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MAXhealth Proudly Welcomes Bradenton Physicians Medical Center To Our Family!!

We are excited to introduce the newest addition to our MAXhealth family: Bradenton Physicians Medical Center!! Dr. Aruna Narasimman, Dr. Werther Marciales, Dr. Shahnaz Ahmed, Dr. Suguna Kona, and Carol Lewis, ARNP, are delighted to continue to serve our community under their new roof. (We fondly refer to them as BPMC, and welcome our patients to do the same!) After much anticipation and hard work by the physicians, staff, families, and many more, we are pleased to welcome our Manatee community to schedule appointments in our beautiful, state-of-the-art, new facilities. Click here to learn more about our physicians! THANK YOU to everyone who helped us to open our doors, and we look forward to having all of our past, present, and future patients visit us in the new office! We are currently accepting new patients! Please call us at 941.357.5550 to schedule an appointment today!

Medical Myths

Do we really need to drink 8 glasses of water daily?  Should everyone be on a daily aspirin or multivitamin?  Medical myths, or half-truths, are just that.  There is no scientific evidence behind these claims.  These myths, for one reason or other, have pervaded and persisted into our popular culture.
We don’t necessarily need to drink a full 8 glasses of water a day.  The majority of fluids we need to stay hydrated are already found in the food and drinks we take in during a typical day.  Too much water can actually be toxic!  We actually use more than 10% of our brains!  Studies show that there are no silent or dormant areas of brain activity.  Not everyone should be on a daily aspirin.  Aspirin benefits those who have known cardiovascular disease, but not for those who are generally healthy.  The risks of bleeding can actually outweigh the benefits.   Daily multivitamin or supplements only benefit those with a true vitamin deficiency (B12, folate, iron, Vitamin D), osteoporotic, and pregnant patients.  A daily multivitamin has not been shown to prevent chronic disease.  Too much supplementation can actually be harmful, as extra vitamin E can actually increase prostate cancer risk.
Some physicians, when queried, even believe some of these myths to be true and are espousing the messages to their patients.  Albeit, the majority of the myths are harmless, we as physicians and educators owe it to our patients to provide the best evidence based medicine.

Breast Cancer Second Opinion

Should A Second Pathology Opinion Be Standard Practice In The Management Of Node Negative Breast Cancer? Kennecke, et al from the British Columbia Cancer Agency report their experience with secondary pathology review of breast tissue and evaluable nodes from patients diagnosed with node-negative or carcinoma-in-situ in the June 20th issue of the Journal of Clinical Oncology.

In this study, 45% of over 900 eligible patients had pathology specimens submitted for a second opinion. A total of 102 pathology changes were made in 81 patients. Not surprisingly, the majority (66%) of changes were of nuclear grade or lymphovascular invasion status. However,
of greater importance for potential change in treatment plan, nodal status was changed in 15% and margin status in 12% of cases.

The authors make the important point that the issues addressed by pathology review are complemented by molecular studies such as Oncotype Dx. For the majority of patients with lymph node negative disease, it is my view that the availability of molecular prediction models,
without question, has made a larger impact on clinical decision making then pathology second opinions.

The reported discordance between primary and secondary pathology review is not surprising and is consistent with other similar publications in the area of breast cancer. From prior clinical experience in cooperative group studies requiring centralized pathology review, a similar rate of discordance has been noted with other malignancies in particular lymphoma.

This article from the Journal of Clinical Oncology and the accompanying editorial make the valid point that second opinions on all pathology specimens are not practical for a number of reasons. However, the subgroup of patients with node negative breast cancer, in particular, may well benefit from secondary review.

Targeted Therapy in Melanoma

The most common skin cancers in the Western world are basal cell carcinoma, squamous cell carcinoma, and melanoma. Melanoma is the least common and the most dangerous. Until recently, treatment options for melanoma have been limited to surgery, chemotherapy, biotherapy with the use of alpha interferon and interleukin-2, and, under special circumstances, radiation therapy.

More recently, an oral agent has been approved for treatment of patients with metastatic melanoma. The medical literature suggests that approximately 50-60% of patients with metastatic melanoma have tumors that have a point mutation (71799A) in the BRAF proto-oncogene that selects for response to selective BRAF inhibitors. Of interest in our oncology population here in Sarasota, Florida, BRAF mutation in melanoma, thus far, appears to be the exception (the average patient age is 80 years old) rather than the rule. In our clinical practice, in an older patient population of limited size, it appears that BRAF mutations in melanoma may be a great deal less common, and needs further investigation. We are currently exploring the possibility of a retrospective data mining analysis to answer this question.

Unfortunately, the majority of patients with BRAF mutation-positive metastatic melanoma appear to develop drug resistance. Research is currently underway to understand, and possibly exploit, the molecular mechanisms of resistance to BRAF inhibitors.

Coffee Consumption Lowers Mortality

Yes, I had to do a double take when I read that headline.  I enjoy my latte just as much as the next person and the idea that drinking coffee would lessen my risk for dying…well I had to investigate.

In the May edition of the New England Journal of Medicine, the largest study about coffee and its health benefits concluded that there was an inverse relationship between coffee consumption and total mortality.  Between 1985 and 2008, as a part of the National Institute of Health-AARP Diet and Health Study, 230,000 men and 173,000 women participated.  Ages ranged from 50-71 years and those with cancer, stroke, and heart disease were excluded.

Initially, the researchers found that coffee actually increases mortality.  It was thought that those that drink coffee were probably more likely to smoke, not exercise, and eat less healthy.  After adjusting for these confounders, a truly different picture emerged.
Men and women who drank 6 or  more cups of coffee daily had a 10% and 15% decrease in their risk for death respectively compared with those who drank no coffee.  Specifically the association was seen for deaths associated with heart disease, diabetes, respiratory illnesses, infections, injuries, and accidents but not for cancer.

So, what do we make of that data?  First the study was observational meaning no direct cause and effect relationship can be totally linked.  Maybe it means that if we are already nonsmokers, exercise, and eat right, that coffee probably does not have an adverse effect on our health.
I am quite hesitant to recommend 6 or more cups of coffee to my patients.  It can raise blood pressure, possibly increase LDL ‘bad cholesterol’, exacerbate or even initiate cardiac arrhythmias, irritate GERD, and keep you up way past your bedtime.  Having said all this, I think I’ll keep my coffee consumption about the same, exercise when I can, and try to not overindulge in too many sweets.  If that helps me live longer, that’s definitely a plus.

Drug Shortages

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Drug Shortages – Is It Time For The Federal Government To Produce Generic Drugs?

Recently, there has been widespread media coverage of nationwide drug shortages involving a significant number of commonly used pharmaceuticals, ranging from drugs routinely used in the operating room, to medications used to treat bleeding disorders, neurological, and psychological disorders, as well as cancer. As a hematologist/medical oncologist, I have been particularly disturbed by the widespread and prolonged unavailability of commonly used chemotherapy and support drugs.

American Medical News (amed.com/government) recently reported that, according to the American Society of Health-System Pharmacists, there is currently a national shortage of over 200 drugs. Updates on the status of these drugs are available on the following websites: www.ashp.org (The American Society of Health-System Pharmacists) or www.fda.gov (The Food and Drug Administration). These sites provide information about which drugs are in short supply, the reason for the shortage, and, possibly, an estimated release date. Updates are noted; daily updates from the FDA will be provided upon request.

There is no question that a large number of important pharmaceutical agents are in critically short supply. It is also quite clear that many of the drugs that have been difficult to obtain are generic drugs that have been around for years.
On April 18, 2012, the House Energy and Commerce Health Subcommittee began holding hearings on the issue. A major point of discussion during these hearings was the reauthorization of The Prescription Drug User Fee Act (PDUFA), which was a law passed by the United States Congress in 1992 allowing the Food and Drug Administration (FDA) to collect fees from drug manufacturers to fund the new drug approval process. This was discussed as a potential solution to the current, ongoing problem of pharmaceutical drug shortages.

It is my opinion that if the domestic pharmaceutical industry, in cooperation with the FDA, cannot improve the ongoing situation with drug shortages, the federal government should strongly consider manufacturing, distributing, and selling these pharmaceuticals itself. It is also my strong opinion that we should not rely on foreign-produced pharmaceuticals due to concerns regarding drug pedigree, quality control, and drug counterfeiting. The lack of available generic drugs also places a financial strain on our already stressed national health system. In addition, this drug shortage poses a real threat to our national security if we are unable to assure a dependable, safe supply of pharmaceuticals for the United States.

This article was submitted by Dr. Steve Mamus of the Cancer Center of Sarasota-Manatee. Please contact us for more information.

Suncoast Sun Protection

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Summertime is upon us on the Suncoast, and while the surge of endorphins and “healthy” glow that result from basking in the sun might make us feel good, we all need to be wary of the negative effects of excessive exposure to the sun (wrinkles, age spots, skin cancer, to name a few), and be armed with the best defenses to prevent them.

• Sunscreen

Many of us use a moisturizer that contains a low level of SPF. Though this is good for everyday protection, we all need a stronger shield for those days spent at Siesta Key or Lido, or even at the golf course. For prolonged sun exposure, use a sunscreen that is at least SPF 30, and reapply periodically, especially after swimming or sweating.

Protective Accessories

While sunscreen is a great first line of defense, we inevitably miss spots, and often don’t even realize others are being exposed to UV rays (i.e. through our t-shirts). Consider investing in a few pieces of sun protective clothing that can offer up to UPF 50, always keep your wide brimmed hat on hand, and, of course, sport your sunglasses at all times.

• If You Do Get Burned…
Though we try to avoid it, we all have our moments! In the event of that dreaded sunburn, use a moisturizer containing aloe and apply a cold compress to alleviate the burning sensation. As a cautionary measure, be sure to fill up on foods and beverages containing antioxidants to help prevent free radical damage to skin cells.

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