If you're living with a chronic illness, you're in the right place.

Wednesday, April 30, 2014

In the Spotlight: Pancreatic Cancer

5:55 AM Posted by Tiffany Taft , ,
This month for our "Rare Diseases" topic we're going to discuss pancreatic cancer (PC).  While not as unheard of as other conditions that we'll be covering, this cancer is still a relatively rare (thankfully) diagnosis.  There have been some high profile people diagnosed with PC in the past several years, including Patrick Swayze, Supreme Court Justice Ruth Bader Ginsberg, and Steve Jobs.  However, compared to lung cancer which has over 200,000 new cases per year, PC rates are closer to 40,000 per year.


Snapshot:  Pancreatic cancer is a rare but comes with a poor prognosis for most people who receive the diagnosis. Men are 30% more likely to get PC than women, and it is most common over the age of 60 (under 40 is rare). PC is the 4th leading cause of cancer-related death in the United States.  One-year survival rates are approximately 25%; however 80% of people living with PC are diagnosed late, after the cancer has advanced or metastasized (moved to other parts of the body, usually the nearby lymph nodes or liver), giving them a poor prognosis with an average 6 to 10 month survival rate. There are several risk factors for developing PC including having a family history, being older, smoking, poor diet, obesity, or having type 2 diabetes.

What is It?
Symptoms tend to vary, depending on where the cancer is located, its size, and type of tissue that is affected. These may include abdominal pain, lower back pain, and jaundice (yellowing of the skin and eyes), weight loss, and other digestive problems.  These vague, and relatively common symptoms, make PC difficult to diagnose and patients may not seek medical treatment, or are told they have some other benign condition to explain their symptoms, which gives the cancer time to grow.  Some people will experience pancreatitis (inflammation of the pancreas) prior to developing PC.

How Common is It?
In 2010, approximately 43,000 people in the United States were diagnosed with PC (or .01% of the population).

What About Diagnosis and Treatment?
Pancreatic cancer is often diagnosed by blood tests and imaging studies.  Liver enzyme tests may show abnormalities.  CT scans, ultrasounds, and needle biopsies all can diagnose PC.  Approximately 85% of patients present to their doctor with left-upper abdominal pain, that may radiate to the back, and is usually made worse by eating.

Treatment varies depending on the stage and location of the cancer. Surgery can be used for localized PC, however this is only the case for about 20% of patients.  A procedure called the "Whipple Procedure" is commonly used to treat PC affecting the head of the pancreas while a "Distal Pancreatectomy" is used when the cancer affects the tail end.  After surgery, the majority of patients have chemotherapy as additional treatment.  For the 80% of patients where surgery is not an option, chemotherapy and/or radiation are the standard treatments. Unfortunately, chemotherapy doesn't tend to cure PC rather provides some relief for the patient and improves quality of life. Radiation has similar uses and outcomes.  Palliative care, or treatment that focuses on the relief of pain, symptoms and stress brought on by PC, is most commonly used once active treatment is over.

What is the Social and Emotional Impact?
A cancer diagnosis is devastating for anyone. Since the prognosis for most people diagnosed with PC is so poor, the social and emotional impact is significant.  Some research shows that depression may be present prior to a PC diagnosis, although this relationship is not clear. In a 2010 study that compared PC to other cancer diagnoses, patients with PC reported much higher rates of depression (29% compared to 18%) than people living with lung, skin, and other cancers.  Men also experienced much more depression than women (34% versus 23%). When compared to people with stomach cancer, PC patients report significantly more tension, anxiety, fatigue, confusion, bewilderment, and overall poorer mood.

Thoughts about death and dying, and other existential issues, are common in people living with PC - especially if their prognosis is poor.  Because survival rates are typically under 1 year, patients must face an often overwhelming level of emotions in a relatively short period of time. Brief psychotherapy (ie, fewer than six sessions) and cognitive behavioral therapy can to be beneficial for patients undergoing palliative care by addressing depressive symptoms, anxiety, and adjustment to their illness.

Helpful Resources:
National Cancer Institute Pancreatic Cancer Page
Pancreatic Cancer Action Network (PANCAN)
American Cancer Society Pancreatic Cancer Page
Michael Rolfe Pancreatic Cancer Foundation

One More Thing...
I personally know of someone who has died because of pancreatic cancer, which is part of the reason I chose to write about PC for this month's entry.  Dr. Eric Van Denburg was my clinical training director while I was at the Jesse Brown VA Medical Center as part of my graduate training in psychology in 2009.  In 2011, Eric was diagnosed with and passed away from advanced pancreatic cancer.  He was a pivotal part of my training to be a psychologist, and I'm sure the hundreds of other trainees and thousands of veterans he served would also sing his praises.  I've joined his daughter Alysa's team to run the Michael Rolfe Foundation Pancreatic Cancer 5K this coming Memorial Day weekend.  Here's more information on Eric, his team, and the organization if you're interested.

Team Eric's Page

Best,
Dr. T.

Sunday, April 13, 2014

IBS Awareness Month 2014

5:02 AM Posted by Tiffany Taft , , ,
Every April is IBS Awareness Month, and we're half way through already.  You may have heard of Irritable Bowel Syndrome before, a relatively common condition that affects around 15% of the U.S. population and 7-10% of the global population.  Even though IBS is common, there's still a lot of misinformation out there about it; partly because the medical community itself still hasn't really figured out IBS, and partly because of stigma related to conditions that affect our poop.


IBS is a chronic condition of the digestive tract that causes abdominal pain, bloating, altered bowel habits (constipation, diarrhea, or altering back and forth between these two), fatigue, and nausea.  Once considered a diagnosis of exclusion - aka you were told you have IBS when they ruled out other things like Inflammatory Bowel Disease (IBD), colon cancer, or diverticulitis - there are now set diagnostic criteria for IBS known as the Rome III criteria.
Rome III Criteria for IBS
I've seen a lot of people living with IBS.  My first research studies were on IBS, including the aforementioned stigma, and I've been involved in a large, multicenter clinical trial using cognitive-behavioral therapy to treat IBS.  So I've heard a lot of stories about life with this chronic illness from all sorts of people, enough to know that while IBS is a "functional" condition, its potential for being severe and debilitating should never be undermined.  I'm not going to get into the physiology of IBS right now as this is an emerging field of understanding.  However, the predominant theory of IBS is that the brain-gut axis malfunctions and results in the functioning of the digestive tract to be thrown into a tizzy (technical term).  Why this happens is unclear, and some patients struggle with the nebulous nature of IBS.  Combined with a lack of good pharmacological treatments, IBS can be a downright maddening condition.

So what are some of the facts about IBS?  Let's learn.  Because I'm a research nerd, here are some factoids about IBS.  There's a test next Tuesday.
  • IBS results in a $20 billion economic burden, annually.  This is both from direct medical costs and lost work productivity.  This is also second only to the common cold.
  • Women are 1.5 times more likely to have IBS than men.
  • While not part of the Rome III criteria, 76% of people with IBS report abdominal bloating as a symptom.
  • Our digestive systems have their own nervous system, called the enteric nervous system, which contains 95% of the body's serotonin. Serotonin is a chemical in the body that's implicated in mood and an overproduction of serotonin can cause IBS with diarrhea while too little can cause IBS with constipation.
  • People with IBS with constipation spend around $11,000 annual on health care costs related to their condition, compared to $4,800 for healthy controls  Of that $11,000, 78% is for medical services and 22% for prescription medication.
  • People with IBS feel to a greater degree processes such as hunger, fullness, passage of food, and bowel sounds than those without the condition, and this hypersensitivity is thought to be a main contributor to abdominal pain in IBS.
  • In a study in Canada, people with IBS reported 5.6% work absenteeism, 31.4% presenteeism (being at work but not really working), and 34.6% overall work productivity loss, which is equivalent to 13.8 hours lost productivity per 40-hour workweek.  Similar findings occur in the U.S.
  • Many people with IBS report a negative effect on their mood, with 30% experiencing significant anxiety, 28% reporting depression, and 15% having panic disorder.  
  • Finally, IBS and IBD are not interchangeable terms.  I don't know how many times I've seen "Irritable Bowel Disease" and "Inflammatory Bowel Syndrome" out there, including on reputable news websites.  Yes, they're both diseases of the digestive tract with similar symptoms but very different physiology and treatments.  

Monday, April 7, 2014

Happy Stress Awareness Month!

2:46 PM Posted by Stephanie Horgan , , , ,
I haven’t blogged in a while (I’ve been stressed!) and realized that it is Stress Awareness Month.  I am not sure how widely it is recognized, but according to one organization, the effort has been taking place for 22 years. After such a long and harsh winter here in Chicago, I have noticed a large influx of new client referrals. People seem to be hitting their breaking point. Some manifest with depression, some with anxiety, and all are facing stress.
 
Stress is a part of life and something we can’t avoid, at least not for very long. According to the Mayo Clinic, some of the common effects of stress include headache, muscle tension, chest pain, fatigue, change in sex drive, upset stomach, and sleep problems. If left untreated, stress can contribute to obesity, diabetes, high blood pressure, and heart disease. We learn a lot about our bodies when we are stressed. Do you know where you hold stress in your body? If not, I encourage you to do a short body scan exercise and see where you feel tension.

Stress can resemble a chronic illness sometimes. There is no “cure.” A person experiencing extreme sterss can also have periods during which the symptoms get worse or improve. Just as we need to be proactive about managing our chronic illnesses, it pays to be proactive about stress reduction. I recently found out about an app for smartphones called Mindfulness. It is a tool I have started using personally and professionally in sessions with clients. It is so simple, yet profound. Just by spending three minutes with a guided meditation, it can calm the mind, slow your heart rate, and help bring some stillness into the room. You can choose from various lengths of guided meditations from three minutes up to thirty minutes. As with physical exercise, the more time you put in, the better you may feel. Even adding a few minutes of meditation before bed can make a huge difference in your sleep quality and daily mental health.
I have blogged before about a Stress Toolbox, and I encourage each client of mine-- and anyone dealing with stress-- to make a list of activities that help them combat stress. When we are stressed, decision-making skills can go out the window, so it is helpful to have a physical list to reference. The list should have a variety of activities. For example, include some that are free or low cost, add some that can be done alone, and some that can be done with other people. Vary the level of activity required-- you might have activites that can be done laying down, and others that require you to be active. Here are some questions to ask yourself when making a relaxation list:

What do I like to do on vacation?
What activities recharge me after a long day?
What is pleasing to all five of my senses? (Touch, Sight, Taste, Hear, Smell)
Which friends do I turn to for my various needs?

I would love to hear your lists if you are open to sharing! I am always looking for good things to add to mine. And I wish you a happy, healthy April, full of relaxation despite the unpredictable weather.