Breast Cancer Screening

    Screenings are a vital part of leading a healthy lifestyle because your doctor can catch a disease in the early stages when there is still a good chance to cure it. There is a lot of different information out there on who should get screened for what and when in regards to breast health. Most of the information will be based on the United States Preventative Task Force recommendations (USPSTF).

WHO should get screened for breast cancer?

•  All women should get screened for breast cancer no matter your race or ethnicity!

WHAT does breast cancer screening entail?

•  Breast cancer screening entails self breast exams, clinical breast exams, ultrasound and mammography.
• Self breast exams: I personally do not discourage women from doing monthly breast self exams (BSE), although it is no longer recommended that doctors teach their patients to do self breast exams because adequate evidence suggests that BSE do not reduce breast cancer mortality.
• Clinical breast exams: Performed by a doctor, the clinical breast exam will look for major differences between the size of the two breasts, changes in color, abnormal discharge from the nipple, tender areas,and dimpling/ abnormalities of the skin. Clinical exams not only include the breast but the chest wall area above the breast, the underarm areas which have breast tissue, as well as lymph nodes.
• Breast Ultrasound: if your doctor feels something suspicious in your breast, he/she may opt for an ultrasound first to get an initial clue to the anatomy of the tissue. Ultrasounds are usually preferred for women who are under 40 years old, or have low risk factors for breast cancer. 
• Mammography: mammograms are low-dose radiation X-rays that can find a lump before you even know it's there. They are able to give a more accurate view of breast tissue and anatomy. They are highly sensitive for picking up abnormalities however normal results don’t always completely rule out cancer. Mammograms are the BEST way to screen for breast cancer.
• If your mammogram is suspicious, the next procedure will most likely being a breast biopsy where a sample of breast tissue is examined under a microscope to look for malignant (cancerous) cell
•  Women who have had breast cancer in the past and had a mastectomy, radiation or chemotherapy must STILL get yearly mammograms!

WHEN should women get screened for breast cancer?

• While you are in your 20's and 30's, your doctor may preform clinical breast exams once every 1-3 years.
• These exams may be performed by your primary care physician and/or Ob/GYN
• The USPSTF recommends screening mammography for women aged 50 to 74 years every 2 years.
• The decision to do a screening mammogram a woman below 50 years will be determined based on her risk factors including family history of breast cancer and any changes in her breasts. These women may also have mammograms yearly rather than every other year.

WHERE can women get screened for breast cancer?

• Your primary care physician's office is a great resource and often a 1 stop shop for many screenings.
• If you do not have insurance here are some other options:
• CDC's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides access to breast and cervical cancer screening services to underserved women in all 50 states, the District of Columbia, 5 U.S. territories, and 11 tribes.
• Also, look out for health fairs in your area that may offer free breast cancer screenings
• Contact your local health department to see if they offer any free screening resources.
• More information on screening can be found here: United States Preventative Task Force- Breast Cancer Screening

WHY should women get screened for breast cancer?

• Breast cancer is the 2nd most common cancer in women in the USA, only coming in second to non-melanoma skin cancer. It is also one of the leading causes of cancer death among women of all races. 
• Here is the most recent data we have from the CDC, in 2009:
• 211,731 women in the United States were diagnosed with breast cancer.
• 40,676 women in the United States died from breast cancer.

Tell your mother, daughters, and friends to get screened and if you are a mother, daughter or friend don't forget to get yourself screened as well!

First Case of EBOLA in the U.S.

The EBOLA crises is NOT getting better in WEST AFRICA and now the virus has landed on US soil.

A patient with EBOLA being taken on a plane in Sierra Leone. 

A mystery person in Dallas, Texas is the first to be diagnosed with Ebola in the U.S. The city of Dallas released a statement saying that he or she "moved to Dallas from Liberia a week ago." The CDC is on the case and tells us that the patient is very ill and in intensive care. They arrived to the U.S. on the 20th and presented with symptoms 4 days later. Now it is up to the CDC to find everyone the patient had contact with over the last 4 days and isolate those people for 3 weeks while they are monitored for symptoms. Ebola is not spread through the air like the flu, it is spread through bodily fluids, but if you shook hands with this person you would have to be isolated for at least 3 weeks! 

Ebola under a microscope

 "Every morning we only open one of our centers for 30 minutes, just to admit people who can fill in the beds of the people who died overnight. This is how bad it is. And the rest of the day, we are turning patients back home to go and infect their neighbors and loved ones. So this is not at all under control."

Liu, the President of Doctors without Borders explains the desperation of the situation in an Ebola treatment center headed by Doctors Without Borders in Monrovia, Liberia's capital.

What is Ebola?

Ebola virus disease, also known as Ebola hemorrhagic fever, is a debilitating illness transmitted to people by animals (such as bats) with a fatality rate of about 50%, but fatality rates have ranged from 25 to 90% in recent outbreaks.  

What needs to be done in order to keep outbreaks under control?

It is important that the community is involved in recognizing the signs and symptoms of Ebola, tracing where someone may have contracted the virus, reliable laboratory services and safe burials.

How do you treat Ebola?

Fluids, fluids, fluids and treatment of symptoms as they arise. Per the WHO, "There are currently no licensed Ebola vaccines but 2 potential candidates are undergoing evaluation." These vaccines have been used in cases with some success.

Where is the Ebola outbreak exactly?

This is the deadliest Ebola outbreak in history. This outbreak is particularly concerning because in the past, Ebola has been confined to small villages near rain forests, but now it is being found in major populated cities like Freetown in Sierra Leone. President Obama recently pledged to do more in terms of sending health care workers to West Africa as well as $$$. The map below outlines the countries affected. Nigeria's outbreak is reportedly under control.












What can I do to help?

Click here ---> FIGHT EBOLA

Volunteers of the United Nations Development Program raise awareness by teaching school children the symptoms of Ebola

"There is still a significant gap between where we are and where we need to be," Obama said. "We know from experience that the response to an outbreak of this magnitude has to be fast, and it has to be sustained. It's a marathon, but you have to run it like a sprint." - President Obama

Do you think people from countries that are known to have active EBOLA outbreaks should be allowed to travel abroad?

Survival 101: Pre-Med

When I first started my journey to medicine I honestly did not know where to begin. Unlike many doctors I know, I did not make the decision to fully pursue medicine until my senior year of college (late, I know).
Being late in the game and having very few friends who were following the MD path made it  even more stressful. Looking back  to my undergrad years there are a few things I probably would have done differently.  Here's a list of things you should consider during your college years to prepare for a career in medicine. In the future we will be discussing surviving medical school, residency, and even fellowship so stay tuned!

Make sure you really want to do this
Being a doctor is tough, period. It takes dedication, sacrifice, physical and mental stamina, and the reality of delayed gratification.I suggest anyone who is interested in medicine to do some soul searching and ask yourself, " Is there anything else I could see myself doing that would make me has happy as medicine would". If not,buckle up, you're in for a ride. Also make sure you are doing it for the right reasons. If it is pressure from family or loved ones, or to make money, you may want to rethink this because personal gratification should ultimately be the goal.

Realize it will be a challenge
One of the hardest parts about preparing for medical school is getting in. Once you're in you've already proven that you have what it takes to face the challenge. Many medical schools also work very hard to make sure students graduate (tutors, additional study aids,etc). However prior to matriculation there may be some obstacles. Don't give up! You may have a bad semester, or topics may not make sense no matter how hard you study, but as an over comer you will be better prepared for the pleasures and pitfalls of medicine.

Be ready for the naysayers
With the constant change of the healthcare system, physician reimbursements being cut every year, and the ever growing rates of med school debt, some feel being a  doctor is not as "glamorous" as it used to be. Many people will ask you
Why do you want to be in that much debt?
Don't you want a life?
Don't you want to actually see your family?
Do you want to be in school forever?

                                    

You may not have all the answers, but if you know in your heart this is what you want to do, then you don't have to explain anything to anyone. Besides, these same people will probably be asking you for medical advice in a few years ;)

 If you have concerns about the future of medicine there are more than enough doctors (including us!) who will tell you what it is really like to be a doctor.

You don't have to be a biology major
In the past, it was thought that biology was the only major that would get you into medical school. However that myth has been debunked, as more nontraditional students are now matriculating into medical school.

Admission commitees don't care what major you do, as long as you have a good MCAT score, and do well in your undergrad courses. The most important thing to consider when choosing a major is whether or not you enjoy the subject matter and will excel at it. Consider a major in the humanities, social sciences, or various health sciences.

 Focus Focus Focus
The hours of studying while your friends are out for Thirsty Thursday, Faded Friday and the rest of the awesome weekend is no fun at all. There were many a day that I watched my friends go out while I had to stay home and study for an OChem or Physics exam. And lets not talk about when I had to prepare for the MCATs. You may feel discouraged and even wonder why you are pursuing this studious life- but remember the end of a matter is better than the beginning.

The era of social media also makes focusing all the more difficult. In order to reach your goal, you may have to deactivate your Facebook or Instagram account to spend time on your goal.

 Find a supportive counselor/mentor
This can not be stressed enough. Having a counselor or administrator who has aided others in getting into medical school will help you navigate the exhaustive work of applications, recommendations, and college courses.
A mentor during medical school is also a valuable resource who can guide you and give you tips on how to succeed in medical school.A mentor should be someone you are close to and can discuss your academic (and sometimes personal) concerns with. Look for someone you admire; someone who you wish to aspire to be like.

Get clinical exposure
This includes shadowing your family physician, volunteering with the medical team at a marathon, volunteering at a hospital or free clinic, even doing a medical missions. Clinical exposure will show that you are invested in your career and are willing to go the extra mile to immerse your self in your career field of choice early on.

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Complete an internship or research
Internships, pre-med summer programs,  and collegiate research are a great way to get more exposure in the medical field. They are also great application boosters. Research will show that you are invested in the sciences as well as interested in not only treating patients but figuring out the hows and whys of health.
Summer programs give a glimpse into the medical life. I participated in the SMDEP (Summer Medical and Dental Education Program) in undergrad and this experience solidified my decision to go to medical school.

RIT has a comprehensive list of programs here

Save Money
Applying to medical school is expensive.  From paying for applications, secondary applications, MCAT review books/courses and traveling for interviews you can easily spend a couple thousand dollars. In college saving money is hard with expenses of daily living, but even if you can put away a couple dollars every month you will be in a better position when you begin the application process.

 Have a life!
College is supposed to be some of the best years of your life. Even as a hard worker and dedicated student, you can still have fun! Don't let those years pass you by without some great memories made.

Extra curricular activities are just as important as your grades. Medical school admissions committees love well rounded students. They are especially interested in your non medical endeavors. Leadership activities will show you have what it takes to take charge in the health care world. Get involved in sports, clubs and societies (and not just the Alpha Omega Alpha Honor Society!). If you are a minority, I suggest getting involved in your local MAPS- Minority Association of Pre-Med Students (MAPS-SNMA) chapter. It is a gateway to numerous resources for education, mentorship, and advocacy.

 Consider other options
 The beauty of college is that it opens your eyes to ideas you may have never known before. Keep an open mind about your future career plans. Take the time to look into other health fields or careers in general; you may surprise yourself by realizing there are other things that interest you or you are good at. I'm not saying to give up on your dream of becoming a doctor, but also recognize that your talents may be vast and many.


Good resources for more information are
PreMed Revolution
PreMed Life

What other pre-med tips do you suggest?

MEDICINE HUMOR!

How I Did It: Physical Therapy

Dr. Bridges Darko is a Doctor of Physical Therapy based in New York City

1) How and why did you choose physical therapy?

Growing up, I did not know anything about physical therapy or dream of becoming one until the late years of my undergraduate studies. My initial dream was to become an electrical/mechanical engineer, accountant or work in the military.  To me this was typical of a kid from South Bronx. As I began my college journey in the fall of 2001, I had no inclination of what major to pursue, so I spent my first two years without declaring a major.

In 2003, I took a year off from school and visited Ghana. Prior to going to Ghana, I cared for my late aunt for two months who was hospitalized at Mount Sinai Hospital in NYC. The experience changed my whole perspective and scope about life and provided me with an opportunity to shift my focus towards the health field. Once I decided to go into the health field, my father who is one of my biggest aspirations advised me to pursue nursing or become a doctor based on the job security, financial stability, and other advantages within these professions. In the process, I reconnected with an old friend whose father was a surgeon and worked for the NFL franchise, The New England Patriots. He encouraged me and offered me a job as a Sports trainer after completion of my studies. I was very driven and inspired to seek an interest in exercise science. 

While in my third year at Morrisville State College, I transferred to the University of Buffalo with the intention of becoming an exercise science major. Upon graduating from Buffalo University, I worked for a non-profit organization in NYC for a year, was unhappy with my job and did not feel connected to my goal and the path that I was determined to pursue, so I applied to graduate school. I was accepted to Russell Sage College School of Physical Therapy in the fall of 2008. These events along with the challenges and obstacles I encountered during my undergraduate studies has contributed to the passion I posses towards helping and serving patients in the field I work in. I strive to provide the best and adequate care, as well support to my patients.

2) What is a typical work day like?

I work an 8hr shift which starts from 8:30am-4:30pm with the elderly population. My schedule usually varies from time to time however, within the last three to four years, I have been working a rotational schedule throughout the hospital and in other departments. The rotation takes place every six to eight months and allows me to gain more exposure and experience. I have had the opportunity to work in the following areas (spinal cord, traumatic brain Injury, pulmonary rehabilitation, orthopedic/amputations, outpatient, skills nursing home and sub-acute/acute setting).  Each department differs in schedule and workday. At the present time, I am working at a skilled nursing home and by far, the experience has been great along with a flexible schedule. I also have private patients that I see after work at their homes about once or twice a week.

3) What is the most and least rewarding aspect of your job?

Being a physical therapist is very rewarding in itself. You get the privilege of working with patients one-on-one and see the progress through treatment as well as getting to know them and see the difference that you make in their lives. Over the years, what has been the most rewarding for me is helping patients to recover and live their daily lives to the best of their ability. The least rewarding part of my job is seeing patients health and mobility decompensate as well as lack of motivation towards getting better.

4) What educational requirements are necessary prior to applying to Physical therapy school?

As with most health professions, anyone applying to physical therapy (PT) school must have an understanding of the sciences, particularly anatomy, biology, physics, physiology and other health sciences. It is important to lay a foundation as early as possible, even starting with advanced science courses in high school. Physical therapy education includes both classroom instruction and clinical experience.  There are a number of schools that offer physical therapy degrees in the NYC tri-state area and other places across the country.

 When considering physical therapy, it is very critical to make sure to take the time to research the schools available to you and determine the ones with the best fit. The key is to ensure that the schools you apply for are accredited. Then complete prerequisite courses for your designated programs. Also, look for opportunities to gain physical therapy experiences and have all of your hours verified by a physical therapist, if required by your designated program. Take the Graduate Record Examination (GRE) at least 6 weeks before the application deadline. (Freshmen-entry students may be required to submit SAT or ACT scores). Request references from appropriate individuals, if required by your designated programs. Arrange for official transcripts from every college/university attended, to be sent to PTCAS or the institution, as required by the programs. Submit the completed application early and before the program's deadline date. Some programs use a rolling admissions process. PTCAS applicants should also review the PTCAS checklist. In order to practice, all physical therapists must receive a graduate degree from an accredited program prior to taking the national licensing exam.  With few exceptions, most programs are on the doctorate degree level.

5) Would you choose this career if you could make this decision again?

 

Yes, I can honestly say that being a physical therapist has tremendously changed my life and given me a purpose. Each day, I meet new patients from diverse cultural and socio-economic backgrounds. I truly enjoy what I do and I can only hope for the best in my future as a physical therapist.  You can also open up your own private practice if you have the means/finances.

6) What do you wish you knew when you were contemplating this career that you know now?

Prior to undergrad, I wished I had more exposure in the field of physical therapy and obtained more course work and understanding of the sciences. Having the foundation in the sciences and biomechanics earlier in high school would have prepared me much better. In addition attending some state schools may have proven to be a less expensive option that private ones, without necessarily compromising on quality.

7) Are there any trends in your career that concern you? What is the future of this field?

Currently there are no trends that concern me. As a matter of fact, physical therapy was among the 10 fastest-growing jobs in November 2012, according to CNNMoney.com and USNEWs 100 best jobs of 2014. Employment for physical therapists is forecast to grow 39 percent from 2012 to 2022, according to the U.S. Bureau of Labor Statistics.  Therefore the future is very promising. However, inspite of its positive outlook, it remains one of the most challenging careers to enter.

8)Career and life balance, is it possible?

It all depends on the department/facility/settings.  Each varies from acute care, rehab/sub-acute rehab, skilled nursing facility, outpatient clinic, school/preschool, wellness/prevention/sports/fitness, home health, hospice, industrial/occupational environments, local/state/federal government and research center. Aside from a full time position at your work place, you can work as much as you want or as little as you want. There are a lot of opportunities to work for extra pay or get paid by the day. It is all up to you and what you hope to accomplish financially.  Overall, many professionals join physical therapy for the great work/life balance and financial stability.

9) Average salaries?

The median annual wage for entry-level physical therapists was $79,860 in 2012, according to the BLS. The best-paid 10 percent of workers in the category made $112,020, while the bottom 10 percent made $55,620. The highest wages are for home health care, consulting positions and per diems, making anywhere from $100,000-125,000. The best-paid physical therapists live in Las Vegas, Nevada, Fairbanks, Alaska, and Jacksonville, Florida. For salary range, 75th percentile makes $92,860, median, about $79,860 and for the 25th percentile, something in the neighborhood of $66,950.

10) Any websites you recommend for more information on physical therapy?

The APTA’s websites and APTA’s centralized application system allows students interested in physical therapy to view school admission requirements. For more information, visit www.ptcas.org.

A.L.S: Amyotrophic Lateral Sclerosis

So you wake up and start doing your #socialmediacrawl while lying in bed. Then you notice a Facebook or Instagram notification about a post you have been tagged in and you realize your time has finally come. You've been nominated for the ALS Ice Bucket Challenge.

    

The ALS Ice Bucket Challenge is a viral charitable act that hit social media in August 2014. Participants are expected to dump a bucket of ice water on themselves and/or donate money towards ALS research. The acute shock of cold as the water hits your body is in theory supposed to mimic some neurological symptoms people with ALS may feel.The challenge has quickly taken social media by storm with several celebrities and politicians taking part.

What exactly is ALS and why is awareness needed? Here's the scoop: 
Amyotrophic (without muscle nourishment/growth) Lateral (nerves and muscles affecting the peripheral body parts- i.e arms, legs) Sclerosis (hardening ), commonly known as Lou Gehrig disease is a neurodegenerative disease which causes muscle degradation and paralysis. It is the most common motor neuron disease and usually presents between the ages of 40-60 years.There is a predominance with the Caucasian race however all races and ethnicities are affected, with more cases occurring in men than women.

Disease occurs when upper and lower motor neurons in the brain and spinal cord begin to dysfunction and are no longer able to send signals to muscles. Muscles are unable to move appropriately, creating atrophy (muscle wasting).

Patients often times initially present with a complaint of muscle weakness. There are three classifications of onset:

• Limb Onset- Symptoms include dropping things out of hands, increased clumsiness,tripping and awkward walking. Signs may be focused to one limb or several limbs.
•  Bulbar Onset- Changes in speech (slurring or quieter voice) and/or difficulty swallowing.
• Respiratory Onset- The muscles which assist with breathing become weak and patients present with difficulty breathing.

These varying symptoms are generalized into the Three D's

Dysarthria- difficult speaking
Dysphagia- difficulty swallowing
Dyspnea- difficulty breathing

Other common symptoms include hyperreflexia, spasticity and fasciculations (involuntary movements of muscles), and muscle cramps.  Some individuals will develop bulbar weakness (weakness of the cranial nerves affecting facial, eye, and mouth movement). 50% of people with ALS will also develop cognitive impairment (memory loss, behavioral changes). Voluntary eye movements are usually the last function to be lost and may often times be used as a way for communication.

 Most patients become wheelchair bound due to loss of function of lower extremities. They also need breathing support including respirators and other breathing mechanisms (non-invasive ventilation) due to loss of function of muscles. Esophageal movement is usually also lost and patients eventually must be fed percutaneously (directly through the stomach). 

 Death usually occurs 3-5 years after symptom onset but there are cases of people living for over 10 years. The majority of  individuals will ultimately succumb to respiratory failure or infection.
 
Management for ALS is largely supportive and includes using medications to relieve symptoms and improve quality of life. Aggressive physical, occupational, and speech therapy is also necessary. Riluzole is the only FDA approved medication that offers possible delay in progression, if only for a few months. However it does not provide physical improvement.

Source

Currently there is not a specific test that can diagnose ALS. Various laboratory testing and imaging must be done to exclude other causes of ALS symptoms first. Other possible causes include brain tumor, muscular injury, HIV, syphilis, and demyelinating disorders.

The process of developing ALS may be multi factorial (genetic and environmental). Many speculations regarding environmental causes include head trauma, diet, and neurotransmitter dysfunction.Several hereditary gene mutations have been identified in families with ALS in multiple members. The most frequent of these mutations has been identified as SOD1 (superoxide dismuatse) on chromosome 21. More information on this gene can be found at The National Institutes for Health Website.


Active research is still being done to find new treatments and a viable cure for ALS. This is where the Ice Bucket Challenge comes in. Monetary funds help with research, public policy and advocacy, and care resources.


More information on local resources and how you can help can be found at  ALS Association
Check out Star Wars' beloved R2D2 risking his life in the Ice Bucket Challenge

                    

Psoriasis

Psoriasis is the most common autoimmune disease in the US, affecting approximately 7.5 million Americans.   It is caused by rapid growth of the cells which make up the top layer of skin, the epidermis. This leads to a constant turnover of cells which creates thick, flaky skin. This chronic genetic condition tends to go away then reoccur (relapse/remit).
The classic look of psoriasis is a red, raised and inflamed patch of skin with silvery linings within. These patches will sometimes bleed upon scratching. Psoriasis is not contagious and is not caused by an infection.

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 Common areas of involvement include the scalp, elbows, behind the ears, gluteul cleft, and around the umbilicus (belly button). Nails can also be affected, growing abnormally and become dysfigured.

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There are numerous speculations as to what causes skin cells to grow and overturn so quickly in psoriasis, however a precise cause has yet to be found. For the most part, psoriasis can be controlled with various treatments, but certain "triggers" may cause a flare. Triggers include personal stress, changes in environment/weather, medication,obesity, and smoking.

Psoriasis can also involve the joints, called psoriatic arthritis. This usually involves multiple joint most often in the fingers and toes. There may also be finger swelling (dactylitis) and inflammation of tendons (tenosynovitis). Psoriatic skin changes usually occur prior to joint involvement, and approximately 30% of people with psoriasis will develop some type on joint involvement.



Psoriasis affects all races and men and women are equally affected. Though not completely understood,it increases an individuals risk of stroke, diabetes, heart disease, and depression.

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Many people often get confused between psoriasis and eczema.Eczema is usually concentrated in areas like behind the knees and in front of elbows. It is often times associated with allergies and asthma.  Eczema skin patches are not as raised as psoriasis plaques and do and not easily bleed when scratched. 

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Though there is no cure for psoriasis, there are treatments which can lessen its severity. These include but are not limited to

•  Biologic Agents- medicines that are given through intravenous infusion
• Topical Steroids- placed on the plaques, these will decrease the inflammation and severity of plaques
• Systemic Treatment- taken either by mouth or via injection, these are used to suppress the immune system
• Phototherapy- involves exposing the affected skin to UV light in the hopes that it will slow the rapid growth of the skin cells.

Your doctor may help you decide which treatment is most appropriate based on the severity of your condition, how many/how large your plaques are, and if you have any other medical conditions that may be affected by treatment. Skin may become resistant to treatment over time so combination therapies (multiple types at once) may have to be used.

There have been a number of alternative/homeopathic remedies that several people with psoriasis claim have helped aleve their discomfort. This includes aloe vera, fish oils, and hydrotherapy. Though there is no scientific research identifying these as plausible therapies, if they help reduce signs and symptoms they can be used with caution. Prior to starting these regimens, consult a physician to go over their pros and cons.

If you are still unsure as to whether or not you have psoriasis or another skin condition, its best to seek medical advice.

For more information on psoriasis visit The National Psoriasis Foundation