MARCH 2011
Khaas Baat : A Publication for Indian Americans in Florida
Health & Wellness

‘GO RED FOR WOMEN’S HEART DISEASE’

By M. P. RAVINDRA NATHAN,
MD, FACC, FACP

Sometimes, it is difficult to diagnose heart disease in women. Ask Ginny Rau, a nursing coordinator at Brooksville Regional Hospital, where I practice my cardiology and she will tell you her scary story.

“As caregivers, taking care of our husbands, family members and in my case, patients as well, we women don’t think our symptoms are important and we have a tendency to neglect ourselves. Then all of a sudden, the symptoms escalate and you have to run for help. That is what happened in my case.” Rau was giving a testimonial at the ‘Go Red for Women & Heart Disease’ Fashion Show recently held at Silverthorn Country Club in Brooksville. “After putting up with several days of fatigue and shortness of breath, which I attributed to my never- ending work week, I had to be rushed to the hospital and had to undergo an emergency heart catheterization followed by a stent implant in a major artery. That saved my life,” she said with relief.

February is traditionally recognized as National Heart Month. The American Heart Association’s ‘Go Red for Women’ initiative helps bring awareness of the issue of heart disease in women. We asked people to wear anything red during some days in this month to show their support. Although February has passed, we must not forget that cardiovascular disease is still the leading cause of death in United States.

Rau’s case is not isolated or unusual. Often, heart disease in women is missed or the diagnosis is delayed. Why? In many cases, their symptoms are atypical and the patients and sometimes the doctors too, dismiss their fatigue, vague chest discomfort, shortness of breath, unexplained sweating and irregular heartbeats as psychosomatic symptoms! This is particularly true if they reported that they had been under stress lately. Because of all these, men who present to the emergency department with similar symptoms may get faster and more aggressive treatment. Clearly, we need to rectify this gender bias. Researchers agree there is a definite overlap of coronary heart disease and anxiety symptoms. Even with the higher prevalence of stress and anxiety among women, coronary heart disease should be ruled out first by physicians.

Also, the risk of heart disease in women is often underestimated, because they tend to develop it later than men, often after menopause. But that is changing too, with changes in societal habits and customs. The younger ones with significant risk factors such as hypertension, smoking, diabetes, obesity, high cholesterol levels, etc., are just as likely to suffer from heart disease as the elders. Hence, young women should not feel they are immune to the disease.

By doing the right screening tests, we can identify who might be at higher risk. Recognition of this is important; so appropriate preventive measures can be instituted, which include maintaining a normal weight, observing healthy eating habits, exercising regularly and controlling risk factors as best as possible.

Several thousands of women die every year from heart disease. This is indeed the No. 1 killer of American women (Indian women too), not breast or uterine cancer. And the uniqueness in women needs emphasis. That is the reason the American Heart Association launched the ‘Go Red for Women’ movement in 2004. The ‘red dress’ pin you see on your doctor’s white coat or the nurse’s uniform is the national symbol for awareness of heart disease in women and you too can wear one of them all year around. By joining the movement, you become part of the fight against heart disease. So, make it your mission to stop heart disease in women and keep your loved ones healthy.

Dr. M.P. Ravindra Nathan is a Brooksville cardiologist and director of the Hernando Heart Clinic.


Guest Column

By SHIVAKUMAR VIGNESH, M.D

This past February was Cholangiocarcinoma Awareness Month and March is Colorectal Cancer Awareness Month. In an effort to inform our readers, we invited Dr. Shivakumar Vignesh to contribute a column.

DIAGNOSIS AND SCREENING OF GASTROINTESTINAL CANCERS

OVERVIEW OF GASTROINTESTINAL CANCERS, ROLE OF GASTROENTEROLOGISTS, COLORECTAL CANCER SCREENING – PART I

Cancer is the second leading cause of all deaths in the United States and GI cancers are a significant part of that. GI cancers arise from the food pipe, stomach, liver, biliary system, pancreas, small and large bowel (colorectal cancer) and anus. Screening plays an important role in the early detection and prevention of cancers, but is under utilized. Both a lack of awareness of screening recommendations and a lack of access to gastroenterologists also prevents people from getting screened appropriately. Examples of screening tests include blood tests, stool tests, X-rays, CT scan, colonoscopy and endoscopy.

Screening tests are used to detect a disease in healthy individuals without signs or symptoms of that disease. This is based on knowledge of the prevalence of a disease, time of onset of a disease in a population and the improved outcome with early diagnosis. Many GI cancers develop initially as a precancerous abnormality that can be detected by a simple screening test. Then the patient can get appropriate treatment at a curable stage in the disease. Screening tests such as checking occult (trace) blood in stool can detect colon cancer in some people. The early detection leads to appropriate treatment at an early stage of the disease resulting in better patient outcomes. Colonoscopy is one of the few screening tests that can detect the precancerous (precedes appearance of cancer by years) abnormality called “polyp” and offer treatment by removal of the polyp.

Gastroenterologists specialize in the diagnosis and treatment of diseases of the GI tract. After a three-year medical residency, they undergo a three-ear GI fellowship. Some undergo further advanced training pertaining to GI cancers and are called endoscopic oncologists. In addition to standard endoscopy, endoscopic oncologists perform Endoscopic Ultrasound (EUS), Endoscopic retrograde cholangiopancreatography (ERCP), stent placement to bypass a blockage and EUS-guided nerve blocks for pain. EUS is performed to stage the cancer (how advanced the disease is at diagnosis) and this determines the treatment (surgery/radiation/chemotherapy). ERCP is used to treat a blockage of the bile or pancreatic duct with stents, remove tumors at the lower end of the bile duct (ampulla) and treat biliary cancer (laser).


Colorectal Cancer (CRC)

CRC is the second leading cause of cancer death. A precancerous growth called a polyp precedes CRC. Polyps occur in people between the ages of 45 and 55. Polyps can turn into cancer over 5-10 years. By removing colonic polyps, colonoscopy prevents CRC. Colonoscopy is recommended at age 50 in all and at age 45 in African Americans. If someone has a family member with colon cancer (or other GI cancer) or polyps, they should discuss the timing of colonoscopy with their gastroenterologist. Risk factors for CRC include being African American, family history of CRC or polyps, smoking, red meat, heavy alcohol use, physical inactivity and Type 2 diabetes. Virtual colonoscopy (CT scan of the colon), stool tests for blood, barium X-ray and sigmoidoscopy (partial colonoscopy) are not recommended for CRC screening.

Colonoscopy is a 20-minute, painless, outpatient test that prevents CRC. It is safe when performed by a well-trained gastroenterologist. The day prior to colonoscopy, one is required to drink a prescribed liquid to clean the colon. An intravenous sedative is given before colonoscopy and the patient is asleep during the procedure. The patient’s breathing and heart function are monitored during and after the procedure. A soft, thin and flexible rubber tube (colonoscope) with a small camera is used to look inside the bowel. Tissue samples (biopsies) may be taken and polyps (small growth from the bowel lining) can be removed during a colonoscopy. Patients are instructed not to perform activities that involve coordination (driving or operating machinery) for 24 hours after the procedure. An accompanying person is helpful to take note of the doctor’s instructions and drive the patient home after the procedure.

There is no reason to fear a colonoscopy and patients should discuss their concerns with a gastroenterologist. It is a small price to pay to prevent cancer. If your colonoscopy is normal, you don’t need another one for 10 years! Colonoscopy is the only screening method accepted by the American Gastroenterology Association and the American Cancer Society.

Dr. Shivakumar Vignesh is an Endoscopic Oncologist at H. Lee Moffitt Cancer Center and Research Institute in Tampa and can be reached at (813) 745-3824 or email shivakumar.vignesh@moffitt.org

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