Bowel cancer
Early detection offers cure
Cancer of the lower bowel (also called colorectal cancer) is one of the
most common cancers in the western world and affects about 1 in 20 people.
Men are affected only slightly more than women. The usual age of diagnosis
is over 50, the risk increasing with age, though younger people even in
their 20s have been diagnosed. The causes seem to be genetic though we do
not yet fully understand inheritance patterns. Diet and lifestyle factors
do play a role and guidelines for reducing the risk of colo-rectal cancer
have been developed.
Guidelines for prevention of colorectal cancer include:
Regular physical activity 30-60 minutes per day.
Restrict alcohol intake.
Do not smoke.
Keep weight in healthy range. Restrict calorie intake – men less than
2,500cal/day, women less than 2,000cal/day.
Reduce dietary fat to less than 25% of daily energy intake.
Eat 5 or more portions per day of vegetables and fruit.
Limit intake of processed meats.
Consume poorly soluble fibre (e.g. wheat bran) if at high risk of
colorectal cancer.
Ensure dietary calcium intake of 1,000-1,200mg/day.
Symptoms are variable and may not occur early on in the disease. Things
to report to your doctor include any change in your bowel habit, such as
constipation or loose bowel actions, increased wind, pain or mucous, and
any sort of bleeding - bright or dark, mixed with bowel action or on the
toilet paper. Unexplained weight loss and anaemia (low red blood cell
count) may also be symptoms and your doctor may want to test further to
exclude bowel cancer.
The key test for investigating the large bowel is called a colonoscopy.
A specialist uses a long fibre-optic tube passed via the anus, to view the
entire lining of the large bowel and take samples of any areas that look
suspicious. Most people are sedated and have no discomfort at all with
this procedure. Preparation of the bowel with special drinks to flush it
clean is an important part of the test.
Patients at increased risk include those with a close relative diagnosed
with bowel cancer before age 55, those with multiple growths on the bowel
called polyps, and those with chronic inflammatory bowel disease (such as
ulcerative colitis). For these higher risk groups, colonoscopy is usually
offered at least every 5 years to detect any cancers early when treatment
is most effective.
A much simpler investigation called a Faecal Occult Blood Test (FOBT)
can be offered as a screening test. This detects microscopic amounts of
blood in the bowel action which may indicate a problem. If the test is
positive, a colonoscopy is usually recommended. The FOBT may be done every
2 years in people over 50. In some countries, recent research into
widespread use of this test is showing positive results in increasing
early detection of bowel cancer.
Advances in surgical techniques and chemotherapy for bowel cancer in
recent years have provided a much better outlook for length and quality of
life, even when the disease is advanced. However, early detection gives the
best chance of cure.
Lentils – a tasty source of good nutrition
Lentils are the dried seeds of a small bushy plant. They belong to the
legume plant family. Unlike other dried legumes such as peas and beans,
lentils do not need soaking and cook more quickly.
Lentils are an excellent source of plant protein, are low in fat and are
a good source of carbohydrates and fibre. They provide many vitamins and
minerals, especially folate, calcium and iron.
Lentils can be bought ‘whole’ or ‘split’. Generally they have a mild
earthy flavour and readily absorb stronger flavours. Some of the commoner
types of lentils are:
Black – Beluga, are small and plump. When cooked they are firm and
glisten like caviar. They can be used in soups and salads.
French green – puy, have a delicate peppery flavour. They need a
slightly longer cooking time and will hold their shape. Use in salads and
to accompany fish.
Brown – continental. They hold their shape when cooked but will become
mushy if overcooked.
Split lentils - known as dhal, are used extensively in Indian cuisine.
The most common are yellow and red and are used in soups and purees. When
cooked they turn a golden colour and have a mild spicy flavour and break
down to a puree. Moong dhal are mung beans that have been skinned and
split. They are yellow and cook very quickly.
Lentils will keep for over a year when stored in a cool dry place.
Before cooking wash in several changes of water to remove dust and grit.
Spread on a chopping board or clean tea towel to check for small stones.
They will become tough if salt is added before they are cooked.
Dhal is a traditional Indian dish. It can be eaten by itself as a thick
soup or served with curries.
Dhal (Lentil Puree) (serves 4-6)
250g red lentils
1 tb oil
1 large onion, chopped
3 cloves garlic, chopped
2 tsp grated fresh ginger
½ tsp ground tumeric
1 tsp ground cumin
1 tsp ground coriander
Wash lentils. Gently fry onion, garlic and ginger in the oil until soft.
Add tumeric, cumin and coriander and stir fry for a few minutes. Add
drained lentils and 3 cups water, cover and simmer until lentils are soft.
Add salt to taste. Continue cooking until thick.
Peanut allergy in children on the rise
A recent article in the Lancet medical journal points out that peanut
allergy in children is on the rise worldwide though we do not yet know
why. About 3 in every 100 preschool children are allergic to peanuts.
Medical diagnosis is made based on the pattern of symptoms and further
testing. As many as 1 in 5 children may outgrow their peanut allergy by
the age of 6 years, as the immune system matures.
There is a risk of anaphylaxis (sudden life-threatening reaction) with
peanut allergy. Anaphylaxis usually occurs when a peanut is eaten rather
than when skin or airborne contact with peanut protein occurs. Parents and
carers need to know how to avoid peanuts and how to respond to signs of
allergy. Common medications that may be required include adrenaline,
antihistamines and sometimes corticosteroids. A written emergency plan
should be provided to all carers of the child.
Strategies to reduce allergy in the future may include genetically
modifying peanut proteins. This is complex as several proteins can be
involved with allergy. Other strategies involve modifying the body’s
immune response. In the meantime, we rely on the education of all child
carers in managing this potentially lethal condition.
Vitamin D has many health benefits.
Vitamin D is a fat soluble vitamin that regulates calcium absorption
from the gut and uptake of calcium by bones. The sun’s UV radiation
converts sterols in the skin to vitamin D.
Lack of Vitamin D is associated with softened bones (osteomalacia) and
deformed bones (rickets) in children. Recently, an increasing number of
studies are indicating that maintaining high vitamin D levels may be
important not only for bone health, but also to prevent cancer, heart
disease, diabetes and multiple sclerosis. There is evidence that low
levels of the vitamin increase the risk of prostate cancer, lymphoma and
breast cancer.
An American study of middle-aged patients showed that those with
moderate vitamin D deficiency were 62% more likely to have a stroke, heart
attack or heart failure than those with higher levels.
At the equator, plenty of vitamin D is made during normal daily
activities. When UV levels are lower, sufficient vitamin D levels may
require 2-3 hours per week of sun exposure. Dark skinned races and people
who completely cover their skin are at risk of deficiency. A simple blood
test can detect vitamin D deficiency and indicate whether supplements are
needed.
New treatments improve MS outlook
Multiple sclerosis (MS) is a disease of the nervous system and the most
common non-traumatic cause of neurological disability in young adults. The
first symptoms usually occur between the ages of 20-40 and it affects twice
as many women as men. The latest research has so far not found the cause
but there are definite genetic associations, possibly modified by
environmental challenges. MS is more common as one moves further from the
equator. Several theories including vitamin D levels and viral triggers
are being investigated.
It appears to be an autoimmune condition where inflammation damages
myelin, a protein which coats the surface of the brain and spinal nerves.
The damaged areas become scarred, hardened (sclerotic) patches, affecting
the function of the nerves and brain cells. There can be many different
sites causing a variety of symptoms. As well as being quite variable, the
symptoms may come and go at different times and can mimic other disorders.
This often makes diagnosis tricky. Possible symptoms include fatigue,
blurred (or ‘double’) vision, loss of balance and coordination, vertigo or
dizziness, muscle spasms or tremors, areas of ‘pins and needles’ or
numbness, bladder or bowel problems and sometimes partial or complete
paralysis.
There is no single test for MS but Magnetic Resonance Imaging (MRI) is
now widely used to help make the diagnosis. Early diagnosis and new
treatments aimed at the immune system can now significantly improve
symptom-free periods and reduce long term disability. Many expensive
alternative therapies are not supported by good evidence and the current
recommendations are for a balanced healthy diet, high in fibre and low in
saturated fats. There is no evidence that omega-3 supplements are of
benefit. Exercise can sometimes bring on symptoms but patients should
continue with exercise to the limit of their physical condition. Studies
show that smoking is a risk factor for MS, and smokers with MS who stop,
do better than those who continue. Alcohol may aggravate symptoms and
should be used with care.
Pregnancy has a more or less neutral effect on the disease so is still
an option for women with MS, though it may limit treatment options.
Prognosis is difficult to predict and ranges from 10-15 years with no
disability, to steadily progressing disability. Whilst many advances are
being made into our understanding of this disease, and new treatments are
becoming available, we still cannot cure it. Thankfully, the majority of
people with MS do not become severely disabled.
Health News in Brief
Researchers find adults grow new fat cells
International scientists headed by Peter Arner of the Karolinska
Institute of Sweden have reported that 10% of our fat cells die and are
replaced each year. They found that fatter people have about 50% more fat
cells than thinner people. The number of fat cells may be set in pre-adult
life and weight changes do not alter that number, only the volume of each
cell. New research could be directed at reducing the formation of new fat
cells as old ones die off.
Vitamin D linked with depression in elderly
A study reported by Dutch researchers in the Archives of General
Psychiatry has shown a link between low levels of vitamin D and depression
in older adults. Those with depression had vitamin D levels 14% lower than
those without the illness. Both minor and major depression were
represented as having lower vitamin D. The question of which came first –
the depression or the low Vitamin D levels has not been answered and
requires further research.
Children as young as 6 have severe eating disorders
A new report from Australia’s Westmead Hospital shows anorexia and
starvation in children as young as 6-8 years is becoming more common. The
disease is often more severe in children and is not being picked up early
enough to prevent severe medical problems. Untreated disease does
permanent damage but treatment success rates in children are high, with
70% becoming well within a year.
Alcohol ups cancer risk
A new study from the New South Wales Cancer Institute shows that 4
standard drinks a day increases a man’s risk of bowel cancer by 64%. Just
2 drinks a day increases a woman’s risk of breast cancer by 22%, while for
both men and women, 2 drinks a day increases the risk of mouth cancer by
75%.
Some good advice on keeping your blood pressure down, and choosing a surgeon
Keep the lid on that pressure
High blood pressure claims millions of lives prematurely each year
around the world as well as 76 million healthy years of life, according to
a recent study.
In case you’re complacent about your own blood pressure, the researchers
took as their starting point 115mm systolic – that’s the top number your
doctor measures. 115mm is the average blood pressure in people and places
with a low risk of heart disease and stroke.
The findings showed that most people who get into grief because of their
blood pressure are just on the edge of having high blood pressure – in
other words not high enough to need pills. It means that all of us need to
do something to bring it down, like reducing alcohol intake, losing weight,
taking exercise daily and reducing salt intake.
Choosing a surgeon
If you need an operation, what are the right questions?
One is how many of these operations the surgeon does a year? The
usefulness of the answer depends on the operation. The more major and the
higher the risk, the more important doing a lot of them a year becomes but
the trouble is that no-one’s too sure what the right numbers are.
And what about smaller, safer operations? Swedish researchers studied
groin hernia repairs comparing the surgeon’s numbers to the chances of
needing a repeat procedure. Reassuringly they found that the cut-off was
five hernia repairs a year. Beyond that, additional numbers made little
difference.
The common cold needs common sense
Each year most people succumb to at least one bout of the common cold.
The symptoms of sore throat, runny nose, mild fever and feeling ‘under the
weather’ are caused by a range of viruses (mostly rhinoviruses) for which
there is no immunization. These are spread by droplets when people cough
or sneeze, and can also be spread by sharing towels or eating utensils,
and close contact. Hand washing after contact with infected people may
help limit spread. It is normal to have 3-5 bouts a year though young
children may have more. Common sense tells us to take time out to rest,
stay away from crowds and drink plenty of fluids. Some tips to help with
cold symptoms include:
The common cold will get better in about a week. Antibiotics do not help
as they do not work against the viruses that cause colds.
Cough is caused by irritation of the trachea (windpipe) by the virus,
and also by increased mucous secretions, which are removed by the cough.
Warm, moist air will help the latter. Warm drinks will ease a sore throat
and dry mouth.
Nasal drops or spray, either saline or a commercial preparation, may
help with stuffiness and runny nose.
Paracetamol will help with fever and aches and pains. Aspirin should be
avoided in children and teenagers as there is a risk of Reye’s syndrome (a
rare life-threatening condition linked with aspirin and viral illness).
See your doctor if symptoms become more severe or are not improving
after 7-10 days.
