you meet criteria for lung cancer screening?  Have you had a low dose CT scan?

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Gastrointestinal Bleeding

Today started out as an ordinary day.  You’re going about your business as usual when you start to get a little crampy lower stomach pain.  You know that feeling, when you’ve got to find a bathroom?

No biggie, you head to the bathroom and have a seat.  After you’re done and tidied up, you stand up and get a big shock.  The toilet is full of blood!

Two patients this week have come in with similar stories so, in the interest of giving my readers an idea of what to do if something similar happens to them, I figured I’d better write about gastrointestinal bleeding.

Gastrointestinal bleeding is, as the name implies, bleeding that happens anywhere in the GI tract.  The most common places for bleeding to happen are in the stomach and first part of the small intestine (called upper GI bleeding) and the colon (called lower GI bleeding).

Let’s talk about upper GI bleeding first.  This is often caused by an ulcer in the stomach eroding into a blood vessel. There may be pain, but there may not.  The bleeding can be brisk, or it can be a slow seep that has no obvious symptoms but gradually results in iron-deficiency anemia.

Significant bleeding in the stomach can cause the stool to become very dark.  If the bleeding is very brisk the stool can become black and tarry and smell like blood or raw meat.  Generally upper GI bleeding will not cause red blood in the stool.

When fresh blood is digested by stomach acid it looks like coffee grounds.  Because blood is irritating to the inside of the GI tract, gastrointestinal bleeding often causes vomiting and diarrhea.  Another sign of an upper GI bleed is vomiting up a substance that looks like coffee grounds.

What about lower GI bleeding?  Usually that IS bright red.  Many things cause lower GI bleeding, from colon cancer to anal fissures to hemorrhoids to diverticulosis.  It may be just small amounts passed with formed stool, or it may be enough to completely fill the rectum and scare the pants off you when you look into the commode.  There may or may not be pain.

One word about bleeding from the small intestine – it usually does not cause obvious blood in the stool.  Generally small intestine bleeding is found because of iron deficiency and a positive test for blood in the stool.  This diagnosis is difficult to make and thankfully is not common at all.

So what do you do if you think you may be bleeding from your GI tract?  First of all, DON’T PANIC!  In nursing school, medical school and EMT training they teach you in an emergency, first take your own pulse.  It’s a little bit of a joke, but it’s a good time to mention that staying calm is the first order of business.

After you’ve taken your pulse (or a couple of good deep breaths) you should call your doctor.  He or she should be able to at least tell with a couple of questions whether you are safe to wait until you can be seen in the office, or whether you should get checked out right away at the urgent care or emergency room.

In general the evaluation for GI bleeding involves stopping the bleeding, finding and treating the source, and reducing the risk that it will happen again.

If you develop black, tarry stool, vomiting up something that looks like coffee grounds, or bright red blood in the stool (without a known history of something harmless like hemorrhoids) you should call your doctor right away and get it checked out.  The cause could be life-threatening.

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When Fear Blocks Transformation

One of my patients, let’s call her Anne, is massively obese.  She is a very sweet woman with a supportive husband and family.  Her family is well off financially and she is educated.  Why on Earth would she struggle so with her weight?

She has the means to hire the most expensive trainers available.  She could build an entire gym in her own home.  She can buy potions and pills and exercise videos galore.  Why can’t she lose weight?

I’m not sure, not with any real confidence, because we haven’t taken the time to dig into the whys and wherefores.  I’m not a trained counselor, after all, and it’s not something we can really get into in the confines of a 15-minute visit when I also have to address all her medical problems and refill all her medications.

But if I had to venture a guess, I’d say she’s scared.  Terrified, even.  There is something about the PROCESS of weight loss that has her so frightened it is easier for her to stay massively obese than to tackle her weight.  What can we do when fear blocks transformation in your health, your career, your life?

Lately I’ve been doing some reading in the leadership coaching industry in the interest of skilling up my ability to help patients with behavior change.  I AM first and foremost a coach, after all.  I’m not a surgeon to take out appendices or cancerous growths.  My most effective tool is my ability to help patients change their lifestyle to change their health for the better.

One of the most fascinating insights I’ve had in the reading I’ve been doing is the idea that patients resist change not because they don’t want the results but because they’re scared.  They see the goal, they know how to get there, they’ve gotten practical advice and a roadmap that works.  But there is something about the roadmap that scares them to death.

Even though I don’t know what Anne’s fear is, I know there is one.  Something about weight loss triggers her brain’s threat response and makes her completely UNABLE to move beyond that point in her efforts to get healthy.  We can speculate that maybe as a child her parents withheld food as a punishment.  Now anytime she even THINKS she might get hungry that threat response is triggered and she compulsively seeks to eat to reassure herself that she is not that helpless child anymore.

Maybe she has confined herself to the role of a sick person so thoroughly that if she gets healthy she won’t know who she is anymore.  She’s afraid her husband won’t take care of her anymore if she is able to care for herself.  Maybe she’s afraid if she loses weight he’ll want to have sex with her again and there’s a history of sexual abuse in her past buried so deep she can’t bear to remember it.

I don’t want to speculate about my friend Anne.  I would love to have the time to sit down with her and really dig in with her as a willing participant, to figure out what frightens her so.  I KNOW something does, because she tells me she wants to lose weight but we can’t make any headway.  She’s not weak, not weak-willed, and not self-sabotaging.  She’s afraid.

What about you?  What are you doing that you KNOW is hurting your health?  Do you eat the wrong foods when you KNOW which foods will support your body’s health and even know tasty recipes to cook them for yourself and your family.  Do you continue to smoke even though you hate every stupid cigarette you take out of the pack?  Do you find yourself making excuses about exercise even though when you drag yourself to the gym you feel amazing and sleep so much better?

What scares you?  What’s holding you back?  I would love to have you email me at drjen@jenniferwurstmd.com and tell me about it.  I will let you in on a secret – once we address that fear and make a plan to help you feel safe, you will be able to transform your habits, meet your goals and make your life even more amazing than it is now.

I’m a coach, after all.  This is what I do.  I help people transform their health and, by extension their lives.  But I can’t do it alone.  I need you to be brave, be honest and real and raw.  I will not judge you – I make my living dealing with real people and real problems.  Send me an email at drjen@jenniferwurstmd.com and let’s get started!

QUESTION: Would you like to share one of your fears?  I’ll start – I eat too many sweets because they soothe me when I’m stressed (stress = fear).  One of my goals is to find ways to soothe stress that do NOT involve food.  I have good days and bad days with that, like most of us.

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Info For Cancer Survivors

In my practice I care for a large number of cancer survivors.  Breast cancer, colon cancer, bladder and prostate cancer, even appendiceal and esophageal cancer survivors are among my patients.

This week I am attending an adult medicine conference and one of the talks was about caring for cancer survivors.  Today I want to review my big two take-home points from that lecture.

First of all, let’s talk about our definitions.  What is a cancer survivor.  Well, if you have been diagnosed with cancer, from that day for the rest of your life you are a cancer survivor.  That’s a LOT of people.  In fact there were estimated to be almost 15 million people in the US and over 500,000 Ohioans (as of January 2014) living as cancer survivors.

Many people don’t realize that once you are a cancer survivor, one one hand you are very different from a medical standpoint from those who have never experienced cancer.  And on the other hand, you are no different at all.

Let’s review the differences first.  Once you have received treatment for cancer you have specific needs and health risks related to your cancer and its treatment.  If you received chemotherapy, radiation or surgery you may have aftercare needs related to those treatments.  For instance, some chemotherapy agents can damage your nerves or cause other long-term side effects.  Radiation to certain parts of the body can increase the risk of damage to healthy tissue in the radiation field.  Colon cancer patients may wind up with a permanent colostomy which obviously requires care long-term.

Survivors of childhood cancers have special needs that will have to be monitored by their physicians.  Learning difficulties, future fertility concerns, and other considerations will need to be addressed.

Any cancer survivor should have a complete survivorship plan developed by their oncologist within 6 months of finishing treatment.  The patient, the oncologist, AND the primary care physician need to have copies of the survivorship plan.  The patient should clearly understand what they will need to have done in the future, how often, and why.  Any long-term effects of treatment should be explained thoroughly with descriptions of symptoms to watch for.

This was my first take-home point.  Cancer survivors have unique needs that depend on the type of cancer they had and what treatments they received to address it.  This makes every survivor different and their survivorship plan must reflect this.

The second take-home point was actually the direct opposite.  Cancer survivors are no different from anyone else in that they need their routine screening exams performed on-time.

Many cancer survivors (including one in particular that I know very well) are content to use their oncologist as their primary care doctor, even years after their treatment is complete.  Oncologists are NOT primary care doctors.  They will not assess your cardiovascular risk and check your cholesterol.  They won’t discuss contraception and STD screening.  They may or may not check hepatitis C and bone density.

Also, many cancer survivors don’t feel they need to be screened for OTHER cancers.  They believe (incorrectly) that they have used up all their bad luck in having one cancer.  Cancer survivors should be aware that their risk of all other cancers is the same as or higher than those who have never had cancer – it will NEVER be lower.  And in many cases the treatment for their first cancer INCREASES their risk of developing a second cancer (so-called secondary malignancy).

This is my advice for cancer survivors.  By all means focus intensely on surviving your cancer.  Get through your surgery, chemo, radiation, all the treatments prescribed by your oncology team.

However, when your treatment is finished, make sure to sit down with your oncologist and get a comprehensive survivorship plan.  This document (and it will probably be a long one full of words you may not understand) should be explained to you in language familiar to you.  It should contain all the details of the treatments you received, including amounts of radiation and chemo drugs delivered.

Your survivorship plan should also detail follow-up testing you will need, how often, and for how long.  For instance, certain chemo drugs (like Adriamycin and Herceptin which are used in breast cancer) can harm the heart muscle and testing should be done periodically to make sure the heart is functioning well after treatment.  As another example, those who received radiation therapy to the chest for Hodgkin’s lymphoma are at higher risk for breast cancer.

If you have survived cancer, it is even more important that you take good care of your body.  Eat healthy and avoid smoking, using drugs and drinking alcohol to excess.  This means limiting alcohol to an average of two drinks per day for men and one for women.  Get plenty of exercise, drink clean water and avoid toxic exposures like industrial chemicals and heavy metals.  Make sure you are up-to-date on appropriate vaccines.  Get good sleep, manage your stress, and maintain a healthy weight.

God willing, you will have many years of life as a cancer survivor.  Your survivorship plan will spell out the road map for you and your primary care doctor to keep you healthy for many years to come.

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How To Choose A Multivitamin

I get asked all the time “What multivitamin should I take?”  My answer is usually to recommend Shaklee’s multivitamin of course 😉 but sometimes I can’t discuss product brands by name.

This week I got an email from Dr. Steve Chaney, a PhD biochemist and professor emeritus from the University of North Carolina where he taught nutrition to medical and dental students.  If you’re interested in such things, please subscribe to his website at by clicking this link.  And you can scroll down to see his post from 3/28 which is what inspired me to write about this topic this week!

This week’s email was about how to choose a multivitamin and his suggestions were fascinating and so USABLE!  Here are the three takeaways that struck me most from Dr. Chaney’s email.

Before you read any further, go get your multivitamin bottle.  You’ll want to look at the label as you read this article.

Your multivitamin should be COMPLETE

There are 24 nutrients for which the US FDA has set Daily Values (DV).  The DV is the amount which is judged to be able to prevent nutritional deficiency in nearly all healthy individuals.  Notice this is not necessarily OPTIMAL intake, just what is needed to prevent deficiency in healthy people.  Those who have medical problems may need different amounts.  The DVs also vary based on age, gender, pregnancy and lactation status.

Your multivitamin should have all 24 nutrients (23 if it doesn’t contain iron).  Count them to make sure.  If it doesn’t have all 23/24, don’t buy it, it’s not complete.

Let’s look at two labels for comparison.  First is the label for Shaklee’s Vita Lea with Iron.

All 24 nutrients are present and accounted for.  You’ll also note that most of the nutrients are present at 100% DV (daily value) or better.  For some (like magnesium, which can cause diarrhea, and calcium, which can cause constipation) the amounts are lower to avoid side effects.

There are also nutrients that the FDA believes are important for humans but there isn’t enough evidence to set a DV.  These nutrients have a “dagger” symbol next to them.  If you see the five trace minerals at the end of the label above, those have the dagger next to them.

Let’s look at another label for a very popular brand of vitamins sold at every grocery store and pharmacy in America.

Credit: Walgreens.com

This one has only 21 nutrients in it.  No magnesium (and if you know me, you’ll know magnesium is one of my FAVORITE nutrients to prescribe), phosphorus or molybdenum.  Not complete.

Your multivitamin should only include safe ingredients

If your multivitamin’s ingredient list includes artificial colors or sweeteners, don’t buy it.  This includes aspartame, acesulfame, and anything that has a color plus a number (like Red 40).  These ingredients have no business in a nutritional supplement.

I want to say a word about gummy vitamins for a moment.  Look at your gummy vitamin’s nutritional panel.  I’ve included a popular one for reference.

Credit: Walmart.com

Definitely not complete.  Here’s the ingredient list:

Credit: Walmart.com

Sugar (3 grams and 10 calories per serving), artificial colors and artificial flavors.  NOT healthy.

Gummy vitamins are candy pretending to be healthy.  If you can find one that’s complete and has no added sugar or unnecessary calories, artificial flavors, artificial sweeteners or artificial colors, by all means buy it and send me the info so I can put it on my website and issue an official apology.  Until then, if you want candy buy candy, but if you want a high-quality nutritional supplement that will support your overall health, a gummy vitamin is worse than not taking a multivitamin at all.

Don’t fall for marketing hype!

If there is no DV or dagger symbol next to an ingredient in your multivitamin, that ingredient probably does not add anything of value to support your health.  (Notice I’m talking about your multivitamin, not herbal products taken for proven health benefits in addition to your multi.)  Similarly, a lot of multivitamins have marketing buzzwords on the label like “organic,” “natural,” “whole-foods,” etc.  Also be aware that the individual nutrients in a multivitamin are highly purified and contain no DNA or protein so “non-GMO” is meaningless.

Companies also will claim that their products are safer than other companies’ products.  Ask for proof.  How do they know?  How many quality tests do they run on their raw materials and finished products?  How often do they issue recalls?  What is the procedure if a customer has a problem with a product?  Is there a guarantee?

Now that we’ve discussed how to make sure a multivitamin is complete, whether its ingredients are safe, and whether you’ve unwittingly fallen for marketing hype, let’s check in with you, Dear Reader.  How did your multivitamin do?  Leave me a comment and let me know!

PS – If you found your multi isn’t all you thought, please check out Shaklee’s Vita Lea multivitamins or email me at drjen@jenniferwurstmd.com with any questions.

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