Newsletter 05/18/18 – Polyps, Parenting and Pounding Headaches

To My Patients and Friends,

I thought you might find these latest medical news topics of interest.

Also: you may recall that in a recent email, I inquired about interest in a mindfulness meditation series.  I’m putting the pieces in place, and I’d like to get a sense my patients as to the best timing for the groups.  We are tentatively planning on one Tuesday evening per week for four weeks in July if that works for people, or perhaps after the summer if that works better.  Sessions will last 60-90 minutes.  Groups will be small (likely no more than 10-12 participants), and spots for the series will be filled on a first-come first-served basis.  The current plan is for existing patients to receive first priority access (free of charge), and then to offer any remaining spaces to others in the community.  Please note: we would need participants to be willing to commit to attending all sessions.  Feel free to reply to this email with feedback or questions.  Thanks in advance, and happy reading!

So you have polyps…how soon will you need that follow-up colonoscopy?

Many patients can get away with fewer colonoscopies, as noted in a study recently published in the Journal of the American Medical Association.  According to the researchers, only an advanced adenoma (a colon polyp exhibiting specific microscopic features) increases the likelihood of developing colon cancer, thereby justifying a more accelerated follow-up schedule.  But for those with other types of polyps, the risk for colon cancer appears to be no greater than for those with no polyps, and a routine screening schedule (colonoscopy every 10 years) may be acceptable.  To date, it has been customary for patients with polyps to be called back for repeat colonoscopies in for 3 to 5 years (though recommendations tend to vary among GI docs).  It goes without saying that every patient deserves an individualized approach (consideration must be given to individual factors such as family history and genetics, as well as patient preference), and further studies are underway to confirm these findings.  But it would be appropriate to ask your GI doctor to clarify his or her recommendation when you are advised as to when to schedule your follow up procedure.

Regarding risk: according to the American Cancer Society, there are a number of factors that increase someone’s risk for developing colon cancer.  Those within our control include the following:

  • Being overweight or obese
  • Physical inactivity
  • Diets high in red meats and processed meats
  • Smoking
  • Heavy alcohol use (more than 2 drinks a day for men and 1 drink a day for women)

Other factors are outside of our control; these include:

  • Being older (colon cancer is more common after age 50)
  • A personal history of advanced adenomas (see above)
  • A personal history of Crohn’s disease or Ulcerative Colitis
  • A family history of colon cancer or advanced adenomas
  • Certain genetic syndromes related to polyps and cancer
  • Racial or ethnic background (African Americans and Ashkenazi Jews are at increased risk)
  • Having type II diabetes (which is associated with lifestyle factors, so it may actually fall under the “in our control” category above)

Other factors which may also increase risk:

  • Night shift to work (according to some studies)
  • Previous treatment for other types of cancer, such as testicular or prostate cancer.

These should all be taken into consideration when determining if and when to undergo colonoscopy.

Do later-life money woes increase our risk for dementia?

Although this is not the first time this connection has been noted in the medical literature, a new study published in the Psychiatry edition of the Journal of the American Medical Association adds to the strong body of evidence linking financial stress to the development of dementia.  These results were found to be independent of educational level or other variables.  And previous research has revealed that other forms of chronic stress, including those related to work or chronic illness, also increase our risk.  And stress can lead to other chronic illnesses as well, according to a number of studies.  So it would behoove us all to incorporate stress reduction measures into our daily lives- whether it be through prayer or meditation, exercise, spending time with loved ones or pursuing hobbies such as art or gardening.

Our teens may be struggling

The percentage of hospital visits for suicide attempts by US adolescents has doubled from 2008 to 2015, according to a review of database records of 49 hospitals published in the journal PediatricsAdditionally, the average increases were higher among girls across all age groups, and were most notable in the spring and fall seasons.  This may be a reflection of increased stress and decreased mental health during the school year, according to the authors of the study.  So be sure to check in with your teens on a regular basis… the Mayo Clinic offers some good guidance as to what signs to watch for (summarized below).

Be alert for emotional changes, such as:

  • Feelings of sadness, which can include crying spells for no apparent reason
  • Feeling hopeless or empty
  • Irritable or annoyed mood
  • Frustration or feelings of anger, even over small matters
  • Loss of interest or pleasure in normal activities
  • Loss of interest in, or conflict with, family and friends
  • Low self-esteem
  • Feelings of worthlessness or guilt
  • Fixation on past failures or exaggerated self-blame or self-criticism
  • Extreme sensitivity to rejection or failure, and the need for excessive reassurance
  • Trouble thinking, concentrating, making decisions and remembering things
  • Ongoing sense that life and the future are grim and bleak
  • Frequent thoughts of death, dying or suicide

Watch for changes in behavior, such as:

  • Tiredness and loss of energy
  • Insomnia or sleeping too much
  • Changes in appetite — decreased appetite and weight loss, or increased cravings for food and weight gain
  • Use of alcohol or drugs
  • Agitation or restlessness — for example, pacing, hand-wringing or an inability to sit still
  • Slowed thinking, speaking or body movements
  • Frequent complaints of unexplained body aches and headaches, which may include frequent visits to the school nurse
  • Social isolation
  • Poor school performance or frequent absences from school
  • Neglected appearance
  • Angry outbursts, disruptive or risky behavior, or other acting-out behaviors
  • Self-harm — for example, cutting, burning, or excessive piercing or tattooing
  • Making a suicide plan or a suicide attempt

What’s normal and what’s not:

It can be difficult to tell the difference between ups and downs that are just part of being a teenager and teen depression. Talk with your teen. Try to determine whether he or she seems capable of managing challenging feelings, or if life seems overwhelming.

Food can go right to your head

While numerous studies have looked at the connections between diet and cognitive function, a new study recently published in the journal Neurology reveals that a healthy diet actually contributes to increased brain size (which we know to be positively correlated with better cognitive health).  So eat your fruits, veggies, whole grains, nuts and legumes for a bigger, better brain!

And finally, some really (really, really) good news for migraine sufferers


Last week, the FDA approved the first in a new class of drugs designed to prevent migraines. Up to now, we’ve experimented with drugs designed for other purposes (i.e., antidepressants, seizure and blood pressure meds), but this is the first time a drug has been approved specifically for migraine prevention. The drug, Aimovig— being co-marketed by Amgen and Novartis— is a monthly injection that can be self-administered by patients. Studies have demonstrated that Aimovig, which contains an antibody that blocks a protein fragment involved in the migraine pathway, significantly reduces the frequency and severity of migraine headaches. Not surprisingly, it’s going to be expensive— it will cost about $7,000 per year… so time will tell how readily insurers will pay for it (although Amgen has reportedly indicated that they will pay most out-of-pocket costs for eligible patients with commercial insurance). Studies demonstrate that the drug can confer life-changing benefits for many patients who experience frequent migraines, with no major side-effects. Too good to be true? It may not be a panacea, but it sure represents some meaningful progress for migraine sufferers. It should be available in the next couple of weeks, so stay tuned.

That’s it for now.  Stay healthy, and have a nice weekend!