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- Behavioral Health, Men's Health, Women's HealthGeneral Page Tier 3BlogIn recent years, electronic cigarettes (e-cigarettes) have increased substantially in popularity. They are commonly advertised as a “healthier” and cheaper alternative to cigarette smoking. Smoking e-cigarettes, an activity known as vaping, is not approved by the Food and Drug Administration (FDA) as a method for smoking cessation. It is important to remember that e-cigarettes contain nicotine. Unlike FDA-approved nicotine replacement therapies, such as the patch, lozenge and gum, which contain regulated amounts of nicotine, the nicotine found in e-cigarette cartridges can vary widely among brands. Without large scale, well-designed research studies it is difficult to determine the real impact of e-cigarettes both now and in the future. Furthermore, by appealing to teenagers and young adults, there is the concern that e-cigarettes usage will reverse the progress made in smoking prevention, as well as normalize smoking behaviors. A Battery-Operated Nicotine Delivery Device Let’s look closer at what an e-cigarette is. An e-cigarette is a battery-operated nicotine delivery device. Rather than inhaling smoke from burning tobacco, users inhale a vaporized liquid solution. In 2009, the FDA published a study that identified varying levels of nicotine in these solutions, even in some e-cigarette cartridges that claimed to be nicotine free, and known carcinogens including diethylene glycol, an ingredient found in anti-freeze, and nitrosamines. Although sale to minors is prohibited in Maryland, virtually anyone can sell or buy e-cigarettes. Convenience stores, gas stations and grocery stores offer the most popular brands. Unlike traditional tobacco products there are no restrictions on Internet sales, which makes it relatively easy for youths to make online purchases. This may account for teen use of e-cigarettes doubling between 2011 and 2012. While e-cigarette manufacturers may claim they do not market directly to young people, flavored cartridges such as bubble gum, caramel and chocolate clearly appeal to children. And the industry has exploded. Revenues for e-cigarette companies have doubled every year since 2008, and the market exceeded $2 billion in 2013. A Lot of Unknowns for E-Cigarette Safety So, are they safe? While it is widely believed e-cigarettes are less toxic than cigarette smoking, there are no scientific studies to support this belief. Furthermore, there is no information as to the future effects of vaping or the effects of second-hand vapor inhalation. Most importantly, the lack of regulations for the e-cigarette industry leads to a wide variation in e-cigarette nicotine levels and potentially toxic substances in the vapor. Without scientific data establishing the safety and efficacy of e-cigarettes, there is no basis for recommending them as an alternative to cigarette smoking. Combining counseling and medications is proven to be an effective way to quit. The FDA has approved several forms of nicotine replacement therapies, including gum, lozenges, transdermal patches, inhalers and nasal spray, as well as bupropion and varenicline (Chantix). Talk to your doctor about how to stop smoking. If you have teenagers, talk to them about the dangers of e-cigarettes and vaping. Ready to quit smoking? Learn more about smoking cessation programs at Anne Arundel Medical Center. Courses and individual counseling are free if you live, work or attend school in Anne Arundel County. If you live elsewhere in the region, our staff may be able to navigate you to free resources in your area so please call 443-481-5366. Author By Stephen Cattaneo, MD, medical director of Thoracic Oncology at Anne Arundel Medical Center. He may be reached at 443-481-5838.
- Cancer Care, Men's Health, Women's Health, Patient StoriesGeneral Page Tier 3BlogIt was finally time to celebrate. Earl Shellner had just received an honorary certificate for completing a long course of chemotherapy. This was the last big hurdle in his cancer treatment. Earl had already been through surgery and radiation to treat an aggressive form of rectal carcinoma. Now he was cancer free. Earl sat down to write thank-you notes to friends and family who’d supported him during his struggle. It was then that he realized something new was seriously wrong. He seemed to have forgotten how to write basic letters. ‘”I was starting on the notes and couldn’t remember how to make a cursive S and a J,” he recalls. “I had to look it up on the internet, how to make the lines and curves for those letters.” Friends and Family May Be the First to Notice Signs Earl didn’t understand what was happening. He spoke to his mother, who’d been staying with him during his cancer treatment. She had even more bad news. She told him it wasn’t just the alphabet he was forgetting. “She told me I’d been telling the same stories over and over again. I’d tell a story and then 15 minutes later I’d tell it again.” And there were other lapses. He couldn’t remember the name of a neighbor’s son who he’d known for years. When he went to brush his teeth, he couldn’t remember how to use the toothbrush. It turns out many of Earl’s friends also noticed his brain seemed muddled. No one wanted to tell him because he’d already been through so much. He was devastated. Before his cancer diagnosis, he’d been a high-energy, multitasking restaurant manager. “Now I didn’t want to leave the house. I didn’t want to socialize, and my mom had to take over my banking. I just couldn’t handle any of my stuff anymore,” he says. AAMC Nurse Identifies Chemo Brain Earl shared his concerns with his radiation oncologist, and a nurse on the team recognized the symptoms. She told him he had what’s known as cancer-related cognitive impairment or “chemo brain.” Estimates vary but studies suggest a significant number of cancer patients who’ve undergone chemo may experience some degree of cognitive impairment. Until recently, however, many doctors tended to dismiss the memory loss as a given side effect of treatment. Their advice was for patients to wait it out and hope the problems diminished over time. “There is a real knowledge gap,” says Matt LeBlanc, the nurse navigator for Anne Arundel Medical Center’s Cancer Rehabilitation Center. “Chemo brain exists but it is under recognized and undertreated.” A little over a year ago, AAMC decided to address the need directly by launching the cancer rehab program. Among other things, it offers cognitive therapy to cancer patients using techniques developed for those who’ve suffered traumatic brain injuries. Speech Therapy Helps Rebecca Gondak is a speech language pathologist at the center. She says many of her cancer patients arrive with significant cognitive impairments, including short-term recall and language retrieval. “Intelligence is not affected, the problem is a patient’s ability to access intelligence,” says Gondak. The good news is that with help, even a brain damaged by chemotherapy can form new pathways to compensate for what’s been lost says Gondak. Earl is a perfect example. When Shellner arrived at the Cancer Rehab Center, he tested far below average for memory and word recall. Gondak began a vigorous course of treatment using a combination of exercises, strategies and tricks to teach the brain new ways to access information. “Since people with chemo brain often have trouble with short-term memory one thing I do is teach them how to connect new information to something they are already familiar with,” says Gondak. Gondak says many effective strategies for recall are quite simple “Let’s say a patient parks on level 3A. How will they remember if they’re having short-term memory loss? Well, I’ll have them think of connections to the level. Maybe they have 3 children and want an A in school. That’s 3A.” Gondak also uses repetition and problem-solving exercises to help jump-start the brain. Rehab Gave Earl His Life Back After twelve sessions, Earl was thrilled with his progress. He’d jumped from the 13th percentile in cognitive function to the 79th percentile. Other patients have seen similar results. Gondak says one of the things she finds most moving is that many of her patients are making huge leaps in memory skills even as they endure cancer treatment. “We get a lot of patients in pain or who aren’t sleeping and still we see improvement, ” Gondak says. Earl says rehab has given him his life back. He’s no longer afraid to go outside or talk in public. He also continues to heed Gondak’s advice. He uses lists so he doesn’t overload his brain with too much information, he takes brain breaks and he puts essentials, like his keys and phone, in a designated place so he doesn’t lose them. The bottom line, says Earl, is the skills he’s acquired in rehab have allowed him to function again. “Rehab has made a tremendous difference in my life,” Earl says. “I can feel it everyday.” Read Earl’s first-person account of his journey on the Huffington Post.
- Cancer Care, Men's Health, Women's Health, UncategorizedGeneral Page Tier 3BlogExcerpts from the Living Well with Cancer podcast interview with Rebecca Gondak, speech language pathologist at Anne Arundel Medical Center. Rebecca discusses therapy to treat cognitive impairment, chemo brain, that results from cancer treatment and AAMC’s Cancer Rehab Program. Listen to the entire interview here. What kind of symptoms would you notice in someone with chemo brain? People who come in with chemo brain often report problems with attention and multitasking, their processing speed, their word retrieval, their planning and organizational skills and their memory. How do you treat chemo brain or chemo fog? We start by educating the patients on what impairments they’re having difficulty with, then we teach them to apply compensatory strategies to manage those difficulties. That can include pacing of cognitive activities, preventing or minimizing distractions, using short-term memory strategies and word-finding strategies. Secondly, we teach them exercises to improve weaknesses, and we gradually increase the complexity of those exercises to encourage functional reorganization of the brain. Read the transcript of the interview or listen to the recording. For more information on AAMC’s cancer care services, visit www.askAAMC.org/cancer.
- Cancer Care, Men's Health, Women's HealthGeneral Page Tier 3BlogExcerpts from Living Well with Cancer podcast interview with Joanne Ebner, Supervisor of Anne Arundel Medical Center’s DeCesaris Cancer Institute’s cancer prevention program. Listen to the entire interview here. Why would someone want to get screened for cancer? It’s best to first of all prevent cancer but the second best is early detection and early detection is important because the treatment options are greater and they’re more effective and quality of life is much better. The important thing is to screen people before they have any symptoms of the disease and in this case cancer. Who makes the recommendation to get a screening? There are a number of organizations that make cancer screening recommendations and they don’t always agree. That’s why it’s important to have the conversation with your doctor to determine which screenings are best for you. Read the transcript of the interview or listen to the recording.
- Cancer Care, UncategorizedGeneral Page Tier 3BlogExcerpts from Living Well with Cancer podcast interview with Stephen Cattaneo, MD, thoracic surgeon at Anne Arundel Medical Center. Dr. Cattaneo discusses screening for lung cancer and Anne Arundel Medical Center’s Lung Cancer Screening Program. Listen to the entire interview here. Who should be screened for lung cancer? Those at the highest risk of lung cancer are the ones that we recommend be screened. What that means practically is folks between 55 and 80 who either are currently smoking or have stopped in the last 15 years. They also should have smoked at least 30 pack-years of cigarettes over their lifetime What that means is a pack a day for 30 years, two packs a day for 15 years, something like that to get to a multiple of 30 pack years. Is it just a one-time thing to get screened for lung cancer? No, that’s a great question. Absolutely not. In fact the important thing is not to just get the first screen but to keep getting subsequent lung cancer screenings once a year until you reach the age of 80 or until it’s been 15 years since you’ve stopped smoking. The goal of screening is to find lung cancers early, at a time when they’re treatable and we’ve learned that more cancers aren’t found on that initial scan but they’re actually found on later scans which is why it’s important to continue to follow-up and to have scans every year. Read more about a three-year, $1.25 million grant from the Bristol-Myers Squibb Foundation to help us expand our Rapid Access Chest and Lung Assessment Program.