Too Bad, so SAD?

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When the days are getting shorter and the temperature colder, do you find yourself getting a little more irritable?  Have a little less energy?  Feel a little more moody?  And if you find that this pattern is consistent year after year, starting every fall and disappearing each spring, you may be suffering from Seasonal Affective Disorder, or SAD.

Seasonal Affective Disorder is a subset of major depression, and may have general characteristics of daylong depression and low energy.  Feelings of hopelessness or worthlessness, as well as no interest in activities that once were enjoyable are common.  Poor sleep patterns, difficulty concentrating, changes of appetite or weight and feelings of agitation are also frequent.  Specific to SAD include craving starches and subsequent weight gain, heavy feelings of the arms and legs, as well as trouble with interpersonal relationships including hypersensitivity to rejection and problems getting along with others.

Although the specific cause is not known, some factors are likely contributing to the development of the disease.  It is season specific, commonly starting as days get shorter and diminishing as longer days return.  The decrease in sunlight may disrupt your circadian rhythm or “bio clock” which sets your wake/sleep cycle.  Disruption of this cycle may lead to depression.  Reduced sunlight can also cause a drop of serotonin which is known to affect mood and contribute to depression.   Melatonin, another neurotransmitter, can be disrupted by a shrinking photo period and will affect sleep patterns and mood.

Females seem to be more likely to suffer from SAD, but males may experience greater severity of symptoms.  Younger individuals are at greater risk for SAD, however the risk does decrease with increasing age.  Those with a personal history of depression or family history of Seasonal Affective Disorder are also more likely to have SAD.  The greater the swing of day/night intervals, the greater likelihood of this disorder as well.

The diagnosis of Seasonal Affective Disorder may be difficult to make.  Health problems and lab tests that contribute to depression need to be investigated.  Additional types of depression may muddy the picture as well and need be considered.  There are some factors that do support the SAD diagnosis if present for over two years.  These include depression that begins during a specific season every year, and ends during another specific season annually, there are no episodes of depression during seasons of normal mood, and there are more seasons of depression than seasons without depression over time.

There are treatments for Seasonal Affective Disorder, but must be used with caution if there is a concern for additional underlying bipolar depression.  Light therapy (phototherapy) involves exposure to a special type of light.  The light source mimics the natural light of the outdoors and seems to influence the brain chemicals linked to mood.  After days to weeks of consistent periods of exposure, this treatment seems to have a positive effect with most people suffering from SAD.  Consult your doctor regarding light therapy treatment, as you need to assure the proper equipment for efficacy and safety.  A common medication for preventing SAD is bupropion, an antidepressant.  This may be considered for severe SAD, and is usually started every year before the onset of symptoms and continued beyond the usual seasonal recovery time before stopping the prescription.  Psychotherapy can help control negative thoughts and behavior as well as assist developing healthy coping skills and stress management.  Of course, should you identify with these symptoms, please consult your health care provider as soon as possible.

Bradford Croft, DO

East Flagstaff Family Medicine

A Head of Trauma – TBI

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Traumatic brain injury (TBI) is caused by an acute bump, blow or penetrating head injury that disrupts the normal brain function. If you ever “saw stars” because of head trauma, even without loss of consciousness, you may have experienced a mild concussion.  The source of the experience is due to the physical bruising of the brain against the inside of the skull.  Likely, you recovered without a problem.

Not every blow to the head results in TBI.  Those that do may have a wide range of severity from mild, a brief change in consciousness or thought process, to severe, a prolonged period of unconsciousness or coma.  The lasting effects of TBI are also quite variable, lasting from days or weeks in many cases to prolonged, causing lifelong consequences.

TBI contributes to one third of all trauma related deaths.  Although three out of four TBIs are mild, there are 153 people who die every day from sustaining a severe TBI.

According to the CDC, the leading cause of TBI resulting in ED visits, hospitalization and death is from falls, accounting for almost half of all reported cases.  The young, up to age 14, and the elderly, those over 65, are a greater risk than the general population, accounting for fifty-four and seventy-nine percent of all TBI cases respectively.  The sources of TBI related trauma that result in death are the greatest in ages 65 and older from falls, 25 to 64 years old from intentional self-harm, 5 to 24 years old from motor vehicle accidents, and 0 to 4 years old from assault.

There are four categories of concussion symptoms.  “Thinking and remembering” may present as difficulty with reasoning, feeling slow mentally, difficulty concentrating and difficulty remembering new information.   “Physical effects” may include fuzzy or blurry vision and headache, nausea and vomiting, sensitivity to noise and light, dizziness, balance problems and feeling tired and no energy.  “Sleep patterns” may include sleeping more than usual, less than usual or difficulty falling asleep. “Emotional and mood changes” may include irritability, sadness, emotional lability and nervousness or anxiety.  Some symptoms may be noticed immediately, whereas others may not show up for weeks to months after the incident.  If presenting symptoms are subtle, they may initially be overlooked by family, physicians and even the patient.

Those with a history of previous concussion are at greater risk to have another and may also find it takes longer to recover with repeated incidents.  With the recent attention from the NFL, it is also known that repeated brain trauma may lead to Chronic Traumatic Encephalopathy (CTE), a disease with progressive development of any of the concussion symptoms previously discussed.

Those who experience milder forms of TBI should consult their health care provider as soon as possible.  It is important to get adequate rest and limit activity.  Protection from additional trauma is critical.  Physical activity may need to be restricted for a period of time.  Medications should be reviewed, and alcohol should be avoided.  Severe TBI which may include loss of consciousness should be evaluated emergently.  It should also be treated after the acute phase with a formal rehabilitation program to improve the likelihood of better long term outcomes.  More information is available at this link: https://www.cdc.gov/traumaticbraininjury/. 

Bradford Croft, DO

East Flagstaff Family Medicine

 

Breast Cancer Awareness

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Many of us are aware that breast cancer is the second most common cancer-causing death in women, surpassed only by lung cancer.  The U.S. Department of Health and Human Services notes this disease affects one of every eight women throughout their lifetime.  But with early detection and treatment in initial stages, the five-year survival rate is ninety-nine percent.  As October is National Breast Cancer Awareness month, this is a time for all women to consider their risks.

Early detection is critical to best outcomes.   There are many common changes that may be found such as lumps, nodules or changes in skin tissue.  Many of these findings, however, may not be breast cancer.  But early familiarization performing a monthly breast self-exam is beneficial beginning in early adulthood.  Your primary care provider will routinely perform a clinical exam as a part of your annual wellness physical.  Most abnormal finding may require additional evaluation in conjunction with your physical.  Direction for performing a self-exam should be included in your visit if you require instruction.  As well, there is a wealth of information and instruction online, including http://www.nationalbreastcancer.org and www.ncbi.nlm.nih.gov.

As women get older, there is an increasing incidence of cancer with age.  As well, women who have a family history of breast, uterine, ovarian or colon cancer, have been on hormones, or those who have never had children or not had children until later in life are at greater risk.  There is also a laboratory evaluation known as BRCA gene mutation testing to determine a significant increased risk of cancer, especially if there are multiple family members with a history of breast cancer.  There are as well, increased risks associated with smoking, daily alcohol consumption, prior radiation therapy and obesity.  Common misconceptions that do not increase the risk include underwire bras, antiperspirant use and implants.

The most common imaging study to aid in breast health is the mammogram.  It is normally included as a preventive health benefit by most insurance carriers.  Then National Cancer Institute recommends annual screening mammograms in all women 40 to 74.  Those with family history should consult your physician.  The benefit of early detection is to see subtle changes that are not yet large enough to be felt on exam.  And comparative views each year may be able to confirm stability or detect a subtle change.  Additional studies that may be indicated in breast evaluation include ultrasound, MRI and, if needed, biopsy.

There are many organizations promoting awareness, walks for cancer, fundraisers, research, support and education.   So ‘guys’, encourage the women close to you to participate in breast cancer awareness.  And please, ‘gals’, you as well, starting with the one in the mirror.

Bradford Croft, DO

East Flagstaff Family Medicine

Flu Season – Coming Soon!

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It is, once again, time to consider our health concerns as days are growing shorter.  Social distancing and health hygiene may be beginning to wane as we become more complacent with pandemic precautions.   We still need to beware of the influenza season once again this winter. Last year, our health awareness provided less opportunity for influenza, but it will still be present and potentially deadly once again this year, particularly if we let our guard down.  Things you should know…

Influenza is a respiratory infection that causes fever, cough, sore throat, and nasal congestion.  Additional symptoms include headaches, muscle aches and fatigue.  Although these complaints are similar to the common cold, the severity is typically much worse.  Not only can the intensity be serious enough to cause weeks of lost work or school, but the infectiousness can be so powerful as to impact a workplace or school from a single source.  Influenza can cause complications which kills thousands of Americans every year, more commonly those with chronic health problems, the elderly and very young.  However, anyone can suffer a complication of this illness, sometimes requiring hospitalization with significant lost time from daily routines, or even resulting in death.  Fortunately, there is treatment for influenza with early intervention.

A severe outbreak may commonly last up to eight weeks regionally and can often infect one out of every three people in a community.  Hand washing and hygiene are always important, but the single best prevention of influenza is the seasonal immunization.  Appropriate for almost everyone six months or older, it is especially important for those with any chronic disease such as asthma, COPD, diabetes, heart, kidney or liver disease, and any kind of cancer.  Also, those who are overweight or 50 and older are at a significant risk as well.

The influenza immunization recommendation from the CDC for the 2021-2022 season includes only quadrivalent injectable vaccines.  This year vaccines have been updated to match the expected circulating viruses and are provided as the inactivated influenza vaccine (IIV), the live attenuated nasal spray (LAIV4) and the recombinant influenza vaccine (RIV).

For those interested, the updated protections for this year’s likely infections include:

*Egg-based H1N1: A/Victoria/2570/2019 (H1N1) pdm09-like virus;

*Cell/recombinant H1N1: A/Wisconsin/588/2019 (H1N1) pdm09-like virus;

*Egg-based and cell/recombinant H3N2:  A/Cambodia/e0826360/2020 (H3N2)-like virus;  B/Washington/02/2019- like virus (B/Victoria lineage);

B/Phuket/3073/2013-like virus (B/Yamagata lineage).

* Updated Strains

Annual flu vaccines are commonly covered by most health insurance programs at no cost to patients.  These immunizations are usually readily available at county health clinics, most retail pharmacies, and many family doctor offices.  You should have your immunization by the end of October.  Of course, the sooner the administration, the sooner you are protected for the entire influenza season which may go well into the spring.  It can take up to two full weeks to acquire immunity from the shot.  Talk to your health care provider soon.  Now is the time to prevent the flu!

Bradford Croft, DO

East Flagstaff Family Medicine

Human Papilloma Virus

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The Human Papilloma virus is responsible for almost all cervical cancers and some cancers of the vagina, vulva, penis, anus, and oropharynx.  Averaging 34,800 cases per year in the United States, these cancers are not as common as colon, prostate, breast, and lung, all running almost ten-fold over HPV.   It is significant to know that this cancer is both readily screened as well as commonly immunized.  This provides a double opportunity for surveillance and treatment not known to any other cancer.

As a sexually transmitted disease, most cases of HPV have no symptoms.  Upon contracting the infection, the body can clear many of this family of viruses within a year or two spontaneously.  There are different strains of virus that may lead to precancers as well as cancer outright.  Those strains of HPV include types 16, 18, 31 33, 45, 52 and 58.  There are also strains 6 and 11, not leading to cancer but responsible for venereal warts.  All nine viruses are responsive to the 9vHPV immunization.  The most common cancers listed are oropharyngeal and cervical.

HPV vaccines are the most common way to impact cancer prevention, usually administered during early adolescence, ages 11 or 12.  Unfortunately, only about half of these eligible individuals have received their vaccines.  There is a process of catch-up vaccines provided to those at risk up to age 26 not previously vaccinated.  Although there is controversial benefit to vaccinate those into their mid-40s, the benefit if immunization diminishes into the older age groups.

Cervical cancer is the only HPV cancer that routine screening is recommended.  The age group for screening is suggested for women ages 21 to 65 in three different subgroups.  Women 21-29 should be screened with Papanicolaou (Pap) smears every three years.  Those 30 to 65 are recommended to have either a Pap every three years, an HPV test every five years or both a Pap and HPV every five years.  The progression of persisting infection to precancers and eventually cancer is a slow, years duration process.  Even if there is no evidence of early infection, the insidious process of infection dictates the need for ongoing screening later in life.  For more information about HPV, contact your primary care provider.

Bradford Croft, DO

East Flagstaff Family Medicine

Smell the Flowers, or Maybe Not…

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Asthma is a disease of the lungs that causes difficulty breathing.  It is a very common disease in children, although some may have symptoms that persist throughout their lifetime.  Others may develop it as an adult.  The symptoms of asthma are wheezing, shortness of breath, tightness in the chest, and commonly a nighttime or early morning cough.  Although the disease of asthma may not be always active, it is constantly present.  It only becomes prevalent when the lungs become irritated.  Unfortunately there is no cure for asthma, but there are a number of medications that can treat it.  It is also commonly seen to run in family bloodlines.

All wheezing is not necessarily asthma, but common recurrences of these symptoms that are associated with the presence of upper respiratory infections may provide suspicion.  Other triggers of asthma include respiratory allergies, inhalant exposures and, for some, physical exercise or exertion.  Anyone with asthma should avoid tobacco smoke.  There are tests such as spirometry or pulmonary function tests that can be ordered to help decide if asthma may be an underlying health problem.

The air channels in the lungs start with a large main airways, or bronchi.  As these airways branch out through the lungs, the size becomes smaller and smaller until they terminate at the alveoli, similar to branches of a bare tree.  When an acute asthma attack occurs, the airways in the lungs become inflamed, the airways congest and spasm making it difficult to breathe from restricted air flow.  If triggers are recognized, avoidance is extremely important if possible.  Some irritants cannot be avoided however, such as seasonal pollens.

There are medications for asthma.  The initial treatment usually starts with “rescue” inhalers that are used when symptoms occur.  These work by relaxing airway spasm and opening the channels.  If the need for this medication continually increases over time, there are additional medications taken on a daily basis to help reduce flare ups from the start.  These medications typically reduce chronic inflammation and airway spasm and thickening.  These long term control medications do not help acute exacerbations, but many times can markedly reduce the frequency and severity of asthma attacks.  It is important for those taking asthma medication to use it properly.  Some patients may reduce or stop their prescription when symptoms are controlled thinking their asthma is resolved, but put themselves at great risk for exacerbations of a potentially fatal disease with improper use of their prescriptions.

Bradford Croft, DO

East Flagstaff Family Medicine

What’s That Again?

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As June is National Alzheimer’s Awareness Month, this is a good time to highlight this form of dementia.   As of last year, the CDC estimates that there were 5.8 million people in the US living with Alzheimer’s.  As the number of cases double every five years after 65, it is expected that the diagnosis will triple to almost 14 million by 2060.

As the brain succumbs to Alzheimer’s, the centers that control language, thought and memory become impaired.  The usual characteristics that may develop begin with mild memory loss, evolving into difficulty in carrying on conversations and challenges with recognition of the environment.  It has been shown that physical changes can occur well before objective findings develop, which is not a normal process for the ageing brain.

Although there are no specific risk factors assuring the development of the disease, there are some predictors of Alzheimer’s.  The most common begins with age.  Although it can develop earlier, the usual age of diagnosis develops after age 60.  There is an increased likelihood of disease if there is a positive family history, but not an assurance.   It is thought that adequate exercise, a healthy diet, limited alcohol intake and not smoking may bear favorably on not developing Alzheimer’s, as has also already been shown to improve health outcomes in cancer, diabetes, and heart disease.

As there is no “usual” presentation of early Alzheimer’s, sometimes the individual becomes aware of subtle changes in mentation.  In other scenarios, it becomes evident to family and friends of such changes as the patient remains oblivious or is in denial when challenged with these observations.  The CDC posts the following ten warning signs of dementia as scenarios that warrant evaluation:

  1. Memory loss that disrupts daily life:forgetting events, repeating yourself or relying on more aids to help you remember (like sticky notes or reminders).
  2. Challenges in planning or solving problems:having trouble paying bills or cooking recipes you have used for years.
  3. Difficulty completing familiar tasks at home, at work, or at leisure:having problems with cooking, driving places, using a cell phone, or shopping.
  4. Confusion with time or place:having trouble understanding an event that is happening later, or losing track of dates.
  5. Trouble understanding visual images and spatial relations:having more difficulty with balance or judging distance, tripping over things at home, or spilling or dropping things more often.
  6. New problems with words in speaking or writing:having trouble following or joining a conversation or struggling to find a word you are looking for (saying “that thing on your wrist that tells time” instead of “watch”).
  7. Misplacing things and losing the ability to retrace steps:placing car keys in the washer or dryer or not being able to retrace steps to find something.
  8. Decreased or poor judgment:being a victim of a scam, not managing money well, paying less attention to hygiene, or having trouble taking care of a pet.
  9. Withdrawal from work or social activities:not wanting to go to church or other activities as you usually do, not being able to follow football games or keep up with what is happening.
  10. Changes in mood and personality:getting easily upset in common situations or being fearful or suspicious.

Alzheimer’s does not have a cure, but there are treatments available.  It is important to seek medical care at the first concern of dementia, particularly as there may be other reasons to develop dementia other than Alzheimer’s.  There are various forms of testing that may include lab, imaging as well as cognitive evaluation.  Neurocognitive screening, such as the Montreal Cognitive Assessment (MoCA) is standardized and reproduceable, as well as other formal evaluations which will help determine the severity and progression of dementia.

A diagnosis of Alzheimer’s dementia is important to make early and accurately, as the process is progressive and unrelenting.   Accommodations will need to be made: future planning, arranging financial and legal issues, addressing safety concerns, making eventual living arrangements and developing a support network.   Should there be concerns of developing dementia regarding you or your family, your first stop should be with your primary care provider.  Early intervention is critical to best outcome,

Bradford Croft, DO

East Flagstaff Family Medicine

One Stroke May Be Three Strikes

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May is National Stroke Awareness month.  Responsible for one out of six deaths in the U.S. in 2018, the signs of stroke are worth being aware.  On average, according to the CDC, a stroke happens nationally once every forty seconds, and there is a death every four minutes, totaling almost 800,000 cases per year.  Stroke is responsible for more long-term disability than any other disease in the U.S.

A stroke occurs when there is a compromise of circulation to the brain.  There are common health problems that increase the risk of developing a stroke.  High blood pressure, elevated cholesterol, diabetes, smoking, and obesity are the major contributory health risks.  About one in three Americans have at least one of these health concerns, and one out of every four patients have already had a stroke previously.  Although the likelihood of stroke increases with age, the CDC notes that about one third of hospitalized patients are under sixty-five.  Stroke risk doubles every decade after the age of fifty-five.

Most strokes are ischemic, caused by blocked circulation.  A cerebral thrombosis is a clot that develops in a blood vessel in the brain and clogs circulation at that area of the brain.  A cerebral embolism is a clot that forms in a remote part of the body, commonly in the heart or upper body.  As it follows the circulation to the brain, it then lodges in a vessel in the brain, stopping further circulation.  A common heart problem that causes this is known as atrial fibrillation, as clots repeatedly develop in the heart due to this rhythm irregularity.

Less common but equally devastating is a hemorrhagic stroke.  Rather than a blockage, this stroke is caused by bleeding in the brain.  Examples would be from a leaking blood vessel or one that has burst or ruptured.  A brain aneurysm has potential to break and bleed, as it can be a naturally occurring weak spot.

Time is of the essence in treating stroke.  Those patients who have been treated within the first three hours of the development of symptoms often have less disability at three months after the stroke.

F.A.S.T is an easy mnemonic to spot the development of a stroke.

F: face drooping.  Ask the person to smile and look for drooping on one side of the face.

A: arm weakness.  Have the person raise both arms and look for one side to drift downward.

S: speech difficulty.  Slurred or difficult speech, have the person repeat a short sentence correctly.

T: time to call 911.  Even if symptoms may resolve, early intervention is critical.

In addition to FAST, there are other symptoms of stroke that should be considered.  This includes a sudden numbness or weakness of the leg; sudden trouble with understanding or confusion; sudden difficulty seeing with one or both eyes; acute trouble with balance, walking, incoordination, or loss of balance; and sudden severe headache with no known cause.

A transient ischemic attack, or TIA, has all the features of a stroke except for the duration and damage.  The same mechanism of stroke occurs, but spontaneously clears in a short period of time without any neurologic compromise.  Nonetheless, there is medical evaluation that needs to be done.   Should you experience a TIA, seek medical care urgently as one in three will evolve into a full-blown stroke within a year.

Bradford Croft, DO

East Flagstaff Family Medicine

Along Comes the Wind

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As we endure the spring season, there are many common allergens indigenous to northern Arizona that evolve throughout the year.  Those allergy sufferers may complain of itchy, watery eyes; stuffy or runny nose; sinus pressure; ear congestion and scratchy throat.  And for those with asthma, the complaints may commonly include tight chest, difficulty breathing, cough, wheezing and shortness of breath, sometimes severe.

The Asthma and Allergy Foundation of America estimates that there are 50 million of us who have allergies.  Allergic conditions are the sixth leading cause of chronic illness in the U.S.  The longer you are here, the more likely you will be to acquire allergies with repeated exposures season after season.  Although common allergens include seasonal pollens, there are also a host of year round irritants including dust mites and animal dander that can be addressed with some proactive awareness and avoidance.  This time of year from February through the end of spring, the juniper and cedar trees pollens are in abundance in northern Arizona.   These can be an overwhelming source of irritants, some of the most significant of common allergens to many.

Common over-the-counter medicines can be used for allergy treatment.  Antihistamines reduce the histamine reaction responsible for sneezing, itching, runny nose and hives. This medicine is the foundation of allergy management, including seasonal and indoor allergies.  Nasal corticosteroids are nose sprays that reduce swelling and irritation producing sinus pressure, stuffy, runny and itchy nose.  Decongestants are also commonly used.  As their action is to dry congestion, it may sometimes worsen symptoms in our dry climate of the southwest.  Many medicines are “all-in-one” which have additional combined drugs.  Please read these ingredients, as there may be unnecessary and possible contraindicated components for some, including aspirin and other NSAIDs.  As well, there may be other medications included for cough, congestion and other symptoms of upper respiratory infections that may not be appropriated for those who suffer from environmental allergies.

There are additional levels of prescription intervention including mast cell stabilizers, leukotriene inhibitors, and oral steroids to name a few. Possibly allergy testing and hyposensitization treatment may be needed if symptoms are not controlled with the previously mentioned medications.   With early intervention and preventive treatment, many of these complaints may be minimized.  Reducing the health risk of allergy and its association with asthma can markedly improve both the financial and personal cost of uncontrolled disease.  If you have such symptoms, a visit to your primary care provider may be appropriate to evaluate, discuss and initiate the appropriate care for your complaints.  For these health problems, as with many others, early intervention is optimal to best outcome.

Bradford Croft, DO

East Flagstaff Family Medicine

 

Cancer – Who is at Risk?

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Colorectal cancer (cancer of the colon and rectum) continues to be the second leading cancer-causing death of both men and women in the U.S.  It is, however, the third most common cancer diagnosed in our country.  The only more common cancers in men are that of prostate and lung, and women are breast and lung.   According to the most recent statistics of the CDC, 141,125 people were diagnosed with colorectal cancer in 2017 with 52,547 deaths.  Of every 100,000 people, there are 37 diagnosed with colorectal cancer and 14 deaths.

Colorectal cancer begins in early stages as growths or polyps that develop in the large bowel.  The most common polyps are adenomatous.  These are not initially cancer by nature but are likely to turn into a cancer over time.  There are also inflammatory, hyperplastic, and villous polyps ranging from minimal to significant risk of evolving into colon cancer.  As cancer evolves, one may eventually have complaints of blood in the bowel movement, persisting abdominal pains or cramps, or unexplained weight loss.  Although these symptoms are not exclusive to colon cancer, immediate medical help should be sought if these complaints are present.  Early on, there may be absolutely no symptoms at all.

Although there are no absolute reasons that individuals develop colon cancer, there are some risk factors to consider.  As we age, our probabilities increase.  According to the CDC, more than 90% of cancers occur in those over fifty.  As such, the general recommendations are that men and women begin routine screening soon after turning fifty.  There is an increased incidence for those with underlying inflammatory bowel diseases such as ulcerative colitis and Crohn’s disease.  If you have a family history (mother, father, sister, or brother) with a diagnosis of colon cancer discovered before age 50, or if you have a genetic syndrome such as familial adenomatous polyposis or hereditary non-polyposis colorectal cancer, you may have an increased risk and require screening earlier than the routine recommendation of 50 years old.

As March is Colorectal Cancer Awareness Month, your family physician can help you evaluate Colon your risk and screening options and may provide preliminary testing in office.  There are several screening tests.  Most involve the evaluation of a stool specimen, such as the guaiac-based fecal occult blood test (gFOBT) which tests for the presence of blood, the fecal immunochemical test (FIT) that measures antibodies that indicate bleeding, and the FIT-DNA test, checking for altered DNA combined with the antibody test. Although a positive screening test is not an assurance of cancer, it is a marker for timely evaluation.

Colonoscopy is a procedure that checks for cancer in the rectum and entire colon.  With the patient under sedation, a long, thin, flexible scope is used to painlessly visualize the bowel and remove polyps as well as biopsy areas of suspicion.  This is also the procedure commonly used if any of the previous screening tests return as positive.  Usually, this screening test is only needed once every ten years as opposed to annually for the less reliable gFOBT and FIT, or every three years for FIT-DNA, commonly marketed as Cologuard.

Additional techniques include capsule endoscopy (swallowing a camera in a pill) and virtual colonoscopy (a series CT radiology pictures combined to provide an image of the bowel).  As relatively new procedures, they may not be covered by insurance or available in your area.  Along with recommendations from your doctor, check with your insurance coverage to determine which tests may be choices for your screening evaluation.

Bradford Croft, DO

East Flagstaff Family Medicine, LTD