By Jeri-Lynn Atwood

Lymphedema is one fairly common side effect of cancer treatment where a rehabilitation program can be particularly beneficial for the patient. It’s a condition that arises when structural damage to the lymphatic system occurs following treatments for breast cancer, although it can be associated with other cancers as well. While there is no cure, early diagnosis and treatment improves both the prognosis and the condition.

The lymphatic system is comprised of a series of tiny vessels and nodes throughout the body which transports fluid collected in the spaces between the cells (the interstitium) which the body produces during normal metabolism. This fluid, called lymph, contains proteins, fats, water, cells, and waste products. This complex network collects one to four liters per day then transports the fluid back into the venous system. When the system is properly functioning, the fluid balance within the body is maintained.

Lymphedema is an abnormal accumulation of protein-rich fluid in the interstitial tissue which results in swelling, most commonly in the arms or legs, and occasionally in other areas of the body. There are two forms of lymphedema, primary and secondary. Primary lymphedema is the result of an insufficient lymph system caused by the malformation or absence of lymph vessels from birth and accounts for only 1% of lymphedema in the United States. It may manifest soon after birth or later in life, often around the time of puberty. Secondary lymphedema is caused by damage to the lymph system due to cancer treatment, surgery, trauma, or infection.

Lymphedema as a result of cancer treatment can occur due to trauma to the lymph nodes and lymphatic vessels from surgery, removal of lymph nodes, and radiation therapy. Lymph fluid becomes trapped in the tissues resulting in swelling of the limb. Not all patients who have treatment for cancer will develop lymphedema since there are significant variations in individual anatomy and the lymph vessels will sometimes form alternate routes around an affected area. The overall risk of developing lymphedema for all cancers is estimated to be 15.5% according to the National Lymphedema Network.

Lymphedema begins slowly and is usually progressive. If left untreated, lymphedema results in hardening of the tissues (fibrosis), chronic infection, distortion of the shape of the affected area, and loss of function. Early diagnosis and treatment can prevent these complications. Early signs of lymphedema include a feeling of heaviness or achiness in the limb, tight fitting jewelry, and swelling which may resolve overnight with elevation in early stages. The swelling usually starts at the hand or foot then progresses further up the arm or leg.

Treatment of lymphedema begins with an accurate diagnosis by a physician followed by medical clearance to begin treatment. The treatment for lymphedema is called Completed Decongestive Therapy (CDT). CDT is considered the “Gold Standard” in the treatment of lymphedema and it has been shown to be safe and effective. Treatment is administered by healthcare professionals who have completed specialized training in CDT. It consists of five components of treatment: skin care, manual lymph drainage, compression bandaging and/or compression garments, remedial exercises, and instruction in self-care.

BMH’s new STAR-certified cancer rehabilitation program includes Complete Decongestive Therapy. Treatment is provided by a physical therapist that has completed over 150 hours of training and has been certified in CDT. If you or anyone you know suffers from lymphedema, consult with a primary health practitioner about a referral.

Jeri-Lynn Atwood, PT, CLT works in the Rehabilitation Services Department at Brattleboro Memorial Hospital. She can be reached at 802-257-8255. The BMH STAR Program team will be hosting an open house on May 22 from 5 to 6 PM on the 1st floor of the Richards Building for anyone interested in learning more about the program and meeting with the staff. Light refreshments will be served.

Kelly McCue, RN, MSN, CNS, OCN, CHPN

Breast cancer is the 3rd most common cancer in the world and is the most common cancer seen in women. It’s not surprising then that many of the patients seen at Brattleboro Memorial Hospital’s Oncology department are breast cancer patients. The treatment approach for breast cancer is varied and may include surgery, chemotherapy or radiation. Many times a woman may receive a combination of these treatments. The oncology team, along with the patient, determines the best treatment approach based upon a number of factors including the type of cancer and how early it was discovered.

Fortunately, with increased awareness among women to perform self-exams and regular screening by mammography, many breast cancer cases are discovered early. Thanks to early diagnosis and advances in treatments the survival rate from breast cancer has improved over the past several decades.

Along with these improvements in diagnosis, treatments and survival rates there has been a steady shift in how oncology patients are viewed. The National Comprehensive Cancer Network and the Commission on Cancer is now emphasizing how survivorship is a distinct part of oncology care and has its own needs. As more patients are surviving long term after cancer treatment it has become clearer that some patients are left to deal with side effects after treatment. Many of these side effects are amenable to rehabilitation; in fact oncology rehabilitation is a growing and advancing field.

Depending upon the treatment given for breast cancer a patient may deal with a variety of issues. Many folks are familiar with the side effects of chemotherapy such as hair loss or nausea. But many people do not know that chemotherapy may also cause loss of appetite or even balance issues. A number of patients feel an overwhelming sense of fatigue. Some patients may complain of memory issues or difficulty concentrating. Radiation or surgery can limit how well a patient can move their arm or perhaps cause swelling in the arm called lymphedema. Patients may feel that they shouldn’t complain or don’t want to bother the doctor telling them about the difficulties they are having each day. But it is important that your oncology team knows about any side effects you may be having. If your doctor doesn’t ask, be sure you bring up the subject because there are things that can help and there is no need to suffer in silence.

Many of the difficulties that may be caused by cancer itself or by cancer treatments can be helped with oncology rehabilitation. Some patients may benefit from rehab while they are still undergoing cancer treatment. For others it makes more sense after their cancer treatment is completed. Various health care disciplines can be involved in the rehab process. A nutrition consult may help to ensure that you are getting adequate nutrition despite having a decreased appetite. A speech therapist can help with teaching you strategies for dealing with forgetfulness or difficulty concentrating so that you can better manage your day to day activities. A specially trained physical therapist can help manage swelling, or lymphedema, in the arm or provide proactive education that can lessen the chances of having this side effect. An occupational therapist can help manage symptoms of fatigue, teaching energy conservation or assisting in obtaining equipment to help you take care of day to day activities. The roles of rehab are varied and are individualized for each patient. Some patients undergoing cancer treatments may have many needs and others may have none. The beauty of rehab is that it is tailored to your needs and can work hand in hand with you and your oncology team.

Some patients may feel that they just don’t think they can handle cancer treatment and rehab when they are first diagnosed. But even one rehab session can provide valuable information for managing symptoms that can help you deal with cancer and make its treatment easier. Rehab can help offer patients a sense of control over their treatment and healing process. And when you feel in control you can have less anxiety about your diagnosis and can devote more time to healing optimally. Talk to your doctor about a rehab referral if you are experiencing side effects from treatment.

BMH is launching our oncology rehab program, the STAR Program®, this month. An open house will be held on May 22 from 5-6 PM on the first floor of the Richards Building for anyone wishing to meet the staff and learn more about oncology rehab.

Kelly McCue, RN, MSN is the Administrator and Nurse Navigator for the BMH Comprehensive Breast Care Program. She can be reached at 802-251-8437.

In 1929 an article in the Journal of Medicine offered this advice about how to help patients who have suffered a heart attack:

Eileen Casey

“The nurse should be carefully instructed to do everything in her power to aid the patient in any physical activity so that all possible movements such as feeding himself or lifting himself in bed are spared…Finally the patient should be urged to spend at least 6 weeks and preferably 8 weeks or more absolutely in bed.”

This outlook had significant consequences and by the late 1930s many people were out of work due to cardiac disease. Slowly things started to change. By the 1950s medical research was beginning to show that this was the wrong approach to treat someone after a heart attack. By the 1960s it was known that early movement and supervised exercise were optimal. Cardiac Rehab was born. Today comprehensive cardiac rehab is the gold standard of care.

Oncology or cancer rehab is undergoing a similar evolution. In years past, a number of patients who finished acute cancer treatment were left to struggle with issues such as pain, profound fatigue, deconditioning or loss of motion due to surgery, chemo or radiation treatments. There was little in the way of help to offer these patients and many were left with the impression that this was their “new normal” that they just had to accept. With over 12 million cancer survivors in the U.S., and nearly a million new cancer diagnoses each year, we need to offer more to these patients.

Many professional organizations are recognizing the need for formal cancer rehab. The American College of Surgeons’ Commission on Cancer (COC) has become a leader in ensuring that cancer rehab is part of the continuum of care for oncology patients. The National Comprehensive Cancer Network (NCCN) has issued clinical guidelines for survivors including guidelines to address pain, fatigue, cognitive function and exercise. Many of these issues can be addressed with rehabilitation. A growing body of research suggests that exercise can help improve survival, prevent declines in fitness and improve outcomes of cancer treatments.

Despite the growing evidence demonstrating the benefit, many patients are never referred for formal rehab services. Some patients may be told to “stay active” or “exercise more” and some may even be referred to an exercise class; however, many survivors are not ready to exercise with people who are not healthcare providers. Exercise alone is not cancer rehab. Cancer rehab should be a comprehensive, multidisciplinary team approach. Care provided should be evidence-based. Outcomes, or how well patients respond to treatment, should be tracked. Rehab is meant to help improve function and decrease disability.

Think about someone who has had a stroke or broken bones and is having problems getting around. Their doctor would generally refer them to rehab first, not to a fitness center to exercise on their own. Rehab professionals would evaluate the person to see what their problems were and then develop a treatment program to help address those problems. Rehab would not change the fact that the person had a stroke or broken bones but could significantly improve how well that person functions. Once their maximum function was achieved, then the person would be ready to continue on with a community-based exercise program.

Rehab is almost a given for orthopedic issues, trauma, strokes, brain injuries or other neurological issues. A cancer diagnosis can be as life changing as a stroke or a major trauma. Cancer patients have to deal not only with the psychological trauma that a cancer diagnosis can produce but they are also given treatments that can cause physiological trauma that leave as many as 1 in 4 with physical problems. Rehab can help optimize their recovery. Yet for cancer patients this is not yet the standard of care, but progress is being made in that direction.

BMH has partnered with Oncology Rehab Partners to be able to provide a comprehensive, coordinated rehab program to oncology patients through the Survivorship Training and Rehab (STAR) Program® Certification. The STAR Program® was developed in response to the need for well-developed and integrated cancer rehab training. Our multidisciplinary team includes physical therapy, occupational therapy, speech therapy, nutrition and oncology nurses. By obtaining STAR Program® certification, the staff at BMH has made a commitment towards providing an integrated approach to cancer care that includes rehab for our patients.

Not every cancer patient needs rehab, and those who do may not need all services offered. But for those who do need it, the staff has been trained to help provide oncology patients with a range of services such as physical or occupational therapy, speech therapy and nutritional counseling. If you think you or someone you know may benefit from the program, please speak to your doctor about a referral.

Eileen Casey, PT, is the Director of Rehab Services at Brattleboro Memorial Hospital. She can be reached by calling 802-257-8255. The BMH STAR Program team will be hosting an open house on May 22 from 5 to 6 PM on the 1st floor of the Richards Building for anyone interested in learning more about the program and meeting with the staff. Light refreshments will be served.

Lynne Vantassel

While most of us are familiar with the use of hyperbaric oxygen chambers for scuba divers with decompression sickness, the use of Hyperbaric Oxygen Therapy (HBOT) in wound care is an effective and FDA approved treatment for non-healing ulcers and wounds. HBOT is an adjunctive medical treatment in which the patient is entirely enclosed in a pressure chamber breathing 100% oxygen at greater than one atmospheric pressure. Treatment is determined by a specially trained physician who, after determining if the patient meets the criteria for HBOT, will work with the center to have the patient scheduled to begin therapy in the chamber, five days a week, for a period of up to four to five weeks.

The chambers that will be used in the Center for Wound Healing at Brattleboro Memorial Hospital are called monoplace chambers—which means that only one person can occupy the chamber at any given time. Prior to the treatment, patients will receive detailed instructions on preparing for their HBO treatment and during their “dive” can watch television, movies, or listen to music. The patient will be provided with a garment to wear in the chamber. Patients are restricted from using makeup, lotions, perfumes, hair spray, wigs, contacts, nail polish, jewelry or deodorants. A full list of items and guidelines will be given to the patient prior to their time in the chamber. Prior to each treatment, the technician will take the patient’s vital signs and check their ears. Also, blood sugar will be checked on diabetic patients.

The HBO technician is in the room at all times and the patient can communicate with the technician if they have any questions or concerns at any time during the treatment. The patient, once placed in the chamber, will be breathing 100% pure oxygen, which will saturate their blood plasma and allow it to carry 15-20 times the normal amount of healing oxygen into the body’s tissues. HBOT works in several ways to aid healing while enhancing the patient’s immune response. The therapy increases resistance to anaerobic bacteria. It will increase phagocytosis (phagocytosis is the killing function of white blood cells) and pure oxygen improves this function. It also can inactivate certain toxins, including gangrene, and will reduce local tissue edema (swelling).

HBOT is not painful. At the beginning of the treatment, the patient will feel some pressure in their ears. This pressure is similar to the pressure of flying in a plane or driving into the mountains. This pressure can be relieved by swallowing, yawning, or opening and closing the mouth. If the patient anticipates feeling claustrophobic, their physician can prescribe something to keep them calm during treatment, and the patient will be able to see outside the chamber.

HBO treatment has been approved by Medicare and other major insurance carriers for treatment of certain non-healing ulcers and wounds, and the Center can receive insurance approval prior to treatment.

The type of HBOT technology BMH has selected for its new Center for Wound Healing is the Sechrist 3300 Monoplace Hyperbaric Chamber. Manufactured in the USA within Sechrist’s state of the art production and manufacturing facility, these chambers are designed and tested to provide to most complete and safest chamber on the world market. The chambers are expected to arrive on April 25 and when they become operational on May 9, it will be the first time this treatment will be available in the state of Vermont.

Lynne Vantassel is the Program Director for the Brattleboro Memorial Hospital Center for Wound Healing. She can be reached at lvantassel@bmhvt.org. An Open House takes place at 5:00 PM on Tuesday, May 7 to allow the public to tour the Center and meet the staff.

By Ina Feidelseit

Ina Feidelseit

In observance of National Volunteer Week (April 21-27), BMH has asked one of its volunteers to contribute a column about her experiences at the hospital.

If you’ve driven past the main entrance of the hospital this year, you’ve caught a glimpse of the Emergency Department construction project taking place. Sometime in the summer of 2013, the hospital will have a new front door in which to welcome the community. What won’t be changing, however, is that the person greeting you there or offering assistance will very likely be a volunteer, like me.

BMH currently has more than one hundred active volunteers. Some work behind the scenes in departments and administrative offices. But a lot of us also interact with the public on a daily basis at the Information desk and in Transportation. Transportation is the department that aids patients and visitors who need a wheelchair, as well as transporting specimens, paperwork or whatever needs to go between departments. I volunteer in both areas, and we’ve been on the front lines of helping people find their way around the hospital since the Richards Building became the primary entryway in November.

Some visitors are unfamiliar with the Richards Building even though it houses many medical services, including the walk-in lab, x-ray imaging, digital mammography, MRI and physical therapy. It is definitely disorienting for someone who is used to coming in through the main entrance. A volunteer has been stationed at an Information desk on both the ground and first floors, right where the corridors connect to the main hospital building, to help people get where they need to go.

The distance between buildings can feel long for people who need assistance to walk or are having respiratory problems. We had planned out the best possible routes for visitors even before they broke ground. Some routes have been adjusted a little as we have learned what works best for certain types of visitors and where they need to go. The volunteer coordinator, JoAnne Rogers, keeps a red binder at every volunteer station with the most recent information. We check it at the beginning of our shifts to see if there have been any changes or updates.

The longer routes have also meant more people are requiring wheelchair assistance than before. This is true for patients as well as the friends and family coming to visit them. JoAnne has made sure there is an ample supply of wheelchairs at the Richards Building entrance. They’re the first things you’ll see when you walk into the lobby. The hallways between the two buildings have ramps and carpeted floors in some sections so please don’t hesitate to get a volunteer instead of having a family member push a wheelchair when one is needed.

I should point out that everybody at the hospital has taken it upon themselves to help with wayfinding during the renovation. Nurses, technicians, physicians, and administration are all directing visitors or escorting them where they need to go. It’s been a nice reminder of what a warm and caring community we have within the hospital. The staff is always supportive of the volunteers and let us know how appreciated our efforts are.

It may be a cliché about volunteering, but I think a lot of my fellow volunteers would agree that the joys of giving flow in both directions. We are all here because we want to help people and know we’re doing something meaningful. As we head into National Volunteer Week, I encourage you all to find a place in the community to donate your time. You’ll quickly discover why I really do believe I get back much more than I give.

Ina Feidelseit has been a volunteer at Brattleboro Memorial Hospital for the past seven years. For information about volunteering at BMH, contact JoAnne Rogers at 802-257-8238.

Gregory R. Gadowski, MD

It’s been an exciting time at BMH since the Green Mountain Care Board approved the establishment of a state of the art wound care center at our hospital. We’ve been doing intensive staff training and working hard to have everything in place when the facility opens its doors next month.

The BMH Center for Wound Healing will be the first of its kind in Vermont and the only one in the vicinity providing comprehensive, multidisciplinary care for chronic and non-healing wounds. While technologies like hyperbaric oxygen therapy get the lion’s share of public attention, I’d like to emphasize that it is just one of the tools that will be available as we provide our patients with state of the art wound healing services. The majority of chronic wounds can be healed completely by following evidence-based clinical treatment guidelines and a team approach. Studies have shown that healing occurs faster and is more cost effective in comprehensive wound care centers.

The general definition of a chronic wound is one that has lasted longer than 30 days. Most patients have a variety of contributing factors including diabetes, circulation problems, infection, inflammation, swelling, etc. By approaching these problems in an organized, systematic way, we can establish what has prevented healing and then work on eliminating these obstacles and get the wound closed.

Whatever the cause, consistency is also very important to healing. That means having the same physician/nurse team committed to an individual patient during each weekly visit. This “case management” style of patient care ensures the same sets of eyes are monitoring how wound healing progresses and what the appropriate next steps might be. Healing wounds requires a commitment from the patient, too. It becomes difficult to assess whether a wound is improving or if it needs further evaluation if we’re only seeing a patient every couple of weeks or once a month. With weekly visits, most wounds can be completely closed in roughly 30 days.

A wound care center like the one at BMH will have resources to help patients get help with tobacco cessation, nutrition consultation or other information that helps manage their condition. We will also have access to medical specialists such as orthopedic and vascular surgeons who can be consulted to provide individualized care.

The work doesn’t stop once the wound is healed, however. The ultimate goal is to prevent another wound from occurring. Most chronic wound patients are referred for treatment by their primary healthcare provider. After he or she is discharged, it’s important that the primary care provider is well informed about what happened, why the wound occurred and how future wounds can be prevented.

In summary, the best approach to healing difficult wounds involves a “team” including the primary care provider, patient, consulting experts, and an advanced wound care center like the one opening soon at BMH.

Gregory Gadowski, MD, is the Medical Director for the Brattleboro Memorial Hospital Center for Wound Healing, opening next month and hosting an Open House on Tuesday, May 7. For more information call 802-275-3674 or visit online at bmhvt.org.

Chronic wounds currently affect more than eight million people in the United States. Fueled by an aging population, the incidence of such wounds is on the rise as more patients are diagnosed with chronic medical conditions.
A chronic or non-healing wound is a wound that hasn’t healed within 30 days using conventional treatments. These sores are symptomatic of one or more underlying conditions that prevent the normal flow of blood and hurt the natural healing process. Diabetes and venous disease put a patient at risk for chronic wounds.

In fact, non-healing wounds are particularly prevalent in the estimated 25.8 million Americans affected by diabetes. A person risks losing sensation in their feet and legs when their blood sugar is not under control. A cut can occur and become infected before they are aware they have stepped on or came in contact with a sharp object.

Twentieth century research found dry dressings could cause secondary trauma and damage to cells needed to support healing. From the 1960s on, the care and management of acute and chronic wounds made rapid improvements as a result of this discovery. Today’s approach to moist wound healing expands the purpose of dressings considerably. The dressing still protects the wound from infection. But a moist dressing also facilitates natural debridement, maintains a moist environment, acts as a natural barrier, reduces pain and diminishes scarring.

There are nine different steps to determine clinical treatment of a non-healing wound. This systematic approach to evaluation, description and identification ensures consistent progress is made in healing the wound. It also makes it easier to perform any necessary re-evaluation and changes in a patient’s treatment plan.

Of course, patients play an important role in the healing of their own wounds. Any successful treatment of a chronic wound requires education about how to care for it. Non-healing wounds often occur because vascular function is compromised, preventing normal blood flow. Nutrition and exercise also play an important role in healing.

Hyperbaric Oxygen Therapy is a relatively new medical treatment available for patients suffering from non-healing wounds. Also known as HBOT, this therapy involves enclosing the patient in a pressure chamber, where he or she is exposed to pure oxygen for a period of time. The body’s natural healing process is aided through increased oxygen flow to the wound. HBOT also kills bacteria that may be preventing a wound’s healing or keeping new tissue from forming over the sore. A physician who is specially trained in the treatment of chronic wounds would be able to determine who is a candidate for HBOT.

In early May, Brattleboro Memorial Hospital will be opening its new Center for Wound Healing. It will be the first in Vermont to offer HBOT as part of its comprehensive treatment options for helping patients with chronic and non-healing wounds. We hope you can join us at an Open House at 5:00 pm on Tuesday, May 7 to learn more and meet the medical staff.

Lynne Vantassel is the Program Director for the Brattleboro Memorial Hospital Center for Wound Healing. She can be reached at lvantassel@bmhvt.org.

Kathleen McGraw, MD

One of the exciting things about the role of Chief Medical Officer at Brattleboro Memorial Hospital right now is the change in health care that is currently underway in the state. Vermont is leading the nation in health care reform. The process of implementation, which is going to take many years, has medical professionals paying attention to patient quality and safety and tying it to the patient experience in ways we never have in the past. The doctors and staff at Brattleboro Memorial Hospital have been committed to providing quality care since our founding in 1904. But health care has changed a lot since then! Staying focused on the patient as well as the process must always be the goal.

In the past decade, The Centers for Medicare and Medicaid Services (CMS) has required acute care hospitals, such as BMH, to participate in their Core Measures program. This program tracks compliance with a wide variety of processes, from the timing of antibiotic administration before surgery to the choice of antibiotics used for a patient with pneumonia. These measures help a hospital track its quality of care, and compare that to other hospitals in our region and across the nation.

In 2013 CMS required a new set of measures specific to care in the Emergency Department. We are measuring things such as how long it takes for a patient to see a doctor, how long it takes the doctor to determine if the patient needs to be admitted, and if admitted how long it takes to actually get that patient into their hospital room. The renovation and expansion of the Emergency Department at BMH not only brings us an expanded and pleasing space. It also provides us the opportunity to revise patient flow and staff processes so that we can achieve the parallel goals of excellent care that is delivered in a timely manner.

Measuring medical processes is only one part of determining quality. Also important is the patient’s perception of their care. Patient responses on the surveys called or mailed to them after they are home provide this very valuable information. Through comments and the voicing of concerns we at BMH get a much more complete picture of how we are doing. We gather more information about how we can improve both the details of care and the way in which it is provided. Our patients become our partners in delivering quality care by taking the time to respond.

One could look at a hospital’s overall patient satisfaction rate at 85 or 90 percent and think that’s good, but not if it’s your loved one that lands in the other 10 – 15 percent. The new federal guidelines are asking health care facilities to really dig down and be more proactive in looking at these measures with the goal of establishing national benchmarks for excellence, which are then tied to compensation. A hospital has to have all these different pieces reach very high levels to ensure everyone is getting high quality, error free, experienced care.

Whether the goal is zero hospital acquired infections or 100 percent adherence to guidelines for treatment, the notion that perfection is not attainable is starting to be challenged. It has to be hardwired into the processes of an organization in order to make it work, however. Physicians, nurses, techs and other kinds of clinical staff all want to do their duties perfectly every single time. That can’t happen just because everyone is trying really hard. We all try really hard, and we all need to continue trying really hard. But we have to have the systems in place that are set up to ensure that success.

CMS Core Measure data and our patient’s perception of care are both rolled up into a summary report for each hospital by the organization Consumer Assessment of Healthcare Providers and Systems. Check our website at bmhvt.org and you will find the link for Hospital Report Card at the bottom of the page. This link allows anyone to see the results for BMH, and to compare them to others locally and nationally. This link will also give you additional information about the quality of care at BMH.

While it is important that we pay attention to these indicators, it is also important that we keep in mind that quality care is what happens to a patient from the moment they step into the hospital until the point that they leave. And quality doesn’t end there. We have come to learn that it rolls over to the next care site, from the hospital to the outpatient doctor, and out into the community. Serving an increasingly health community is the goal of every hospital, and certainly our goal here at BMH. That’s the kind of accountability we are striving for and is one of the exciting aspects about being a member of the team at BMH.

Kathleen McGraw, MD, is board-certified in Hospital Medicine and is the Chief Medical Officer at Brattleboro Memorial Hospital.

Back in February, just before the start of Colorectal Cancer Awareness Month, the Dana-Farber Cancer Institute in Boston published results of a new study linking obesity and inactivity with an increased risk for a subtype of colorectal cancer known in the medical world as CTNNB1-negative. Such a discovery could lead to new treatment options sometime in the distant future. For now, however, the results reinforce the need for people ages 50 and over to undergo routine screenings for colorectal cancer, especially if they are overweight or do not regularly exercise.

Gregory R. Gadowski, MD

CTNNB1 is a molecule associated with obesity and cancer. What the researchers found was that for every 11 pounds of body fat (measured by body mass index) a participant’s risk for CTNNB1-negative colorectal cancer increased by about one-third. Meanwhile, the study also found that people who took part in 30 minutes of moderately intense exercise at least four to five times a week reduced their risk by 20-30 percent. The risk of another form of the cancer known as CTNNB1-positive was not impacted by BMI or physical activity, according to the researchers.

Body mass index, also known as BMI, and exercise regimen are just two pieces of information gathered during a screening for colorectal cancer. It’s also important to know whether any close relatives of the patient have had colorectal cancer. After gathering all of this information, the physician might recommend the patient have a colonoscopy more frequently than the recommended timeframe of once every 10 years.

Before getting a screening colonoscopy, it’s important the patient understand why it’s necessary. Colorectal cancer is basically silent at the early stages. It generally starts as a polyp, and the polyps do not cause any symptoms. They don’t bleed. They don’t hurt. They don’t change your bowel habits at all. So there is no way of knowing they are there unless there is an investigation.

The advantage that a colonoscopy has over other screening tests is that physicians can take out any polyps detected right then and there. It is a more invasive test that requires anesthesia. But for most patients that are in good general health we will choose that option. Other tests for patients who might not tolerate a colonoscopy are barium enemas or x-rays. But if a polyp is detected that patient will likely have to have a colonoscopy afterwards to remove it.

The awareness raised in the past 10 to 15 years about the importance of colorectal cancer screening has helped reduce the number of diagnoses. However, the most recent data says that it is still the second most common cancer diagnosed in Americans, just behind skin cancer, and that people still have a 1 in 20 chance of getting colorectal cancer during their lifetimes. An estimated 140,000 new cases of colorectal cancer will be diagnosed this year, according to the American Cancer Society, with approximately 50,000 deaths caused by the disease.

I think the primary care providers in our community are very good about referring patients when it’s time for a colorectal screening. But as we learn more about what causes colorectal cancer, it’s important to remind everyone that there’s more to prevention than just having the colonoscopy. Who you are and how you live your life can also make a difference. Make sure you ask questions and share information about your health and family history during medical visits.

Gregory Gadowski, MD is a board-certified surgeon practicing at Brattleboro General Surgery, which is part of BMH Physician Group. He can be reached at 802-254-5510.

When people hear about varicose veins they most often think of a disease that affects women. One reason that varicose veins are more prevalent in women is that pregnancy is an additional risk factor for varicose veins. Of the more than 4 million people in the United States with varicose veins, it is estimated that 25 to 30 percent of them are male. Risk factors include family history of varicose veins, obesity, sedentary lifestyle, smoking, and prolonged standing.

Gregory R. Gadowski, MD

Our veins have one-way valves that keep blood moving toward the heart. Varicose veins develop because these valves deteriorate and become ineffective, causing blood to pool in the veins. Over time, this causes the veins to enlarge and become more visible. In the early stages of venous disease the veins appear as small visible vessels but don’t cause pain or discomfort. Having these “spider veins” is considered mainly a cosmetic problem. Insurance companies usually don’t even cover treatment; however, treatment is available and includes injecting the veins with a solution that may make them fade.

Venous disease can get worse over time. The veins enlarge further, protrude and become more visible. Eventually, this can lead to swelling, pain, blood clots, skin damage and leg ulcers. The best prevention for this progression is generally to maintain a healthy lifestyle including exercise. When we walk, our leg muscles essentially act as pumps to help move the blood toward the heart. Elastic compression stockings are also beneficial for patients with venous disease and have come a long way in terms of style and comfort. I highly recommend them to school teachers, machine operators, factory workers, and other people with jobs that require them to stand for long periods of time.

Surgical options for treatment of varicose veins are usually indicated when conservative measures such as exercise, leg elevation, and stockings fail to relieve symptoms and the disease continues to progress. This treatment is generally covered by insurance. Surgery has become much less invasive and is generally done in the outpatient setting of the hospital. Recovery is typically swift and very little (if any) time out of work is necessary.

Men (and women) who have visible varicose veins should consider having them evaluated. Ultimately they may not just be a cosmetic issue. Even if no surgical intervention is necessary, a physician familiar with varicose veins can help you understand the disease and the options available to make your legs look and feel better!

Gregory Gadowski, MD is a board-certified surgeon practicing at Brattleboro General Surgery, which is part of BMH Physician Group. He can be reached at 802-254-5510.