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Skin Cancer (Melanoma)

“Melanoma rates are now rising faster than for any other cancer in men and second only to lung cancer in women,” says Dr. Darrell Rigel, Associate Professor in the Department of Dermatology at the New York University School of Medicine.

There are three types of skin cancers: Basal Cell Cancer, Squamous Cell Cancer and Melanoma. First two are very common and can invade local tissues but are not fatal. Melanoma is not that common but can be fatal if not detected early and excised.

The death rate from melanoma continues to rise about two percent annually. Most skin cancers are due to exposure to sunlight and ultraviolet rays. So, this is a good time of the year to remind ourselves of the dangers of sunrays and ultraviolet radiation.

Skin is not only the largest organ of our body but has many important functions to protect us from environment Skin is constantly exposed to sun, wind, industrial elements and other causes of external and internal injury.

There are more than 25 human disorders that are either caused by or aggravated by exposure of the skin to sunlight.

Melanoma arises from cells called melanocytes. These cells contain melanin (melas = black) – a principal pigment responsible for the color of human skin, hair, and eyes. Melanin also acts as a filter to decrease the harmful effects of ultraviolet rays to the dermis.

When the skin is exposed to ultraviolet radiation, there is immediate increase in the number of melanocytes and production of melanin pigment. This results in tanning. The amount of melanin produced is genetically determined. That is why some people burn easily without tanning.

The risk of skin cancer is increased in individuals who spend too much time outdoors, children who have had episodic sunburn, and if there is a family or personal history of skin cancer (especially melanoma). Males are affected more than females.

Can we prevent skin cancer?

Yes! The Canadian Cancer Society recommends the following preventive measures:

1. Avoid prolonged exposure to the sun especially between 11:00 am and 4:00pm.

2. Wear protective clothing, such as long-sleeved shirts, and wide-brimmed hats.

3. Use a sunscreen with a SPF of 15 or higher to absorb ultraviolet rays.

4. For the nose or lips, use a sun block preparation containing zinc oxide or titanium dioxide that will deflect ultraviolet rays.

5. Seek prompt treatment of any skin abnormality.

Skin cancer can be cured if detected early and appropriately treated. If a mole bleeds or is in a place where it gets irritated constantly; if there is a change in size, shape, and colour of a mole then it should be removed.

Prognosis for melanoma depends on the depth of the mole (deeper the mole worse the prognosis). Therefore, full thickness biopsy is important.

Konrad Adenauer, former Chancellor of the then West Germany once said, “A thick skin is a gift of God”. Let us put it this way: “A healthy skin is a gift of God; to be treated with respect and care”.

So have fun but be sun smart!

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Injuries

“Ninety percent of injuries suffered by Canadians are predictable and preventable,” says Dr Barry McLellan, chair of the National Trauma Registry Advisory Committee.

Why are they predictable and preventable?

They are predictable because we know the circumstances under which most accidents occur. They are preventable because, most of the time, the events leading to accidents can be modified.

Injuries can be intentional (suicides, homicides) or unintentional (motor vehicle accidents, falls, poisoning, fires, drowning).

With the weather getting better there are more people on the roads. They are walking, jogging, biking, or driving. Can we do something for them so they can safely enjoy what they are doing?

Yes, the following ten principles of injury prevention are developed from the information contained in the Alberta Motor Association Collision Facts and the New England Journal of Medicine:

1. Do not drink and drive. Why? Because 23 percent of drivers involved in fatal collisions had consumed alcohol prior to the crash. Males between 18 and 21 years old make up the group most likely to have been drinking prior to an accident.

2. Drive carefully on weekends and holidays. Why? The collisions fatality rate usually doubles on long weekends. In 1997, the highest number of fatal collisions happened in August, with Friday being the most collision-prone day of the week.

3. Use your seatbelt. Why? People who do not buckle up are more than twice as likely to be injured as those who wear a seat belt. The current three-point lap-shoulder restraints are thought to reduce the risk of death or serious injury by 45 percent.

4. Avoid common driving mistakes. Why? Running off the road, following too closely and left turns across the path of oncoming vehicles were the most common mistakes contributing to casualty collisions.

5. Be careful if you are young and restless. Why? Traffic collisions cause 7 out of 10 unintentional fatal injuries to people between 15 to 24 years of age. Injuries are the most common cause of death among people 1 to 34 years of age.

6. Be careful on all types of road conditions. Why? Because 60 percent of fatal collisions happen on dry roads. And 70 percent of fatal collisions occur on highways in rural areas.

7. Use children’s safety seat correctly. Why? About 50 percent of car seats are used incorrectly. Air bags can cause deaths of infants in rear-facing car seats. Car seats for children reduce the risk of death or serious injury by approximately 70 percent.

8. Use bicycle and motorcycle helmets. Why? Helmets decrease the risk of head and brain injury by 85 percent.

9. Cross streets at pedestrian crossings only. Why? Injuries to pedestrians are the second largest category of motor vehicle deaths. School aged children are at greatest risk.

10. Do not drive when tired or sleepy. Why? Because fatal car accidents increase by 7 percent in Canada on the Monday after the spring time change. When the Canadians move their clocks back an hour in the fall, collisions drop by 7 per cent. Even an hour of sleep can make a difference!

It was in 1899, U.S. reported the first death related to motor vehicle accident. Are we proud of our record in the last hundred years?

Enjoy the good weather. Be safe!

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Impotence (Erectile Dysfunction)

“My brain? It’s my second favorite organ,” says Woody Allen in Sleeper.

For many men, like Woody, a properly functioning phallus is fundamental to their self esteem, says Dr. Alain Gregoire, Consultant Psychiatrist and Senior Lecturer at University of Southampton.

The proper functioning of this organ depends on many factors – internal and external -and now chemical with the advent of Viagra (sildenafil).

Sexual function and satisfaction have many components: desire, erectile function, orgasmic function, ejaculation, and fertility. About 20 percent of men have problems relating to one of these functions.

Erectile dysfunction (impotence) is the most common complaint and the most distressing of all complaints related to sexual function and satisfaction. It can destroy a man’s ego and threaten happy relationship.

Erectile dysfunction (ED) affects 52 percent of men aged 40 to 70 years and is estimated to affect as many as 2 to 3 million couples in Canada. Many men suffer in silence and less than 10 percent of men seek medical treatment.

Now, Viagra (sildenafil) has brought the whole problem “out of the closet.”

Normal erectile function is initiated by body’s five senses: touch, sight, smell, taste, hearing and by imagination. This results in increased blood flow to the penis followed by erection.

Many medical and psychological conditions can impair erectile function. Some of them are: high blood pressure, diabetes, kidney failure, and diseases of the nervous system. Any chronic illness can have a negative effect. Several medications can do the same.

Viagra is now available in most Medicine Hat pharmacies. Before Viagra, there were limited treatment options: penile injections, suppositories, vacuum constriction devices and surgical implants. Now, there is a pill which can work within an hour.

Public’s expectations are raised to a new height!

Does it help all men with erectile dysfunction? No.

Viagra increases the blood flow to the penis. It does not increase sexual desire. It only works with stimulation. It is not an aphrodisiac. It only helps 60 to 70 percent of men with erectile dysfunction.

It has side effects too. It should not be taken by men who use nitrates (nitroglycerin for angina). If nitrate is combined with Viagra then there may be a sudden drop in blood pressure. It can also cause headaches, facial flushing, indigestion, nasal congestion, and visual problems – a bluish discoloration and difficulty differentiating blue from green.

All side effects disappear within 3 to 4 hours.

Viagra comes in 25, 50, and 100mg strengths. One pill to be taken an hour before sexual activity. Daily dosage not to exceed 100mg. Your doctor will advise you the appropriate dose for your problem.

The “little blue pill” has already helped millions of men. In U.S., 85 percent of the prescriptions were written for men between the ages of 50 and 70. The sales of Viagra are estimated to top $400 million this year in North America.

In the next few years, we will see if Viagra will stand the test of time. In the meantime, it is considered an effective and safe oral therapy for impotence.

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Indigestion

“Dr. B, its my indigestion. It is getting worse. Could it be an ulcer?” asks Susan as I enter the examination room.

Well Susan, what do you mean by indigestion?

“Dr. B, its my stomach!”

O.K. Susan, indigestion means different things to different people. Doctors describe indigestion as dyspepsia. Both terms are pretty vague. Medical text books describe this as a chronic (usually over 3 months), recurrent, often meal-related upper abdominal discomfort, pain or fullness.

Dyspepsia occurs in about 10 percent of the population. Most people carry on with off- the-counter medications. One-third of the people, who do seek help, will have no ulcer on investigations. This is called non-ulcer dyspepsia.

“Dr. B, what is an ulcer?” An ulcer is a break in the lining of an organ. The body responds to this with tissue reaction which may heal the ulcer or produce local tissue destruction with a crater formation.

There are 3 conditions to think about when a patient presents with indigestion: 1) ulcer of the stomach or duodenum (first part of small intestine), 2) cancer of the stomach and 3) non-ulcer dyspepsia.

Symptoms from gall bladder and pancreatic disease may mimic above conditions but they are more acute in nature with intervals where everything may be fine.

Clinically, I do not think Susan has cancer of the stomach as she is 38, has a good appetite and has not lost weight. Abdominal examination does not reveal any lumps.

Complicated ulcers can present with bleeding, weight loss, or vomiting and may mimic symptoms of cancer. Patients who are on non-steroidal anti-inflammatory drugs are prone to ulcers. In Susan’s case, there was no such history.

“Dr. B, what next? I have already tried off-the-counter medications. Is there a way to find the cause and treat it?”

Sure, Susan, let’s investigate with an ultrasound and gastroscopy. Ultrasound will check the gall bladder, liver and pancreas. Gastroscopy will examine the lining of the esophagus, stomach and duodenum.

Most of the ulcers in the stomach and duodenum are caused by Helicobacter pylori organisms (bugs). Biopsies taken during gastroscopy will identify whether these bugs are present. Gastroscopy will check for ulcer and cancer as well.

“Dr. B, you lost me! Gastroscopy? Helicobacter pylori………bugs? Scary stuff!

Susan, gastroscopy is not a difficult procedure. A flexible instrument with light and camera at the tip is swallowed under mild sedation. The magnified lining of the esophagus, stomach and duodenum are seen on a TV screen.

It allows us to do biopsies, remove polyps, dilate narrow areas, can often control bleeding and allows us to take photographs and video of the procedure.

Helicobacter pylori (H. pylori) is a bacteria found beneath the mucus layer of the stomach. In Canada, 10 to 20 percent of the population is infected with this organism. In developing countries, most people are infected before the age of 10 years.

It is estimated that 1 in 5 individuals with H. pylori will develop gastric or duodenal ulcer. A very small percentage may develop cancer of the stomach.

Susan’s ultrasound is normal. Gastroscopy reveals a duodenal ulcer with presence of H. pylori infection. Susan is treated for seven days with “triple therapy” – two antibiotics and an acid reducing agent.

Response rate to this therapy is over 90 percent for healing the ulcer and eradicating the bugs. The risk of recurrent infection is 1 to 3 percent over 5 years, usually from the immediate environment.

Susan feels great and is happy that we are able to identify the cause and treat it. A classic example of modern technology at work!

(This series of articles explore the health problems of Dave and his family. They are composite characters of a typical family with health problems)

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