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Can I Lower My Risk of Developing Breast Cancer?
The risk of developing breast cancer in women is factual. As women grow older, this scare tends to strengthen. The statistics about women developing cancer as they age are shocking. They say that one in every eight women is vulnerable to developing cancer as she reaches forty years of age. No one remedy or tonic will remove the chances of you developing cancer. However, there are many things that you can do to lower your risk of breast cancer. It is possible to act wiser and change your lifestyle to reduce your risk of developing this deadly disease. The steps that you need to take in this regard are as follows:

1. Exercise:

Exercising comes with a plethora of advantages, and the most valid one is that it lowers your risk of breast cancer. Studies have shown that working out cuts down the chances of a person having this disease. Alongside this, it aids the breast cancer survivors to have a longer life and develops their stamina to heal. What you want to do is to choose your favorite form of exercise and stick to it. It could be jogging, running, walking, swimming, or dancing. You can select one of your choices quickly.
Exercising for at least thirty minutes a day will reduce your chances of developing breast cancer a lot.

2. Quit smoking:

In case you are a smoker, you need to quit this habit soonest possible. The nicotine in the cigarette tends to damage a lot of crucial body organs and parts. The most damaging effect of smoking is on the lungs, hearts, and veins. The habit of smoking is directly connected to the chances of premenopausal women developing breast cancer.
You can surely lower your risk of breast cancer by abandoning smoking once and for all.

3. Do not opt for HRT:

Hormone replacement therapy is one of the biggest reasons behind women developing breast cancer. If you are someone who is about to decide to opt for HRT, you need to reconsider it. It is always recommended to discuss it with your doctor and share your concerns before jumping into it.

4. Change your eating habits:

If you are a junk food lover and have never touched vegetables, you may need to do this for your health. Adding vegetables and fruits as a necessary part of your life will keep the scare of cancer away from you. As these vegetables are natural antioxidants, they fight with all the toxic chemicals getting their way into your body.
It is always recommended to avoid taking supplements for the needed nourishments. A platter of veggies and fruits a day would be enough for the required nourishments for you.

5. Regular scans:

As soon as you find something weird happening to your breast, you need to get a scan immediately. At times it is a harmless bump, which can be removed easily. If not removed on time, it can turn into a tumor. Thus immediate response to anything strange occurring to the body is necessary. 

Being a woman is the biggest risk factor for developing breast cancer. As women age, the absolute risk of developing breast cancer increases.  We have all heard the 1 in 8 statistic.  We know that 1 out of every eight women has a risk of developing breast cancer.  But as a surgical oncologist, I need women to understand the difference between the Absolute Risk of developing breast cancer vs the Relative Risk for developing breast cancer.  I want my patients to feel in control during their entire journey.
Absolute Risk of Developing Breast CancerWhen I tell my patients about the risk of developing breast cancer, I mean “the absolute risk” that they are likely to get breast cancer or develop recurrence.  The term “risk” is used to refer to a number or percentage that describes how likely a certain event is to occur.  

• If your current age is 20, the probability of developing invasive breast cancer in the next 10 years is   .06%, or 1 in 1,732. This means that 1 in 1,732 women in this age group can expect to develop breast cancer. Put another way, your odds of developing breast cancer if you are in this age range are 1 in 1,732.
• If your current age is 30, the probability of developing invasive breast cancer in the next 10 years is .44%, or 1 in 228.
• If your current age is 40, the probability of developing invasive breast cancer in the next 10 years is 1.45%, or 1 in 69.
• If your current age is 50, the probability of developing invasive breast cancer in the next 10 years is 2.31%, or 1 in 43.
• If your current age is 60, the probability of developing invasive breast cancer in the next 10 years is 3.49%, or 1 in 29.
• If your current age is 70, the probability of developing invasive breast cancer in the next 10 years is 3.84%, or 1 in 26.

       (BreastCancer.org)
Basically the younger you are the lower your absolute risk while the older you are, your absolute risk for developing breast cancer increases. These numbers and percentages are averages for the whole population. Your individual breast cancer risk may be higher or lower, depending on a number of factors, including family history, reproductive history (such as menstrual and childbearing history), race/ethnicity, and other factors.  When I see patients, I pay careful attention to risk factors such as family history.  Women who have inherited mutations in the genes known as BRCA1 or BRCA2 carry a higher absolute risk for developing breast cancer.  For women with a BRCA1 mutation, the risk of developing breast cancer by age 80 is 72%. For women with a BRCA2 mutation, the risk is a bit lower, at 69%.
Relative Risk of Developing CancerThe relative risk for developing breast cancer is basically reported by research studies, which often compare groups of women with different characteristics or behaviors to determine whether one group has a higher or lower risk of breast cancer than the other (either as a first-time diagnosis or recurrence).  Basically I want to empower my patients, to make If I make certain lifestyle choices that will impact their relative risk of developing breast cancer or having a recurrence.  The Relative Risk calculation is always a bit tricky and can easily be distorted. It is very important to have a clear understanding of the actual medical research rather than  jumbled interpretations of medical research.

There’s the famous study that links breast cancer to drinking two or more alcoholic drinks per day.  Summarily, women who have two or more alcoholic drinks each day have a have a 50% higher risk for developing breast cancer than non drinkers.  That is an astounding statistic and frankly dishonest. It is also unnecessary to burden a woman going through breast cancer with guilt. The truth is that women who drink two or more alcoholic beverages a day are NOT 50% more likely to develop breast cancer.  Women who already have a 12% absolute risk of developing beast cancer, increase their absolute risk by 1.5 (50% is .5 and the number one is used as a baseline-BECAUSE MATH) times if they consume 2 or more alcoholic beverages. (.12 x 1.5 is about .18 or 18%).  So out of the 12% of women who develop breast cancer, women who have two or more alcoholic drinks a day have an18% absolute risk of developing breast cancer.  When it comes to statistics, ignore the hype beasts and focus on the math.  
So now that I have explained the difference between absolute risk vs. relative risk, its important that women know there are many different factors can increase and/or decrease the absolute risk of developing breast cancer.  My next blog will discuss those factors.

The Treatment Recommendations for Colorectal Cancer Patients in the Pandemic

1. The Rationale for the Newer Guidelines

The patients of the rectal cancer are already on the thinner side of the immunity, therefore, deliberately risking their lives, and “presenting” them to COVID-19 is never desirable.

The previously developed protocols for the “non-pandemic” period can’t be observed as it is. A benefit to risk ratio-dependent more current guidelines is the need of the time.

2. Latest Guidelines for the Management of the Rectal Cancer

The journal “Radiotherapy and Oncology” recently published a consensus statement by leading cancer experts for the treatment of rectal cancer. 

They recommend a modification in the radiotherapy regime. 

It suggests the administration of one week of high-radiation therapy instead of five-week radiotherapy before surgery.

Following this protocol, chemotherapy can be avoided. Avoidance of chemotherapy is the requirement in this situation as it can further reduce the patient’s immune status. 

Surgery can be delayed further for 12 weeks safely. The Previous protocol was to perform surgery 1 or 2 weeks after the radiation.

3. The Base of the Guidelines- The Short Course Radiotherapy (SCRT)

The authorities used the previously available guidelines of the “European Society for Medical Oncology” (ESMO) as the base. 

They improvised with the latest research available about “Preoperative short-course radiotherapy (SCRT)” by David Sebag-Montefiore, Professor of Clinical Oncology and Honorary Clinical Oncologist with the Leeds Teaching Hospitals NHS Trust.

According to this study, 3469 patients underwent SCRT for rectal cancer but the time of the surgery following the radiation was split into 3 groups.

1. 76% – surgery after 0-7 days
2. 19% -surgery after 8-14 days
3. 5%- surgery after 15-27 days

This study concluded that there was no difference in postoperative outcomes up to a year due to the time interval between SCRT and surgery.¹

This data became the central argument presented in the support of the latest guidelines of deferring surgery with short-course radiation therapy.

4. The Goods of the Newer Guidelines in the COVID-19 Pandemic

Experts have developed these recommendations taking into account the current requirements. The advantages are;

• Fewer hospital visits due to shorter radiotherapy mean less likelihood of encountering the COVID-19 virus.
• Elimination of Chemotherapy which could have further dropped the immune status of these patients
• Delaying of Surgery- As the hospitals are coping with an overwhelming surge of COVID-19 patients, delaying the elective surgeries is the ongoing practice

The global emergency of the COVID-19 is re-shaping the medical practices rapidly. The “Pandemic-led” protocols developed in a few weeks will provide enormous advantages to the rectal cancer patients as well as hospitals.

Reference

1. Levick BA, Gilbert AJ, Spencer KL, et al. Time to Surgery Following Short-Course Radiotherapy in Rectal Cancer and its Impact on Postoperative Outcomes. A Population-Based Study Across the English National Health Service, 2009-2014. Clin Oncol (R Coll Radiol). 2020;32(2):e46-e52. doi:10.1016/j.clon.2019.08.008

What Is The Function Of Gallbladder?

The Gallbladder functions to store bile, which is a secretion produced by the liver. This secretion moves from the liver to the Gallbladder; via the common hepatic duct.

Bile has following functions:

• Digestion of lipids
• Vitamin A, D, K, and E absorption
• Removal of bilirubin from the body

2. Gallbladder complications & What Can Lead To Gallbladder Removal:

The gallbladder can develop multiple abnormalities.

• Cholelithiasis-Gallstones:  This is one of the most common reasons for the removal of the Gallbladder. Gallstones also known as cholelithiasis, is the process that occurs when stones develop in  the Gallbladder. This can lead to a number of different complications.
•  
• Biliary Colic: This painful  condition occurs when gallstones block the drainage of bile fluid from the gallbladder.

• Cholecystitis– Inflammation or infection of the Gallbladder: This condition is usually the result for bacterial overgrowth within a gallbladder which has been blocked by gallstones.

• Choledocholithiasis-Stones in main bile duct between the liver and intestin : This condition can cause pain or inflammation of the pancreas or yellow jaundice. In addition to gallbladder removal, this condition often requires that the bile duct stones be removed as well.

• Gallbladder cancer: This is a rare condition, but can require Gallbladder removal.

3. Signs and Symptoms:

A person with Gallbladder illness may experience the following symptoms:

• Pain in the upper right side of abdomen or in the mid upper abdomen
• Nausea
• Vomiting
• A referred pain between shoulder blades
• Often pain follows a fatty meal 
• Fever
• Yellow Jaundice

4. Surgical Removal of Gallbladder- Cholecystectomy

There are three possible ways of performing cholecystectomy.

• Open Cholecystectomy 
• Laparoscopic Cholecystectomy
• Robotic Laparoscopic Cholecystectomy

Open cholecystectomy: This rarely used procedure involves removal of the gallbladder using an open incision. Therefore, this technique has the following drawbacks.

• A large incision line
• greater likelihood of infection and bleeding
• Longer hospital stay
• Longer Recovery time

Laparoscopic Cholecystectomy: This more modern technique utilizes small (keyhole) incisions and the use of long narrow instruments to remove the gallbladder without making a large incision. This technique has the following advantages.

• Small keyhole incisions
• Lower chances of infection and bleeding
• Shorter hospital stay
• Early Recovery

Robotic Surgery:  This procedure uses the latest technology to remove the gallbladder. With robotic surgery, the surgical instruments are attached to robotic arms The surgeon, sitting on operating console, viewing in 3D, controls these robotic arms.

 This has the following advantages:.

• Comfortable position for surgeon
• 3D Vision
• Full Range of motion
• Elimination of tremors 
• Smaller keyhole incisions
• Less chances of infection and bleeding
• Short hospital stay
• Early Recovery

5. Why Choose Surgery Group Los Angeles?

• Surgery Group LA (Los Angeles) is a team of highly skilled board-certified surgeons with vast experience in robotic and  laparoscopic cholecystectomy and open cholecystectomy when needed. 

• When appropriate we favor conservative management and always try to avoid  unnecessary surgery.

• Please, schedule an appointment with us for an evaluation for you or a loved one experiencing any of the symptoms mentioned. We will provide a professional and objective analysis that will enable you to make an informed decision.

By Surgery Group Los Angeles

What Is the Thyroid Gland?

The thyroid gland is a butterfly or Bow-tie-shaped gland located in the middle of the neck just below the Adam’s apple, situated around the trachea or windpipe. Usually, one cannot feel the thyroid unless there is some pathology associated with it. Interestingly, the thyroid gland is one of the most vital glands of the human body.

What Is The Function Of Thyroid Gland?

The thyroid gland produces three thyroid hormones:

1. Tri-ido-thyronine (T3)
2. Thyroxine (T4)
3. Calcitonin

Functionality:

1. Growth of body
2. Protein Synthesis
3. Metabolic rate
4. Calcium Regulation

What Can Go Wrong With Thyroid Gland?

1. Abnormal function. (over or under performing) 

• The size of the gland may change or enlarge due to multiple pathologies.

These include:

• Inflammation
• Cysts and or nodules
• Goiter- (Diffusely enlarged thyroid)
• Congenital abnormalities
• Malignancies (cancer)
• All of the above may require surgical removal depending upon the extent and type of disease.

Thyroid Surgery Process:

Preparation for the surgery includes the establishment of the diagnosis by history, examination, and detailed investigations. The surgery is mostly performed under general anesthesia and requires an incision in the middle of the neck to explore the gland. The size of the incision depends on the extent of the gland removal and expertise of the surgeon. After surgery, there is often a hospital stay of one night.  It’s becoming more common though, that many patients are actually able to go home the same day.

Complications of Thyroid Surgery

Several important anatomic structures need preservation during the surgery. The damage to these can result in many problems;

• Recurrent Laryngeal Nerve– A small nerve running near the thyroid gland supplies the vocal cords. Injury to the nerve results in the hoarseness of the voice which usually is temporary and hoarseness resolves between several days to up to 6 months.

• Parathyroid Glands– These glands, of which there are four, are present at the back to the thyroid gland at different locations. These are usually preserved in thyroid surgery, but if injured, results in abnormal calcium regulation in the body.

• Blood Vessels – Like any other surgery, there is a chance of bleeding in this surgery. The tiny vessel makes it even more difficult. An expert surgeon can easily bypass this complication through different surgical techniques.

Factors for Selection of The Right Surgeon

Thyroid surgery is a common but tricky surgery. Smaller access with multiple important anatomic structures within the neck make this procedure even more challenging. A surgeon who has performed many thyroid surgeries finds no problem in this procedure. Therefore, this procedure requires the highest level of surgical training with years of experience to perform a successful thyroid operation.

The Best Surgeons for Thyroid Surgery- Surgery Group Los Angeles

 Dr. Jason Cohen of the Surgery Group of Los Angeles has performed hundreds of thyroid surgery and is a world-renowned surgical specialist in thyroid-related procedures. with high knowledge and vast expertise in thyroid surgeries, he has proven to be one of the top surgeons in the country. If the surgery can be avoided, this becomes our prime choice. This exactly matches our mission statement. 

Please, schedule an appointment with us for the evaluation and recommendations for you or your loved one’s condition so you can make an informed decision.

HEMORRHOIDS

 OVERVIEW, TREATMENT, AND PREVENTION 

SURGERY GROUP LOS ANGELES

Hemorrhoids, commonly known as piles, are cushions of vascular tissue found within the anal canal.  Approximately 50% of adults, over the age of 50 have symptomatic “hemorrhoidal disease”.  Although it is more common in adults, it is still possible to experience hemorrhoidal disease at a younger age.

Hemorrhoids, like many diseases, do not discriminate to one’s age, gender, or socio-economic status.  Therefore, it is essential to gain the necessary knowledge to help prevent, detect, and treat hemorrhoids.

CAUSES OF HEMORRHOIDS

Risk factors:

• Straining and constipation
• Obesity
• Prolong sitting
• Chronic diarrhea
• Pregnancy
• Portal hypertension

TYPES AND SYMPTOMS

External hemorrhoids: develop below the dentate line (the dentate line divides the upper 2/3rd and lower 1/3rd of the anal canal).

Symptoms include:

• Pain, if there is a thrombus (blood clot) formation
• A leftover skin tag
• Irritation and itching
• Hygiene issues

Internal hemorrhoids: develop above the dentate line.

Symptoms include:

• Rectal Bleeding
• Usually painless
• Prolapse

DIAGNOSIS

• Complete physical examination to include visual/digital examination and anoscopy
• Flexible sigmoidoscopy or colonoscopy may be performed to rule out other more severe conditions such as colon cancer, polyps, or inflammatory bowel disease. 

TREATMENTS

Medical management:

• Dietary and lifestyle modification (proper hygiene, high fiber diet, stool softeners)

Non operative/office based procedures:

• Injection sclerotherapy – injection of chemical agents into hemorrhoids to cause fibrosis, scarring, and shrinkage.
• Rubber band ligation –  placement of rubber band at the base of hemorrhoid constricting and compromising the blood supply. Hemorrhoids will shed within a few days.

Surgical:

• Hemorrhoidectomy – procedure in which hemorrhoids are surgically removed .
• THD (transanal hemorrhoidal dearterialization) – minimally invasive surgical procedure which has show to cause less pain and discomfort.  It does not involve surgical removal of the hemorrhoids but rather a doppler probe is used to stop hemorrhoidal blood flow and to suture pexy of the hemorrhoid back into the anal canal. 

PREVENTION

• Weight loss and exercise
• High fiber diet
• Increased fluid intake
• Avoid constipation and straining

SURGERY GROUP LOS ANGELES:

THE CENTER OF CHOICE FOR PROFESSIONAL TREATMENT OF HEMORRHOIDS

Surgery Group Los Angeles is an experienced medical group constituting of highly skilled board-certified colorectal surgeons. Our team concentrates in hemorrhoid management. Conservative management and avoidance of surgery is the desired treatment.

Please, refer to our website and mission statement for further information. You may schedule an appointment with us for the evaluation and recommendations for you or your loved one’s condition so you can make an informed decision.

Crohn’s Disease

Crohn’s disease is a type of inflammatory bowel disease caused by inflammation of the digestive system. It commonly involves parts of small & large intestines but may affect any area of the digestive system from mouth to anus.

Sign & Symptoms

One may experience;

• Abdominal pain
• Diarrhea
• Weight loss
• Fatigue
• Fever
• Anemia
• Bone & joint problem
• Eye conditions
• Skin issues

Cause and Risk Factors

The exact cause of Crohn’s disease is unknown. The condition is triggered by the immune response of the body. Studies suggest that it is a complex interplay of genetics and environmental factors. It usually runs in families with no gender predilection. Other factors include;

• Smokers-3 times more prone to disease
• Geographical location- Caucasians>non-Caucasians
• Stress
• Different drugs
• Disturbance in microbes of digestive system

Diagnosis & Treatment

The symptoms of Crohn’s disease can mimic multiple digestive system issues therefore a complete history and latest diagnostic modalities can help in establishing a diagnosis and ruling out other bowel diseases. These may include a complete blood examination, CT scan, MRI, and colonoscopy.

Colonoscopy is the gold standard to identify Crohn’s disease. This technique allows the surgeon to directly visualize the affected area of the GIT. An experienced colorectal surgeon can easily spot the affected regions by their typical appearance.

The treatment mainly focuses on relieving the symptoms. It includes;

• Medications to reduce pain and inflammation 
• Dietary changes to manage malnutrition 
• Change of eating habits
• Stress management
• Active lifestyle

Why Choose Us?

Crohn’s disease resemblance to other GIT problems in terms of symptoms makes it challenging to identify. It requires qualifications of super-specialty, years of experience, and a team approach to rightly manage the disease, ultimately leading the patient’s life back to normal.

Surgery Group LA is a team of highly skilled professionals with contemporary knowledge and advanced surgical skills. Our board-certified colorectal surgeons have been treating Crohn’s disease patients for many years with the highest number of recoveries. Expertise, communication skills, and fear & anxieties management, all these factors contribute towards the rehabilitation of the sufferer.