by Sucharu Chris Prakash, MD
Oscar winning actress Anjelina Jolie announced last week that she had prophylactic bilateral mastectomies after learning that she had a faulty gene that significantly raised her risk of breast cancer. This news not only stunned the world but also has ignited the debate on gene testing and treatment options.
Dr. Chris Prakash
What surgery did Jolie have?
She had prophylactic bilateral mastectomies (preventive removal of both breasts) in order to prevent breast cancer. She also had breast reconstruction soon after.
Why did she do it?
Jolie tested positive for one of the breast cancer susceptibility genes (BRCA1 gene mutation). This put her risk of developing breast cancer at 87% and of ovarian cancer at 50%. It should be noted that her mother was diagnosed at age 46 and died 10 years later.
How common is this gene mutation?
Only a small percentage of women have BRCA1 or BRCA2 mutations. They are most commonly found in women of Eastern European Jewish descent. These mutations are estimated to cause only 5 to 10% of all breast cancers (90 to 95% of breast cancers are not due to this gene).
Who should be tested for this gene?
Guidelines have been developed to determine if a woman would be at high risk for BRCA1 or 2 mutations:
Why is everybody not tested?
Even though it is a simple blood test, it is not something your doctor can automatically order. A woman should go through a process called genetic counseling, where the pros and cons of the test are discussed. The test is expensive ($3000) and may not be covered by insurance. If you test positive for a BRCA gene mutation, you may have feelings of anger or sadness, and concerns over possible insurance discrimination. Then you will have to make difficult decisions about preventive measures which will have long term effects. You may suffer from anxiety and feeling of inevitability that you will develop cancer.
Test is positive, now what?
At this time you will have a discussion with your doctor to decide what measures you should take to reduce the risk of developing cancer. Some of the options are:
So, did Jolie make the right choice?
This is a very personalized decision, but obviously it was the right choice for her. However, it may not be the right choice for others. After all, only 30% of women with BRCA mutations decide to undergo prophylactic mastectomies! Due to Ms Jolie’s celebrity status, this decision will likely have a great impact. If nothing else, it may make women more in tune with their family history, and empower them to make informed decisions about their health. I also hope that this triggers a greater adherence to cancer screening guidelines, since we know that it is very hard to prevent cancer, and our best chance is to catch it early if we can.
This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.prakash@usoncology.com.
by Sucharu Chris Prakash, eParis Extra!
Q: Are organic foods better for us than conventional foods? Should I spend the extra money and buy organic for the health of my family?
Dr. Chris Prakash
A: I am asked this question a lot, and often have no idea how to answer. Instinctively, it would appear that “organic” has to be better for us. However, the answer may not be that simple.
Organic products continue to get more popular. Between 1990 and 2011, U.S. sales of organic foods increased from $1 billion to $24.4 billion (Organic Trade Association). Most of us are willing to pay a premium for these products (Organic foods are often twice as expensive as conventional). So, there is a common perception that organic foods are better for us, but is it scientifically proven? – I will try to discuss this issue.
First, we need to understand what organic means. The word “organic” refers to the way farmers grow and process agricultural products, such as fruits, vegetables, grains, dairy products and meat. Organic farming practices are designed to be “greener” and reduce pollution. Farmers who grow organic produce don’t use conventional chemical fertilizers, do not use pesticides, and do not give animals growth hormones and antibiotics.
How do you know if something is organic? In order to be certified as organic by the USDA, all organic foods have to meet strict standards. These standards are based on how these foods are grown and processed. If a product is certified as at least 95% organic, they can display the following seal:
Organic vs Natural
Organic and natural are not interchangeable terms. The term “natural” doesn’t have a set, strictly defined or regulated definition, while “organic” does. When you see the word “natural” on food packaging, it can mean any number of different things, such as free range or hormone free, but the term “organic” is strictly defined by uniform, federal regulations (as mentioned above).
Is organic better?
This question was researched by a team of scientists at Stanford, and their findings were published in the Sept. 4, 2012 issue of Annals of Internal Medicine. They concluded that “there is no difference between organic and conventional foods as far as the nutritional value is concerned”. This was the most comprehensive meta-analysis to date of existing studies comparing organic and conventional foods, and included 237 of the most relevant studies to date. The review showed no evidence that conventional foods posed greater health risks than organic products. Organic produce however, had a 30 percent lower risk of pesticide contamination in their study.
What should you do?
Now that you know the scientific data, you can make an educated decision whether you should choose “organic”. You may want to buy organic, not for nutritional value, but for other reasons:
This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.prakash@usoncology.com.
by Chris Prakash, MD
Q: I have been feeling very tired lately. My friend told me that her doctor gives her B12 shots and I should do the same. Do you think that is a good idea?
Dr. Chris Prakash
A: I am sure that your friend has good intentions with that advice. I also know that a lot of people believe that vitamin B12 injections give them “pep” and alleviate fatigue. However, scientific data does not back this up. For people who are not deficient in B12, there is no evidence whatsoever that supplemental B12 helps. I recommend that you be evaluated by your doctor for possible causes of fatigue, and if it turns out that you lack B12, you may very well feel better with supplementation.
What is B12?
B12 is an essential vitamin with an important role in optimal functioning of various organ systems in the body. Most of all, it is needed for the development and maintenance of a healthy nervous system, the production of DNA and formation of red blood cells.
What are the symptoms of B12 deficiency?
A B12 deficiency can manifest in various ways. It can result in anemia, which can be picked up on a routine blood test. But the less dramatic symptoms of B12 deficiency may include muscle weakness, fatigue, shakiness, unsteady gait, incontinence, depression, and poor memory.
B12 deficiency can mimic dementia!
Sometimes, we may notice our elderly parents or grandparents becoming increasingly confused, and having short term memory loss. Immediately, dementia, or even Alzheimer’s comes to mind. In fact some of these people may even be treated for dementia, before it is recognized that they are deficient in vitamin B12. A B12 level is an easy blood test, and can prevent misdiagnosis, and unnecessary treatment.
Labs differ in what they consider normal B12 levels, but most experts consider a level below 400 needs to be treated.
Where do we get B12?
In its natural form, B12 is present in significant amounts only in animal foods, most prominently in liver. Other good food sources include red meats, turkey, fish and shellfish, dairy products, eggs and chicken. Vitamin B12 is generally not present in plant foods, but fortified breakfast cereals are a readily available source of vitamin B12 with high bioavailability for vegetarians.
Recommended dietary amounts of B12 vary: 2.4 micrograms daily for those ages 14 and older, 2.6 micrograms for pregnant women and 2.8 micrograms for nursing women (National Academy of Sciences). Usually, these levels are easily obtained from a well-balanced diet containing animal protein.
Who is at risk of B12 deficiency?
Vitamin B12 deficiency rises with age, to about 15% of elderly people. The rate is also much higher among people who don’t eat meat or dairy products, people with intestinal absorption problems, people taking acid-blockers and those with diabetes who take the drug Metformin. Heavy drinkers are also at increased risk of B12 deficiency.
Some people lack Intrinsic Factor (needed for absorption of B12), especially in people with an autoimmune disorder called pernicious anemia. This results in B12 deficiency.
How do we treat B12 deficiency?
Although injections of B12 work fast to correct a B12 deficiency, considerable evidence indicates that, in large enough doses, sublingual (under-the-tongue) tablets of B12 may work as well as injections, even for those with pernicious anemia.
Most often, a daily supplement of 2,000 micrograms is recommended for about a month, then lowered to 1,000 micrograms daily for another month, then lowered again to 1,000 micrograms weekly.
What is the role of Folic Acid?
Large doses of folic acid can mask a B12 deficiency and cause permanent neurological damage if normal levels of B12 are not maintained. This may be happening to a lot of elderly people due to the mandated folic acid fortification of foods. The folic acid masks the anemia and fatigue associated with B12 deficiency thus allowing the B12 deficiency to go undetected for a long time.
This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.prakash@usoncology.com
by Sucharu Chris Prakash, MD
eParis Extra!
Q: I am a 60 year old fairly healthy woman. For the last several months, I have experienced a sudden urge to urinate that is difficult to control. Sometimes I am not able to get to the toilet in time and have leaking. What should I do?
Dr. Chris Prakash
A: You most likely have an overactive bladder. This is also called “urge incontinence”. It is a condition that can cause the following symptoms: a sudden urge to urinate that’s difficult to control; involuntary loss of urine immediately following an urgent need to urinate; frequent urination, usually eight or more times a day; awakening two or more times in the night to urinate.
What causes an overactive bladder?
Symptoms of an overactive bladder occur due to involuntary contractions of the bladder muscles, which create the need to urinate urgently. Most commonly, an exact cause cannot be found. However, several conditions may contribute to signs and symptoms of overactive bladder, including some neurological disorders (Parkinsons, stroke), urine tract infections, medications, enlarged prostate in men.
Is it a normal part of aging?
Although common among older adults, an overactive bladder is NOT considered a normal part of aging. As we age, we are at higher risk of other diseases such as enlarged prostate and diabetes, which can contribute to problems with bladder function.
What is stress incontinence?
Some women may also have a disorder called mixed incontinence, when both urge and stress incontinence occur. Stress incontinence is the loss of urine when you exert physical stress or pressure on your bladder, such as during running or jumping.
What tests can the doctor do?
The doctor may order some special tests to check if the bladder is emptying well. This may require referral to a urologist. Most commonly, a diagnosis of urge incontinence can be made by reviewing your history and performing a simple exam. But sometimes further testing is necessary. To measure residual urine after you’ve voided, your doctor may request an ultrasound scan of your bladder. To measure the volume and speed of your voiding, you may be asked to urinate into a uroflowmeter. Rarely, a Cystometry may be done to measure pressure in your bladder.
Treatment
1) Behavioral interventions are the first choice in helping manage an overactive bladder. The interventions may include:
2) Medications
Several medications are available that work by relaxing the bladder muscles. They can help with symptoms of urge incontinence. Some of the common ones include: Detrol, Ditropan XL, Oxybutynin skin patch, Sanctura, Vesicare, Enablex.
Common side effects of most of these drugs include dry eyes, dry mouth, and constipation.
This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.prakash@usoncology.com
*by Sucharu Chris Prakash, MD*
How often should cholesterol levels be checked?
The National Cholesterol Education Program recommends that all adults have their fasting lipid profile checked at 20 years of age and every five years thereafter.
Dr. Chris Prakash
What should your cholesterol level be?
High cholesterol is associated with an elevated risk of cardiovascular disease, which can include coronary heart disease, stroke, and peripheral vascular disease.
A complete cholesterol profile is made up of three different things:
Figuring out the best cholesterol levels to aim for can be confusing. I use the American Heart Association guidelines to help interpret the numbers:
| Total Cholesterol Level | Category |
| Less than 200 mg/dL | Desirable level that puts you at lower risk for coronary heart disease. |
| 200 to 239 mg/dL | Borderline high |
| 240 mg/dL and above | High blood cholesterol – A person with this level has more than twice the risk of coronary heart disease as someone whose cholesterol is below 200 mg/dL. |
| HDL Cholesterol Level | Category |
| Less than 40 mg/dL (for men) Less than 50 mg/dL (for women) |
Low HDL cholesterol. A major risk factor for heart disease. |
| 60 mg/dL and above | High HDL cholesterol – An HDL of 60 mg/dL and above is considered protective against heart disease. |
| LDL Cholesterol Level | Category |
| Less than 100 mg/dL | Optimal (especially if high risk of heart disease) |
| 100 to 129 mg/dL | Near or above optimal |
| 130 to 159 mg/dL | Borderline high |
| 160 to 189 mg/dL | High |
| 190 mg/dL and above | Very high – Your other risk factors for heart disease and stroke help determine what your LDL level should be. |
| Triglyceride Level | Category |
| Less than 100 mg/dL | Optimal |
| Less than 150 mg/dL | Normal |
| 150–199 mg/dL | Borderline high |
| 200–499 mg/dL | High - A triglyceride level of 150 mg/dL or higher is one of the risk factors of metabolic syndrome. Metabolic syndrome increases the risk for heart disease and other disorders, including diabetes. |
| 500 mg/dL and above | Very high |
Every individual has his or her unique set of risk factors for cardiovascular disease. It is important that a discussion be held with your doctor about your risk factors (and cholesterol profile is an important part of that). Only then can you arrive at a strategy to lower your risk, which may include a combination of lifestyle modification and drugs.
This information is strictly an opinion of Dr Prakash, and is not intended to replace the advice of your doctor. Dr Chris Prakash is a contributing columnist, and author of eParisExtra’s “The Doctor is In” column. He is a medical oncologist at Texas Oncology Paris. He is board certified in Internal Medicine, Oncology and Hematology. He lives in Paris, TX with his wife and two children, and can be reached at 9037850031, or Sucharu.prakash@usoncology.com
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