HOW DO I KNOW I DON'T HAVE CANCER?

I see new patients every day, and some of them ask me to be "tested to make sure I don't have cancer." The truth is, there is really no test that can do this. The problems are:
1. There are too many cancers, and one test can't evaluate for all of them.
2. Most cancers are diagnosed by complicated imaging tests and biopsies, both of which are not completely safe. So it's generally not a good idea to do these tests unless your doctor has a high suspicion that you have cancer.
3. Some of the tests for cancer, particularly CT or CAT scans, can actually cause cancer. So again, you shouldn't get one unless you really need it.
However, there are "screening tests" for cancer- these are tests that are performed on healthy people to try to detect certain cancers early. There are only a few of them, because only a few tests have been shown to save lives by providing reliable information about cancer at an early stage. All people should get cancer screening tests, starting at various ages depending on the test. Please note: IF YOU HAVE A FAMILY HISTORY of cancer, your doctor may want to start doing screening tests on you at an early age. The below applies only to people who do not have a family history of cancer. Also: FAMILY HISTORY of an illness like cancer, in most cases, means that you have a parent or sibling with the disease in question, usually at a certain age. I know it sounds complicated. For example, if your mother had breast cancer before age 50, you have a family history of breast cancer. If your aunt had breast cancer at age 70, you don't have a family history of breast cancer. You really need to talk to your doctor about your family history to know what's relevant.
CANCER SCREENING TESTS YOU SHOULD HAVE:
1. Pap smears: this may actually be the single best cancer screening test in terms of lives saved. You need to start getting this test:
-if you're a woman
-at age 19
-at an earlier age if you're sexually active (within the year of becoming sexually active)
-how often? Yearly at first, but if you have 3 normal pap smears in a row and you're monogamous, you can then change to every 2-3 years.
2. Mammograms: there is controversy over whether to start these for women at age 40 or 50. I get them every 2-3 years in women 40-50, and yearly after that. If you want to make it easy to remember, just do one at the same time every year starting at age 40. All women should get mammograms, even if no one they even remotely know has ever gotten breast cancer!
3. Colon cancer screening. There are actually 3 total tests and you need at least 2 of them at various intervals. It works like this:
-start getting colon cancer tests at age 50.
-EVERY YEAR you should do a "stool card test", which detects blood in your stool.
-HAVE YOUR FIRST COLON SCOPE AT AGE 50. This may be what's called a "flexible sigmoidoscopy," a "colonoscopy," or a "virtual colonoscopy." Ask your doctor which is right for you, but do it at age 50.
-After your first colon scope, you need to do it again every 5 to 10 years, depending on what they found on the first scope. If you have any precancerous "colon polyps," you'll need to get a scope every 5 years.
-People seem terrified of colon scopes. But the whole thing takes 20-30 minutes and you can be sedated for the procedure. It's easy to do!
FOR THE GENERAL POPULATION, that's it, believe it or not. There are other cancer screening tests, and some of them are worth doing if you have a family history of cancer. But these 3 are the only ones in wide use for the general population. Beating cancer is not easy. But as you can see, getting your cancer screening done is.

MORE INFO ON RECENT TOPICS

1. WHY NO PICTURES LATELY?
My brother Randy does the photos, and he's been staying with me. We haven't been blogging much. So there is a temporary hiatus from pictures on Dr. Tofuhead. Sorry for all those waiting eagerly for a visual image of a douchebag. While waiting, check the Oprah show: she has douchebags as guests on her show all the time!
2. REALLY NO CAFFEINE IN DECAF?
Randy dug up some fairly interesting study that compared decaf levels at various coffee shops. It turns out I was wrong- some purveyors of decaf actually do have a significant amount of caffeine in their decaf beans. Starbuck's was the highest- some of their decaf drinks approach 30% as much caffeine as in regular caffeinated coffees. And caffeine amounts seem to be highly variable in different types of beans. So if, for some reason, your doctor has told you to completely avoid caffeine, you probably need to avoid decaf coffee most of the time. Or you can drink Sanka, that 70s powdered instant decaf coffee that has survived the test of time. Sanka ain't that bad, and it's caffeine quantity is not noticeable. I bring it camping frequently and enjoy it immensely. But I'm not that picky about coffee.
3. IF I PEE A LOT, DO I HAVE DIABETES?
Frequent urination can be a sign of diabetes, especially if it is accompanied by frequent thirst and visual blurring. Just remember that most people who pee a lot, or think they pee a lot, don't have diabetes. People also tend to overestimate how much they pee. If your pee is clear and you pee a lot, chances are it's because you are drinking a copious, and HEALTHY, amount of water. There are a number of benign conditions that cause people to pee a lot, such as "overactive bladder," prostate enlargement, nervousness, some allergy medications, and yes, even caffeine. Caffeine does not actually dehydrate you, but it probably stimulates the bladder to contract a bit more frequently, and some people find they are peeing a lot when they drink it. If you are concerned that you are peeing too much, talk to your doctor- there are easy tests to run that can tell you if your frequent urination is a serious problem.
4. MORE QUESTIONS PLEASE
Presumably because it's summer and you are all exercising all day, eating well, sleeping like babies, and feeling fantastic, I haven't gotten many health-related questions lately. Even in my office, I'm seeing fewer patients and many of them are healthier than me. My medical brain is undergoing atrophy. You, dear reader, can help me: post a health related question in the comments! Remember, no question is stupid and all questions are answered anonymously.

WHAT'S WRONG WITH DOUCHEBAGS?

The term "douchebag" is so commonly used as a term of derision, or in the context of an insult, that it's hard to remember that a true douchebag is a health care product. That's right- if you don't have enough "douchebags" in your life already, you can actually go down to Walgreen's and buy yourself one. Not only that, but they are cheap and come with a variety of pleasant-smelling concoctions.
WHY DO DOUCHEBAGS EXIST?
Douchebags have probably been around for thousands of years, like beer or giant pyramids. They came into common use in the Victorian era, and at that time they were primarily used as a form of birth control. Condoms at that time were not very reliable, and birth control pills and IUDs did not yet exist. Short of the "rhythm method," in which couples tried to avoid intercourse around a woman's ovulation, douchebags were really all someone could count on in days of yore. They were also used in preparation for intercourse, a use that was popularized by prostitutes- this was to keep the vagina "fresh." So you can think of douchebags historically as functioning as a sort of perfume before sex, and as a way to wash out semen after sex, to prevent pregnancy.
THE PROBLEM WITH DOUCHEBAGS
Though "douching" has become more sanitary, the problems is that douchebags don't really accomplish either of their historical functions very well. In addition, they can create problems of their own. Here's why you should avoid douching if at all possible:
1. Using douchebags is a terrible way to prevent pregnancy. Sperm are fast, and they hang on tight to the reproductive system. It can take less than a second for a sperm to make its way up to the Fallopian tube, where it is difficult to flush out. Douching will only flush out the stragglers, leaving a few million sperm unharmed.
2. Douching may actually flush something bad IN: the vagina and uterus do a very respectable job inhibiting the growth of harmful bacteria and other microbes, the kind that can cause sexually transmitted diseases (STDs). Many STDs are able to get through these defenses, causing an annoying and painful infection. But these same STDs, particularly gonorrhea, can cause a much more dangerous infection called Pelvic Inflammatory Disease if they get beyond the uterus and into the Fallopian tubes. Because of the fluid pressure douchebags cause, they can actually push infectious organisms higher into the reproductive tract. There is a higher risk of Pelvic Inflammatory Disease, or severe reproductive infections, in women who douche; never mind the fact that douching does not prevent any STDs.
3. Douching has little to no affect on vaginal odor. The vagina is colonized by good, healthy bacteria, and it is these bacteria and your own natural vaginal secretions that produce odor, if you want to call it that. The vagina is also very active in maintaining its own fluid and chemistry. While douching may temporarily flush the vagina with a nice aromatic floral rinse, any resulting scent will be removed within minutes, not hours. Even frequent douching is unlikely to have any substantial impact on vaginal odor.
In short: unless you go through a time machine and find yourself in Victorian times, don't mess around with douchebags!

THE GYM

     Today I went to "the gym."   I don't go that often, these days.   Going to the gym, after all, is a pain in the ass.    However, I simply can't deny it, nor do I wish to: I really feel fantastic after a trip to the gym.

     I'm easy to spot at the gym.   I'm the guy with old, out-of-fashion gym clothes and a farmer's tan, sweating a lot on the treadmill or the exercise bike.   Once in a while I'll even lift some weights, and because I'm down with "hydration," I'm always surrounded by water bottles.   When my workout is over, I'm one of the 2-3 patrons who still likes so soak in the hot tub afterward.    I suppose I get my money's worth.    As with anything that costs money, "the gym" has its advantages and disadvantages.

THE GYM: DISADVANTAGES

1. Evenings and late afternoons: just like the doctor shortage in America, there must be a gym shortage.   Every gym I have ever been to is so packed between 5 and 8 PM as to almost make it not worth going.     You don't get much exercise when you're just standing around waiting to exercise.

2. The music: why must music at the gym always suck?   Solution: bring your own.

3. The people at the front desk asking, "did you bring your workout towel today?" before they let you in.   I have a feeling that's an absurdity unique to 24 Hour Fitness.

4. Parking.    But you can get around this by biking to the gym, which I did.  Once.

5. The cheap, weak gel-like soap substance in the showers that smells like chlorine.

6. Dudes who shave in the bathroom at the gym.   I'm not sure why, but they annoy me.   Maybe they live in trash cans behind the gym or something, like Oscar on Sesame Street.   If so, I can understand shaving at the gym.

THE GYM: ADVANTAGES

1. It's hard NOT to get some pretty good exercise at the gym, even during peak hours.

2. Mainstream gyms are pretty diverse these days.   Probably because all sorts of people have doctors telling them to go to the gym, all sorts of people go to the gym.   Even if you look terrible in spandex and you sweat like a pig, trust me: there will be many people at the gym who look more horrifying than you do.   No one cares.

3. Exercise equipment has gotten much, much better.  And it ain't cheap.   The treadmills at the gym have fans to keep you cool, instructions to get you going, and when you're done they tell you exactly how many calories you burned.   Unless you have a ton of cash, it's difficult to get machines that good to use at home.

4. A full workout and cool-down: where else but the gym offers you the ability to work your muscles with some weights, whip your heart into shape with a cardio machine, then get the muscles relaxing with a hot tub or sauna?   

5. Off hours: try going to the gym early in the morning, late at night, or mid-day.   You'll have access to whatever you want, without the crowds.

6. Classes: I'm not big on classes at the gym, but recently I started doing a spin class every now and then.   I can hardly walk the next day, but in a good way.    It was a brutal workout but the teacher kept the pace fast and it went by quickly...and it was fun.   Most gyms have a ton of classes.

7. Fashion exploration: you can wear anything at the gym.   And people do.   It is strangely liberating to wear fluorescent, breathable plastic gymwear and hideous shoes sometimes.  Try throwing in a headband to let people know what decade you were born in.   Just don't try to run on the treadmill in Crocs.

8. Mental improvement.   Don't discount the emotional benefits of a workout.   If you work out hard, you will leave the gym feeling content, or maybe even happy.   Perhaps even "euphoric."  Even if it wasn't so good for your body, a gym experience can be fantastic for your mind.  Try it. Don't worry if you don't own a "workout towel." 

THE HEALTH CARE SYSTEM: AN INTRODUCTION

Let's take a break from your personal health for a bit, and look at the broader "Health Care System." This term is a misnomer, because there actually is no "Health Care System." There are multiple systems. A few of the major players are as follows:

1. The Federal Government Health System: this includes Medicare (the health care system for people over 65), the Veterans Administration Service for veterans, the Indian Health Service which covers Native Americans, and various insurance systems that contract with other systems, providing coverage for government employees and helping the individual states.

2. The State Government Health System: each state has its own "Medicaid" system to cover the poor and uninsured, funded by both the federal government and the state. States also fund some state-run and county-run facilities for the uninsured. Some states are getting into the business of providing insurance to cover more people (Massachusetts is the primary example).

3. The Private, For-Profit Health System: this system is run by for-profit, large insurers, who sell health insurance to employers. This system is probably the system you're familiar with, if you have health insurance. Your employer pays a premium for you every month to an insurance provider, such as Aetna, Cignal, or United Health, and that insurer in turn contracts with groups of doctors and hospitals to provide you with health care. You pay a small part of the cost via "copays" for various services. You probably notice that these "copays" are getting higher, but you have no idea what a tiny fraction of the health care cost you're paying. You can purchase this kind of insurance yourself, if you don't have an employer. You will be surprised how expensive it is.

4. The Private, Non-Profit Health System: this system is one of the options for some employers, and it works very much like the For-Profit Private System. It's just that the insurance provider is a non-profit, so they don't have to pay money to company shareholders. Geisenger Healthcare in the East and Kaiser Permanente in the West are two examples of non-profit insurance providers. Like for-profit insurance, you can buy this kind of insurance yourself if you don't have an employer buying it for you. But it's not cheap.

Most people have government health insurance, employer based for- or non-profit private insurance, or no health insurance. There are more complicated hybrid products, "catastrophic" plans, and various charity-funded insurance-like plans. But they aren't as common. Chances are, you're familiar with one or more of the above systems. If you've ever had a decent job, you've probably had private for-profit, or non-profit, health insurance that your employer paid for. If you're over 65, you probably have Medicare. If you've served in the military, you might have insurance and health care through the VA system. If your family was or is low-income, you might have gotten some of your childhood immunizations or medications through state-funded Medicaid. And if you're uninsured, you might need to seek treatment at some point in a state-funded county hospital or clinic.

One way or another, these various health-care "systems" supply some degree of health insurance and health care to a majority of Americans, the exception being the 50-60 million "uninsured Americans." Yes, there are a lot of uninsured Americans- but they still make up only 1/6 of the population. That might be why not much has been accomplished when it comes to dealing with their health-care situation.

MAJOR PROBLEMS WITH HEALTH CARE IN AMERICA:

1. It's expensive.

2. There is NOT ENOUGH MONEY even to keep providing the current level of health care to the current population of people who have insurance.

3. There are a lot of uninsured Americans. Providing them health care = more money.

4. There aren't enough doctors, especially in "primary care," the first line of care for most Americans.

5. People are living longer. That's good for them, but bad for health care, because more years = more health care needs = more money.

6. The quality is not as good as it should be, for the amount of money it costs in America.

IN SHORT:

What you can expect over the coming years is the following: you may have a harder time finding health insurance, and when you do have it you will have a hard time finding a primary care doctor, and you will wait longer to see that doctor. Your share of the cost of doctor's visits, medications, and hospitalizations will continue to increase. And when you are older and retired, you will spend much more of your retirement savings than you ever dreamed of. We'll probably see quite a few changes in how people get health care in the next few years. Some of these changes ain't going to be pretty.

A BITE-SIZED BLOG YOU CAN DIGEST

     Sometimes it takes a long time to read one of my blog entries.  Too long, perhaps.  Back when I was trying to review a "Food of the Day," every day, I think the topics were more short and sweet.  But I was researching them every day, blogging every night, losing sleep, and becoming exhausted.    So less frequent, more well-thought topics are the result.    However, I still would like people to be able to tune in quickly now and then and get a fresh, short, and useful little bit of knowledge.   So here's one, or ten, of those little bits.   They are all things I learned from other health professionals, and most of them have "science" behind them:

10 EASY THINGS YOU CAN DO TO IMPROVE YOUR HEALTH

1. Use toothpicks after you eat.   Dentists all seem to agree on this one.

2. Eat breakfast every day, even if it's just a "Zone Bar" or something.

3. If you're fatigued after lunch and you can manage it, take a short nap.

4. Replace beat-up old shoes, or at least stick some padded arch supports in them.

5. Keep some sunscreen in the medicine cabinet, and get in the habit of putting it on your face on most days.   SPF 15 is fine and it won't make you look like you just got back from clown camp.

6. Wash all fruits and vegetables before eating them, EVEN IF they are organic.  Remember: salmonella is organic, too.

7. Wear a helmet when you bike, ski, or snowboard.

8. If you hate the gym, invest in a treadmill or stationary bike, or whatever will get you an easy 30 minutes of exercise on most days.

9. Wash your hands any time you even talk to someone with a cold.

10. Bring a quart of water with you to work every day.  Try to finish it before going home.   Stop giving worrying about peeing so much.

HAVE YOU HEARD THE GOOD NEWS? THE TRUTH ABOUT COFFEE

Some dude once came up to me on my college campus, and blurted, "Have you heard the good news?"

I said, "What good news?"

"Christ has risen!" Was his answer.

Who cares? I thought. Isn't that pretty much the oldest news around? It may be "good news" if you're a Christian. But even so, isn't "news" by definition something at least somewhat "new?" If it wasn't, Anderson Cooper wouldn't have to travel the world to find new stories about gorillas or hurricanes now, would he? He could just sit in his air-conditioned office at CNN, going on and on about the great news of the fall of the Tower of Babel or Alexander's victory at Tyre. But no: he works hard to give you the "news" that is "new."

So do I. And this might be old news to you, but to most people I think it's relatively new news: Coffee is GOOD FOR YOU!

For years I've been collecting all the research articles I can find on coffee, tea, and caffeine. In fact, Dr. Tofuhead consumes a lot more coffee than he does tofu. So it was in my own interest to know, is coffee really "good?" I've found research articles demonstrating that coffee reduces asthma symptoms, dissolves bile stones, decreases the risk of developing diabetes, increases alertness and performance on mental tasks- the list goes on and on. I've also found loads of relatively unsubstantiated claims in medical guidelines suggesting that coffee causes heartburn, insomnia, dehydration, anxiety, heart palpitations, migraines, and high blood pressure. So what's the bottom line?

The largest study on coffee that I know of just came out this week, and the results were rather shocking. The study looked at the absolute holy grail in medicine: "all cause mortality." "All cause mortality" basically gets at the question, "does this stuff kill you faster, make you live longer, or neither?" It's the most sought-after statistical phenomenon in studies of drugs, diets, exercise regimes, or any other instrument we might use to alter human health. It's also a phenomenon that is frightfully affected by a huge number of variables, and therefore any study attempting to evaluate the affect of something on "all cause mortality" needs a massive number of subjects, a boatload of high-powered statistical analyses, and some very smart people drawing the conclusions.

Without boring you, let me just say this: the big study published this week showed that coffee, even in large amounts, does not "increase mortality;" in other words, coffee does not kill you faster than no coffee. What was more impressive to me was the fact that the more coffee subjects drank on average, the LOWER their overall mortality. That is to say, coffee appears to make people live longer, especially when consumed in large amounts. The subjects in this study who had the lowest risk of dying were those who drank, on average, 6 OR MORE cups of cofee per day! Shocking!

Some caveats: the authors of the study were merely out to prove that coffee did not kill you faster; so they note that they cannot draw firm conclusions that coffee prolongs life. They note that the study "suggests" this effect, but that the life-prolonging effects of coffee "warrant further investigation." They also demonstrated that coffee is probably good for your lifespan, but they did not examine whether it's good for your life- in other words, they did not study the potentially ill effects of coffee that are not fatal. Can coffee give you a longer life that is fraught with heartburn and insomnia? This study did not get at that, or similar questions.

Now it's time to bust some

MYTHS ABOUT COFFEE

1. Myth #1: Coffee is a diuretic. This is just plain wrong in so many ways. Coffee is not a diuretic. If you were dying of thirst, you could rehydrate yourself with coffee. A diuretic is a substance that causes a "net loss" of water from your body. Fortunately, there are only a handful of true diuretics.

2. Myth #2: Coffee causes migraines. No, the LACK OF coffee can cause a migraine, if you usually have lots of coffee in your system.

3. Myth #3: Coffee causes high blood pressure. Nonsense. It just doesn't. Numerous studies have failed to show any significant effect of coffee on blood pressure.

4. Myth #4: Decaf coffee still has a significant amount of caffeine. The truth is, decaf coffee has a completely insignificant amount of caffeine.

5. Myth #5: Coffee causes heartburn. Even I have a hard time letting go of this one. But gastroenterologists from across the country will tell you, the research simply fails to show that coffee causes, prolongs, or exacerbates heartburn.

6. Myth #6: Coffee can sober you up faster. I'm not sure a ton of people still believe this one- at least, I hope not. Coffee will not make you any less drunk any faster. It can make you into a more slightly AWAKE, but equally impaired, drunk person.

WHY IS COFFEE SO GREAT?

-It is full of antioxidants.

-According to the new study, it may have anti-inflammatory effects.

-It appears to reduce cardiovascular death, i.e. heart attacks.

-In addition to antioxidants, it is a rich source of minerals.

-It may decrease the risk of developing diabetes or gallstones.

-It looks, smells, and tastes wonderful.

-It can wake you up, give you energy, and increase your mental focus or "attention."

-EVEN IF YOU DON'T WANT TO DRINK CAFFEINE, decaffeinated coffee has all the above benefits, except the last one- it can't wake you up or give you energy. But it's true: DECAF COFFEE HAS ALL THE HEALTH BENEFITS OF REGULAR COFFEE!

As I see it, that last fact simply means that coffee really has something to offer everyone. Not everyone likes to be heavily caffeinated all day, like I do: I respect that. I do not in the least frown on people who order massive coffee drinks with decaf coffee or nonfat milk.