Davis Square Family Practice Newsletter
July 18, 2010            Issue No. 11
actinic keratosis

    Donate or Run in      The Sun 1/2 Marathon


  In This Issue 

Help Cure Carcinoid with the
Bay State Marathon
Government  Report on
Environmentally Caused Cancer
Probiotics and Your Health
Gum Disease and Your Heart  

Help Cure Carcinoid - Donate or Run in the Bay State Marathon
Many of you may remember Debra Gerson and Carol Dansky, two wonderful practitioners who used to work here. Well Debra called me the other day and asked if I'd like to run The Sun 1/2 Marathon with her in Lowell on Octber 17th to help increase awareness of carcinoid and raise money to fund research.  Carcinoid, while rarely making headlines, is not an uncommon cancer that can affect the bowel and the lungs and has unique features that make it difficult to treat and eradicate. Carol, who is now practicing on the Cape, has lived with carcinoid for over 15 years. She's doing great but the tumor is difficult to cure.
So the entire medical staff, Marie, Bob and I, as well as Bari-Sue Brodsky, another beloved former clinician at Davis Square Family Practice, and our administrative staff are teaming up to contribute to the cause.  We already have a patient from the practice, Michelle Figueiredo, who will run with us. 
Want to join the fun?  You too can contribute to the cause by making a
donation, running the 1/2 marathon or cheering us on, and any participation will be  greatly appreciated.   If you're interested in joining us in Lowell to run or cheer, call the office or email me at dbershel@gmail.com.   Click on the link, half-marathon, for a sample 10 week half-marathon training program. (Of course, contact me if you are unsure about whether it is medically prudent for you to run with us).
How Can We Prevent Cancer From Our Environment

I do apologize for the doomsday nature of this article. You can take it with a grain of salt and decide for yourself if any specific recommendations resonate with you.
Below is a copy of the US government recommendations on how we as individuals might prevent cancer in ourselves, our families and society.
The entire report is here:
The report is lengthy but the meat of it is about 100 pages and  well-organized. You can skim through it to get the highlights many of which are eye-opening and disconcerting. Fundamentally, it strongly states that we have been living in a dreamworld. We think that government agencies have been making sure that toxins and pollutants are not allowed into our lives. The facts are that these agencies cannot possibly keep tabs on the 80,000 chemicals manufactured each year to ensure that they are not carcinogenic.
I want to give you a meaningful summary of all of the findings in the report but it would divert your attention from the bigger picture. We are polluting the air, soil and water we breath with chemicals that are likely unhealthy for us and other living things. When we find that something is unhealthy for us, we often replace it with a chemical that may itself be unhealthy . For example, we have replaced BPA containing plastics with other plastics that have have not been proven to be risk-free.
When it comes to medicine, we doctors have blithely ordered CT scans for decades without an understanding of the amount of radiation exposure is involved. This report has made me aware, in plain English, of another reason to be judicious about using this tool.
The summary of Recommendation for Individuals on pages 111 and 112 provides us with mostly straightforward suggestions to minimize risk to ourselves, families and community. In New England we all should have a radon check of our basements. It makes sense to filter our water (I'm skeptical about drinking water or any beverage from plastic bottles). Don't char your meat (if you must eat it) in a broiler or barbecue (microwaving for 2 minutes prior to grilling removes most heterocyclic amines mentioned in the recommendations below). Microwave in glass or ceramic bowls and not in plastic.
'Endocrine disrupting compounds' refers to chemicals in our environment that mimic hormones (mostly estrogen) and there is some concern that they can affect fertility and brain development as well as promote cancers. Phthalates and BPA are used to make plastics and are endocrine disrupters. They can be found in PVC (#3 recycling logo) and BPA is found in some plastics with a #7 recycling logo.  (I have removed Poland Spring water from the office because it had a #7.)  Kids just should not be sucking on plastic toys in general. Other endocrine disrupters are many of the pesticides we use and some are naturally occuring in our foods
Below is a copy of the recommendations as laid out on pages 111 and 112:
What Individuals Can Do: 
It is vitally important to recognize that children are far more susceptible to damage from environmental carcinogens and endocrine-disrupting compounds than adults.  To the extent possible, parents and child care providers should choose foods, house and garden products, play spaces, toys, medicines, and medical tests that will minimize children's exposure to toxics.  Ideally, both mothers and fathers should avoid exposure to endocrine-disrupting chemicals and known or suspected carcinogens prior to a child's conception and throughout pregnancy and early life, when risk of damage is greatest.

Chemical Exposures 
Individuals and families have many opportunities to reduce or eliminate chemical exposures.  For example:

Family exposure to numerous occupational chemicals can be reduced by removing shoes before entering the home and washing work clothes separately from the other family laundry.

Filtering home tap or well water can decrease exposure to numerous known or suspected carcinogens and endocrine-disrupting chemicals.  Unless the home water source is known to be contaminated, it is preferable to use filtered tap water instead of commercially bottled water.
Storing and carrying water in stainless steel, glass, or BPA- and phthalate-free containers will reduce exposure to endocrine-disrupting and other chemicals that may leach into water from plastics.  This action also will decrease the need for plastic bottles, the manufacture of which produces toxic by-products, and reduce the need to dispose of and recycle plastic bottles. 

Similarly, microwaving food and beverages in ceramic or glass instead of plastic containers will reduce exposure to endocrine-disrupting chemicals that may leach into food when containers are heated.

Exposure to pesticides can be decreased by choosing, to the extent possible, food grown without pesticides or chemical fertilizers and washing conventionally grown produce to remove residues.

Similarly, exposure to antibiotics, growth hormones, and toxic run-off from livestock feed lots can be minimized by eating free-range meat raised without these medications if it is available. 

Avoiding or minimizing consumption of processed, charred, and well-done meats will reduce exposure to carcinogenic heterocyclic amines and polyaromatic hydrocarbons.

Individuals can consult information sources such as the Household Products Database to help them make informed decisions about the products they buy and use.

Properly disposing of pharmaceuticals, household chemicals, paints, and other materials will minimize drinking water and soil contamination. 

Individuals also can choose products made with non-toxic substances or environmentally safe chemicals. 

Similarly, reducing or ceasing landscaping pesticide and fertilizer use will help keep these chemicals from contaminating drinking water supplies.

Turning off lights and electrical devices when not in use reduces exposure to petroleum combustion by-products because doing so reduces the need for electricity, much of which is generated using fossil fuels. 

Driving a fuel-efficient car, biking or walking when possible, or using public transportation also cuts the amount of toxic auto exhaust in the air.

Individuals can reduce or eliminate exposure to secondhand tobacco smoke in the home, auto, and public places.  Most counseling and medications to help smokers quit are covered by health insurance or available at little or no cost.

Adults and children can reduce their exposure to electromagnetic energy by wearing a headset with wires when using a cell phone, texting instead of calling, and keeping calls brief.
It is advisable to periodically check home radon levels.  Home buyers should conduct a radon test in any home they are considering purchasing.

To reduce exposure to radiation
from medical sources, patients should discuss with their health care providers the need for medical tests or procedures that involve radiation exposure.  Key considerations include personal history of radiation exposure, the expected benefit of the test, and alternative ways of obtaining the same information.  In addition, to help limit cumulative medical radiation exposure, individuals can create a record of all imaging or nuclear medicine tests received and, if known, the estimated radiation dose for each test. 

Adults and children can avoid overexposure to ultraviolet light by wearing protective clothing and
sunscreens when outdoors and avoiding exposure when the sunlight is most intense.

Each person can become an active voice in his or her community.  To a greater extent than many realize, individuals have the power to affect public policy by letting policymakers know that they strongly support environmental cancer research and measures that will reduce or remove from the environment toxics that are known or suspected carcinogens or endocrine-disrupting chemicals.  Individuals also can influence industry by selecting non-toxic products and, where these do not exist, communicating with manufacturers and trade organizations about their desire for safer products.

If anyone has thoughts or comments on this artical please feel free to email me.
Deborah Bershel

Probiotics and Your Health
Gum Disease and Your Heart
Probiotics seem to be good for everything these days. Probiotics are 'good bacteria' that we would normally have in our gastrointestinal system. Not all probiotics are comprised of the same bacteria.  A study showing that lactobacillus may be as, or even more, effective in treating breast infections may not apply to other probiotics on the shelf. And yogurt, which usually contains active lactobacillus in it, may not have enough of a concentration to be of use for some conditions.
To date, I know of studies that show that probiotics treats colic, diarrhea and now breast infections in nursing moms. It prevents diarrhea and dangerous bacterial overgrowth, psuedomembranous enterocolitis, that can occur when we take antibiotics. It also markedly lowers the incidence of colds and ear infections in infants.
You may want to go to the Wikipedia Article  on the subject to see other possible benefits of probiotics. So probiotics may eventually become an important part of maintaining good health. But at this point nothing has been shown to be better for you health than regular exercise, a balanced diet and avoiding cigarettes, excess alcohol and street drugs.
Gum Disease and Your Heart
A recent study out of Scotland reminds us that good dental hygeine is probably good for more than  pretty teeth.
Gum Disease
Conclusion - those who never brushed their teeth had a 70% higher risk for heart disease than those who brushed daily. Please excuse me if I'm insulting anybody in my practice here, but I have to assume that those who never brush their teeth are special in other ways too.  Nonetheless, this is not the first study to make the conclusion that there may be a connection between gum inflammation and heart disease. One theory is that gum disease causes 
inflammation in the body that could lead to heart disease.
Until Next Time 
Please visit our website www.dsfamilypractice.com
to request prescription refills and referral authorizations or just read back issues of our newletters as well as many interesting articles in our medical library.
If you know someone who would like to receive our newsletters, they can join by visiting our website and accessing the Newletter link at the top of the page. 
In Health,
Deborah Bershel, M.D.