Archive for June, 2016

Bone Health and Cancer – Never an Easy Answer

By Margot Malin, Founder and CEO of Lots To Live For, Inc.

Have you recently been diagnosed with cancer and are evaluating treatment options? Have you completed cancer treatment and have learned that you have developed osteopenia or osteoporosis? If you are at any stage of the cancer journey then this blog post is for you. Bone Health and Cancer – there are no easy answers. But that doesn’t mean that you should not ask the right questions. Learn about risks and research your options.

Chemotherapy, steroid medications, or hormonal therapy may cause osteoporosis, or the thinning of the bones, which makes them weak and fragile, and puts them at risk of fracture. “Accelerated bone loss is a real issue in cancer care,” says Kenneth W. Lyles, MD, professor of medicine and medical director of Medicine Site-Based Research at Duke University Medical Center. Therefore, it is important to have an open discussion with one’s health care provider and/or oncology team to learn about the side effects that can be caused by specific cancer treatments and how they can be mitigated. You are your own health advocate and it is helpful to educate yourself and participate in decision making about your treatment plan. Knowing the risks to bone health before starting treatment, and how you can to maximize bone health is important. “Marked improvements in survival for many cancers mean that strategies to limit bone loss and reduce fracture risk must be incorporated into the care plans for nearly all patients with cancer.” (NIH.gov Osteoporosis and Cancer, in references)

What is Osteoporosis?

Bone Comparison

Bone Comparison

“Osteoporosis is a disease that causes bones to thin and weaken. It can cause bones to easily break. A risk factor is anything that increases your chances for a disease. Risk factors for osteoporosis include being female, family history, advanced age, low body weight, sedentary lifestyle choices, and low calcium and vitamin D levels. More than 10 million Americans have osteoporosis and as many as 40 million more have low bone mass and are at high risk of developing the disease.” (refer to the first reference at the end of this post)

“People undergoing cancer treatment are more at risk for osteoporosis. “Treatments including radiation, chemotherapy, and medications may pose a bone health risk,” says Richard Theriault, DO, MBA, professor, Department of Breast Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, Houston. “Radiation may have direct toxic effects on bone but remains a mainstay of treatment for bone metastases and local therapy post primary breast surgery. Radiation techniques have been designed to minimize risks to bone health,” he says. (see – first reference)

Chemotherapy, says Dr. Theriault, has a major effect on bone health by shutting down the ovaries and causing early menopause in premenopausal women. “This results in a hypoestrogen state with negative impact on bone density.” Further, Dr. Theriault explains that some medications, such as steroids, used to prevent nausea and vomiting may also have a negative impact on bone health. “In postmenopausal women, aromatase inhibitor agents used for adjuvant therapy to reduce the risks of cancer recurrence result in profound hypoestrogen states and thereby increase risks of osteopenia/osteoporosis and fractures,” Dr. Theriault says.” (see – first reference)

Be Proactive: How to Enhance Your Bone Health and Reduce The Risk of Osteoporosis

There are some positive and proactive things that everyone, including cancer patients and survivors can do to improve bone health. All of the following are within your control and are important to focus on and try to incorporate into your lifestyle.

Nutrition

In addition to foods rich in calcium and vitamin D, there are other supplements and nutrients that the body needs to increase bone formation and strength. These include but are not limited to: Magnesium, Vitamin K, Collagen, Essential minerals, and according to some sources progesterone (preferably bio-identical). To learn more, visit: Good For Your Bones Foods.

Exercise can build bone strength.

Exercise can build bone strength.

Exercise

Vital at every age for healthy bones, exercise is important for treating and preventing osteoporosis. Not only does exercise improve your bone health, it also increases muscle strength, coordination, and balance, and it leads to better overall health.  Better balance helps to prevent falls and related fractures.

Bone is living tissue and responds to exercise by becoming stronger. There are two types of osteoporosis exercises that are important for building and maintaining bone density: weight-bearing and muscle-strengthening exercises. Some examples of weight-bearing exercises include weight training, walking, hiking, jogging, climbing stairs, tennis, jumping and dancing. Resistance exercises include free weights, weight machines and elastic bands. Yoga and Pilates are excellent exercises for balance, strength and flexibility (accommodations should be made in certain yoga and pilates movements if you have already been diagnosed with osteoporosis so be sure to work with an educated instructor).  Exercise should be individually tailored to your needs and capabilities. Overall, most people should aim to exercise for 30 to 40 minutes three to four times each week, with some weight-bearing and resistance exercises included in the program. Studies have shown people with a sedentary lifestyle are more likely to have a hip fracture than those who are more active. Weight-bearing exercises force your body to resist gravity and stimulate cells in the body that make new bone. Strength training causes the muscles to pull on the bone.

The Flamingo Study: Balancing on one leg  3x per day can help prevent falls.

The Flamingo Study: Balancing on one leg 3x per day can help prevent falls.

Numerous studies have proven that people with better posture, better balance, and greater muscle power are less likely to fall and are therefore less likely to be injured or experience a fracture. An interesting study performed in Japan, sometimes referred to as the “Flamingo Study” showed that standing on 1 foot to balance 3 times per day for 1 minute each (6 minutes in total – 3 times on each foot for 1 minute each per day) was effective in helping improve balance and prevent falls. This is called the unipedal balance exercise and the study is entitled: Effects of unipedal standing balance exercise on the prevention of falls and hip fracture among clinically defined high-risk elderly individuals: a randomized controlled trial. According to the principal author, K. Sakamoto, “Unipedal standing captures the 2.75 times weight load to the femoral head. Unipedal standing for one minute is equivalent to the amount of integral load gained through walking for approximately 53 minutes.  Unipedal standing balance exercise in one minute 3 times per one day is useful to create the proximal femoral bone density and to prevent falls.”  This “Dynamic Flamingo Therapy” seems like an obvious exercise for anyone to do because the benefits are significant, it is easy to do, it doesn’t take much time, and it is free! There is no downside to trying it daily. You can stand on one foot when you are brushing your teeth or washing dishes. Create a reminder for yourself, such as placing an hourglass or egg timer near your sinks.

Avoid Tobacco Products

Several research studies have identified smoking as a risk factor for osteoporosis and bone fracture.  To learn more read this WebMD article about: The Effects of Smoking on Bone Health

Limit Alcohol Consumption

High levels of cortisol seen in people with alcoholism can decrease bone formation and increase bone breakdown. Chronic alcohol consumption also increases parathyroid hormone, which leaches calcium from the bone, she says. Also, excess alcohol kills osteoblasts, the bone-making cells. See more in this WebMD article about: The Effects of Alcohol on Bone Health

Prescription Pharmaceuticals

Although prescription pharmaceuticals are outside the scope of this article, it is important to mention that there are a number of drugs that are frequently prescribed to help rebuild bones. Many women have refused treatment of these drugs due to reports of debilitating side effects such as osteonecrosis of the jaw (rotted jawbones) and atypical femoral fractures (snapped thigh bones). Please click here to read: “Fearing Drugs’ Rare Side Effects, Millions Take Their Chances With Osteoporosis” an informative article from the NY Times about this topic. A more scientific review of bisphosphonate drugs can be found in this article from the Mayo Clinic Proceedings: Adverse Effects of Bisphosphonates: Implications for Osteoporosis Management

Forewarned is Forearmed

If you are beginning cancer treatment, be sure to ask about how the recommended treatment protocol will affect your bones. If you know that you are at risk for developing osteopenia or osteoporosis you can take the positive and proactive steps outlined above. If you are diagnosed with osteopenia or osteoporosis it is important to consult with your medical professionals to evaluate all the options and create a program that you are comfortable with. Consider a multifaceted approach to bone health including lifestyle modification, exercise and possibly natural supplements and/or pharmaceutical products.

References:

National Comprehensive Cancer Treatment (www.nccn.org) – Bone Health

https://www.nccn.org/patients/resources/life_with_cancer/treatment/bone_health.aspx

Safirstein Research – Osteoporosis

http://fromcancertohealth.com/osteoporosis/

Fearing Drugs’ Rare Side Effects, Millions Take Their Chances With Osteoporosis

http://www.nytimes.com/2016/06/02/health/osteoporosis-drugs-bones.html

Adverse Effects of Bisphosphonates: Implications for Osteoporosis Management

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2704135/

Atypical femoral fractures and bisphosphonate use: current evidence and clinical implications

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480549/

NIH Osteoporosis and Related Bone Diseases National Resource Center

http://www.niams.nih.gov/health_info/bone/Bone_Health/Exercise/default.asp

International Osteoporosis Foundation Exercise Guidelines

http://www.iofbonehealth.org/exercise

Effects of unipedal standing balance exercise on the prevention of falls and hip fracture among clinically defined high-risk elderly individuals: a randomized controlled trial.

http://www.ncbi.nlm.nih.gov/pubmed/17013734

http://ebm.cgh.org.tw/gongzuofang/revman-material/literature-fall-prevention-cochrane2010/sakamoto%202006.pdf

The Effects of Smoking on Bone Health

http://www.webmd.com/osteoporosis/features/smoking-cigarettes

The Effects of Alcohol on Bone Health

http://www.webmd.com/osteoporosis/features/alcohol

Good For Your Bones Foods

https://www.nof.org/patients/treatment/nutrition/

Osteoporosis and Cancer

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3783531/

To read about one patient’s experience with Bone Health and Cancer please read “I Am Furious: Learn From My Cancer Story About Why You Must Become Your Own Medical Advocate” by Pat Wetzel, Founder of the Anti-Cancer Club.

About the author:

Margot Malin is the Founder and CEO of Lots To Live For, Inc.  After receiving her MBA from The Wharton School, she joined a major New York City investment management firm as a managing director and equity portfolio manager. She enjoyed analyzing companies and industries, investing, and earning competitive returns for her clients for almost twenty years. Lots To Live For was founded in tribute to her mother and grandmother who both fought courageous battles against cancer. Becoming involved in the cancer community allows her to give back to people in need by helping them through a difficult time in their lives. Margot enjoys mentoring other entrepreneurs and is also an angel investor.

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What is a PICC Line and What is it Used For?

By Chat Razdan, Co-Founder and CEO of Care+Wear

We often get asked, what is a PICC line? Why is it important? So many people wonder why we created Care+Wear and what our products do to help patients. I wanted to write this blog post to share a bit more on PICC lines and what our PICC line covers do.

I am always glad to share more on the topic. Often times, patients are given a PICC (peripherally inserted central catheter) line to help access the blood stream. Peripherally Inserted Central Catheters refer to the fact the catheter is placed peripherally (in an arm vein) with the tip of the catheter located centrally, as in a central vein in the body.  Access to the blood stream is required for a number of treatments including treatments for Cancer, Diabetes, Lyme Disease and TPN (total parenteral nutrition). PICC lines allow patients to receive IV treatments such as antibiotics, chemotherapy and pain medications.

To get a little more technical…a PICC line is inserted in a peripheral vein in the arm, like the cephalic vein, basilic vein or brachial vein, and then advanced proximally toward the heart through increasingly larger veins, until the tip rests in the distalsuperior vena cava or cavoatrial junction.

PICC lines are usually inserted by physicians, physician assistants (in the US), radiologist assistants (in the US,) respiratory therapists, nurse practitioners, or specially trained certified registered nurses like vascular access nurses and radiologic technologists using ultrasound, chest radiographs, and fluoroscopy to aid in their insertion and to confirm the placement of the line.

PICC Catheter diagram

PICC Catheter diagram

The insertable portion of a PICC varies from 25 to 60 cm in length, that being adequate to reach the desired tip position in most patients. Some lines are designed to be trimmed to the desired length before insertion; others are simply inserted to the needed depth with the excess left outside.

PICC lines can remain in position for extended periods of time, from several days to years on end.

They are used for both in patient and out-patient scenarios. The versatility of PICC lines has led to their increased use (e.g., administering antibiotics, drawing blood/blood transfusions, chemotherapy, prolonged IV antibiotic treatment, and TPN nutrition). In fact, over 6 million patients have a PICC line installed annually and that number continues to increase every year!

Before using a PICC line, it is important to understand the key benefits and risks!

What are some of the benefits of using a PICC line?

  • A PICC is more comfortable compared with the many “needle sticks” that would have been needed for giving medications and drawing blood. The goal is to spare your veins from these frequent “needle sticks.”
  • A PICC can also spare your veins and blood vessels from the irritating effects of IV medications.
  • A PICC can be used in the hospital setting, nursing facility, or at home and can stay in place for weeks, months or years if needed.
  • A PICC can be used for many types of IV treatments.
  • A PICC can be used to draw blood for the majority of blood tests.

There are a number of risks of using a PICC line.

  • There may be slight discomfort during the procedure.
  • Bleeding may occur at the insertion site.
  • Leakage can occur due to skin elasticity, outward line migration, or line rupture.
  • It is sometimes necessary to attempt the PICC line placement more than once and it may not be possible to insert the entire length of the PICC.
  • During insertion of a PICC, accidental puncture of an artery, nerve, or tendon can occur near the insertion site. However, this is a rare event.
  • A clot may form around the catheter in the vein (thrombosis), which can cause swelling and pain in the arm.
  • Inflammation in a vein (phlebitis) can develop from the use of all types of IVs, including PICCs.
  • An infection may occur at the insertion site or in the bloodstream. An estimated 8-25% of all PICC lines that are installed become infected and can lead to complications and increased mortality rates.
  • The PICC can come out, partially or completely, if not well-secured and completely covered.
  • The PICC can move out of position in the vein and may need to be removed or repositioned.
  • The PICC may become blocked. Medication may need to be used to clear it.
PICC Cover - Care & Wear

PICC Cover – Care & Wear

If you have a PICC line, you want to watch for several signs, including:

  • Swelling, redness, red streaking, hot or hard area in PICC line arm
  • Pain in PICC line arm
  • Fever or chills
  • Swelling of the hand, arm and/ or neck on the same side as the PICC line.
  • Leaking of fluid when you flush the catheter

Call your healthcare provider or PICC line care provider right away if you notice these signs or if you are worried or concerned.

We created the Care+Wear Ultra-Soft PICC line cover to help patients who have a PICC line. Our PICC line covers are made of anti-microbial fabric, are machine washable, and provide a unique, breathable mesh window to allow air circulation over the PICC line and visibility to the insertion site. Our PICC line covers help eliminate some of the challenges of having a PICC line by making it easier to securely and healthily cover the line without having to worry about exposure to outside agents or low quality materials. Let’s get back to living!

Interested in learning more? Here’s some other links as well.

Feel free to check out our website at www.careandwear.com and join our community as we help patients get back to living their lives!

About the Author:

Chat Razdan is the Co-Founder and CEO of Care+Wear. They started Care+Wear after having friends and family diagnosed with cancer and told to wear tube socks on their arms. They felt that there was an incredible opportunity to help patients get back to living their lives.

Chat is a proud University of Virginia alum with an MBA from the University of Chicago Booth School of Business who spent time as a strategy consultant at A.T. Kearney and as an investment banker at Goldman Sachs. Nicknamed “Smiley” in middle school basketball camp, he has tried to bring a smile wherever he goes. A die-hard Baltimore fan, he continues to cheer for the Orioles and Ravens and can often be found running up the West Side Highway in the mornings. In his spare time, he helps to plan his class reunions for UVA and Booth and serves on young alumni boards for UVA

 

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