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Let’s Talk About Colon Cancer

 

Eng

Written by Dr. Ady Oster

People do not talk about colon cancer very much.  Perhaps this is because it’s embarrassing to discuss, perhaps because they do not know much about it. That is a shame, because colon cancer is common and it is one of the most preventable cancers.

Colon cancer is the fourth most common cancer among Asian Americans, for both men and women (after breast, prostate, and lung) and (because it is more deadly than prostate cancer) colon cancer is the third most common cause of cancer deaths. While a few people with colon cancer have family members who also had colon cancer, most colon cancer occurs in people who do not have a family history of this cancer.

Cancers occur when a group cells grow out of control. Initially, they remain in one organ forming a lump. In time they can spread to other organs.  Most cancers are much more easily treated when they are still in one organ. Colon cancers start as a polyp. These are small, warty-looking bulges in the inside lining of the colon.  Over time, some of these polyps can become cancers (10% in ten years), invade the lining of the colon, and eventually spreading to other organs. Because polyps are small, they do not cause pain, diarrhea or constipation.  It is impossible to feel polyps.  The only way to know if you have a polyp is by having a doctor look at the inside of the colon.  If polyps are removed, they can no longer become cancer. Therefore, the best way to prevent colon cancer is to have a colonoscopy to look for and remove polyps.

Most polyps and cancers cause bleeding (not visible) into the stool. Usually it is too small to be visible, but it may be detectable with special stool tests. Another way to look for polyps or colon cancer is to have stool tested for microscopic blood. Older tests required eating a special diet for several days and collecting several stool samples. Newer tests do not require any special diet and only one stool sample. If any blood is found, a colonoscopy will be required to find the source of the blood and remove any polyps that are found.  If no blood is found, stool tests will need to be repeated every year in order to provide adequate reassurance that no polyps or cancers are in the colon.

During a colonoscopy, a doctor uses a long, flexible fiberoptic scope to examine the entire colon.  If any polyps are found, they are usually removed at that same time. Since polyps take several years to develop and will take even longer to become a cancer. People without any polyps can safely wait ten years between each colonoscopy. People who do have polyps will need to have colonoscopies more often, depending on how many and how big these polyps were. People are usually sedated for a colonoscopy, so most people do not remember having the procedure.  Unfortunately, in order for doctors to clearly see the lining of the colon, it must be cleaned of any stool. Therefore, people are asked to drink only clear liquid on the day or two prior to the test. On the evening before the test, they need to drink medicine that cleans the stool in the colon by causing diarrhea. This can be uncomfortable for a few hours.

The risk of cancer increases with age. Most people should begin testing for polyps or colon cancer at age 50.  People who have family members with colon cancer should talk to their healthcare provider about the right age to start.

Despite the embarrassment or discomfort, it is important to talk about colon cancer. Talk to your primary care doctor about whether colon cancer testing is appropriate for you.  Talk to your loved ones to make sure they have talked to their doctor about colon cancer. You can make an appointment to meet with a primary care provider here at Charles B. Wang Community Health Center by calling (212) 379-6998 for Manhattan, and (718) 362-3006 (37th Ave) or (929) 362-3006 (45th Ave) for Queens. For more information, visit the internal medicine webpage.

Written by Dr. Ady Oster. Dr. Oster is the section chief of internal medicine at the Charles B. Wang Community Health Center. He received his medical degree from the Albert Einstein College of Medicine, and completed his residency training at Yale-New Haven Hospital and University of California at San Francisco. Dr. Oster is board-certified in internal medicine.


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Growing Older with Hepatitis B: Prevention and Precautions Still Matter

This September we are celebrating seniors for Healthy Aging Month. The Hepatitis B Foundation is doing a series on Growing Older with Hepatitis B, and we have adapted part two of their series. If a senior you know or love is living with hepatitis B, make sure to share!

Most people living with chronic hepatitis B today are over age 50, and like their younger counterparts, they need to keep themselves healthy and prevent spreading hepatitis B to their sexual partners, housemates, and neighbors.

Remember to take care of yourself. Hepatitis B can still affect your health even if you are older. A hepatitis B “carrier” can still get sick. Remember to see your doctor every year for a checkup, which includes checking on hepatitis B. You may need blood tests to see if the virus is still active and affecting your liver and an ultrasound to make sure there is no liver cancer or other liver problems developing. Your doctor can also make sure there are no other illnesses or medications affecting your liver and to see if you need any vaccinations (shots).

You’re never too old for safe sex: You may not have to worry about pregnancy anymore, but you still need to protect yourself and your partner against diseases that can be transmitted through sex, such as hepatitis B. Using a condom is important, because many seniors have not been immunized against hepatitis B. Your partner should be checked for hepatitis B—there is a vaccine available if he or she is not immune.

Seniors see doctors more often than young people, but they are less likely to discuss sex and ask about (or use) safe sex practices. According to the U.S. Centers for Disease Control and Prevention (CDC), syphilis, chlamydia and HIV infections are rising again, and about one-quarter of newly reported HIV infections are in people age 55 and older.

If you live with hepatitis B, make sure you practice safe sex and your partner is vaccinated.

You’re never too old for the hepatitis B vaccine. However, as our immune systems age, our response to immunizations can weaken. The hepatitis B vaccine is effective, but sometimes our aging immune systems don’t produce enough antibodies after vaccination to protect us.

If you or your partner are getting immunized against hepatitis B, about one or two months after you get the last dose, see your doctor and get tested for hepatitis B antibodies (called titers). If you don’t have enough antibodies to fight infection, you can get a fourth vaccine (booster) shot or you can get the entire three doses again. In the meantime, use safe sex to protect you and your partner.

Make sure all medical equipment is sterile. As we all know it’s easy to spread colds and germs when you live with people in close quarters, but spreading hepatitis B can occur when health care workers re-use glucose monitors, which check blood-sugar levels in people with diabetes.

Each year, the CDC reports outbreaks of hepatitis B in nursing homes and assisted living facilities. Remember, the hepatitis B virus can live for several days in dried blood on hard surfaces, so a little will go a long way if it’s on medical equipment used to poke or probe or collect blood.

What can you do? If you or a family resident has hepatitis B, remind health care staff who work in these facilities to be sure to practice universal precautions and make sure medical equipment is never re-used or shared.

Don’t assume your specialist knows about your hepatitis B. As you age and develop illnesses that require you to see specialists, make sure they know you have hepatitis B.

We all like to think doctors look carefully at our medical records, but sometimes information gets missed. Why should a specialist know about your hepatitis B? Because some of the medications they may prescribe can hurt our livers and weaken our immune systems.

For example, chemotherapy and other immune-suppressing drugs deliberately weaken our immune systems in order to fight cancer or rheumatoid arthritis. But when our immune systems weaken, hepatitis B can reactivate, resulting in the virus growing again and causing liver damage. To prevent this, doctors can prescribe antiviral medication to keep the hepatitis B virus under control during treatment with immune-suppressing drugs.

Make sure your specialists know about your hepatitis B, and ask them to monitor your viral load and liver health if you require immune-suppressing medication. It’s important to protect your health and speak up at every age.

Adapted from the Hepatitis B Foundation www.hepb.org. To read more blogs about hepatitis B, visit http://hepbblog.org. The Hepatitis B Foundation is a national non-profit organization dedicated to finding a cure and improving the quality of life for those affected by hepatitis B worldwide.


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Falls Prevention Awareness

September 23 is Falls Prevention Awareness Day. Falls can cause serious injury and even early death among older adults. According to the CDC, 1 out of 3 people age 65 and older fall each year. In fact, falls are more common than strokes and can be just as harmful.

Unfortunately, many everyday activities like walking and bathing can pose fall risks for older adults. The good news is that falls are largely preventable. If you know or care for an older adult, here are a few tips to share on fall prevent.

  • Exercise regularly. Focus on exercises that improve balance and leg strength. Tai chi is a great option.
  • Review medications (both over-the-counter and prescription) with your doctor. Some can make you dizzy, drowsy, and more likely to fall.
  • Get your eyes checked each year. Make sure you’re seeing the best you can to avoid falling.
  • Keep your home safe. Hazards are everywhere, from wet, slippery bathroom floors to poorly lit hallways. Make your home safer by adding grab bars by the toilet and tub/shower, adding lighting to dark rooms, and removing clutter.

Half of falls happen at home. Here are more ways to ensure that your home is safe.

  • Have handrails on both sides of the staircase.
  • Place frequently used items in places you can reach without a stepstool.
  • Wear shoes inside the home—avoid wearing slippers or going barefoot.
  • Remove throw rugs or use tape to make sure they don’t slip.

For more information about home safety, check out the CDC’s Home Falls Prevention Checklist in English and Chinese.

Preventing falls is important for healthy aging. Take steps toward falls prevention for you and your loved ones.


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Growing Older with Hepatitis B: Why Testing for Liver Damage Still Matters

This September we are celebrating seniors for Healthy Aging Month. The Hepatitis B Foundation is doing a wonderful series on Growing Older with Hepatitis B, and we are sharing part one of their series. If a senior you know or love is living with hepatitis B, make sure to share!

Around the world, older adults bear the greatest burden of hepatitis B. Born before the childhood vaccination became available, about 4.7 percent of U.S. adults over age 50 have been infected and their chronic hepatitis B rate is nearly two-fold higher than in younger adults.

The 50-plus generation has lived with chronic hepatitis B for decades, and over time their risk of liver damage, cirrhosis, and cancer has steadily increased. That is why it is very important that older adults living with this infection see their physicians regularly and have tests for liver damage and cancer performed as needed.

Our immune system and liver weaken with age: With age, our immune system loses its edge. Think chicken pox—that virus stays dormant in the body and emerges as shingles later in life when aging immune systems can no longer keep the virus in check.

As our immune systems age and weaken, they may no longer be able to suppress reproduction of the hepatitis B virus and you may notice an increase in your viral load (HBV DNA). Even when there is no notable increase in viral load, you can still experience liver damage, scarring (cirrhosis) and even cancer as you age. This is why getting your alanine aminotransferase (ALT) tested regularly for tell-tale signs of liver damage is essential.

When estrogen declines, women may be at greater risk of liver damage: Estrogen appears to confer some protection against liver damage, but as women age and estrogen levels decline, their risk of liver damage increases, which means monitoring may need to occur more frequently.

The liver loses its resiliency with age: According to researchers, over time our livers lose some of their ability to regenerate and their blood flow and screening capacity declines, leaving them more vulnerable to inflammation, scarring and cancer from the hepatitis B virus that hijacks liver cells to replicate.

Decades of exposure to environmental toxins take their toll: The cumulative effect of decades of exposure to environmental toxins impacts our liver health over time. It is the liver’s job to screen out those toxins, and the older we are, the greater the impact those toxins have had on our livers.

Other medical conditions affect hepatitis B: As we age, we often develop other medical conditions that weaken our immune system and impact our hepatitis B, which is why it’s always important to remind all of your doctors, including specialists, that you have hepatitis B, especially when they prescribe new medications. Immune-suppressing drugs, such as chemotherapy or rheumatoid arthritis treatments, can cause hepatitis B to reactivate.

Weight gain matters! As we age, we become less active and our metabolism slows, which is why so many of us pack on the pounds. In addition to risking diabetes, we also risk developing a fatty liver if we consume fatty foods, sugary drinks and alcohol. Fatty liver disease by itself increases the risk of liver damage and cirrhosis, when combined with hepatitis B, it can be deadly.

How often your hepatitis B is monitored depends on your medical history, and whether you have had elevated viral loads and ALT levels and other signs of liver damage in the past. Now that you’re older, talk to your doctor about whether more frequent screening is needed. For a summary of medical guidelines to monitor and manage hepatitis B click here.

For an in-depth description of managing hepatitis B in the elderly, read Viral Hepatitis in the Elderly.

Reprinted courtesy of the Hepatitis B Foundation www.hepb.org. To read more blogs about hepatitis B, visit http://hepbblog.org. The Hepatitis B Foundation is a national non-profit organization dedicated to finding a cure and improving the quality of life for those affected by hepatitis B worldwide.


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Happy Older Americans Month! How Are You Celebrating?

grandmother and girl

Written by Bonnie Tse.

There is Mother’s Day, Father’s Day and even Children’s Day celebrated in certain cultures. If there is a day to honor our seniors, it would be in May. May is Older Americans Month and we are sharing fun ways you can spend time with your grandparents and seniors in your life. Here are a few healthy activities to do together.

  • Plan trips. Visiting new places and exploring scenic routes can help motivate everyone to stay physically active. You do not have to go far to plan a local trip. There are also many parks, museums and attractions in the city that offer senior discounts. Check out the NYC website for more information and a list of senior friendly activities.
  • Cook and eat meals together. Your grandparents may be culinary experts of your family recipes. Find a day when the whole family can learn recipes and cook together. Challenge your seniors, family members or yourself to see if you can make heart-healthy versions of your family’s favorite dishes. Read our fact sheets for tips on how to lower sodium and fat in your meals.
  • Discover new hobbies and interests together. Learning something new is always exciting. For seniors, whether it’s learning a new language, skill or hobby, keeping the brain mentally active helps to improve their memory. Take classes together at your local library or recreation center. Many recreation centers in the city offer seniors low to no-cost membership fees. Our Health Center also has free health educational workshops that you and your grandparents can attend. We cover different health topics such as healthy eating, diabetes management, stroke prevention and blood sugar control. View our workshop schedule here.
  • Plan a family volunteer day. Volunteering provides a meaningful experience that is often linked to better health. The act of giving one’s time and energy to support a cause builds our self-confidence and sense of achievement. Volunteering brings people together and shows that every individual, regardless of age, is capable of making a difference. For seniors, volunteering also gives them an opportunity to meet new people and do activities they like. Make it a family tradition to volunteer at a local organization. Visit the NYC website for a list of volunteer organizations and fun opportunities.

At the end of the day, any activity you do together is irreplaceable. Celebrate Older Americans Month with your grandparents or a senior you love today.

Written by Bonnie Tse. Bonnie Tse is part of the Health Education Department at the Charles B. Wang Community Health Center. She has a bachelor’s degree in Nutrition and Food Science from Hunter College.


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You Can Prevent Colorectal Cancer

Colerectal Cancer

Written by Dr. Ady Oster

March is Colorectal Cancer Awareness Month, a time to consider this important health issue for Asian Americans. When found early, it is one of the most preventable and treatable forms of cancer. It is recommended to get screened beginning at age 50. Here are a few reasons why it is so important that you get screened early and regularly.

Colorectal Cancer affects both men and women

It is a misconception that colorectal cancer only affects men. In fact, colon cancer is the second most common cancer among Asian American women and third most common among Asian American men.

Waiting until symptoms show may be too late

This type of cancer usually begins when the cells in your walls of the colon or rectum change and form into a lump or mass called a polyp. Polyps usually do not cause symptoms before they become large enough to spread. At this point, colorectal cancer becomes more difficult to treat and less likely to be curable.

Family history may mean less than you think

Many patients believe they do not need to worry about colorectal cancer if no one in their family has had colorectal cancer. A family member with colorectal cancer may increase your risks, but most colorectal cancers occur in people who do not have a family history.

Get screened this month!

Make an appointment this month to be screened for colorectal cancer. There are three tests that can detect colorectal cancer: colonoscopy, sigmoidoscopy and fecal immunochemical test (FIT). Learn more about these tests from this factsheet. Talk to you doctor about which screening is best for you.

Dr. Ady Oster is the section chief of internal medicine at the Charles B. Wang Community Health Center. He received his medical degree from the Albert Einstein College of Medicine, and completed his residency training at Yale-New Haven Hospital and University of California at San Francisco. Dr. Oster is board-certified in internal medicine.


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Healthy Aging through Movement and Exercise

HEALTHY AGING

Written by Bonnie Tse and Dr. Perry Pong

As part of September’s Healthy Aging Month, we want to share how to stay strong and active. As you age, small exercises can go a long way to improve your mind, body and overall health. Try some of these activities to keep your health at its best.

 Start with a Stretch

Start your day with a stretch! Stretching not only makes you more flexible, but can also boost your mood and energy. Going out into the sun also allows your body to make Vitamin D, an important nutrient that improves your bone health and prevents osteoporosis or bone loss. The National Institutes of Health has a great page on stretches, check them out here.

Take a Walk

It’s free, fun and good for you in many ways. All you need are twenty to thirty minutes a day, but even short walks several times a day helps your breathing, heart, brain and muscles. Try climbing stairs during your walk. This keeps your thighs strong and takes pressure off your knees.

 Move Your Muscles

Practicing tai chi and aerobics can improve your balance and keep your heart and muscles strong. By exercising your muscles, your bones become stronger and can prevent falls from occurring. Using light weights or filled water bottles during aerobic or chair exercises can further improve your muscle strength.

 Join a Class

Local recreation programs such as Shape Up NYC, Be Fit NYC and senior centers offer many free exercise classes like table tennis and Zumba that you can join. Simply type in your zip code and find one that’s convenient for you!

Invite a Friend!

Exercising with a friend not only makes exercising more enjoyable, but doing it together motivates you both to stay active. Why not spend time being active and talking and sharing with your loved ones or friends?

To celebrate healthy aging month, try a new exercise today! For more information on how to care for your health, visit our page on health information for seniors.

Written by Bonnie Tse, with contributions from Perry Pong, MD. Bonnie Tse is part of the Health Education Department at the Charles B. Wang Community Health Center. She has a bachelor’s degree in Nutrition and Food Science from Hunter College. Dr. Pong is the chief medical officer at the Charles B. Wang Community Health Center. He received his medical degree from the University of California San Diego School of Medicine, and completed his residency training at Veterans Affairs Medical Center New York. Dr. Pong is board-certified in internal medicine.