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Saturday, January 25, 2020 | Body, Mind & Soul
TABLE OF CONTENTS
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Incorporating mindfulness into our busy lives Mindfulness is the ability to pay total attention to the present moment with nonjudgmental awareness
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People of all ages want to enjoy life to its fullest Berkshire Orthopaedic Associates helps to keep our community active and healthy
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Exciting changes in the care of venous disease There have been dramatic improvements in the medical care of persons suffering from CVI
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Weight loss surgery offers a lasting solution for chronic obesity Weight loss surgery often can significantly alleviate, even eliminate the presence and risks of serious medical conditions
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Over-the-Counter Medications: Use Only as Directed The misuse of OTC medicines overall results in nearly 200,000 hospitalizations nationally each year.
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Hunger in the Berkshires is an all too silent, but stark reality At least one of every 10 households in Berkshire County is likely go to bed hungry every night.
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BMC Program Helps Detect Lung Cancer Early Through Screening Lung cancer alone is responsible for 29 percent of cancer deaths, more than those from breast cancer, colon cancer, and prostate cancer combined.
Incorporating mindfulness into our busy lives brings peace of mind and body BY ANGELA WILSON
It only took 10,000 years or so, but the ancient principles of mindful meditation are finally being embraced by mainstream society as a means to cope with everyday stress, appreciate each moment and stay emotionally and physically healthy. No longer the seemingly secret domain of those who sat in lotus positions chanting their mantras, people from all walks of life are incorporating the basic tools of mindfulness into their busy lives. Mindfulness isn’t a complex concept. As described by one leading teacher, mindfulness is simply being aware of what’s happening right now without wishing it were different. It’s enjoying the pleasant without holding on when it changes (which it will). It’s being with the
unpleasant without fearing it will always be this way (which it won’t). Mindfulness is the ability to pay total attention to the present moment with nonjudgmental awareness, taking the good with the bad, and moving forward. While simple in practice, the physical, cognitive and emotional benefits of mindfulness can be quite beneficial. Physically, mindfulness meditation has been shown to reduce blood pressure and helps to activate our relaxation response. Cognitively, it has been shown to boost attention and reduce the tendency to become stuck or preoccupied with every little twist and turn in life. Emotionally, mindfulness improves resilience to stress and helps control impulsive reactions. One good metaphor for the way
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A FEW EASY MINDFULNESS EXERCISES YOU CAN BUILD INTO YOUR DAILY SCHEDULE:
Breathing to Relax: This is something you can do no matter where you are – at your desk, in a meeting or somewhere else on the job. No one needs to know. Inhale slowly for a count of four. Exhale
Mindfulness is simply being aware of what’s happening right now without wishing it were different.
for a count of six to eight. Repeat five or six times. You may quickly notice how this breathing technique helps you feel more relaxed. Practice the Pause Meditation: Pausing during your day can help reduce stress and increase focus. One easy way is while washing your hands. Feel the water on your hands. Notice its temperature, texture and speed of flow. Feel the soap, smell it, notice your hands being cleansed. Take a few deep
breaths. Release tension from your hips: Using a chair, it only takes a few minutes. In a sitting position, lean forward slightly, place the ankle of one leg onto the knee of the other leg and lightly stretch. Switch to the other side. A variation, sitting forward more, is to extend your leg, heel on floor, and stretch. Mindful Eating: Before you begin your meal, take a moment to
look at and smell your food. Eat slowly and really taste each bite. Try eating in a quiet space without a lot of distractions like TV or the internet. Give thanks. Mindful E-Mailing: Create boundaries and rules around the amount of time you spend on emails, as well as the time of day you are e-mailing. Be conscious of the tone and wording of your emails, resisting the impulse to fire off an e-mail in the heat of the moment. Just a few touches of mindfulness practice each day become a powerful personal investment in our physical, mental, and emotional health. Angela Wilson is a licensed mental health counselor and health educator with Berkshire Health Systems.
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mindfulness works is like that of the gas and brake pedals in your car. Our inclination these days is to step on the gas and drive our lives at 100 miles per hour, never braking until it’s time to go bed, at which point it’s impossible to decelerate. By consciously practicing some simple mindfulness techniques during the day, we put the brakes on stress, are more likely to enjoy the ride and leave some extra fuel in our tanks.
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People of all ages want to enjoy life to its fullest Berkshire Orthopaedic Associates helps to keep our community active and healthy.
PHOTO COURTESY OF BERKSHIRE HEALTH SYSTEMS
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You should never live in pain from an illness or injury involving a bone, joint, or the surrounding ligaments, muscles, nerves and tendons. That’s the main message from Berkshire Orthopaedic Associates (BOA), the area’s most experienced team of orthopaedic surgeons. They are here to help keep area residents healthy and active well into their senior years. BOA surgeons treat everything from simple muscle aches and pains to joint replacement surgery and even severe trauma injuries. Their physicians understand that maintaining great health and a high quality of life depend on your ability to move and be pain-free. They also understand that many in the Berkshires are passionate about their particular sport and want to continue at their highest potential. These are among the reasons why BOA – an affiliate of Berkshire Health Systems – has broadened its reach with offices in North Adams, Pittsfield and Great Barrington for the convenience of residents from Southern Vermont to the southern tip of the Berkshires. In addition, BOA has also expanded its team to include more board-certified surgeons to provide better access and comprehensive care. Many of them are also fellowship trained in
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Body, Mind & Soul | Saturday, January 25, 2020
One of the fastest-growing areas of practice at BOA is sports medicine, with a comprehensive program designed for all athletes - from little league to high school, college, and weekend warriors. BHS Sports & Wellness, an affiliation between BOA and BHS, is the community’s resource for all injuries or conditions that challenge area athletes. With dedicated clinic hours reserved for sports emergencies, the sports medicine team will diagnose and treat athletes in an expedited manner, allowing them back into the game as quickly and safely as possible. To enhance patient-centered care, BOA also seeks more effective ways to advance connection and communication. For example, Force is an online platform that now enables the providers to stay in contact with patients by providing instructions and videos about how to best prepare for a surgical procedure, and exactly how to follow their physician’s directions as they recover. It sends out messages to reinforce the physician’s instructions and enables the patient to send messages and questions back to the provider. Force doesn’t replace communication with physicians. Instead, it’s another resource for consistent, standardized care. Patient results confirm that BOA is the region’s best resource for orthopaedic care. Already in
2020, BMC has been recognized by CareChex© by Quantros as a Top 100 Hospital in the Nation and Top 10% Hospital in the Nation for Orthopedic Care, in addition to other
national awards in recent years. With exceptional patient care as its goal, these awards validate BOA’s commitment to patients and community.
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specialty areas, including joint replacement surgery, hand surgery, rehabilitation, and sports medicine. The orthopaedic team also consists of physician assistants, physical therapists, certified athletic trainers and support staff to ensure that patients are seen quickly and their treatment is efficiently coordinated at a one-stop shop where patients are at the center of care. Leading-edge technology and innovation also figure prominently in BOA’s approach to care. Surgeons are trained in state-of-the-art surgical techniques and technology, which enable the safest and fastest return to daily life. Among them is MAKO-assisted joint replacement surgery, which enables a more exact placement of a new joint. In fact, Berkshire Medical Center is the only hospital in the region with MAKO technology. The surgeons are also skilled in the anterior approach to hip replacement surgery – the most advanced surgical procedure available for hip replacement that leaves key muscle groups surrounding the hip and thigh bones undisturbed. The end result is less pain and a faster recovery. BOA specializes in surgical arthroscopy to diagnose and treat problems inside a joint. With smaller incisions and less pain, many patients are able to return home the same day and look forward to quick recoveries.
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Exciting changes in the care of venous disease There have been dramatic improvements in the medical care of persons suffering from CVI BY RICHARD M. BASILE, M.D., FACS
PHOTO COURTESY OF BERKSHIRE HEALTH SYSTEMS
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Phlebology is the branch of medicine that focuses on evaluation and treatment of patients with vein disease. This is an extremely common and underappreciated problem. Venous disease of the legs is often referred to as chronic venous insufficiency (CVI). It is estimated that 72% of women and 42% of men in America, will experience varicose veins by the time they are in their 60’s. CVI effects more people than coronary artery disease, cerebrovascular disease, such as stroke and peripheral vascular disease, (including arteriosclerosis of the legs, PAD, PVD) all combined. While venous disease is common and impacts negatively on quality of life, the good news is that there have been dramatic improvements in the medical care of persons suffering from CVI. The most common cause of leg vein problems (CVI) is reflux, or leaking valves. Reflux allows blood to travel backward and pool in the legs causing varicose veins and increased vein pressure. Symptoms most commonly include
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endovenous laser therapy (EVLT). Both are performed with local anesthesia and placement of a catheter or wire into the abnormal vein. RFA uses electrical energy to close the abnormal vein and EVLT does the same thing using laser energy. Both procedures revolutionized treatment of venous reflux and have almost completely replaced vein stripping surgery. While RFA and EVLT still remain the cornerstone of treatment for venous reflux disease, further advances in technology have provided even less invasive options and more tools for treatment. Refluxing veins can now be closed with medical adhesive or glue through procedures that can be performed without extensive needle injections of local anesthesia. Sclerotherapy, the injection of medication into an abnormal vein can both improve appearance and resolve symptoms, and is an important tool used in most vein clinics. Microphlebectomy, surgical removal of abnormal veins under local anesthesia through needle punctures, is also a useful tool. Physicians with expertise and
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experience in phlebology now have multiple minimally invasive tools to achieve accurate diagnosis and effective treatment of vein problems. Thus, extensive and painful surgery for the treatment of lower extremity venous disease is now rarely performed. These physicians most commonly practice in a vein clinic, such as Basile Vein Specialists or the Berk-
shire Vein Center. In 2020, people with vein disease can often achieve substantial improvement in their condition with minimally invasive techniques provided in a vein clinic. These are associated with minimal pain, no scarring, no hospitalization, no major surgery, and allow rapid return to normal activities with minimal downtime.
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Body, Mind & Soul | Saturday, January 25, 2020
heaviness, aching, swelling, throbbing and itching. Complications can include skin discoloration, dermatitis, bleeding and open leg wounds, called venous ulcers. Prior to the paradigm change in phlebology in the late 1990s, treatment of venous disease of the legs was largely limited to rather extensive surgery, often referred to as vein stripping; this was associated with hospitalization, significant pain, scarring and lost time from work and other activity. Advances in technology have allowed for less invasive treatment of CVI. As reflux or leaking valves with backward flow of blood in leg veins is the most common cause of problems, the elimination of reflux is the cornerstone of treatment. In the past this was largely accomplished by surgical removal of leaking veins or vein stripping. In the late 1990s, two minimally invasive procedures were introduced that allowed surgeons to achieve “closure” or “ablation” of refluxing veins in an office setting using only local anesthesia. These treatment methods are called radiofrequency ablation (RFA) and
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Saturday, January 25, 2020 | Body, Mind & Soul
Weight loss surgery offers a lasting solution for chronic obesity Weight loss surgery often can significantly alleviate, even eliminate the presence and risks of serious medical conditions
BY ANDREW LEDERMAN, MD FACS FASMBS
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For the roughly one-third of Americans who suffer from chronic obesity, following through on well-intentioned plans to eat better and lose weight can be a lonely, uphill battle. They find themselves caught in a seemingly endless up-and-down cycle, trying diet after diet, experiencing occasional success, but ultimately ending up where they started or heavier than ever. The good news is that thereâ&#x20AC;&#x2122;s a proven medical solution for those with chronic obesity, a way to halt the cycle, literally change your metabolism and dramatically improve your health. Bariatric or metabolic surgery, known more simply as weight loss surgery, is a tool unlike any other to help you
gain control of your weight, eliminate chronic health conditions and vastly improve your quality of life. Weight loss surgery is recognized by the National Institutes of Health as the only weight loss method that works for people suffering from chronic obesity. The American Diabetes Association now considers bariatric surgery a standard treatment option for treating type 2 diabetes. Obesity is at the root of many life-threatening health conditions, but also is a preventable cause of death. Weight loss surgery often can significantly alleviate, even eliminate the presence and risks of serious medical conditions, including type 2 diabetes, heart disease, high blood pressure, stroke, hypertension, high cholesterol, joint pain, chronic depression and sleep apnea.
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Body, Mind & Soul | Saturday, January 25, 2020
You may be a candidate for weight loss surgery if you are: • Over the age of 18 • Obese with a Body Mass Index (BMI) of 35 or above • Struggling with diabetes, high blood pressure and/or cholesterol, heart disease or sleep apnea, arthritis and joint pain and other obesity-related conditions • Have tried or are currently trying to lose weight through other means such as diet and exercise • Psychologically ready for weight loss surgery and willing to commit to a whole new lifestyle • Not drug or alcohol dependent
THERE ARE TWO MAIN TYPES OF WEIGHT LOSS SURGERY.
the equation; you’re the other half. The surgery is a tool to help you gain control of your weight and improve your health. Like any tool, it only works if used correctly. That’s why it’s essential that any weight loss surgery is accompanied by a comprehensive patient education program designed to teach you how to use that tool successfully. Before and after surgery, you need to make a strong personal commitment to changing your life. If any of what you’ve read here resonates, talk to your primary
Gastric Bypass ILLUSTRATIONS COURTESY OF BERKSHIRE HEALTH SYSTEMS
care physician about whether weight loss surgery would be right for you. It’s not just about shedding weight and looking better. It’s about changing your body’s metabolism. It’s a transformation. It’s the ultimate resolution to strength-
en your health and lengthen your lifetime. Andrew Lederman, MD, FACS, FASMBS, is a bariatric surgeon and medical director of the Berkshire Center for Weight Loss Surgery at Berkshire Medical Center.
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Gastric Bypass. This uses several mechanisms to help patients lose weight. Using minimally invasive surgery, the stomach is divided to create a small gastric pouch. The small intestine is connected to the pouch in a Y configuration, diverting digestive enzymes downstream. You will feel full quickly, eat less, and not feel hungry. At the same time, changes in your metabolism help you lose weight and improve problems like obesity. Patients generally lose 60 to 80 percent of their extra weight in the first year. Sleeve Gastrectomy. A narrow sleeve of stomach is created with surgical staples, and the rest of the stomach is removed. The sleeve is about the size of a banana. This procedure limits the amount of food you can eat and helps you feel full sooner. Food passes through the digestive tract in the usual order, allowing it to be fully absorbed in the body. Generally, patients lose around 60 percent of their excess weight. The surgery itself is only half
PITTSFIELD, MASS
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PHOTO COURTESY OF BERKSHIRE HEALTH SYSTEMS
Over-the-Counter Medications: Use Only as Directed 50% off membership for Health Expo attendees
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It’s four days into one of your worst colds ever, and you’ve got another one of those piercing headaches that just won’t quit. The DayQuil you’ve been taking has suppressed the coughing and congestion, but your head’s still pounding. So you pop a couple more extra strength Tylenol, the same dose you’ve been taking like
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clockwork all week. As bedtime nears, determined to get a good night’s rest and back to work, you take two of those store-brand sleep aid capsules you found in the medicine cabinet. Three hours later, after waking up with severe abdominal pain and a violent bout of vomiting, you’re in the Emergency Room being treated for acute liver failure, caused by acetaminophen overdose.
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Overdosing on acetaminophen, found in more than 600 OTC and prescription medicines, is the leading cause of acute liver failure in the U.S. non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen-based Advil and Motrin and naproxen-based Aleve and Naprosyn. NSAIDs are used to ease fever, minor aches and pains, colds, sinus pressure and allergies. They inhibit an enzyme associated with those symptoms. But because this enzyme is also used in other systems of the body, high doses of NSAIDs can actually cause too much inhibition, leading to stomach bleeding, kidney injury or heart attack. The risk is low for people who use it occasionally, but increases exponentially for people over 60 who are taking prescription drugs for other conditions. If you’re on blood thinners, steroids, diuretics,
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blood pressure pills or any other prescription meds, the interaction with NSAIDs could be problematic, so it is important to consult with your doctor before using them. The booming popularity of OTC drugs is fueling the problem. More than 700 products sold OTC today use ingredients or dosage strengths available only by prescription 30 years ago. That’s good news for consumers seeking convenient, effective relief for common aches and pains. But if they’re not taken as directed, particularly in combination with other drugs, the results could be toxic. Some strong suggestions on how to avoid such dangers: • Always start by reading the la-
bel – all of it. • Look for an OTC medicine that will treat only the symptoms you have. • When in doubt, ask your doctor or pharmacist before you buy or use an OTC medicine. • Take the medicine EXACTLY as stated on the label. Many OTC drugs become prescription strength if taken more than recommended on label. • Use extra caution when taking more than one OTC drug product at a time. • Don’t combine prescription medicines and OTC drugs without talking to your doctor. • Keep a list of all the OTC medicines, prescription drugs, dietary supplements and herbal remedies you take. And update your doctor regularly. • Always give infants and children OTC medicines specifically indicated for their age and weight. Hayden Kuhn, PharmD, RPh, is a pharmacist at Berkshire Community Pharmacy at Berkshire Medical Center.
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You’ve just learned a frightening, all too common lesson about the dangers of not paying full attention to the active ingredients of everyday over-the-counter or OTC medicines. In a scenario that plays out every day across this country, it turns out each of the three OTC drugs you were taking contained various levels of acetaminophen, and the combined volume was toxic. Overdosing on acetaminophen, found in more than 600 OTC and prescription medicines, is the leading cause of acute liver failure in the U.S. About 60,000 people a year are hospitalized for acetaminophen overdose complications. Most patients fully recover without serious liver damage, though more than 1,500 Americans reportedly have died after taking too much of the drug. Acetaminophen isn’t alone among OTC medicines which, though safe and effective when taken as directed, can be dangerous if not properly used. The misuse of OTC medicines overall results in nearly 200,000 hospitalizations nationally each year. The second type of OTC pain relievers of greatest concern are
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Saturday, January 25, 2020 | Body, Mind & Soul
Hunger in the Berkshires is an all too silent, but stark reality Seventy percent of county residents fall below 200 percent of the federal poverty line. BY PETE GAZZILLO
METRO CREATIVE
at the The Berkshire Eagle | BerkshireEagle.com
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At least one of every 10 households in Berkshire County, some 14,300 people – a population larger than North Adams – is likely go to bed hungry every night. Those neighbors, nearly a third of them children, are food insecure, meaning they don’t have reliable access to a sufficient quantity of affordable, nutritious food. Even if they have enough to put on the table some days, more often than not they don’t. It’s a disturbing reality triggered by a combination of economics and geography. Berkshire County is one of the poorest regions in the state and also one of the most rural, remote and largest in square miles. Seventy percent of county residents fall below 200 percent of the federal poverty line. The vast majority are among the “working poor,” families that often hold multiple jobs, but still are unable to consistently, adequately feed themselves. In fact, 30 percent of food insecure individuals earn too much to qualify for nutrition assistance programs. Even if they do qualify, many don’t have transportation or access to food pantry donations, community meal sites or other programs that help feed those in need. Of course, the food insecurity issue here is part of a much larger national and global crisis. Eight hundred million people worldwide, including some 15 million in the U.S., suffer from food insecurity. About nine million people in the world die of starvation or associated disease every year. Every 10 seconds, a child somewhere dies from hunger. With an estimated 11.2 percent of Berkshire County’s roughly 127,000 residents being food inse-
cure, a deep cross-section of multiple groups in the area, including local farmers, supermarkets, restaurants, churches, philanthropies, social service agencies, hospitals, health care organizations, municipal governments and public and higher-education schools, are working individually and collectively to fill the hunger gap. Two of the county’s leading nonprofits dedicated to feeding the hungry, Berkshires Bounty and Backyard Bounty of the Berkshires, last year merged as Berkshire-Bounty in a strategic move to maximize efforts to collect and distribute fresh produce and other food to those in need. Be Well Berkshires, an initiative of the state Mass in Motion program and the Northern Berkshire Community Coalition, recently completed a comprehensive community food assessment of Berkshire County. The report shined a brighter light on the scope of the food security challenge here and identified opportunities for moving forward. Among the priorities echoed by many involved in strengthening food security in Berkshire County: Address transportation gaps. The county’s rural nature and limited public transportation options create a population that is vulnerable to food insecurity, particularly for low-income and carless households. Tighten coordination. Though several organizations are actively working together on this issue, greater integration around logistics would help provide more food to more people in more places. Better educate the population about resources. Older adults and members of our immigrant communities in particular face barriers to utilizing food assistance
Body, Mind & Soul | Saturday, January 25, 2020 PHOTO COURTESY OF BERKSHIRE HEALTH SYSTEMS
feed people in need. That farm-topeople connection lies at the heart of the solution. Expand access to local foods through Berkshire public schools. This is an often overlooked source of healthy food access for children who may not be
getting that nutrition at home Borrow best practices from other places. As this region focuses on a truly integrated and sustainable plan, it can benefit from many creative solutions already under way in other parts of the nation and world.
All of this is food for thought – and food for people – as we seek to end needless hunger in the Berkshires. Pete Gazzillo is Director of Nutritional Health at Berkshire Health Systems.
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resources. They often don’t know what resources are available and that they may very well qualify. Sustain local agriculture as a major source of food security. Through open-air markets and other means, Berkshire farmers have long pioneered the effort to
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Saturday, January 25, 2020 | Body, Mind & Soul The Berkshire Eagle | BerkshireEagle.com 14
BMC Program Helps Detect Lung Cancer Early Through Screening BY CHRISTIAN GÁLVEZ, MD
Though cigarette smoking has reached the lowest level ever recorded among U.S. adults, it still remains the number-one cause of preventable disease and death, accounting for more than 480,000 deaths every year, or about 1 in 5 deaths. Lung cancer alone is responsible for 29 percent of cancer deaths, more than those from breast cancer, colon cancer, and prostate cancer combined. Even so, nearly 40 million U.S. adults still smoke cigarettes. That’s 14 of every 100 Americans 18 years or older. And a new generation is being lured to the habit. Every day, about 2,000 U.S. youth younger than 18 years smoke their first cigarette. According to the Centers for Disease Control and Prevention (CDC), some 4.7 million middle and high school students use at least one tobacco product, including electronic cigarettes. Those numbers underscore not only the dangers of smoking and the persistence of the habit, but the need to carefully monitor the health of both current and former smokers. Whether or not you’ve quit, your odds of developing lung cancer are 25 times higher than someone who never smoked. Today, there’s only one proven way to dramatically improve your chances of surviving lung cancer if you get it – early detection through low-dose computer tomography (CT) screening. If lung cancer is detected early, patients can have up to an 88 percent survival rate 10 years following diagnosis. Sadly, more than 85 percent of lung cancer cases are diagnosed too late for effective treatment. That’s why primary care physicians urge their at-risk patients – particularly those with significant smoking histories – to get screened. A low-dose CT scan can identify small nodules (spots on the lungs) or other abnormalities before there are any outward symptoms. Most of these nodules will not be cancer and that will be determined by additional imaging studies or biopsy. Radiation exposure from the initial screening is low – more than an x-ray, but about the same level as six months
in your natural environment. Studies consistently have shown that screening high-risk patients before symptoms appear can detect lung cancer early, when it is easier to treat and more likely to be cured. The likelihood of surviving cancer is greatly improved – by as much as 20 percent. If the entire at-risk population of the US. were to be screened for lung cancer, we would prevent 12,000 deaths a year. WHO SHOULD GET SCREENED?
The National Comprehensive Cancer Network recommends that patients without symptoms of lung cancer be assessed for risk based on these factors: age, smoking history, radon exposure, occupational exposure, personal cancer history, family history of lung cancer, lung disease history, and secondhand smoke exposure. Screening with low-dose CT is recommended for these patients at high risk: Category 1: Patients 55 to 74 years old with a 30 or more “packyear history” (calculated as the number of packs per day times the number of years smoked). If patients have quit, they must have stopped within the past 15 years Category 2: Patients age 50 or older with a 20 or more pack-year history of smoking and one additional risk factor other than second-hand smoke (family history of lung cancer in first-degree relatives, occupational exposure to lung carcinogens, personal history of chronic obstructive pulmonary disease or pulmonary fibrosis, radon exposure, personal history of smoking-related cancer, prior radiation to chest or neck). Lung screening is an outpatient procedure at hospitals and certified clinics throughout the U.S. Most screenings are done through referrals by primary care physicians, but you can also schedule a screening without a referral. The screenings usually are covered as a preventive service at no cost by most private health insurance plans as well as by Medicare. Christian Gálvez, MD, is a thoracic and general surgeon at Berkshire Medical Center.
FREEDOM STARTS WITH THE FIRST STEP
At Swift River, we provide all levels of addiction recovery care, in a comfortable and safe environment, offering the perfect place to reflect, learn, and thrive. Our drug and alcohol treatment programs are tailored to each resident, and overseen by dedicated addiction recovery professionals. Levels of Care: • Residential • Detox • PHP • IOP • Transitional sober living
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Please Consume Responsibly, This product may cause impairment and may be habit forming. For use only by adults 21 years of age or older. Keep out of the reach of children. This product has not been analyzed or approved by the Food and Drug Administration (FDA). There is limited information on the side effects of using this product, and there may be associated health risks. Marijuana use during pregnancy and breast-feeding may pose potential harms. It is against the law to drive or operate machinery when under the influence of this product. KEEP THIS PRODUCT AWAY FROM CHILDREN. There may be health risks associated with consumption of this product. Marijuana can impair concentration, coordination, and judgment. The impairment effects of edible marijuana may be delayed by two hours or more. In case of accidental ingestion, contact poison control hotline 1-800-222-1222 or 9-1-1. This product may be illegal outside of MA.
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