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Tue, Mar 5 8:23am · All your awkward colonoscopy questions answered

colonoscopy

Colorectal cancer is the second-leading cause of cancer deaths among men and women combined in the United States, yet it is estimated that 60 percent of those deaths are preventable through current screening methods.

Why, then, are people so hesitant to get screened?

“There’s an ‘ick’ factor when it comes to colorectal cancer screening because people don’t want to talk about” these issues, said Fola May, MD, PhD, a gastroenterologist at UCLA Health and an assistant professor in the Vatche and Tamar Manoukian Division of Digestive Diseases at the David Geffen School of Medicine at UCLA. “Making a point to talk about is the only way to make sure that people known about colon cancer risk and get screened.”

The main screening methods are the colonoscopy and the fecal immunochemical test, or FIT, kit.

The colonoscopy, a 30-minute procedure that requires people to drink a colon prep the day earlier, is the most common method and is only performed once every 10 years if everything looks normal. If potentially-cancerous growths known as polyps are found during a colonoscopy, the gastroenterologist often can  remove them during the procedure.

The FIT kit, a test in which the patient collects a small stool sample, is an alternative screening method that must be done annually. If blood is found in the sample, the doctor will recommend a colonoscopy for further observation.

Dr. May, also a member of the UCLA Jonsson Comprehensive Cancer Center, discussed some of the factors that make patients uncomfortable and may prevent them from getting screened.

For those who don’t want to get a colonoscopy, what are the alternatives?

Patients hesitant about colonoscopy can do a FIT kit at home. A lot of people think the stool collection process is messy or gross, but we provide a clean and easy way to collect the sample. About 7 to 10 percent of people who use a FIT kit receive a positive result – a confirmation of blood in the stool, which could indicate a cancer or a polyp – meaning they then have to get a colonoscopy anyway.

For the average person, we don’t care which initial screening method you pick, as long as you choose one and prioritize getting it done.

What is the prep like? Is it really as awful to drink as I’ve heard?

Prior to a colonoscopy, people will have to drink a prep liquid the day before, which helps empty the colon so that we can clearly inspect the colon walls for polyps during the procedure. And yes, it is far from delicious. It can taste like salty water.

But think of it this way: most people only have to get a colonoscopy once every 10 years, which means you’re likely to only have to do the prep once every 10 years. This screening test can also find polyps and cancer early, which can save your life. So, it’s definitely worth drinking the prep.

If you can, plan not to do much on your prep day. This is the day that you get to turn on Netflix, chill out, and stay near your bathroom.

Will I be awake during the procedure?

We typically use monitored anesthesia care for our colonoscopy procedures at UCLA Health. Medications are administered to the patient through an IV and the patient is monitored by a qualified anesthesia provider. This anesthesia provider is focused exclusively on the patient’s airway and vital signs, while the gastroenterologist is allowed to focus completely on performing the colonoscopy. This puts you into a pain-free state during the procedure and allows for a quick recovery once the colonoscopy is done.

Everyone frets the actual procedure, but very few people actually remember it. Many patients wake up after the colonoscopy asking when we are going to get started!

Will the colonoscopy hurt?

No, it shouldn’t. At most, you’ll feel some pressure.

If you’re feeling any pain, we’ll typically give more medication. Our job is to make sure everyone is as comfortable as possible.

What’s the difference between this and a prostate exam?

 A lot of men are confused about the difference between a colonoscopy and a prostate exam.

Prostate cancer and colorectal cancer are conditions that typically occur – and must be screened for – in older age. The confusion seems to stem from the fact that screening methods for each involve an evaluation through the anus.

Getting screened for prostate cancer includes a digital rectal examination in which a doctor places a finger into the rectum for about five seconds to feel for an enlarged or abnormal prostate. Because the prostate is located next to the rectum, we can feel it by pressing on the back wall of the rectum.

In a colonoscopy, we use a tiny camera with a light on the end to examine the walls of the colon. The colon is six feet long, so a colonoscopy goes much further than a prostate examination. While they are completely different procedures, both are part of a healthy screening program for men as they age.

What if I accidentally pass gas during the procedure?

Patients are so worried about passing gas during the colonoscopy.

Guess what? You’re going to. Everyone does. You won’t be the first and won’t be the last. And if you don’t let the gas out during the procedure, you’re going to feel pretty uncomfortable. We are able to examine the colon walls so well because we put air into the colon as we do the colonoscopy to distend the walls. We always encourage patients to let that gas come out naturally.

Oct 2, 2018 · What's the deal with brown fat? This researcher is uncovering its function

Dr. Xingxing Kong, assistant professor of pediatrics at the David Geffen School of Medicine at UCLA and UCLA Mattel Children’s Hospital. (Photo credit: UCLA Health)

When most people think of fat, they think of what medical experts refer to as white fat, or the fat tissue in the body that stores calories. But we all have another kind of fat, with a completely different function: brown fat.

“Until somewhat recently, we thought only babies had brown fat,” says Dr. Xingxing Kong, a researcher who studies fat, or adipose tissue. “Then we discovered adults have some brown fat, too.”

Brown fat, the type of fat tissue that actually burns energy, is less familiar to those outside the medical field. But researchers are learning just how important it is.

Kong, an assistant professor of pediatrics at UCLA Mattel Children’s Hospital, believes brown fat may hold clues to better understanding metabolism. She and other researchers also suspect it could be targeted when it comes to potential interventions to combat obesity and type 2 diabetes – especially in children.

Illustration courtesy of Dr. Xingxing Kong and her team.

Recent studies have focused on the relationship between brown fat and muscle. Researchers know, for instance, that exercise can increase the amount of brown fat in our bodies.

In breakthrough research published August 2018 in the journal Cell Metabolism, a team of scientists including Kong, then at Beth Israel Deaconess Medical Center in Boston, demonstrated for the first time the mechanism behind the other side of the relationship: how brown fat influences muscle function.

Brown fat can burn calories and produce heat, a process called thermogenesis. Our risk for weight gain and obesity increases when we experience issues with thermogenesis.

In the Cell Metabolism study, Kong and the research team found that when mice lacked a particular gene that regulates thermogenesis, their ability to exercise was hampered. In such mice, the researchers also discovered that the hormone myostatin, which inhibits muscle growth, increased.

Myostatin, and its relationship with brown fat, presents an important avenue for further research. Myostatin levels are higher in those with obesity or type 2 diabetes. Animals that lack myostatin – or are treated with substances that block its activity – have significantly more muscle mass and lower levels of white fat.

If the discoveries of Kong’s team are found to be consistent in humans, the findings would change the way we understand weight gain.

“Our study of fat tissue will give us critical knowledge about metabolism,” says Kong. “Our hope is that such insights could be harnessed to produce therapies for the fight against obesity and type 2 diabetes.”

Sep 21, 2018 · Urologist's first pitch at Dodgers game raises awareness for prostate cancer

Dr. Mark Litwin, left, with Dodger legend Steve Garvey. (Photo: Courtesy of Los Angeles Dodgers)

The crowd at Dodger Stadium on a recent night received a reminder (and a reassurance) of something many prefer not to think about: prostate cancer.

UCLA Urology Chair Dr. Mark Litwin threw the ceremonial first pitch at the game, a request of former Dodger star Steve Garvey. The pitch marked the beginning of Prostate Cancer Awareness Week.

Prostate cancer is the most common cancer diagnosis in men. Risk for the disease increases with age, and the average age at diagnosis is 66.

With the pitch, Litwin’s aim is to reduce fear of the disease.

“Our ability to diagnose and treat patients with prostate cancer – and to classify the risk of individual patients based on their cancer – has greatly improved,” says Litwin, a researcher with the UCLA Jonsson Comprehensive Cancer Center. “Treatment isn’t one-size-fits-all. For some men, watchful waiting can be best. For others, advanced therapies or surgical intervention are better options.”

A ceremonial first pitch is a pointed reminder of the need to be aware, to be tested if necessary, and to remember that the disease can be beat – often on a man’s own terms.

“For men of a certain age, it’s important to begin that conversation with your doctor, who can assess your individuals needs and preferences and find the best path forward for you,” says Litwin.

Aug 9, 2018 · With new fellows program and research underway, music therapy expands at UCLA

Elyana Solis, a patient in the NICU at UCLA Mattel Children’s Hospital who received music therapy services. (Image courtesy of Jenna Bollard)

A program that provides music therapy for patients at UCLA Mattel Children’s Hospital is expanding by adding two music therapy fellows who will assist patients and new research beginning in the neonatal intensive care unit (NICU) over the course of a year.

A $100,000 gift from The Music Man Foundation enabled UCLA Mattel Children’s Hospital to establish a music therapy fellowship program for two people – Kristina Casale and Sandra Cheah – who will be assisting Jenna Bollard, manager of expressive arts therapies at UCLA Mattel Children’s Hospital, and Dr. Isabell Purdy, director of the High Risk Infant Follow-Up Clinic at UCLA Mattel Children’s Hospital, with the research study.

Casale and Cheah received bachelor’s degrees in music therapy from the Berklee College of Music in Boston and then completed clinical music therapy internships with UCLA Mattel Children’s Hospital under Bollard’s supervision. The two use music therapy as a way to connect with individual patients and help them achieve clinical goals during their treatment, recovery or care at the hospital.

As part of the expansion, UCLA Mattel Children’s Hospital also will be conducting research in the neonatal intensive care unit (NICU) to evaluate how personalized lullabies and parents’ recorded voices can help premature babies improve their ability to properly feed and suckle, build their endurance and reduce their perception of pain. Led by Bollard, the research will include the use of a device called a pacifier-activated lullaby (PAL).

“The work that we have the opportunity to do here on the NICU is innovative and cutting edge – yet is a completely non-invasive way to support both the infants and their caregivers,” says Cheah.

Premature infants’ ability to feed properly and gain weight is essential to their healthy development outside the mother’s womb. Many preemies require support in improving their sucking in order to get the nutrients they need.

Music therapy fellows Sandra Cheah, left, and Kristina Casale, right. (Image courtesy of Jenna Bollard)

Certain tactics show promise in encouraging infants to do so. One of those tactics is the use of the PAL device. The PAL plays developmentally appropriate sounds, such as a soft lullaby or a parent’s recorded voice, to the child as they are feeding in order to reinforce the activity. Preliminary findings show that the PAL helps premature babies learn to feed for longer, thereby helping them develop faster and leave the hospital.

“Within the NICU, I have seen how music therapy interventions incite change in patients and their families on a physiological and psychological level,” says Casale. “During the personalized lullaby writing process, we can empower families.”

The research will be conducted over a 10-month period on premature infants that achieve an age equivalent to 32 weeks of gestation.

Bollard notes that the use of music therapy in the NICU is a careful and scientific process that can have a big impact on patients and parents alike.

“When parents welcome a newborn into the world early, it can be distressing to be faced with a medical situation that seems so out of their control,” says Bollard. “By using music therapy and the PAL device, we’re able to support infants in reaching their physiological and developmental goals while simultaneously supporting and empowering their families during a very emotional time.”

A gift from the Peterson Family Foundation made it possible for the hospital to hire its first full-time music therapist, and its ongoing support ensures the sustainability of the program in providing comprehensive music therapy services to patients. The music therapy program at UCLA Mattel Children’s Hospital hopes to continue its growth and development by one day securing funding to create a permanent music therapy position in the NICU. To learn more about the program and how to support it, please visit: http://www.uclahealth.org/mattel/music-therapy.

Jul 27, 2018 · Worried about varicose veins? Here's what you need to know

Compression socks. (Photo credit: iStock)

On a summer day, many people like to wear shorts to get some relief in the heat. For people with varicose veins, however, the idea of wearing shorts can lead to more anxiety than comfort.

Varicose veins affect about 25 percent of women and 15 percent of men in their lifetime, and there are many ways the condition can be treated.

UCLA interventional radiologist Dr. Cheryl Hoffman discusses the causes of varicose veins and some common treatments.

What are varicose veins?

“Varicose veins can form when the vein valves that move blood back to the heart malfunction, causing swelling and inflammation,” says Hoffman. “The veins then become dilated due to the abnormal blood flow.”

Dr. Cheryl Hoffman, a UCLA interventional radiologist

Varicose veins most commonly occur in the legs, where gravity and other factors make the normal flow of blood returning to the heart more difficult.

Many people with varicose veins often report that they are painful, uncomfortable, and unsightly.

What causes varicose veins?

“Your genes are the number one factor contributing to your risk for developing them,” says Hoffman.When one or both parents have varicose veins, your risk for them increases.

Other contributing factors include pregnancy, obesity, older age, prolonged standing, and physical inactivity.

What treatments are available?

The first thing Hoffman recommends is more physical activity. When we walk, the contraction of the calf muscle helps circulate blood back to our heart, alleviating the buildup that contributes to varicose veins.

For this reason, Hoffman also recommends compression socks or stockings, which will aid with the circulation of blood.

When those measures aren’t enough, doctors can treat varicose veins with minimally invasive procedures:

  • Endovenous thermal ablation is a treatment that uses heat and a laser to close off a vein that is not functioning properly, redirecting blood flow through other veins.
  • Mechanochemical ablation is a non-thermal ablation that uses a rotating catheter and a drug to close off the varicose vein.
  • Phlebectomy uses a series of tiny incisions in the skin to physically remove the affected veins.
  • Sclerotherapy uses an injection of a specific chemical to make the veins shrink.

For more information on varicose veins and treatment, visit the UCLA Varicose Vein Clinic website.

Jul 18, 2018 · To ease the transition to a plant-based diet, try these foods

Photo credit: Flickr/cabeel

Plant-based diets are associated with numerous health benefits, but it’s not so easy for meat eaters to suddenly drop foods they’re used to eating daily.

Certain foods can help ease that transition, says UCLA senior dietitian Dana Hunnes, by providing nutrients and textures that are comparable to beef, chicken and other meat.

If you feel you’re lacking certain foods while following a plant-based diet, Hunnes recommends these options.

Seitan

Seitan is a high-protein, gluten-based staple of many imitation-meat products. It also has a similar chewiness to that of meat.

Faux milks

From almond to pea to coconut, alternatives to cow’s milk are available in nearly every grocery store. In addition to drinking such “milks,” they can be used as substitutes in baking and cereal. They often also contain calcium and vitamin D.

Dana Hunnes, a senior dietitian at Ronald Reagan UCLA Medical Center and an adjunct assistant professor at the UCLA Fielding School of Public Health

“From both a health and an environmental standpoint, faux milks are better than the original,” says Hunnes, who is also an adjunct assistant professor at the UCLA Fielding School of Public Health. “You can easily find one to fit your taste preferences.”

Jackfruit

Jackfruit has become popular as a plant-based replacement for pulled pork, largely because it has a similar consistency. Unlike some other meat replacements, it contains neither gluten nor soy.

Super firm tofu

Super firm tofu is another food that can be used as a substitute for meat. The firmness gives it a meat “feel,” and it’s extremely versatile depending on the type of dish you’re making.

“Super firm tofu is able to absorb almost any flavor you choose for it,” Hunnes says.

Mushroom stock

Portobello mushrooms have a rich, umami taste, and can make a flavorful stock base. Mushroom stock can be a great replacement for beef broth.

Legume loafs

Certain legumes can make a meatless take on meatloaf. Lentils, for example, have a hearty and substantial flavor similar to the taste and texture of traditional meatloaf when cooked with other ingredients.

In addition, lentils and other legumes are very high in protein and low in fat, so they’re a nutrient-dense addition to any diet.

Other plant-based faux meats

Various companies create plant-based takes on meat products.

“Many of the plant-based faux meat products are so real looking and flavorful,” says Hunnes. “They give you all the nutrients you need – without the animal.”

Above all, Hunnes advises people to get creative and look at plant-based eating as an adventure rather than an obstacle.

“The myriad choices available today make plant-based eating a cinch compared to when I first started in the early 2000s,” she says. “The choices were much more limited then, so we are in a wonderful time these days.”

Jul 6, 2018 · Extreme heat is a serious health threat. Here's what you need to know.

Photo credit: pockafwye/Flickr

The health risks of heat are no joke. From 1999 to 2010, more than 9,000 people died in the U.S. alone due to heat illnesses.

Dr. Mark Morocco, a clinical professor of emergency medicine at Ronald Reagan UCLA Medical Center, warns that heat stroke and other heat-related illness should not be taken lightly. Rather, extreme heat can have very dangerous – and sometimes fatal – effects on the body.

Dr. Mark Morocco, a clinical professor of emergency medicine at Ronald Reagan UCLA Medical Center. (Photo credit: UCLA Health)

“Extreme heat illness – heat stroke – ‘cooks’ your brain and organs, and can be deadly,” he says. “Think of heat stroke like brain stroke, a true medical emergency causing brain symptoms like confusion, fainting, or difficulty with simple activities like talking or walking.”

If you have such symptoms or see someone who does, immediately seek help or call 911. Don’t wait until the situation is dire, Morocco says.

“Hot, dry skin, lack of sweating, or a fever are late and dangerous signs of heat illness,” he says.

Some people are more prone to heat illness than others. Older adults (especially over age 65), children under age 4, people with chronic heart or lung problems, and people with disabilities are at higher risk.

“Check on them early and often,” Morocco says. “Help move friends, family, and people at risk for heat stroke to cooler places with shade, if needed.”

Heat exposure causes problems across a spectrum, from simple heat rash to sunburn to heat exhaustion. All of these effects, except for heat stroke with its brain-related symptoms, can be easily treated by hydrating and getting out of the heat and sun.

“Drink enough water to the point that you’re urinating every two hours or so,” he says. “If you can’t keep water down due to vomiting or discomfort, without symptom relief after one or two hours, get medical help.”

For more health stories and news, follow @UCLAHealthNews on Twitter.

Jun 14, 2018 · What couples need to know about male fertility problems

Infertility is often characterized as a woman’s issue, but male infertility accounts for an estimated 40% of fertility problems in couples who have difficulty conceiving. And when it comes to a man’s fertility, a number of common factors can be at play, says UCLA urologist Dr. Jesse Mills.

Here’s what dads-to-be – and their partners – need to know about male fertility.

Basic lifestyle changes are fundamental

“Eat, move, sleep.” That’s a mantra Mills, who serves as the director at The Men’s Clinic at UCLA, recites to all his patients.

Taking care of diet, exercise, and sleep is a vital part of a man’s overall health and, in turn, reproductive health.

  • Diet. Focus on fresh fruits and vegetables, high protein foods, and foods rich in polyunsaturated fats (like tree nuts, almonds, and walnuts).
  • Exercise. Men should break a sweat for 30 minutes or more each day. “Exercising just once or twice a week is not enough,” Mills says. “Anything that improves blood flow, heart rate, and metabolism is probably going to translate to better sperm production.”
  • Sleep. Try to get more than six hours of sleep per night. “When men sleep, they recharge their pituitary gland, and the pituitary gland controls sperm production by the testicles,” Mills says. “If you’re consistently not getting enough sleep, there’s a good chance the hormones that control sperm production are lagging.”

Overweight or obese men have a higher incidence of fertility issues. One potential reason is that larger thighs can cause the testicles to be at a higher temperature, affecting sperm health. Obesity also causes decreased testosterone.

In any event, diet, exercise, and sleep all help to stabilize weight – and improve a man’s health overall.

Dr. Jesse Mills, director at The Men’s Clinic at UCLA.

Stress is a very real factor in fertility

“I can’t tell you how many men I see in my clinic that are not only stressed professionally but have the added stressor that comes with trying to get pregnant,” says Mills. “Just that stress of making a baby is enough to send couples fighting and not being able to accomplish their fertility goals, and that doesn’t do anyone any good.”

If stress is an issue, it’s important to do what you can to reduce it. Again, exercise helps, says Mills, as does sufficient sleep.

Some things can signify a potential medical problem

There are certain red flags that could indicate a potential medical problem affecting a man’s fertility. Mills says men should look out for the following issues and let a physician know if they’re experiencing any of them:

  • Pain during ejaculation. Men should not be experiencing pain during ejaculation. It could indicate an infection or a blockage such as an ejaculatory duct stone, a calcification similar to a kidney stone but located somewhere along the reproductive tract.
  • Low ejaculate volume or irregular ejaculate color. Normal ejaculate volume should be about half a teaspoon to a teaspoon. Ejaculate should ideally be a pearly white color.
  • Abnormal testicle size or feel. A healthy man’s testicles should feel firm and should be close to the size of an apricot. Softness or squishiness usually indicates a problem with sperm production, as 80% of the size of the testis is devoted to sperm production.

If any of the above medical issues pertain to you, or if you and your partner have been trying to conceive for six months without a pregnancy, a visit to a men’s health specialist is a good idea. Physicians are able to perform a number of tests to determine the root of fertility issues, and there are a number of surgical and medical options to repair such issues and help couples reach their fertility goals.

For more health stories and news, follow @UCLAHealthNews on Twitter.