Global Health Tribune - June 2011 issue by Global Health Tribune

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JUNE ISSUE â&#x20AC;˘ 2011

S ervin g: Ju p it er

Palm Beach Gard en s

R oyal Palm Bea ch

Wellin gt on

Belle Glad e

www.floridahealthnews-online.com

Lak e Wort h

Lan t an a

Boyn t on n Bo ca R at on

Cell Phones May Cause Brain Cancer, WHO Experts Say Also in this issue

Grand Opening Celebration of SFRO Jupiter Location. PAGE 8

Cell phones may cause brain cancer, a panel of experts reporting to the World Health Organization (WHO) announced. PAGE 4

Palms West Hospital Recognized by U.S. News and World Report in the Specialty Area of Gynecology PAGE 14

FLORIDA HEALTH NEWS P.O. Box 213424 Royal Palm Beach, FL 33421

U.S. Serves Up New Nutrition Guidelines on 'MyPlate' .............2 PINK ELEPHANT ........................3 Cell Phones May Cause Brain Cancer, WHO Experts Say ..........4 Are you leaving money on the table? .........................................5 Poor Sleep Tied to Incontinence, Impotence ..................................6 Show off your skin this summer: tips for a clear complexion.........7 Grand Opening Celebration of SFRO Jupiter Location ...............8 A Non-Surgical Alternative for Treating Skin Cancers ..............10 Chronic Cough .........................11 Parents Should Screen Kids' Summer Web Surfing: Expert ..12 Medical Community Business Networking...............................13 Palms West Hospital Recognized by U.S. News and World Report in the Specialty Area of Gynecology ..............................14 More Than 1 Million Americans Now Living With HIV: CDC.......15

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U.S. Serves Up New Nutrition Guidelines on 'MyPlate' The logo, which replaces the Food Pyramid, is designed to encourage healthful eating.

n its latest effort to get Americans to eat healthier meals and fight the obesity epidemic, the federal government has introduced a new nutrition icon called MyPlate. MyPlate replaces the U.S. Department of Agriculture's Food Pyramid, which was unveiled in 1992 but had become too complicated in ensuing years, many nutritionists contended. "We are going to continue to have conversations about balanced meals to make this seem fun and simple and not complicated and overburdened," First Lady Michelle Obama said during a press briefing to introduce the MyPlate icon. "We can do something that makes a difference, something that people can use in their everyday lives," added Obama, who has made combating obesity a priority since becoming First Lady.

The MyPlate logo suggests people eat balanced meals consisting of servings of fruits, vegetables, grains, protein and a small amount of dairy. To help make healthy choices, the USDA is also introducing a website called ChooseMyPlate.gov.

to promote strategies and actions that we think will empower families and children to change how much and what they eat," he said. One nutritionist said it's about time the Pyramid moved aside for something simpler. "Replacing the Food Pyramid with a Food Plate icon, otherwise known as the Plate Method of nutrition education, is an encouraging step," said Miriam Pappo, director of the department of clinical nutrition at Montefiore Medical Center in New York City.

The site is designed to provide consumers with practical information on healthful eating. For example, MyPlate recommends reducing portion size; making at least half of each meal fruits and vegetables; making at least half of grains consumed whole grains, such as whole wheat bread and pasta; and switching to fat-free or low-fat (1 percent) milk. In addition, the program urges cutting down on salt consumption and drinking water instead of sugary beverages. The ChooseMyPlate.gov website will also include information for health professionals, nutrition educators and the food industry. "We are going to build momentum around MyPlate with a longterm strategy that includes working with community and national partners," said Obama.

Robert C. Post, the USDA's deputy director of the Center for Nutrition Policy and Promotion, said that "dietary health has never been more important," especially given the nation's obesity epidemic. According to federal estimates, about two-thirds of U.S. adults and up to one-third of children are overweight or obese. All that added weight leaves them

at risk for a variety of health problems, including diabetes, high blood pressure and heart disease. Post believes Americans are looking for simple and clear directions about what to eat. "There is a need to provide a simpler approach to empower consumers in knowing about healthier choices," he said. "It's really time to shake things up and motivate all sectors of society

"The Food Pyramid, especially the newer vertical pyramid, was confusing at best. The plate is a universally used utensil. Dividing the plate into four compartments, along with a cup of milk/yogurt, conveys a visual display of both portion size and quantity of foods needed in a healthy diet. The plate's universality is easy for all to understand and the message is made easy to remember," she said. The USDA's Post added that the federal government intends to actively promote MyPlate over the next several years. "We hope this will lead to the behavior changes, which is what we need," he said.

Obesity Greater Risk for Fatty Liver Than Alcohol, Study Finds Moderate amounts of red wine had no ill effect and even improved cholesterol levels, researchers say.

besity and insulin resistance constitute a greater risk for fatty liver disease than moderate alcohol consumption, according to a new study that found drinking modest amounts of red wine posed no greater risk for developing the condition. For their study, published online in Annals of Medicine, Swedish researchers instructed 44 people to either abstain from alcohol or drink one (women) or two (men) glasses of red wine a day for three months. At the beginning and end of the three months, the investiga-

tors collected blood samples and conducted MRIs to measure the fatty content of participants' livers. "It turned out that the amount of fat in the liver was linked with obesity and insulin resistance and was almost not at all affected by the red wine. Specifically, after three months, none of the wine drinkers had developed fatty liver or elevated liver transaminases," Dr. Stergios Kechagias, a liver specialist at Linkoping University, said in a news release from the Swedish Research Council. Moreover, the study found a 16

percent decrease in levels of harmful LDL cholesterol among those who drank the red wine. "There is a strong correlation between moderate intake of alcohol and decreased risk of cardiovascular disease, and our data provides a mechanism for this since LDL cholesterol was lowered to such a large extent," Dr. Fredrik Nystrom, a professor at Linkoping, concluded in the news release. Because it's known that large amounts of alcohol contribute to liver disease, it was long thought that even moderate consumption might have a harmful effect. Fatty liver, which is associated with diabetes, high blood pressure and cardiovascular disease, can lead to cirrhosis of the liver, the researchers noted. PUBLIC RELATIONS Phone: (561) 267-5232 p_relations@floridahealthnews-online.com

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CONTRIBUTING ARTICLES U.S. Department of Health and Human Services, ARA Content, Hispanic PR Wire, Centers for Disease Control and Prevention, METRO Editorial Services, Family Features, ÂŠ SEA PUBLICATIONS, INC. ALL RIGHTS RESERVED. Printed in United States.

Florida Health News is a newspaper published every month in Palm Beach county and surrounding areas. Copyright 2010, all rights reserved by SEA Publications, Inc. Contents may not be reproduced in any form without the written consent of the publisher. The publisher reserves the right to refuse advertising. The publisher does not accept responsibility for advertisement error beyond the cost of the advertisement itself. All submitted materials are subject to editing.

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PINK ELEPHANT “Then who did?” “The pink elephant” Out of fear of the inevitable consequences, my brother proceeded to explain in exaggerated detail how a BIG pink elephant came through the floorboards in the kitchen, ate the cookies, and then disappeared through the floor again. Dr. Shelley D. Plumb

have many fond memories growing up. My brother and I were very close, just years difference between us. Reflecting back there are many stories we chuckle about. My brother was mischievous and often backtracking out of trouble. I can recall one morning waking up and watching him tiptoe past my bedroom door, his pajama top full of newly baked chocolate chip cookies my mother had baked the night before. Knowing my mother would be upset with him I tiptoed to his bedroom door just in time to watch him devour the entire batch. Sure enough, when my parents awoke they were dismayed to say the least at the crumbs left in the cookie jar. I watched as my parents interrogated my brother who sat with big innocent eyes peering up at my father. “Did you take the cookies?” “No”

An unusual analogy, but my brother’s pink elephant is not too much different from stories we make up in our minds as adults. Our bodies daily give signals. Some days we feel good, ready to take on the world. Other days we notice changes we know are abnormal. Out of fear of potential consequences we often make up a story to justify the discomfort. This stall tactic can, unfortunately, have negative effects on our health.

Case 1: Mrs. Doe had a demanding job that involved walking on hard concrete floors. One day she noticed her right foot was sensitive at the base of the toes. Although her foot had swollen to the point that she could not fit in her shoes, she was reported to tell neighbors that the symptoms were from a “strain.” The pain was “nothing.” Sticking to her story, she refused to see her podiatrist for 3 weeks. When she could no longer tolerate the pain she limped into the office. After careful eval-

uation and comprehensive xrays she was found to have displaced fractures of 3 bones in her foot. Had she addressed her symptoms early, treatment would have simple shoe changes and job restrictions. Because she had ignored her symptoms, her condition now required surgical intervention and rigid cast immobilization.

Case 2: Mr. Smith noticed a “sore” one morning on his left foot. For many months he ignored the lesion. Mr. Smith dismissed the condition as not healing because of “poor circulation”. The lesion gradually became larger and began to drain. The borders surrounded the lesion became raised and irregular. When the area became red and inflamed 6 months later he begrudgingly presented to his podiatrist. The area was evaluated and a biopsy was performed. The pathology report came back as an advanced stage of squamous carcinoma. Patient subsequently underwent surgical intervention, radiation, and eventual amputa-

tion. Had the condition been diagnosed sooner, limb salvage may have been possible.

Case 3: Mr. jones woke one morning with a red, hot swollen foot. He had been at the beach the day before, running, and playing in the sand with his grandchildren. Mrs. jones was concerned as her husband was a diabetic and had little feeling in his feet. Mr. jones continued dismissed his symptoms as an attack of “the gout.” Over the next few days his foot became increasingly red, swollen, and painful. After the 4th day following the onset of the symptoms, Mr. jones noticed red streaks progressing up his leg. He now had a fever of 102.5. His wife rushed him to the hospital. MRI evaluation revealed a complicated abscess in his foot. emergent surgi-

cal intervention was necessary. The abscess was subsequently drained and four, 4 mm sea urchin spines were pulled from his foot. each of the above patients’s fabricated a scenario to explain their symptoms. As a result medical help was delayed and the consequences were much worse; Mrs. Doe required surgical intervention for her fractures, Mr. Smith underwent a potentially preventable amputation, Mr. jones put himself in a potentially limb threatening position. You see we all have our pink elephants we fabricate to alleviate our fears whether it be a “strain”, “poor circulation”, or “the gout.” Being honest about your body’s signs and symptoms, and seeking immediate medical treatment will most commonly lead the fastest, most uneventful recovery. What happened to my brother you might ask? Well…..my father was infuriated by his fabricated story containing the fictitious pink elephant. His punishment was much worse than had he told the truth. He was sentenced to a prolonged time period of time out in his room with no toys and NO cookies for a month. I was delighted, more for me… Call to make your appointment

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Cell Phones May Cause Brain Cancer, WHO Experts Say number of users worldwide that have access now to this technology."

World Health Organization now classifies the devices as 'possibly carcinogenic to humans.'

Also, the scientists found notable gaps in the existing research, he said, which "suggest interesting areas of future research that will improve the evidence base which we have in order to make decisions about the usage of mobile phones in the future."

ell phones may cause brain cancer, a panel of experts reporting to the World Health Organization (WHO) announced. After reviewing dozens of studies that explored a possible link between cancer and the ubiquitous hand-held phones, the experts classified cell phones as "possibly carcinogenic to humans" and placed them in the same category as the pesticide DDT and gasoline engine exhaust. The panel determined that an increased risk for glioma, a malignant form of brain cancer, appears associated with wireless phone use. Globally, it's estimated that 5 billion cell phones are in use. "The number of users is large and growing, particularly among young adults and children," the International Agency for Research on Cancer said in a news release.

The IARC made the announcement in Lyons, France, based on the work of 31 scientists from 14 countries. It will present its findings to the WHO, which may then issue its recommendations on safe cell phone use. experts said children are especially vulnerable. "Children's skulls and scalps are thinner. So the radiation can penetrate deeper into the brain of children and young adults. Their cells are dividing at a faster rate, so the impact of radiation can be much larger," Dr. Keith Black, chairman of neurology at Cedars-Sinai Medical Center in Los Angeles, told CNN. Until announcement, the

WHO had said that cell phones were safe to use. The international experts behind announcement met for eight days to review exposure data, studies of cancer in humans and in experimental animals, and other relevant data, looking for associations between cancer and the type of electromagnetic radiation found in cell phones, televisions and microwaves. Dr. Christopher Wild, director of the International Agency for Research on Cancer, said this new paper is important "first and foremost just because of the large

Responding to announcement, john Walls, vice president of public affairs for CTIA-The Wireless Association, a trade group representing the wireless industry said: "Today, an International Agency for Research on Cancer (IARC) working group in Lyon, France categorized radiofrequency fields from cellphones as 'possibly' carcinogenic based on 'limited evidence.' IARC conducts numerous reviews and in the past has given the same score to, for example, pickled vegetables and coffee. This IARC classification does not mean cell phones cause cancer. Under IARC rules, limited evidence from statistical studies can be found even though bias and other data flaws may be the basis for the results. There has been conflicting re-

search in recent years on the health hazards posed by cell phones. As recently as February, British researchers reported that cell phones do not increase the risk of brain cancer. Their analysis of data on newly diagnosed cases of brain cancer in england between 1998 and 2007 - when cell phone use was climbing -- revealed no statistically significant change in the incidence of brain cancers in men or women, said the University of Manchester researchers. That study was released online in the journal Bioelectromagnetics. Dr. Otis Brawley, chief medical officer for the American Cancer Society, said the WHO's classification of cell phones "means that there could be some risk, but that the evidence is not strong enough to be considered causal, and needs to be investigated further. The bottom line is the evidence is enough to warrant concern, but it is not conclusive." elsayyad advises using an ear piece or speaker when talking on a cell phone. "If you hold the phone away from your brain that ought to decrease the risk tremendously," he said.

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Are you leaving money on the table? As a medical practice or solo practitioner you are likely looking at EMR/EHR’s to meet meaningful use and trying to figure out what Health Care Reform means to your practice and patients. Do you know what your fee schedule is for However, we cannot allow • each contract that you are participating? • Do you know if the plan is paying you acourselves to be distracted cording to contract? from being vigilant about • Do you bring on new providers and tie our billing and collections. them to the group properly?

Kelly A. Conroy, CEO Blue Healthcare Management LLC

including rejected at the clearinghouse level. Make sure your staff is working all clearing house transmission rejections/denials every day.

ere are a few tips to be mindful of; whether you have Billing Inhouse or Billing Out-sourced.

Managed Care Contracting- All of your contracts should be reviewed at least once a year. There is money here.

Charge Reconciliation- Make it a point to reconcile the charges transmitted/billed out to your schedule once a week or at a minimum once a month. Many physicians do not realize that some services performed do not “go out the door” for any number of reasons

• Do you routinely request to be a provider with a plan and then sign the first contract that is sent to you? • Do you treat credentialing with a plan as just a necessary evil or do you use the recredentialing process as an opportunity to request an increase?

• Some plans may migrate you to a new fee schedule through-out the year by sending you a notice that you may or may not have seen. Ideally, you should have a mechanism (i.e. excel, access, etc.) to map your participating plans and providers. This “road map” should include all of the plans, all of the physicians/providers, and the current contracted fee schedules. This “road map” helps ensure that your payment poster and/or billing company is receiving accurate payments and this will also be helpful for your contract negotiator/credentialing person to negotiate better rates at the “renewal” time. Make sure you know when your contracts renew. Many times they are tied to an an-

niversary date. (i.e. you must notify plan 90 days prior to the end of the initial period of any requested changes or you may miss the opportunity). Contract language should be reviewed and negotiated • Renewal and Term of Contact (1-3 years) • Timely filing • Offsets/Retroactive Audit time frames (do not waive your rights under state statutes) (641.3155) • Amending the contract with written agreements (do not sign negative response clauses) • Mutual indemnification • Notice Section must be tight • Assignment (if company can assign to successor company/parity for provider). If you have any questions please feel free to contact me. Kelly Conroy, CEO Tel: 561.795.9150

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IRRITABLE BOWEL SYNDROME? We are conducting a clinical research study of an investigational medicine. If you meet the following criteria, you may be interested in participating in this clinical trial. • Age 18 – 79 inclusive • At least 28 stools over a 7-day period • Moderate to severe Pain in your abdomen associated with: • relief by defecation, • change in frequency of bowel movements, or • change in appearance of stool. Participants receive study related care, diagnostic tests, and study medication at no cost. Payment for time and travel to the study center may be provided For more information about the research study, please contact:

Venra Clinical Studies, LLC 561-795-3330 ex. 249 info@venraclinicalstudies.com

FLORIDAHeALTHNeWS-ONLINe.COM

Poor Sleep Tied to Incontinence, Impotence Two studies find links between sleep apnea and ED, and restless nights and urinary problems.

leep problems are associated with erectile dysfunction and urologic conditions such as incontinence, according to the results of two new studies.

The first study examined the relationship between obstructive sleep apnea (OSA) and erectile dysfunction. OSA is a disorder that occurs during sleep, in which a person's upper airway temporarily collapses, causing them to stop breathing. The study included 870 men with an average age of 47.3 years and an average body mass index of 30.2, which is considered obese. Health screening found that 63 percent of the men had OSA, 5.6 percent had a history of diabetes, and 29 percent had a history of smoking. After they adjusted for age and other health conditions, the researchers found that men with erectile dysfunction were more than twice as likely to have OSA than those without erectile dysfunction. And the more severe the erectile dysfunction, the greater the likelihood of having OSA, the investigators noted. The finding suggests that men with erectile dysfunction should be screened for OSA, said the researchers at Mount Sinai Medical Center in New York City. The second study found that sleep problems precede certain urologic conditions, such as urinary incontinence, lower urinary tract symptoms, and the need to get up during the night to urinate (nocturia).

Researchers at New england Research Institutes, Inc. in Watertown, Mass., followedup with 1,610 men and 2,535 women for five years, assessing sleep disturbances and the development of urologic symptoms. The investigators found that short sleep duration among men and restless sleep among men and women was strongly associated with the incidence of lower urinary tract symptoms (8 percent among men and 13 percent among women). Incidences of urinary incontinence and nocturia were associated with restless sleep among women but not men, according to the researchers. Both studies were scheduled to be presented to the media Saturday during a special press conference at the American Urological Association's annual meeting in Washington, D.C. "We know that proper amounts of sleep and quality of sleep can impact a wide range of health conditions, including erectile function and lower urinary tract symptoms," AUA spokesman Dr. Kevin T. McVary said in an association news release. "These data may help us better assess how helping patients modify their sleep patterns may help improve their health and overall quality of life."

Older Caregivers at Greater Risk for Cognitive Decline for a family member (primarily a spouse) with dementia. The review revealed that spouses who are caregivers may have a higher risk of cognitive impairment or dementia than spouses who are not caregivers.

Study finds those caring for spouse with dementia often struggle with attention span and memory

aring for a loved one who is ill is always stressful, but older people caring for a spouse who has dementia may face an increased risk for cognitive problem or dementia themselves, researchers report.

The new study, published in the May issue of the journal of the American Geriatrics Society, warns that caregivers need support to maintain their own mental health and ability to care for their loved ones. Researchers reviewed studies examining the cognitive health of older adults caring

"Persons who are caring for a spouse with dementia may themselves be at risk for cognitive problems which, in turn, will not only negatively influence their quality of life, but may reduce their ability to provide the necessary care for their spouse," study author Peter Vitaliano, University of Washington School of Medicine, said in a journal news release. "Spouse caregivers are extremely important because most care-recipients prefer to be cared for in their homes, and, by remaining in their homes, healthcare costs are reduced greatly." The study attributed the caregivers' cognitive decline to a number of possible contributing factors, including: Psychosocial factors: depression, loneliness, social isolation and sleep problems. Behavioral factors: exercise and diet. Physiological factors: obesity, chronically elevated insulin and inflammation. The researchers concluded that strategies are needed to help ease psychological distress and promote healthy behaviors among caregivers, such as eating right and exercising.

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Show off your skin this summer: tips for a clear complexion Everyone loves the sunshine, but summertime can wreak havoc on your skin. From the damaging sun rays to the poreclogging sweat from your favorite outdoor activities, it's tough to feel confident with skin imperfections holding you back.

on't hide your skin this summer - celebrate Acne Awareness Month this june with a flawless complexion by following a few simple skincare steps. Board certified dermatologist, Dr. julie Karen, offers the following easy tips to keep you looking and feeling great all summer long: n Always wear sunscreen: You've heard it a hundred times, but surprisingly very few people wear sunscreen every day, even during the summer months. Use a broad-spectrum sunscreen with an SPF of at least 15 - preferably 30 - every day year-round, but make sure to reapply frequently during the summer when you are more exposed to sun damage.

n Remove makeup before being active: What's worse than sweat clogging your pores? Sweat and makeup. Remove your makeup with a convenient and easy to use

cleansing wipe like Proactiv Makeup Removing Cloths. The cloths can be used on the go so you never have to worry about getting stuck in a sticky (and sweaty) situation. n Stay shine-free: Carry a small pack of oil blotting sheets with you in your bag or pocket. Simply blot your face when you feel an oil slick to help you remain grease-free. And, treat yourself to an oil absorbing mask like the award-winning Proactiv Refining Mask. With a 6 percent concentration of antibacterial sulfur, the Refining Mask helps to heal the skin and vitamin-enriched omegas help keep skin balanced and toned. This best-seller can also double as an overnight spot treatment to treat the occasional blemish. n Get bathing suit ready: Acne doesn't discriminate - it will show up on your face, back, and even in

unexpected places. Keep your whole body clear this summer with an acne-fighting body scrub containing at least 2 percent salicylic acid. Top it off with a light moisturizer that also contains a dose of this key acne-clearing ingredient to fight acne from head to toe. just in time for Acne Awareness Month, Proactiv customers now have access to professional skin care advice through Proactiv 365, a new program offering 24-hour access to trained Skin Care Advisors, who are available year-round to answer acne questions and concerns, and to help you personalize your own custom skincare regimen.

Achieving clear skin is about prevention. So, in addition to these tips, make sure to cleanse and moisturize on a daily basis (even if you have oily skin) to maintain a healthy balance. exfoliation is key to keeping pores from clogging with oil and dead skin, which can be caused by tanning and other outdoor activities. Make sure to use a sunless self tanner instead for a gorgeous and safe glow. Incorporate these simple steps into your every day routine and celebrate Acne Awareness Month in style - with skin you are proud to show off.

Hula-Hoop Might Help Shed Unwanted Poundst

the hula-hoop, a large ring that can be gyrated around the waist, gained intense popularity in the 1950s and now it seems to be re-emerging as a hot trend in weight loss, a new study has found. "hooping" expends the same amount of energy as walking 4 to 4.5 miles per hour -- enough to help a person firm up and slim down, according to a news release from the american college of sports medicine (acsm). and "it's becoming a popular form of choreographed group exercise," study author John Porcari, of the University of Wisconsin-la crosse, said in the news release. the study found that the average heart rate for the 30-minute class was 151 beats per minute, and the average caloric expenditure was equivalent to 210 calories for 30 minutes of hooping. the total energy cost, the researchers revealed, was enough to help people control their body weight. the findings were to be presented this week at the american college of sports medicine annual meeting, held in conjunction with the World congress on exercise Is medicine, in denver. experts note that research presented at meetings isn't subjected to the same type of scrutiny given to research published in peer-reviewed journals.

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Grand Opening Celebration of SFRO Jupiter Location

on april 28th, 2011, south Florida radiation oncology celebrated the grand opening of their new office located at 225 chimney corner lane suite 100, in Jupiter. the event was attended by area physicians, friends and business owners. For more information or to make an appointment, please call: 561-275-1820. www.sfrollc.com

Dr. Kishore Dass cutting the symbolic ribbon of South Florida Radiation Oncology Jupiter office, accompanied by his family, staff and friends.

Brian Baugaman, Selena Smith and Brenda Bean.

Annette Smith and Karen Mclaren.

Donna Mazza and Jim Quinn.

Dr. Judy Armstrong, Sylvia & Dr. Claude Harmon.

Dr. Alex Mirakian showing the equipment at the guests.

Seema Dass and Dr. Lori Hansen.

Elle Morrison, John Carr and Ellen Cohen.

Jeff Moore, Connie Anderson, Chriss Harris and Mike Anderson.

Dana Prowell, Susan Tanner, Jennifer Kelley and Jennifer Bruk.

Dawn Bitgood, Breonna Tressler and Crystal Donato.

Dr. Rupesh Dharia and Craig Cuden.

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A Non-Surgical Alternative for Treating Skin Cancers Skin cancer is the uncontrolled growth of abnormal skin cells. If left unchecked, these cancer cells can spread from the skin into other tissues and organs. pigment) and is less common than squamous or basal cell carcinoma, but more dangerous. It is the leading cause of death from skin disease.

Anthony E. Addesa, M.D. Board-Certified Radiation Oncologist

kin cancer is divided into two major groups: nonmelanoma and melanoma. Basal cell carcinoma is a type of non-melanoma skin cancer, and is the most common form of cancer in the United States. According to the American Cancer Society, 75% of all skin cancers are basal cell carcinomas.

Causes, incidence, and risk factors The outer layer of skin, the epidermis, is made up of different types of cells. Skin cancers are classified by the types of epidermal cells involved: n Basal Cell Carcinoma develops from abnormal growth of the cells in the lowest layer of the epidermis and is the most common type of skin cancer. n Squamous Cell Carcinoma involves changes in the squamous cells, found in the middle layer of the epidermis. n Melanoma occurs in the melanocytes (cells that produce

Skin cancers are sometimes classified as either melanoma or nonmelanoma. Basal cell carcinoma and squamous cell carcinoma are the most common non-melanoma skin cancers. Other non-melanoma skin cancers are Kaposiâ&#x20AC;&#x2122;s sarcoma, Merkel cell carcinoma, and cutaneous lymphoma. Skin cancer is the most common form of cancer in the Unites States. Known risk factors for skin cancer include the following: n Complexion: Skin cancers are more common in people with light-colored skin, hair, and eyes. n Genetics: Having a family history of melanoma increases the risk of developing this cancer. n Age: Non-melanoma skin cancers are more common after age 40. n Sun exposure and sunburn. Most skin cancers occur on areas of the skin that are regularly exposed to sunlight or other ultraviolet radiation. This is considered the primary cause of all skin cancers. Skin cancer can develop in anyone, not only people with these risk factors. Young, healthy people -even those with dark skin, hair, and eyes -- can develop skin cancer.

Symptoms Skin cancers may have many different appearances. They can be small, shiny, waxy, scaly and rough, firm and red, crusty or bleeding, or have other features. Therefore, anything suspicious should be looked at by a physician. See the articles on specific skin cancers for more information. Here are some features to look for: n Asymmetry: one half of the abnormal skin area is different than the other half n Borders: irregular borders n Color: varies from one area to another with shades of tan, brown, or black (sometimes white, red, blue) n Diameter: usually (but not always) larger than 6 mm in size (diameter of a pencil eraser) n Any skin growth that bleeds or will not heal Use a mirror or have someone help you look on your back, shoulders, and other hard-to-see areas.

Treatment Different types of skin cancer require different treatment approaches. Surgical removal of the cancer is very common. However, in very delicate or sensitive areas, such as on the face, nose, lips and ears a non-surgical approach should be considered before a potentially disfiguring surgery. One such approach, which is relatively painless, is radiation therapy. Re-

cent advances in radiation applicators have afforded patients equal efficacy to surgery without any cosmetic defects. HDR applicators can be custom designed to treat such difficult areas such at nasal folds, eyelids and lips. This is referred to as brachytherapy (HDR) since the treatment distance is very short from source to target and can be customized for size of the skin lesion and depth. Treatment begins with simulation on a CAT scan, which precisely records size and depth of the skin lesion. Next follows a computeroptimized treatment plan that customizes the treatment for each patient and location. Treatment time is 1-2 minutes and a total of 8-12 daily treatments are usually required over a period of approximately 2 weeks given MondayFriday. As opposed to surgery, there is no cutting, and therefore no risk of bleeding or infection. The risk of a poor cosmetic outcome is significantly less than with surgery.

Outcomes When selecting a treatment option for skin cancer it is also very important to consider the cure rates

with each option. The recent advances in this type of radiation (HDR brachytherapy) have now allowed patients to choose this option with equal certainty to surgery that their cancer will not return. The rate of small basal cell skin cancer returning is about 1 -5% with both Mohs surgery and this type of radiation, and up to 10% for other forms of treatment. Smaller basal cell carcinomas are less likely to come back than larger ones. Basal cell carcinoma rarely spreads to other parts of the body. Most (95%) of squamous cell tumors can be cured if they are removed or treated with radiation promptly. The outlook depends on a number of factors, including the type of cancer and how quickly it was diagnosed. Squamous cell carcinoma only rarely spreads to other parts of the body. The use of a non-surgical approach should be a consideration for all patients with nonmelanoma skin cancers. New advances in radiotherapy can afford equal cure rates to surgery while preserving as much normal tissue as possible.

Too Much Work, Food, Media May Be Hurting Health But because it's ingrained in human nature to enjoy what you have when you have it, people may have taken too well to having too much.

Many would do better, physically and mentally, with less, expert says.

merica may be seen as a land of plenty, but some experts are beginning to believe that plenty may have become too much. Cheap and convenient food, busy work and social lives and a constant barrage from media sources have overloaded Americans and are having a detrimental effect on their mental and physical health, according to Mary jane RotheramBorus, a psychology professor at the University of California, Los Angeles, and co-director of the UCLA Center for Community Health and the Global Center for Children and Families.

All of this prosperity goes against the survival instincts that human beings adopted as they evolved, said Rotheram-Borus, who teaches a class at the UCLA Family Commons titled "Too Much? How to Do Less & enjoy More." "We were groomed for millennia to survive on too little," she said. "We didn't have enough food. We didn't have enough clothing. Our genetic code was built on those who could survive adversity."

Cheap fast food has led to Americans eating an average of 1,000 more calories a day than they need, Rotheram-Borus said. Constant media exposure creates stress while also numbing people to normal human interaction. And to pay for it all, people are working longer hours and enduring longer commutes. Dr. Patricia Wong, a Los Angeles psychiatrist and a spokeswoman for the American Psychiatric Association, said that the advent of text messaging and smart phones has added to people's stress because they "create a pressure to be constantly available" that used to

be endured only by doctors, police officers, firefighters and other professionals who spend much of their lives on call. "everyone is on call every minute of their lives now," she said. "There's no wonder people feel stressed out. Now mundane life is an emergency." But doctors are finding that when people cut back -- by eating less or reducing their media viewing, for instance -- their mental and physical health improves, RotheramBorus said. But if people want to improve their health by cutting back, Rotheram-Borus and Wong suggest that they: Set a consistent routine that is aligned with the values they want

their children to have. For example, make family dinners the norm, rather than an occasional treat. "If you value your kids more than your job, you need to be at home for dinner," Rotheram-Borus said. "If you want your kids to be balanced human beings, you can't work 100 hours a week yourself." Take a time out before making a purchase. Be clear about what you need when you go into a store. Cut back on your food intake, and choose healthy foods. Throw out all the junk food in your house. "Once you have it in the house, you're very likely to eat it," Rotheram-Borus said. Turn off the cell phone and disconnect from other media for a set period of time each day. "The reality is, in most situations a text message can wait," Wong said.

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Officials: U.S. Not Affected by European E. Coli Outbreak

Chronic Cough

what they eat," he added. "The U.S. food supply is not in jeopardy."

All tomatoes, cucumbers and lettuce imported from Germany and Spain being tested. U.S. health officials sought Friday to reassure Americans that there is little chance the deadly new strain of e. coli bacteria affecting Germany and other european countries will have any significant impact here. "This outbreak has not affected the U.S.," David elder, director of the U.S. Food and Drug Administration's Regional Operations, said during a news conference. The source of the outbreak in europe -- which has been blamed for 18 deaths -- remains unknown, but produce is a likely suspect, health officials said. "Produce remains safe and there is no reason for Americans to alter where they shop, what they buy,

As a precaution, the FDA has taken the step of detaining any shipments of tomatoes, lettuce and cucumbers arriving from Germany and Spain. Samples from these shipments will be tested for e. coli before being released into the U.S. market, elder said. "Any products found to be contaminated will be refused admission into the U.S. and any future shipments will be detained upon entry," he said. elder noted that produce from europe makes up less than 0.2 percent of all produce imported into the United States, and very little of that european produce comes into the country this time of the year. Chris Braden, director of the U.S. Centers for Disease Control and Prevention's Foodborne Waterborne and environmental Diseases division, said that "the strain of e. coli causing illness in europe is very rare, and [the] CDC is not aware of any confirmed cases of this infection ever reported in the United States." To date there have been four suspected cases of infection in the United States, Braden said, and "in each case the suspected case has been identified as persons who recently traveled to Hamburg, Germany."

Shekhar V. Sharma, M.D. Board Certified in Internal Medicine

ne can have chronic cough due to various reasons. Chronic cough due to chronic bronchitis is defined as cough for at least three consecutive months in a year for three years. Chronic bronchitis can be caused by cigarette smoking and also occupaciontal exposure to chemicals, fumes and sometimes second hand cigarette smoke. I have seen patients in my practice who have had chronic cough and were diagnosed to have chronic bronchitis, but in few instances I have found that these patients actually have chronic post nasal drip which was the prime cause of their malady, in some instances, I have seen chronic cough caused by reflux of acid from the stomach or even food contents aspirate into the lungs causing sleepless nights, in other words known as insomnia.

These conditions can be easily handled in an effective manner, if diagnosed by a cognizant physician. Some antihypertensive medicines can cause cough: Treatments for chronic cough could be varied de-

pending on the etiological factors. Last but not least, I have to reiterate that chronic cough, if left untreated, can be quite disabling and people must be aware that in most instances chronic cough can be either contained or treated.

Dr. Sharma's office in Belle Glade is at 1200 South Main Street, Suite 100 (opposite the Old Glades General Hospital). Dr. Sharma will be seeing patients at this location along with his nurse practitioner Grace VanDyk. He is currently accepting New Patients and the office accepts most insurances

Please call 561-996-7742 for an appointment.

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Parents Should Screen Kids' Summer Web Surfing: Expert Racism, violence, cyberbullying online among things to monitor.

s the school year wraps up, many kids will replace class time with cyber time -- a trend leading one researcher to caution parents to watch out for online hazards such as "sexting" and cyberbullying. "The Internet is a vast place with great things on it for children like games and educational lessons, David Schwebel, a psychology professor at the University of Alabama at Birmingham, said in a university news release. "There also are risks and danger such as sex crimes, violence, hatred and prejudice -- a lot of things children need to be protected from."

Schwebel points to a recent Pediatrics study that revealed about 75 percent of teens have cell phones and nearly a quarter of all American teens (22 percent) are surfing a social media site more than 10 times per day. "Parental controls can help, but are not foolproof," Schwebel noted. "Parents need to teach children to act safely and get help when needed." To that end, he outlines a number of tips designed to boost cyber safety among school children.

For one, Internet activity among young children should be routinely monitored, he advised. Parental participation in their child's web-surfing activities is a way to teach kids how to distinguish between appropriate content and inappropriate content, he suggested. In addition, pressure to join in common Web activities (such as posting overly personal photos) should be a topic of conversation between parents and child, so that children feel empowered to resist such temptations. Parents should also be on the lookout for signs that their child is being unsafely drawn into cyber-prompted activities, such as arranging to meet strangers they've talked with online. Lastly, Schwebel encouraged parents to put time restrictions on cyber activities. "Sitting on the Internet does not burn calories," Schwebel said. "Children need to be out running, playing and active."

Violent Video Games Linked to Increased Aggression In the study, researchers instructed 70 young adults to play either a nonviolent or a violent video game for 25 minutes. Afterwards, their brain responses were measured as they viewed two groups of photos -- one neutral (such as a man riding a bike), the other violent (such as a man sticking a gun in another man's mouth).

It's the first study to demonstrate cause-andeffect, researchers say.

iolent video games trigger aggression among those who play them, according to a new University of Missouri study. Such players showed more hostility because their brains had become less responsive, or desensitized, to violence -- a response that the researchers linked to increased aggression.

"From a psychological perspective, video games are excellent teaching tools because they reward players for engaging in certain types of behavior. Unfortunately, in many popular video games, the behavior is violence," study co-author Bruce Bartholow, an associate professor of psychology at UM College of Arts and Sciences, said in a university news release. Although other studies have linked gamers' desensitization to violence with increased aggression, the study is the first to demonstrate cause-and-effect, the researchers said. The study is published in the current issue of the journal of experimental Social Psychology.

The study found that participants assigned to play a violent video game had a reduced response to the violent photos -- an indication their brains had become desensitized to the violence. Researchers pointed out, however, that participants who had experience with the violent video games prior to the study showed small brain responses to the violent photos, regardless of which type of game they were assigned to play. "It could be that those individuals are already so desensitized to violence from habitually playing violent video games that an additional exposure in the lab has very little effect on their brain responses," said Bartholow, adding that there were additional factors to consider. Researchers also discovered that a reduced brain response to violence predicted the gamers' levels of aggression: The weaker the brain response to violent photos, the more aggressive the participants were. The study found those who played one of several popular violent games, such as "Call of Duty," "Hitman," "Killzone" and "Grand Theft Auto," set louder noise blasts for their opponents during the competitive task than those who played nonviolent games. The researchers concluded that future research should also focus on ways to control the effects of media violence, especially among children whose developing brains could become accustomed to violent behavior.

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Medical Community Business Networking on may 19th the members of the Palms West chamber of commerce networked with the medical community at the south Florida radiation oncology center located at 3347 state road 7 at Wellington. the event was attended by area physicians and members of the medical and business community.

Dr. Cathia Rene and Angela Rojas.

Shannon Letcher and Cesar Rivas.

Kelly Conroy and Cheryl Anders.

Larry Melby and Miguel Muniz.

Members of the Board of Managers of the Palms West Chamber of Mike Chaparro, Dr. Kishore Dass, Dr. Arthur Hansen and Mohan Pillai. Commerce Medical Committee and guests.

Helen Rengepis and Debra Middleton.

Andrew Goldstein and Vince Gerardi.

Dr. Duccio Baldari, Dr. Alex Goldman and Samir Qureshi.

Joe & Annie Stair, Dr. Andrew Shapiro.

Dr. Rouleau, Dr. Drad Glick, Toni Sherwood and Nick Pancorst.

The event was attended by area physicians and business community.

Dr. Jack Newcomer, Loraine Sousa and Peter De Vleeschauwer. Zenia Echeverria and Melissa Mclelland.

Anna Lee and Jerry Fonda.

Jaime Gould and Tera Somogyi.

Dr. Michael Mikolajczak, Palm Beach Urology team and Dr. Georgis Patsias.

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Palms West Hospital Recognized by U.S. News and World Report in the Specialty Area of Gynecology

oxahatchee, Florida, june 2011U.S. News and World Report has recognized Palms West Hospital as one of the top tier-best regional hospitals in the specialty area of Gynecology.

These rankings recognize 622 hospitals in or near major cities with a record of high performance in key medical specialties. There are a total of nearly 5,000 hospitals nationwide. “I am honored that our Gynecology Department at Palms West Hospital received high recognition by U.S. News and World Report. It is because of our top quality physicians and nurses, our County’s top ranked DaVinci Robotic Surgery program and HCA’s commitment to quality care in a safe environment that leads to this recognition”, said Dr. Steven Pliskow, Chairman of the Department of OB-GYN. U.S. News created Best Hospitals more than 20 years ago to identify hospitals exceptionally skilled in handling the most difficult cases, such as brain tumors typically considered inoperable and delicate pancreatic procedures. The new metro area rankings are relevant to a much wider range of healthcare consumers. They are aimed primarily at consumers whose care may not demand the special expertise found only at a nationally ranked hospital. Patients and their families will have a far better chance of finding a U.S. News-ranked best regional hospital in their health insurance network and might not have to travel to get care.

To be ranked in its metro area, a hospital had to score in the top 25 percent among its peers in at least one of 16 medical specialties.

“I am proud that U.S. News and World Report has recognized Palms West Hospital in the field of Gynecology. Our team of doctors and staff has taken a personal interest in making Palms West Hospital the best gynecological surgical center in our area. As one

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of the laparoscopic robotic surgeons at Palms West Hospital, I am honored to know that the time we have put in to improve patient care and services in our community is resulting in true advancements for our patients”, said Dr. Samuel Falzone.

“All of these hospitals provide first-rate care for the majority of patients, even those with serious conditions or who need demanding procedures,” says Health Rankings editor Avery Comarow. “The new Best Hospitals metro rankings can tell you which hospitals are worth considering for most medical problems if you live in or near a major metro area.” For the full list of metro area rankings visit www.usnews.com/hospitals

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More Than 1 Million Americans Now Living With HIV: CDC Plastic Surgery Risks May Depend on More Than Age After screening out other problems, older people had no increase in complications, study find Age alone should not be the sole determining factor when deciding whether an older person should have plastic surgery, a new study suggests. In following 216 women over the course of three years, researchers from the Cleveland Clinic found that, if screened properly, people who have facelifts after age 65 are at no greater risk for complications than those who are younger. More than 12 percent of the U.S. population is older than 65, according to the U.S. Department of Health and Human Services, and many of them have plastic surgery every year. "Facelift surgery in the elderly has always been perceived to carry more post-operative risk," Dr. james Zins, chairman of plastic surgery at the Cleveland Clinic, said in a news release from the clinic. "According to our study and

pre-operative screenings, patients over 65 had no statistically significant increase in complications." For the study, published online in Plastic and Reconstructive Surgery, the researchers analyzed how 148 women younger than 65 and 68 women older than 65 had fared during facelift surgery as well as any complications that resulted from the procedures. They found that complication rates were not statistically different between the two groups, suggesting that age is not an independent predictor of risk. The researchers pointed out, however, that the proper screening of older patients is essential. "It should not be generalized from the study that elderly patients can undergo a facelift operation with the same low complication rate as seen in the younger age group," Zins said. "Careful screening of the elderly patients, and excluding those with significant co-morbidities, led to the low complication rate." The researchers also noted that additional study would be needed to determine whether there's an upper age limit for safe facelift surgery.

While advances in care are leading to healthier lives, preventing new infections is key.

sexually transmitted disease, Kolber said. "The more frequently we test the better chance we get in getting the right number and making an impact on the disease," he said. According to CDC director Dr. Thomas R. Frieden, many Americans may have become too complacent about HIV, no longer viewing it as a major health threat.

lthough HIV/AIDS continues to be an epidemic with no cure, thanks to powerful medications more HIV-infected Americans are living longer and healthier lives, federal health officials said. By the close of 2008 there were 1,178,350 people in the United States living with HIV, 20 percent of whom don't know they are infected, according to researchers from the U.S. Centers for Disease Control and Prevention.

"Our prevalence of individuals with HIV continues to increase," said Dr. Michael A. Kolber, professor of medicine and director of the Comprehensive AIDS Program at the University of Miami Miller School of Medicine. He was not involved with the CDC study. AIDS has taken a terrible toll on the United States since cases were first reported by CDC researchers 30 years ago this week. Since that time, 594,496 Americans have died of the disease, the CDC said. However, thanks to the advent of HIV-suppressing medications, infection can now be considered less of a death sentence and more of a chronic disease, because "antiretroviral [drug] therapy is highly effective," Kolber said.

Classified

Still, the rising number on new infections is troubling. "People do not need to get HIV, it's a preventable disease," Kolber said. "But we also need to identify individuals with HIV and get them into care, which will reduce transmission." In fact, one recent study found that if started early after diagnosis, antiretroviral medications can help cut HIV transmission to a sex partner by 96 percent. Adding condoms to that preventive strategy ups the odds even further that a partner will remain uninfected. Too many people with HIV don't even realize that they carry the virus. What is needed is better access to testing and care, Kolber said. "We know that when people are tested positive it decreases their sexual activity in many cases. And if you get people into care we can reduce their viral loads. And when people are low viral loads they transmit the disease much less." HIV should be treated like any other

"Over the last three decades, prevention efforts have helped reduce new infections and treatment advances have allowed people with HIV to live longer, healthier lives," Frieden said in a news release. "But as these improvements have taken place, our nation's collective sense of crisis has waned. Far too many Americans underestimate their risk of infection, or believe HIV is no longer a serious health threat, but they must understand that HIV remains an incurable infection. We must increase our resolve to end this epidemic." The CDC says that each year in the United States, some 50,000 people become newly infected with HIV. Over half of these new infections are among gay and bisexual men, and of these about 50 percent are African-American, according to the CDC report in the june 3 issue of its Morbidity and Mortality Weekly Report (MMWR). "African-Americans make up about 12 percent of the population, but 50 percent of the new infections," Kolber said. "And it is usually in the urban areas among the lower socioeconomic, lower educated individuals," he added.

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