Keeping your kidneys healthy

About the size of a deck of cards, kidneys are small but mighty organs that perform vital functions to maintain internal stability in our bodies. They do this by regulating the amount of water we hold or release, eliminating waste and sustaining normal blood value ranges, all of which are vital to our overall health.

“The kidneys are crucial to almost every system in the body,” says Dr. Janet Roscoe, Nephrologist at The Scarborough Hospital. “Failing kidneys can result in heart failure due to an inability to remove water, and predispose individuals to infection because of a reduced immune system and damage to other organs such as bones. This is in addition to the toxic effects of being unable to remove poisons.”

Primary risk factors for developing kidney disease include diabetes, heart disease, high blood pressure and a predisposition to kidney disease. Other risk factors can include autoimmune diseases such as lupus, rheumatoid arthritis and infections.

Age is also a risk factor. Our kidneys experience natural wear and tear as we get older, and living an unhealthy lifestyle accelerates the workload on kidney functions. Prevention is crucial to reduce the chances of kidney disease as we age, but even those who have already experienced kidney disease can use the following tips to improve their kidney health:

• Avoid regular and prolonged use of over-the-counter pain medication such as Tylenol, Aspirin, Advil, Motrin and Excedrin. These medications can cause kidney damage and should be used in emergency situations rather than on a daily basis. If your doctor has prescribed non-steroidal anti-inflammatory drugs, ask about the effect they may have on your kidneys.
• Stay hydrated, but avoid over-consumption of water as the kidneys work hard to produce urine.
• Exercise regularly and enjoy a healthy diet including kidney-friendly foods such as broccoli, cauliflower, brussel sprouts, cabbage, berries, apples, garlic, peppers and tomatoes.
• Moderate alcohol as high consumption can elevate blood pressure. Tobacco causes hardening of the arteries and damages the delicate filters in the kidney, which then reduces their ability to remove poisons from the body. Your best bet is to reduce alcohol consumption and quit smoking altogether.

“It’s also very important to book an annual physical with your family doctor to catch any potential problems at an early stage,” says Dr. Roscoe. “Learn about your family’s medical history, and talk to your doctor about getting tested if you think you may be at risk.”

Women and Heart Disease

There is a misconception that heart disease is a man’s disease, when in reality it is a leading cause of death among Canadian women.  Women are also less likely than men to survive a heart attack or recover from heart surgery, yet the basis for diagnosis and treatment of heart disease remains geared towards men.

“Physicians and the general public are being educated that women may present with symptoms of heart disease that are quite distinct from that of men,” says Dr. George Vertes, Cardiologist at The Scarborough Hospital. “The reason for this is not clear, but obviously the diagnosis of heart disease must be entertained and investigated thoroughly regardless of sex.”

Since women’s hearts differ from men’s in both their size and rhythm, it makes sense that the signs, symptoms and risk factors of heart disease between men and women differ as well.

For example, during or prior to a heart attack, women tend to experience subtle, non-severe symptoms unlike the typical crushing chest pain experienced by many men.

Some signs that a woman might be suffering a heart attack include:
• Discomfort in the upper body
• Pain in the shoulders, upper back, abdominal area or neck
• Shortness of breath
• Nausea or vomiting
• Sweating
• Light-headedness or dizziness
• Unusual fatigue

Due to the nature of heart attack symptoms associated with women, and the fact that women generally suffer heart attacks later in life, it’s common to mistake the oncoming attack for a panic disorder or an age-related illness. In some cases, the symptoms aren’t recognized as being related to heart disease at all.

Risk factors for heart disease that affect women include stress or depression, smoking, high blood pressure and high blood sugar. Women who experience low levels of estrogen following menopause can also be at risk for heart disease.

Unfortunately, women remain under-represented in heart disease related research, and more work must be done to build awareness.

Heart disease is a serious health concern for many Canadians, but there are preventative measures both men and women can take to reduce their risk:
• Exercise regularly and maintain a healthy weight
• Quit, or do not start, smoking
• Enjoy a diet low in saturated fats, cholesterol and salt

The importance of prevention and screening for cervical cancer

Worldwide, cervical cancer is the second most common type of gynaecological cancer. In North America, it is the eighth most common cancer. The incidence of cervical cancer has decreased in the developed world because of regular Pap screening. Pap tests detect abnormal cells before they become cancer and further treatments can prevent them from ever becoming cancer. 

“Sadly, not all women go for regular testing and so we continue to see this lethal disease,” said Dr. Georgina Wilcock, an Obstetrician/Gynecologist at The Scarborough Hospital. “Each year in Canada, it’s estimated there are 1,300 new cases of cervical cancer diagnosed and 390 women will die of the disease. “

For these reasons, Dr. Wilcock reminds women about the importance of regular Pap test screening, which has been shown to decrease the incidence of cervical cancer by 50 per cent.

The Pap test is a quick, simple and usually painless procedure where a doctor scrapes and removes cells from the surface of the cervix with a small brush or spatula.  The cells are then examined in a laboratory. In the event that a Pap test shows  changes or abnormalities in the cervical cells, follow-up tests or procedures may be done.

Currently in Canada, it is recommended that women between the ages of 18 and 69 (or women under 18 who are sexually active) undergo cervical screening.

“Although the cause of cancer in general remains somewhat of a mystery, the cause of cervical cancer is not. The culprit is almost always the human papilloma virus (HPV) infection, one of the most common sexually transmitted infections (STIs),” points out Dr. Wilcock.

While some types of HPV cause genital warts, other strains of the virus can infect the cervix and then cause abnormal changes within the cells that may slowly progress to cancer.

There are several other important steps women can take to minimize their risk of developing cervical cancer:

• Get the HPV vaccine – The world’s first vaccination against HPV was approved in Canada and the U.S. in 2006. The vaccination provides protection from four different types of HPV – two of which cause 70 per cent of cervical cancer. In Ontario, this vaccine is given free to girls in grade eight. It is given at this young age because it has been shown that this is the best age for young women to develop a strong immunity to the virus.
• Practice safe sex – The HPV virus is most commonly transmitted via sexual contact and intercourse. Refraining from genital contact with an infected person or using a condom will reduce the risk of HPV infection.  However, condoms are not 100 per cent effective as they only protect the covered area.
• Stop smoking – Both tobacco smoking and exposure to second hand smoke have been associated with the development of cervical cancer. Quitting smoking can reduce the chance of developing the disease.

And, of course, ensure that you are receiving regular Pap testing.

Important information for patients starting dialysis

Patients diagnosed with kidney failure – where kidney functions drop below 15 per cent – have two choices for survival: dialysis treatments or kidney transplants.

Dialysis is a process for removing waste and excess water from the blood, and is used primarily as an artificial replacement for lost kidney function in people with renal failure. The Scarborough Hospital’s Chronic Kidney Disease Program is one of the largest in North America, treating more than 5,000 patients with kidney disease and another 750 dialysis patients.

Diabetes is the most common cause of kidney disease. High blood glucose levels and high blood pressure can damage the kidneys over time. But for long-time dialysis patient Terri Bradshaw, diabetes was not the diagnosis that turned her life upside down 10 years ago.

“It was glomerulonephritis, which is not diabetes-related,” Terri says. “When I was first diagnosed, I was in denial until I became so sick, I had no objections to going on dialysis because I just wanted to feel better.

“I won’t deny that dialysis is very invasive, and there is pain involved,” explains Terri, who is Chair of the Home Dialysis Peer Support Group at The Scarborough Hospital. “You really don’t understand what it means until it happens to you, but I always tell people that it beats the alternative.”

For newly diagnosed patients needing to start dialysis, Terri offers the following advice:

1. Gather as much information as possible provided by doctors and nurses, and review it at home with someone you trust who will help you. Go over it together in a quiet environment that’s less stressful because you can’t possibly absorb all that information in the doctor’s office.
2. Write out questions for your medical appointments even if they seem silly. Quite often during appointments, your discussion with the doctor takes another track. Keep a log of your questions and answers, because when you’re sick, it may be hard to remember everything.  Better yet, take someone with you to your appointment.
3. Don’t allow yourself to be intimidated by healthcare professionals. Be prepared for your appointments and be your own advocate. Be involved, be in charge, and take an interest in your treatment.
4. Take advantage of any non-clinical information or support, such as a peer support group, touring the facility, watching the dialysis machines in action and talking to other patients.
5. And the most important and probably the hardest thing is to stay positive, even when don’t feel good. Without a positive outlook, it’s very easy to slip into black hole of depression.

November is Diabetes Awareness Month. For more information on diabetes, visit www.diabetes.ca.

Important facts about breast reconstruction

Many women who are facing a mastectomy may not be aware that breast reconstruction is considered part of the overall treatment plan. More awareness of breast reconstruction is needed, and that’s why October 19, 2011 has been designated the first National Breast Reconstruction Awareness Day.

“Breast reconstruction is not a luxury. It’s a part of treatment and an option that is readily available and can offer high quality results,” explains Dr. Tim Sproule, TSH Plastic Surgeon.

Dr. Sproule shares the following:

1. More than 10 per cent of women develop breast cancer in North America and other developed countries.
2. Treatment usually involves some type of ablation of the breast, which can be painful, unsightly and psychologically distressing for many women.
3. Sadly, the majority of women do not opt to have breast reconstruction despite effective treatment being readily available. 
4. Plastic and reconstructive surgeons have a large number of options to help with reconstruction of the breast post-mastectomy, which can go a long way to restoring unacceptable appearance, confidence and self-esteem for women who have needed to undergo breast cancer treatment.
5. Options include implants of various kinds, sometimes including tissue expansion or utilizing a patient’s own tissues (autogenous reconstruction). The most popular of these involves using the lower abdominal tissue and transferring this to the breast defect.  This gives the happy result of also providing a woman with a ‘free’ tummy tuck!
6.  The latest advance is to utilize microsurgery techniques to spare more of the abdominal muscle and increase the reliability of the transferred tissues.

“The Scarborough Hospital has a large and sophisticated breast reconstruction program that can provide every type of reconstruction that is presently available anywhere in the world, with the highest level of quality and safety,” Dr. Sproule adds. “A large volume of breast reconstruction procedures is performed at TSH.  In fact, TSH has the third most active microvascular breast reconstruction unit in Ontario.”

Join us on Wednesday, October 19 from 2 p.m. to 6 p.m. at The Scarborough Hospital, General campus Artists’ Walkway where the breast reconstruction group will host a drop-in information session that will include intimate and personal discussions on all aspects of breast reconstruction, including implant choices, pedicled and microvascular flaps, and ancillary procedures such as nipple reconstruction and tattooing. For more information on this TSH event, call 416-439-1718 or email jkhan@plasticos.ca.

Know the risk factors and symptoms of ovarian cancer

Ovarian cancer has been called ‘the cancer that whispers’ because of its vague symptoms and lack of effective screening. But more and more women and health care providers are speaking out about this ‘silent killer’.

“Unfortunately, only about 19 per cent of ovarian cancer cases are diagnosed before the cancer has spread outside the ovaries,” says Dr. Orit Freedman, a Medical Oncologist at The Scarborough Hospital. “However, when ovarian cancer is found after it has spread, while it’s sometimes not curable, it is treatable.”

One of the most important parts of the treatment is the patient’s initial surgery. The Scarborough Hospital has partnered with Sunnybrook Health Sciences Centre to have their surgical oncologists participate in ovarian cancer surgeries at TSH so that patients have the best outcomes possible.

Risk factors for ovarian cancer can include:

• Having a personal or family history of breast, ovarian or colon cancer
• Being post-menopausal
• Being obese
• Infertility and using fertility drugs.

Dr. Freedman encourages women to be aware of the following common symptoms that persist almost daily for two weeks or more:

• Bloating
• Pelvic or abdominal pain
• Trouble eating or feeling full quickly
• Urinary urgency or frequency.

In addition, other symptoms of ovarian cancer may include:

• Upset stomach
• Back pain
• Pain during sex
• Constipation
• Menstrual changes
• Unexplained changes in bowel habits
• Unexplained changes weight gain or loss
• Ongoing unusual fatigue.

“Talk to your family doctor about any concerns you may have about ovarian cancer and ways you can reduce your risk,” says Dr. Freedman.  “General information about ovarian cancer can also be found on the Ovarian Cancer Canada website at http://www.ovariancanada.org/.”

Sun damage and signs of skin cancer

Before heading out into the sun this spring, summer and fall, it’s important to take a moment and consider the harmful effects summer weather can have on our largest organ—our skin.

Even when the sky is overcast, you still need sun protection. Overexposure to the sun can cause your immune system to malfunction, and cause melanoma and non-melanoma skin cancer, as well as wrinkles, freckles and telangiectasias (dilation of small blood vessels).

“I would suggest watching for melanoma characteristics, such as asymmetry (one half is unlike the other), border irregularity (irregular, scalloped or poorly defined), colour that varies from one area to another, with shades of tan, brown and black, and sometimes white, red or blue,” explains Plastic Surgeon Dr. Sarah Wong with The Scarborough Hospital. “Also look for the size – anything greater than 6mm, but it can be smaller. And if it is changing in size, shape or colour. If any of these characteristics occur, have it checked out.”

While nothing can undo sun damage to your skin, Dr. Wong says it’s never too late to start protecting yourself from the sun. She offers the following advice:

1. The sun can damage your skin in as little as 15 minutes. Wear sunscreen or cosmetics with a sun protection factor (SPF) of 15 or greater 30 minutes before sun exposure and then every few hours thereafter.
2. Avoid direct sun exposure as much as possible during peak UV times (between 10 a.m. and 3 p.m.)
3. Perform skin self-exams regularly to become familiar with existing growths and to notice any changes or new growths.
4. The average T-shirt has an SPF rating of less than 15. Wear clothes that fit loosely and long pants in darker colours. Tightly woven fabrics offer more protection to your skin. Hats with brims can also offer protection to your face and neck.
5. Listen to the news to get updates on the latest weather alerts. If a heat warning is in effect, try to stay in the shade, carry an umbrella or avoid exposure to the sun.
6. Eighty per cent of a person’s lifetime exposure is before the age of 18. Foster skin cancer prevention habits in your child.

Great reasons to check your blood pressure

High blood pressure, or hypertension, is known as the silent killer, and it is important to get your blood pressure checked regularly.

According to the Heart and Stroke Foundation of Canada, five million Canadians, or 19 per cent of the adult population, have high blood pressure and 17 per cent are unaware of their condition.

“Along with hypertension, other risks such as diabetes, smoking and high cholesterol can increase your risk of complications of atherosclerosis or hardening of the arteries,” explains Dr. George Vertes, Cardiologist at The Scarborough Hospital. “If you do have hypertension, there are effective and safe medications that can lower your blood pressure and improve the risk of developing problems.

“Maintaining your blood pressure is an essential part of maintaining your well being. Diet, exercise and other healthy lifestyle choices can impact your blood pressure and should be discussed with your doctor.”

Other points to remember:

1. High blood pressure is the leading risk for death in women and the second leading risk of death for men. Awareness can help you fight this illness.
2. Hypertension can increase your risk of eye damage, kidney failure, sexual dysfunction, heart attack, heart failure and stroke.
3. High blood pressure is dependent on your age, diet, alcohol consumption, level of exercise and stress.

If you aren’t at risk of developing hypertension, you should get your blood pressure checked once every five years anyway. If you are at risk, getting checked once every year is recommended.

Ten signs of Chronic Kidney Disease

An estimated 2 million Canadians have kidney disease or are at risk. More than 20,000 Canadians require dialysis to stay alive. Currently, 1,055 people in Ontario are waiting for a kidney transplant.

With the largest Chronic Kidney Disease Program in North America, The Scarborough Hospital provides care to more than 3,000 pre-dialysis patients.

“At The Scarborough Hospital we focus on early detection and prevention. We try to identify patients who are at-risk of developing chronic kidney disease. We work with those patients, providing information, care and support to help prevent or delay the development of the disease and the need for dialysis,” says nephrologist Dr. Robert Ting.

The leading causes of kidney failure are diabetes and high blood pressure.

March is Kidney Awareness Month and Dr. Ting shares some of the signs of Chronic Kidney Disease:

1. High blood pressure
2. Puffiness of the eyes, hands and feet (called edema)
3. Passage of bloody, cloudy or tea-coloured urine
4. Presence of protein in the urine or foaming in the urine (proteinuria)
5. Shortness of breath
6. Frequent urination or passing of urine during the night (nocturia)
7. Passing less urine or difficulty passing urine
8. Fatigue
9. Loss of appetite or weight
10. Persistent generalized itching

Four signs of colon cancer

Colon cancer is one of the most lethal cancers around. In fact, in non-smokers, it is THE cancer most likely to kill. It does not discriminate between genders; males and females who have been diagnosed with colon cancer face a 50 per cent chance of dying from it.

“So this means screening is critically important in saving lives,” explains The Scarborough Hospital Gastroenterologist Dr. Eric Hurowitz. “We think we can prevent 85 to 95 per cent of colon cancer through screening, be it with fecal occult blood testing or telescopic tests like colonoscopies or sigmoidoscopies.”

There is a “weak association” between diet and colon cancer, he adds.

“Vegetarians are less likely to get colon cancer, plus colon cancer is more prevalent in societies that consume higher fat diets, more cholesterol and more red meat,” Dr. Hurowitz explains. “The main thing people can do to prevent colon cancer is exercise; it’s more important than diet or where you come from or anything else.”

The symptoms of colon cancer are:

1. Blood in stool
2. Pain in abdomen
3. Change in bowel habits
4. Weight loss