CANCER IN CHILDREN

Key facts

Cancer is a leading cause of death for children and adolescents around the world and approximately 300,000 children aged 0 to 19 years old are diagnosed with cancer each year. [1]

The most common categories of childhood cancers include leukemias, brain cancers, lymphomas and solid tumours, such as neuroblastoma and Wilms tumour. [1-2]

In high-income countries, more than 80% of children with cancer are cured, but in many low- and middle-income countries (LMICs) only about 20% are cured. [2-3]

Childhood cancer generally cannot be prevented or screened.

Improving outcomes for children with cancer requires early and accurate diagnosis followed by effective treatment.

Most childhood cancers can be cured with generic medicines and other forms of treatments including surgery and radiotherapy. Treatment of childhood cancer can be cost-effective in all income settings. [2]

Avoidable deaths from childhood cancers in LMICs result from lack of diagnosis, misdiagnosis or delayed diagnosis, obstacles to accessing care, abandonment of treatment, death from toxicity, and higher rates of relapse.

Childhood cancer data systems are needed to drive continuous improvements in the quality of care, and to drive policy decisions.

The problem

Cancer is a leading cause of death for children and adolescents worldwide.  In high-income countries, more than 80% of children with cancer are cured, but in many LMICs, only 20% are cured [2-3].

The reasons for lower survival rates in LMICs include an inability to obtain an accurate diagnosis, inaccessible therapy, abandonment of treatment, death from toxicity (side effects), and excess relapse, in part due to lack of access to essential medicines and technologies addressing each of these gaps improves survival and can be highly cost-effective [2-3].

What causes cancer in children?

Cancer occurs in people of all ages and can affect any part of the body. It begins with genetic changes in a single cell that then grows out of control. In many cancers, this results in a mass (or a tumour). If left untreated, cancer generally expands, invades other parts of the body and causes death.

Unlike cancer in adults, the vast majority of childhood cancers do not have a known cause. Many studies have sought to identify the causes of childhood cancer, but very few cancers in children are caused by environmental or lifestyle factors. Cancer prevention efforts in children should focus on behaviours that will prevent the child from developing preventable cancer as an adult.

Some chronic infections are risk factors for childhood cancer and have major relevance in low- and middle-income countries. For example, HIV, Epstein-Barr virus and malaria increase the risk of some childhood cancers. Other infections can increase the child’s risk of developing cancer as an adult, so it is important to be vaccinated and other pursue other methods such as early diagnosis or screening to decrease chronic infections that lead to cancer, whether in childhood or later.

Current data suggest that approximately 10% of all children with cancer have a predisposition because of genetic factors. Ongoing research is needed to identify factors impacting cancer development in children.

Improving outcomes of childhood cancer

Because it is generally not possible to prevent cancer in children, the most effective strategy to reduce the burden of cancer in children is to focus on a prompt, correct diagnosis followed by effective therapy.

Early diagnosis

When identified early, cancer is more likely to respond to effective treatment and result in a greater probability of survival, less suffering, and often less expensive and less intensive treatment. Significant improvements can be made in the lives of children with cancer by detecting cancer early and avoiding delays in care. A correct diagnosis is essential to treat children with cancer because each cancer requires a specific treatment regimen that may include surgery, radiotherapy, and chemotherapy.

Early diagnosis consists of 3 components:

awareness by families and accessing care

clinical evaluation, diagnosis and staging (determining the extent to which a cancer has spread)

access to treatment

Early diagnosis is relevant in all settings and improves survival for many cancers.6 Programmes to promote early and correct diagnosis have been successfully used in countries of all income levels, often through collaborative efforts of governments, civil society, and non-governmental organizations, with vital roles played by parent groups. Childhood cancer is associated with a range of warning symptoms that can be detected by families and by trained primary health care providers.6

Screening is generally not helpful for childhood cancers. In some select cases, it can be considered in high-risk populations. For example, some eye cancers in children can be caused by a mutation that is inherited, so if that mutation is identified in the family of a child with retinoblastoma, genetic counselling can be offered and siblings monitored with regular eye examination early in life. Genetic causes of childhood cancers are relevant in only a handful of children with cancer. There is no high-quality evidence to support population-based screening programmes in children.

Treatment

A correct diagnosis is essential to treat children with cancer because each cancer requires a specific treatment regimen that may include surgery, radiotherapy, and chemotherapy. Access to effective diagnosis, essential medicines, pathology, blood products, radiation therapy, technology and psychosocial and supportive care are variable and inequitable around the world.

However, a cure is possible for more than 80% of children with cancer, in most cases with inexpensive generic medications that are listed on the WHO List of Essential Medicines (EML). WHO EML for children, defined as those meeting the priority health care needs of the population, includes 22 cytotoxic or adjuvant medicines and 4 hormone treatments for childhood cancer. Children who complete treatment require ongoing care to monitor for cancer recurrence and to manage any possible treatment-related toxicity.

Palliative care

Palliative care relieves symptoms caused by cancer and improves the quality of life of patients and their families. Not all children with cancer can be cured, but relief of suffering is possible for everyone. Paediatric palliative care should be appropriately considered as a core component of comprehensive care starting when the illness is diagnosed and continued regardless of whether or not a child receives treatment with curative intent.7

Palliative care programmes can be delivered through community- and home-based care to provide pain relief and psychosocial support to patients and their families. Adequate access to oral morphine and other pain should be provided for the treatment of moderate to severe cancer pain, which affects more than 80% of cancer patients in the terminal phase.

WHO response

In 2018, WHO launched the Global Initiative for Childhood Cancer with partners to provide leadership and technical assistance to support governments in building and sustaining high-quality childhood cancer programmes. The goal is to achieve at least 60% survival for all children with cancer globally by 2030. This represents an approximate doubling of the current cure rate and will save an additional one million lives over the next decade. The objectives are to:

Increase capacity of countries to deliver best practices in childhood cancer care

Prioritize childhood cancer and increase available funding at the national and global levels

WHO and the International Agency for Research on Cancer (IARC) collaborate with the International Atomic Energy Agency (IAEA) and other UN organizations and partners, to:

increase political commitment for childhood cancer diagnosis and treatment;

support governments to develop high-quality cancer centres and regional satellites to ensure early and accurate diagnosis and effective treatment for children with cancer;

develop standards and tools to guide the planning and implementation of interventions for early diagnosis, treatment and palliative and survivorship care inclusive of the needs of childhood cancers;

improve access to affordable and essential medicines and technologies;

support governments to safeguard families of children with cancer from financial ruin and social isolation as a result of cancer care.

This initiative is part of the implementation of the World Health Assembly Resolution Cancer Prevention and Control through an Integrated Approach (WHA70.12), which urges governments and WHO to accelerate action to achieve the targets specified in the Global Action Plan and 2030 UN Agenda for Sustainable Development to reduce premature mortality from cancer.

References

Steliarova-Foucher E, Colombet M, Ries LAG, et al. International incidence of childhood cancer, 2001-10: a population-based registry study. Lancet Oncol. 2017;18(6):719-731.

Gupta S, Howard SC, Hunger SP, et al. Treating Childhood Cancer in Low- and Middle-Income Countries. In: Disease Control Priorities, volume 3.  http://dcp-3.org/chapter/900/treating-childhood-cancers-low-and-middle-income-countries

Howard SC, Zaidi A, Cao X, et al. The My Child Matters programme: effect of public-private partnerships on paediatric cancer care in low-income and middle-income countries. Lancet Oncol. 2018;19(5):e252-e266.

Zhang J, Walsh MF, Wu G, Edmonson MN, Gruber TA, et al. Germline Mutations in Predisposition Genes in Pediatric Cancer. N Engl J Med. 2015 Dec 10;373(24):2336-2346.

CANCER IN CHILDREN

DIABETIC DIET: 16 FOODS THAT HELP REGULATE BLOOD SUGAR

BY SBG-TV

Diabetes can be sneaky, with symptoms that are not always obvious but that cause lasting damage.

Prevent problems by incorporating these 16 foods to regulate your blood sugar levels, as recommended by Healthline and WebMD.

Protein

Protein is a great food choice for diabetics because it doesn’t affect blood sugar levels. It also creates a feeling of fullness while it builds and repairs your body. Protein sources to consider for blood sugar control include Greek yogurt, cottage cheese, eggs and lean meats.

Vegetables

Whether you prefer them raw, cooked or roasted, vegetables do more than just add color to your plate. Choose diabetic-friendly, low-carb veggies like mushrooms, onions, eggplant, tomatoes, Brussels sprouts and zucchini.

Low-carb greens

Popeye had it right. Spinach, chard and kale are powerful foods with a low-carb punch. Pack your diet with these time-tested foods, and you will bring real power to the fight against high blood sugar.

Sour cherries

Fruits are sometimes frowned upon in the diabetic community, but there are some with a low glycaemic index. Food with low GI scores won’t raise blood sugar and can prevent a spike. Sour cherries have a low GI and a chemical called anthocyanins. The National Institutes of Health has shown that anthocyanins may reduce your risk of developing diabetes and obesity. Anthocyanins inhibit some digestive enzymes and slow down digestion. They also help reduce blood sugar spikes following starch-rich meals.

Blackberries and blueberries

Sour cherries aren’t the only fruits you can add. Blackberries and blueberries won’t raise blood sugar levels as much as their fruity friends. These berries are high in fibre and have the highest concentrations of anthocyanins.

Low-calorie drinks

While water is your dietitian’s drink of choice, spruce it up by infusing it with nutrients from vegetables and fruits. Add lemons and cucumbers to water for flavor and to slow your reach for sugary drinks.

Apple cider vinegar

Healthline.com recommends drinking 20 grams of apple cider vinegar in 40 grams of water before a meal to prevent blood sugar spikes. The acetic acid in it reduces certain enzymes in the stomach and can improve insulin sensitivity after meals.

Eggs

Eggs get a bad rap because of their link to high cholesterol. However, eggs can provide satiety and curb cravings without raising blood sugar levels. Both prediabetics and diabetics can benefit from the protein and nutrients.

Whole grains and high-fibre

Fasting insulin rates after eating whole grains are 10 percent lower, according to a report by The American Journal of Clinical Nutrition. The high content of fiber, phytochemicals, and nutrients found in whole grains work to regulate blood sugar.

Beans

Legumes like dried beans, peas and lentils help you feel full longer while providing a low-glucose alternative. Soft-style beans can be combined as a dip with other vegetables to add variety.

Healthy fat

While the wrong kind of fat can be harmful, good fats are essential. Some good fat choices are olive oil, avocado and fish (salmon, halibut, albacore tuna, mackerel and trout).

Polyunsaturated and monounsaturated fatty acids

Polyunsaturated fatty acids and monounsaturated fatty acids improve insulin sensitivity. These fatty acids trigger feelings of satiety while positively impacting blood pressure and inflammation levels. Avocados, peanut butter, other nuts and seeds are sources of monounsaturated fatty acids.

Garlic

A study shows how garlic can lower blood glucose levels. Garlic supplements, raw or cooked garlic, or aged garlic can all help.

Chia seeds

They may be small, but chia seeds are loaded with healthy fats, omega-3s, calcium, fibre, and antioxidants. They help lower LDL cholesterol and triglycerides.

Cacao

Cacao is a foundational ingredient for chocolate and cocoa butter. High in antioxidants and a flavanol called epicatechin, cacao seeds help control blood glucose production by activating key proteins. Cacao also balances blood sugar — even in those who already have diabetes.

Almonds

These tasty, protein-rich nuts help control blood sugar levels following meals. Consuming 2 ounces of almonds per day lowers levels of fasting glucose and insulin.

DIABETIC DIET: 16 FOODS THAT HELP REGULATE BLOOD SUGAR

HOW A STROKE CAN CHANGE YOUR PERSONALITY

By Heidi Moawad, MD 

A stroke can produce major life-altering changes, such as vision and diminished physical strength and coordination. In addition to the obvious physical handicaps of a stroke, a stroke can also produce significant personality changes. If you are a stroke survivor, your post-stroke behavioural changes can hit you and your loved ones by surprise if you suddenly do not act like “yourself” anymore.

Once you learn how to identify the most common personality changes after a stroke, you can begin to gain a sense of reassurance, knowing that there is an explanation for why you or your loved one might be acting a little different. Recognizing personality changes can be a huge step in modifying unwanted behavior as you purposefully work towards getting back some of the personality traits that make you feel more like “you.”

Depression

After a stroke, it is very common to experience a sense of unhappiness and sadness. In fact, as many as 60 percent of stroke survivors report prolonged depression, which is depression that is more severe and long lasting than routine sadness.

Post-stroke depression results from a combination of biological and situational factors. First of all, the obvious effects of a stroke, such as weakness, vision loss, and coordination problems may cause a sense of sadness if you feel disempowered by your handicap. Additionally, after a stroke, you might worry about your health or experience anxiety about your own mortality. The resulting feelings of helplessness or hopelessness can contribute to post-stroke depression.

And the stroke-induced damage to the brain can produce changes in the way the brain functions, resulting in altered biological activity that leads to depression.

Despite all of these elements that contribute to the development of post-stroke depression, post-stroke depression is usually treatable with a combination approach that includes medication and counseling.

Many people, however, are reluctant to seek treatment for depression. Some stroke survivors hesitate to take on the label of depression out of concern that it can be a self-fulfilling prophecy. Others do not trust the medical system to deal with emotional issues, and others view depression as a sign of weakness.

However, if you or your loved one has lingering feelings of sadness or hopelessness, you can get effective help for this problem. The recognition that your depression is not your fault and is not a sign of weakness is an empowering step towards getting the right medical treatment.

Loneliness 

After a stroke, isolation can occur if you are no longer able to do the same things you used to do. If you have to leave your job after a stroke, or if you are no longer a part of your regular social life, this can lead to a sense of loneliness.

Some stroke survivors have severe disabilities that make it difficult to drive, leave the house or even get out of bed. Extreme disability may necessitate moving into a new living environment, in part to obtain more assistance with daily living, and in part to reduce isolation and loneliness. Each stroke survivor can overcome the post-stroke sense of loneliness in his or her own unique way.

Loss of Cognitive Skills

The loss of cognitive skills after a stroke can happen after a stroke in almost any region of the brain, but most often in the frontal lobe, the parietal lobe or the temporal lobes.

Changes in cognitive skills include trouble with problem-solving, reading difficulties, and trouble with simple mathematical calculations. Some stroke survivors become forgetful, forgetting names, or losing things or forgetting to take care of important tasks. Cognitive deficits can also cause confusion or may make it difficult to understand concepts that a stroke survivor would have previously been able to understand.

The loss of cognitive skills can be very distressing for stroke survivors, and many stroke survivors may be in denial, making excuses for frequent mistakes, or even lying about errors to avoid embarrassment.

Building up cognitive skills is a challenge, but just as physical disability can improve with physical therapy, cognitive disabilities can improve with dedicated cognitive therapy.

Emotional Instability

Many stroke survivors find themselves becoming very emotional or inappropriately crying or laughing. Some stroke survivors experience a condition called pseudobulbar affect, which is characterized by mood changes and uncontrollable emotional expressions.

Lack of Motivation

A stroke can lead to a lack of motivation, which is called apathy. Apathy occurs after most types of brain injury. There are several reasons for post-stroke apathy.

The decline in cognitive abilities (problem solving and thinking skills) after a stroke can make many tasks seem too challenging and unsolvable. Additionally, the development of post-stroke depression, having less responsibility to deal with after the stroke, and sometimes the feeling that “nobody will notice” what you do, can all lead to apathy.

Lastly, apathy may also occur due to changes in the structure and function of the brain secondary to the stroke itself.

Aggression 

Some stroke survivors become unexpectedly hostile and angry, behaving in ways that are mean or physically aggressive. Aggression, like the other behavioural and personality-related stroke changes, is often a result of both the emotional feelings about the stroke and the stroke-induced brain injury.

Aggression is particularly noticeable in stroke survivors who have a stroke pattern that produces vascular dementia. Vascular dementia occurs when many small strokes happen over time, leading to a buildup of injuries throughout the brain, and resulting in a distinctive type of dementia. Vascular dementia is characterized by a decline in memory and thinking skills, confusion, trouble finding things, trouble with directions, and changes in behavior.

Denial of a Stroke: Anosognosia 

Anosognosia describes a stroke survivor’s inability to recognize that he or she has had a stroke. Anosognosia is manifest by an interesting overconfidence and unawareness that there is anything wrong after a stroke. In fact, a person who has anosognosia may express surprise and bewilderment at the fact that there is any medical care being administered at all.

Stroke survivors who have anosognosia present a challenging problem for loved ones and caregivers, who try to offer assistance and care, often with no cooperation. Sometimes stroke survivors who have anosognosia treat those who are trying to help them with dismissal or rejection.

Lack of Empathy

The lack of empathy after a stroke is caused by brain damage that affects regions of the right side of the brain. A lack of empathy is a behavioural change that is usually upsetting for friends and loved ones, but is typically unnoticed by the stroke survivor.

It is not easy to predict whether a lack of empathy will improve after a stroke, as some stroke survivors can show improvement, while others do not.

Loss of Sense of Humour 

A sense of humour requires insight and the quick thinking. Humour is often based on the recognition that dissimilar ideas do not belong together and that they are funny and amusing when placed together.

Many types of stroke can diminish a stroke survivor’s sense of humour. A stroke survivor who was previously funny might not be able to construct jokes and a stroke survivor who would have been able to recognize and laugh at jokes might not be able to do so anymore.

A loss of sense of humour can be difficult to recover from because this stroke effect is caused by a loss of cognitive skills. However, understanding that the lack of humour is the result of a stroke, and not a personal rejection, can help in preventing hurt feelings and misunderstandings when a stroke survivor does not respond to light-hearted joking as expected.

Loss of Social Inhibitions

Some stroke survivors may behave in ways that are considered socially inappropriate after a stroke of the right or the left frontal lobe. Behaviours such as taking food from a stranger’s plate, insulting people out loud or even undressing or urinating in public, may pose challenges for the caretakers and family members who are primarily responsible for the safety and care of a stroke survivor.

Generally, a stroke survivor who displays socially unacceptable behavior does not have the insight to understand that the actions are not acceptable, and is unlikely to apologize or try to correct the behavior.

The language or insults of a stroke survivor who has suffered from a frontal lobe stroke are not necessarily consistent with a person’s ‘normal’ pre-stroke personality or beliefs. And it is very important to be aware that mean statements are not reflective of what a stroke survivor ‘really feels, deep down inside,’ but are more likely to be phrases that he or she heard in a completely unrelated setting, such as in a book or on a television show.

The loss of social inhibition can be somewhat better controlled when the stroke survivor is comfortable, in a familiar environment, and under as little stress as possible.

Jealousy 

A rare type of stroke causes a syndrome called Othello Syndrome, which is characterized by irrational and illogical jealousy, particularly in the context of romantic relationships. This syndrome can affect stroke survivors as a result of brain injury affecting areas of the right cerebral cortex.

A Word from Verywell

A stroke can cause major personality changes that can make you feel as if you have lost yourself or that you’ve lost the loved one you used to know so well. Personality changes after a stroke can be emotionally draining for everyone involved.

However, if a stroke survivor and loved ones understand that the source of the behavior comes from stroke-induced brain damage, it can reassure everyone in knowing that the unpleasant behavior is not premeditated or intended to be personally insulting. High functioning stroke survivors who learn about the typical post-stroke behavioural changes can gain enough insight to be able to make some changes, which can result in more satisfying interpersonal relationships.

HOW A STROKE CAN CHANGE YOUR PERSONALITY

URINARY TRACT INFECTION: WHAT YOU SHOULD AND SHOULD NOT EAT

By Pamela Fernandes, MD

50% of women experience a urinary tract infection (UTI) in their lifetime. It costs over 1 billion USD and results in 1 million hospitalizations. It’s common among women compared to men. UTI’s are an infection of the urinary tract involving the kidneys, ureters, bladder, and urethra. Left untreated the infection can escalate and damage the kidney and ureters, permanently leading to scarring and renal failure.

The most common cause is due to bacteria from the gastrointestinal system. The anus is usually quite close to the urethra in women. Bacteria like E. coli travel from the digestive system. These bacteria can also be introduced during sex like Chlamydia and Mycoplasma.

Symptoms of UTI

Some of the common symptoms of a urinary tract infection are painful urination, burning sensation on urinating, an intense urge to urinate, pressure or fullness on the bladder, discharge, nausea, vomiting, cloudy or strange smelling urine, fever and back pain. If severe then you may also see blood in the urine.

Risk Factors

There are certain risk factors that increase the chances of getting a urinary tract infection. These include unprotected sex, intake of antibiotics, not urinating frequently, choosing baths over showers, lack of water in the diet, bacterial entry from the anus and pregnancy. Old age and gender do play a role since immunity is lower in the elderly and the urethra is shorter in women.

Foods You Should Eat When You Have a Urinary Tract Infection: Certain foods are known to help relieve symptoms of UTI.

Water

Water keeps your system hydrated and helps your body flush out toxins. Most people don’t drink enough water. Infections are caused by a buildup of bacteria and with decreased water consumption. The bacteria can be flushed out of the system with hydration.  Studies have shown that increased water intake can help in the prophylaxis and treatment of UTI’s.

Cranberry juice

Everyone’s heard of cranberry juice as a cure for UTI’s. And the science proves it. Two randomized controlled studies prove that cranberry juice does reduce the number of symptomatic UTI’s over a twelve-month period. Unsweetened cranberry juice is best as sugar tends to worsen the infection. You can dilute 1 ounce of juice with 7 ounces of water. Cranberries have proanthocyanidins. This is a compound that prevents E.coli from multiplying within the urethra.

Pineapple

Pineapple contains bromelain. It’s a protease mixture or enzyme mixture that has been proven to have anti-inflammatory properties. It also increases wound healing and immunomodulatory effects. It’s also being studied as an anticancer agent.

Probiotics

Among pregnant and breastfeeding women, probiotics are often recommended. Probiotics contain healthy bacteria which help your immune system and staves off infection. Probiotics like fermented yogurt and live cultures can give you a dose of “good” bacteria.

Vitamin C

If you want to prevent a UTI infection you can take Vitamin C. It makes the urine acidic. This prevents bacteria from multiplying. With the bacteria controlled, the chances of a UTI are less.

Lemon juice

Lemon juice also contains ascorbic acid. It makes the urine acidic and controls the bacteria. You can drink lemon juice or can be used prophylactically in those who have frequent UTI’s.

Baking soda

Urine alkalinization has been studied in female patients with lower UTI’s. In fact, in chronic patients, this alkalinization is done with sodium bicarbonate. You can use ½ tsp of baking soda in warm water and drink this in the morning. This wouldn’t be suitable for people with hypertension as it contains sodium which increases blood pressure.

Apple Cider Vinegar

Dilute two tbsps. of apple cider vinegar in a cup of water. You can add honey to this mixture. Drink this in the morning till your infection clears. Apple cider vinegar hasantimicrobial activity against E. coli, Staphylococcus aureus, and Candida albicans.

Garlic

Garlic has been studied for its effects against dyslipidemia and its antithrombotic effects. It has numerous benefits that now clinicians are considering garlic tablets as part of therapy. However, in uncomplicated urinary tract infections, it also plays a role due to its antifungal and antimicrobial properties. There is very limited scientific evidence about the usage of garlic for non-E. coli UTI.

Blueberries

A few blueberries in your diet either whole or juiced would be great till your infection clears.

Like cranberries, they also contain proanthocyanidins which help stave off E Coli.

Foods to avoid

When you have a UTI there are some foods that can worsen your condition.

Sugar

Sugars can contribute to the growth of yeast which can aggravate your UTI. Any refined flour, white bread, pasta and sweet stuff can be responsible for increasing your sugar levels. Increase sugar levels also affect the immunity and hence can encourage the growth of bacteria and slows down the resolution of your infection.

Caffeine

Caffeine is a stimulant and a diuretic. It is known to be a bladder irritant as it produces early urgency and increases the frequency of urination. If you have symptoms if UTI you should avoid, coffee, tea, and alcohol.

Spicy food

Lay off the spice and other foods that can irritate the bladder. You don’t want a very active bladder when you have a UTI.

Red meat

Red meat also tends to add more acid to your gut and lowers pH levels in the body. Try and avoid red meat if you have an active urinary tract infection. Eat a high fibre diet instead.

Diagnosis and Treatment

After asking about your symptoms, and making a tentative diagnosis your doctor may want to physically examine you and order a routine urine test and a bacterial culture of your urine. This is to confirm if you have an infection. And also to determine the causative bacteria or microorganism responsible for the infection.

Usually, doctors will instruct you to submit a clean catch sample of urine. This is done by washing the area and then collecting a sample midstream. The sample is collected in a sterile container to prevent cross contamination.

Treatments are usually targeted towards the offending bacteria. And these are usually antibiotics. Bacteria that are sensitive to the antibiotics will be killed. However, with every urinary tract infection and subsequent treatment, the bacteria may develop resistance and so it’s essential that you prevent recurrent urinary tract infections.

 

URINARY TRACT INFECTION: WHAT YOU SHOULD AND SHOULD NOT EAT

5 FOODS THAT CAN CAUSE CANCER

By Yasmine Ali, MD

The International Agency for Research on Cancer (IARC), a part of the World Health Organization (WHO), came out definitively with a report on cancer-causing processed meats, stating that such meats definitely can cause colorectal cancer. They have also stated that red meat in general “probably” causes cancers such as colon, pancreatic, and prostate cancer.

Given that obesity is a risk factor for a number of different cancers, it is helpful to do all you can to decrease your risk.

Below are five foods to avoid, based on the report.

  1. Hot Dogs

According to the IARC press release, “Processed meat refers to meat that has been transformed through salting, curing, fermentation, smoking, or other processes to enhance flavour or improve preservation.”

Hot dogs are listed as one example of processed meat that can cause cancer. Specifically, the IARC classified processed meat as “carcinogenic [cancer-causing] to humans, based on sufficient evidence in humans that consumption of processed meat causes colorectal cancer.”

According to the IARC, a little over the equivalent of one hot dog per day is enough to increase the risk of colorectal cancer by 18%.

  1. Beef Jerky

Beef jerky also falls into processed meat group and was listed as a specific example in the IARC press release as a processed meat that can cause cancer.

The IARC press release regarding the recent findings stated that IARC experts “considered more than 800 studies that investigated associations of more than a dozen types of cancer with the consumption of red meat or processed meat in many countries and populations with diverse diets.”

The IARC Working Group found that “the most influential evidence came from large prospective cohort studies conducted over the past 20 years.”

  1. Sausage

Sausage is another kind of processed meat that was given as an example in the IARC press release as being cancer-causing.

The IARC has stated that “each 50-gram portion of processed meat eaten daily increases the risk of colorectal cancer by 18%.”

The IARC further noted that “the consumption of meat varies greatly between countries, with from a few percent up to 100% of people eating red meat, depending on the country, and somewhat lower proportions eating processed meat.”

  1. Ham

Ham is a processed meat that is not only carcinogenic due to its processed nature but has also been linked to high blood pressure and other cardiovascular diseases because of its very high sodium content.

Other processed deli meats, such as pastrami, salami, pepperoni, and the like, present the same cancer-causing risk.

  1. Corned Beef

Corned beef was also one of the examples listed by the IARC as a processed meat linked to colorectal cancer.

The IARC further noted that “most processed meats contain pork or beef, but processed meats may also contain other red meats, poultry … or meat by-products such as blood.”

Other examples of processed meat listed in the IARC press release included canned meat and meat-based preparations and sauces.

Article Sources :

Nagle CM, Wilson LF, Hughes MC, et al. Cancers in Australia in 2010 Attributable to the Consumption of Red and Processed Meat. Aust N Z J Public Health. 2015; 39:429-33.

Amiano P, Chamosa S, Etxezarreta N, et al. Unprocessed Red Meat and Processed Meat Consumption and Risk of Stroke in the Spanish Cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC). Eur J Clin Nutr 2015 Sep 30. [Epub ahead of print]

5 FOODS THAT CAN CAUSE CANCER

ENLARGED HEART

Overview

An enlarged heart (cardiomegaly) isn’t a disease, but rather a sign of another condition.

The term “cardiomegaly” refers to an enlarged heart seen on any imaging test, including a chest X-ray. Other tests are then needed to diagnose the condition causing your enlarged heart.

You may develop an enlarged heart temporarily because of a stress on your body, such as pregnancy, or because of a medical condition, such as the weakening of the heart muscle, coronary artery disease, heart valve problems or abnormal heart rhythms.

Certain conditions may cause the heart muscle to thicken or one of the chambers of the heart to dilate, making the heart larger. Depending on the condition, an enlarged heart may be temporary or permanent.

An enlarged heart may be treatable by correcting the cause. Treatment for an enlarged heart can include medications, medical procedures or surgery.

Symptoms

In some people, an enlarged heart causes no signs or symptoms. Others may have these signs and symptoms:

  • Shortness of breath
  • Abnormal heart rhythm (arrhythmia)
  • Swelling (oedema)

When to see a doctor

An enlarged heart is easier to treat when it’s detected early, so talk to your doctor if you have concerns about your heart.

If you have new signs or symptoms that might be related to your heart, make an appointment to see your doctor.

Seek emergency medical care if you have any of these signs and symptoms, which may mean you’re having a heart attack:

  • Chest pain
  • Discomfort in other areas of the upper body, including one or both arms, the back, neck, jaw, or stomach
  • Severe shortness of breath
  • Fainting

Causes

An enlarged heart can be caused by conditions that cause your heart to pump harder than usual or that damage your heart muscle. Sometimes the heart enlarges and becomes weak for unknown reasons (idiopathic).

A heart condition you’re born with (congenital), damage from a heart attack or an abnormal heartbeat (arrhythmia) can cause your heart to enlarge. Other conditions associated with an enlarged heart include:

  • High blood pressure.Your heart may have to pump harder to deliver blood to the rest of your body, enlarging and thickening the muscle.

High blood pressure can cause the left ventricle to enlarge, causing the heart muscle eventually to weaken. High blood pressure may also enlarge the upper chambers of your heart (atria).

  • Heart valve disease. Four valves in your heart keep blood flowing in the right direction. If the valves are damaged by conditions such as rheumatic fever, a heart defect, infections (infectious endocarditis), connective tissue disorders, certain medications or radiation treatments for cancer, your heart may enlarge.
  • Disease of the heart muscle (cardiomyopathy).As this thickening and stiffening of heart muscle progress, your heart may enlarge to try to pump more blood to your body.
  • High blood pressure in the artery connecting your heart and lungs (pulmonary hypertension).Your heart may need to pump harder to move blood between your lungs and your heart. As a result, the right side of your heart may enlarge.
  • Fluid around your heart (pericardial effusion).Accumulation of fluid in the sac (pericardium) that contains your heart may cause your heart to appear enlarged on a chest X-ray.
  • Low red blood cell count (anaemia).Anaemia is a condition in which there aren’t enough healthy red blood cells to carry adequate oxygen to your tissues. Untreated, chronic anaemia can lead to a rapid or irregular heartbeat. Your heart must pump more blood to make up for the lack of oxygen in the blood.
  • Thyroid disorders. Both an underactive thyroid gland (hypothyroidism) and an overactive thyroid gland (hyperthyroidism) can lead to heart problems, including an enlarged heart.
  • Excessive iron in the body (hemochromatosis).Hemochromatosis is a disorder in which your body doesn’t properly metabolize iron, causing it to build up in various organs, including your heart. This can cause an enlarged left ventricle due to the weakening of the heart muscle.
  • Rare diseases that can affect your heart, such as amyloidosis.Amyloidosis is a condition in which abnormal proteins circulate in the blood and may be deposited in the heart, interfering with your heart’s function and causing it to enlarge.

Risk factors

You may have a greater risk of developing an enlarged heart if you have any of the following risk factors:

  • High blood pressure.Having a blood pressure measurement higher than 140/90 millimeters of mercury puts you at an increased risk of developing an enlarged heart.
  • A family history of enlarged hearts or cardiomyopathy.If an immediate family member, such as a parent or sibling, has had an enlarged heart, you may be more susceptible to developing the condition.
  • Blocked arteries in your heart (coronary artery disease).With this condition, fatty plaques in your heart arteries obstruct blood flow through your heart vessels, which can lead to a heart attack. When a section of heart muscle dies, your heart has to pump harder to get adequate blood to the rest of your body, causing it to enlarge.
  • Congenital heart disease. If you’re born with a condition that affects the structure of your heart, you may be at risk of developing an enlarged heart.
  • Heart valve disease. The heart has four valves — aortic, mitral, pulmonary and tricuspid — that open and close to direct blood flow through your heart. Conditions that damage the valves may cause the heart to enlarge.
  • Heart attack. Having a heart attack increases your risk of developing an enlarged heart.

Complications

The risk of complications from an enlarged heart depends on the part of the heart that is enlarged and the cause.

Complications of an enlarged heart can include:

  • Heart failure.One of the most serious types of enlarged heart, an enlarged left ventricle increases the risk of heart failure. In heart failure, your heart muscle weakens, and the ventricles stretch (dilate) to the point that the heart can’t pump blood efficiently throughout your body.
  • Blood clots.Having an enlarged heart may make you more susceptible to forming blood clots in the lining of your heart. If clots enter your bloodstream, they can block blood flow to vital organs, even causing a heart attack or stroke. Clots that develop on the right side of your heart may travel to your lungs, a dangerous condition called a pulmonary embolism.
  • Heart murmur.For people who have an enlarged heart, two of the heart’s four valves — the mitral and tricuspid valves — may not close properly because they become dilated, leading to a backflow of blood. This flow creates sounds called heart murmurs. Although not necessarily harmful, heart murmurs should be monitored by your doctor.
  • Cardiac arrest and sudden death.Some forms of an enlarged heart can lead to disruptions in your heart’s beating rhythm. Heart rhythms too slow to move blood or too fast to allow the heart to beat properly can result in fainting or, in some cases, cardiac arrest or sudden death.

Prevention

Tell your doctor if you have a family history of conditions that can cause an enlarged heart, such as cardiomyopathy. If cardiomyopathy or other heart conditions are diagnosed early, treatments may prevent the disease from worsening.

Controlling risk factors for coronary artery disease — tobacco use, high blood pressure, high cholesterol and diabetes — helps to reduce your risk of an enlarged heart and heart failure by reducing your risk of a heart attack.

You can help reduce your chance of developing heart failure by eating a healthy diet and not abusing alcohol or using illicit drugs. Controlling high blood pressure with diet, exercise and possibly medications also prevents many people who have an enlarged heart from developing heart failure.

Diagnosis

If you have symptoms of a heart problem, your doctor will perform a physical exam and order tests to determine if your heart is enlarged and to find the cause of your condition. These tests may include:

  • Chest X-ray.X-ray images help your doctor see the condition of your lungs and heart. If your heart is enlarged on an X-ray, other tests will usually be needed to find the cause.
  • This test records the electrical activity of your heart through electrodes attached to your skin. Impulses are recorded as waves and displayed on a monitor or printed on paper. This test helps your doctor diagnose heart rhythm problems and damage to your heart from a heart attack.
  • This test for diagnosing and monitoring an enlarged heart uses sound waves to produce a video image of your heart. With this test, the four chambers of the heart can be evaluated.

Your doctor can use the results to see how efficiently your heart is pumping, determine which chambers of your heart are enlarged, look for evidence of previous heart attacks and determine if you have congenital heart disease.

  • Stress test.A stress test, also called an exercise stress test, provides information about how well your heart works during physical activity.

An exercise stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm, blood pressure and breathing are monitored.

  • Cardiac computerized tomography (CT) or magnetic resonance imaging (MRI).In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine called a gantry. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest.

In a cardiac MRI, you lie on a table inside a long tube-like machine that uses a magnetic field and radio waves to produce signals that create images of your heart.

  • Blood tests. Your doctor may order blood tests to check the levels of certain substances in your blood that may point to a heart problem. Blood tests can also help your doctor rule out other conditions that may cause your symptoms.
  • Cardiac catheterization and biopsy. In this procedure, a thin tube (catheter) is inserted in your groin and threaded through your blood vessels to your heart, where a small sample (biopsy) of your heart, if indicated, can be extracted for laboratory analysis.

The pressure within the chambers of your heart can be measured to see how forcefully blood pumps through your heart. Pictures of the arteries of the heart can be taken during the procedure (coronary angiogram) to ensure that you don’t have a blockage.

Treatment

Treatments for an enlarged heart focus on correcting the cause.

Medications

If cardiomyopathy or another type of heart condition is to blame for your enlarged heart, your doctor may recommend medications. These may include:

  • Diuretics to lower the amount of sodium and water in your body, which can help lower the pressure in your arteries and heart
  • Angiotensin-converting enzyme (ACE) inhibitors to lower your blood pressure and improve your heart’s pumping capability
  • Angiotensin receptor blockers (ARBs)to provide the benefits of ACE inhibitors for those who can’t take ACE inhibitors
  • Beta-blockers to lower blood pressure and improve heart function
  • Anticoagulants to reduce the risk of blood clots that could cause a heart attack or stroke
  • Anti-arrhythmic to keep your heart beating with a normal rhythm

Medical procedures and surgeries

If medications aren’t enough to treat your enlarged heart, medical procedures or surgery may be necessary.

  • Medical devices to regulate your heartbeat.For a certain type of enlarged heart (dilated cardiomyopathy), a pacemaker that coordinates the contractions between the left and right ventricle may be necessary. In people who may be at risk of serious arrhythmias, drug therapy or an implantable cardioverter-defibrillator (ICD) may be an option.

ICDs are small devices — about the size of a pager — implanted in your chest to continuously monitor your heart rhythm and deliver electrical shocks when needed to control abnormal, rapid heartbeats. The devices can also work as pacemakers.

If the main cause of your enlarged heart is atrial fibrillation, then you may need procedures to return your heart to a regular rhythm or to keep your heart from beating too quickly.

  • Heart valve surgery. If your enlarged heart is caused by a problem with one of your heart valves or it has caused heart valve problems, you may have surgery to repair or replace the affected valve.
  • Coronary bypass surgery. If your enlarged heart is related to coronary artery disease, your doctor may recommend coronary artery bypass surgery.
  • Left ventricular assist device (LVAD).If you have heart failure, you may need this implantable mechanical pump to help your weakened heart pump. You may have an LVAD implanted while you wait for a heart transplant or, if you’re not a heart transplant candidate, as a long-term treatment for heart failure.
  • Heart transplant. If medications can’t control your symptoms, a heart transplant may be a final option. Because of the shortage of donor’s hearts, even people who are critically ill may have a long wait before having a heart transplant.

Lifestyle and home remedies

There are ways to improve your condition, even though you can’t cure it. Your doctor may recommend the following lifestyle changes:

  • Quit smoking.
  • Lose excess weight.
  • Limit salt in your diet.
  • Control diabetes.
  • Monitor your blood pressure.
  • Get modest exercise, after discussing with your doctor the most appropriate program of physical activity.
  • Avoid or eliminate alcohol and caffeine.
  • Try to sleep eight hours nightly.

Preparing for your appointment

If you think you may have an enlarged heart or are worried about your heart disease risk because of your family history, make an appointment with your doctor. If you have heart disease, your doctor may refer you to a heart specialist (cardiologist).

Here’s some information to help you prepare for your appointment.

What you can do

  • Be aware of any pre-appointment restrictions. When you make the appointment, ask if there’s anything you need to do in advance, such as restrict your diet or fast before tests.
  • Write down your symptoms, including ones that may seem unrelated to coronary artery disease.
  • Write down key personal information, including a family history of heart disease, stroke, high blood pressure or diabetes, and major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements you’re taking.
  • Take a family member or friend along, if possible. Someone who accompanies you may remember something you missed or forgot.
  • Write down questions to ask your doctor.

Preparing a list of questions will help you make the most of your time with your doctor. For heart disease, some basic questions to ask your doctor include:

  • What is likely causing my symptoms or condition?
  • What are other possible causes for my symptoms or condition?
  • What tests do I need?
  • What’s the best treatment?
  • What foods should I eat or avoid?
  • What’s an appropriate level of physical activity?
  • Are there restrictions I should follow?
  • How often should I be screened for heart disease? For example, how often do I need a cholesterol test?
  • I have other health conditions. How can I best manage them together?
  • Should I see a specialist?
  • Should my children be screened for this condition?
  • Is there a generic alternative to the medicine you’re prescribing?
  • Are there brochures or other printed materials I can take? What websites do you recommend?

Don’t hesitate to ask other questions.

What to expect from your doctor?

Your doctor is likely to ask you questions, including:

  • When did your symptoms begin?
  • Have your symptoms been continuous or occasional?
  • How severe are your symptoms?
  • What, if anything, seems to improve your symptoms?
  • What, if anything, appears to worsen your symptoms?
  • What is your typical diet?
  • Do you drink alcohol? How much?
  • Do you smoke?
  • Are you physically active? How often do you exercise?
  • Have you been diagnosed with other conditions?
  • Do you have a family history of heart disease?

 

Enlarged heart

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