Colonoscopy

Colonoscopy is a procedure that enables an examiner (usually a gastroenterologist) to evaluate the appearance of the inside of the colon (large bowel). This is accomplished by inserting a flexible tube that is about the thickness of a finger into the anus, and then advancing it slowly, under visual control, into the rectum and through the colon. It is performed with the visual control of either looking through the instrument or with viewing a TV monitor.

Why is colonoscopy done?

This test may be done for a variety of reasons. Most often it is done to investigate the finding of blood in the stool, abdominal pain, diarrhea, a change in the bowel habits, or an abnormality found on colon x- ray or a CT scan. Certain individuals with previous history of polyps or colon cancer and certain individuals with family history of particular malignancies or colon problems may be advised to have periodic colonoscopies because they are at a greater risk of polyps or colon cancer.

What bowel preparation is needed for colonoscopy?

If the procedure is to be complete and accurate, the colon must be completely clean. Patients are given detailed instructions about the cleansing of the colon procedure. In general this consists of a large volume of a special cleansing solution or several days of a clear liquid diet and laxatives or enemas prior to the examination. These instructions should be followed to the letter or the procedure may be unsatisfactory and have to be repeated later or a less accurate alternative chosen in its place.

What about current medications or diet before colonoscopy?

Most medications should be continued as usual, but some may interfere with the examination. It is best that the physician is informed of all current prescription or over the counter medications. Aspirin products, blood thinners (Coumadin, etc.), arthritis medications, insulin, and iron preparations are examples of medications that may require special instructions. The physician will also want to be aware of the patient's allergies and any other major illnesses. The examiner should be alerted if, in the past, patients have required antibiotics prior to surgical or dental procedures. Instructions may also be given to avoid certain foods for a couple of days prior to the procedure, such as stringy foods, foods with seeds, or red Jello.

What to expect during colonoscopy?

Prior to the procedure an IV is started and the patient is given a monitor for continuous monitoring of the heart, blood pressure, and oxygenation of the blood. Medication is often given through the vein to make the patient sleepy and relaxed. If needed, the patient may receive additional doses during the procedure. Colonoscopy often gives a feeling of pressure, cramping, and bloating, however, with the aid of the medication it is generally well tolerated and rarely causes any significant pain.

Patients will be lying on their left side or back as the instrument is slowly advanced. Once the tip of the colon, or the last portion of the small bowel, is reached the colonoscope is slowly withdrawn and the lining is again carefully examined. The procedure usually takes 15 to 60 minutes. If the entire colon, for some reason, can not be visualized, the physician may decide to try it at a later date with a better bowel preparation or may decide to order an x-ray of the colon.

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Ultrasound

What is an ultrasound?

An ultrasound test is a radiology technique, which uses high- frequency sound waves to produce images of the organs and structures of the body.

The sound waves are sent through body tissues with a device called a transducer. The transducer is placed directly on top of the skin, which has a gel applied to the surface. The sound waves that are sent by the transducer through the body are then reflected by internal structures as "echoes." These echoes return to the transducer and are transmitted electrically onto a viewing monitor. The echo images are then recorded on a plane film and can also be recorded on videotape. After the ultrasound, the gel is easily wiped off.

The technical term for ultrasound testing and recording is "sonography." Ultrasound testing is painless and harmless. Ultrasound tests involve no radiation and studies have not revealed any adverse effects.

For what purposes are ultrasounds performed?

Ultrasound examinations can be used in various areas of the body for a variety of purposes. These purposes include examination of the chest, abdomen, blood vessels (such as to detect blood clots in leg veins) and the evaluation of pregnancy. In the chest, ultrasound can be used to obtain detailed images of the size and function of the heart. Ultrasound can detect abnormalities of the heart valves, such as mitral valve prolapse, aortic stenosis, and infection (endocarditis). Ultrasound is commonly used to guide fluid withdrawal (aspiration) from the chest, lungs, or around the heart. Ultrasound is also commonly used to examine internal structures of the abdomen. Gallstones in the gallbladder are easily detected, as are kidney stones. The size and structure of the kidneys, the ureters, liver, spleen, pancreas, and aorta within the abdomen can be examined. Ultrasound can detect fluid, cysts, tumors or abscess in the abdomen or liver. Impaired blood flow from clots or arteriosclerosis in the legs can be detected by ultrasound. Aneurysms of the aorta can also be seen. Ultrasound is also commonly used to evaluate the structure of the thyroid gland in the neck.

During pregnancy, an ultrasound can be used to evaluate the size, gender, movement, and position of the growing baby. The baby's heart is usually visible early, and as the baby ages, body motion becomes more apparent. The baby can often be visualized by the mother during the ultrasound, and the gender of the baby is sometimes detectable.
How do patients prepare for an ultrasound?

Preparation for ultrasound is minimal. Generally, if internal organs such as the gallbladder are to be examined, patients are requested to avoid eating and drinking with the exception of water for six to eight hours prior to the examination. This is because food causes gallbladder contraction, minimizing the size, which would be visible during the ultrasound. In preparation for examination of the baby and womb during pregnancy, it is recommended that mothers drink at least four to six glasses of water approximately one to two hours prior to the examination for the purpose of filling the bladder. The extra fluid in the bladder moves air-filled bowel loops away from the womb so that the baby and womb are more visible during the ultrasound test.

How are results transmitted to the patient and doctor?

The ultrasound is generally performed by a technician. The technician will notice preliminary structures and may point out several of these structures during the examination. The official reading of the ultrasound is given by a radiologist, a physician who is an expert at interpreting ultrasound images. The radiologist records the interpretation and transmits it to the practitioner requesting the test. Occasionally, during the ultrasound test the radiologist will ask questions of the patient and/or perform an examination in order to further define the purpose for which the test is ordered or to clarify preliminary findings. Plain x-rays might be ordered to further evaluate early findings. A summary of results of all of the above is reported to the practitioner who requested the ultrasound. They then are discussed with the patient in the context of overall health status.

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Chemotherapy

Take care of yourself

How can you take care of yourself during chemotherapy? You can eat the right foods to build up your strength. Stay away from people who have colds or the flu. Get the rest you need and pace yourself. Talk about your feelings to deal with any sadness, anger, or fear you may have. Work as a team with your health care providers. Knowing how to help yourself can make you feel more in control. These are just a few of the ways that you can help yourself and begin to feel in control again.

This information is designed to help you become an informed partner in your care, but it is only a guide. Self-help can never take the place of professional health care. Ask your doctor and nurse any questions you may have about chemotherapy. Also don't hesitate to tell them about any side effects you may have. They want and need to know.

Understanding chemotherapy

What is chemotherapy?

Chemotherapy is the treatment of cancer with drugs that can destroy cancer cells. These drugs often are called "anticancer" drugs.

How Does Chemotherapy Work?

Normal cells grow and die in a controlled way. When cancer occurs, cells in the body that are not normal keep dividing and forming more cells without control. Anticancer drugs destroy cancer cells by stopping them from growing or multiplying. Healthy cells can also be harmed, especially those that divide quickly. Harm to healthy cells is what causes side effects. These cells usually repair themselves after chemotherapy.

Because some drugs work better together than alone, two or more drugs are often given at the same time. This is called combination chemotherapy.

Other types of drugs may be used to treat your cancer. These may include certain drugs that can block the effect of your body's hormones. Or doctors may use biological therapy, which is treatment with substances that boost the body's own immune system against cancer. Your body usually makes these substances in small amounts to fight cancer and other diseases. These substances can be made in the laboratory and given to patients to destroy cancer cells or change the way the body reacts to a tumor. They may also help the body repair or make new cells destroyed by chemotherapy.

What Can Chemotherapy Do?

Depending on the type of cancer and how advanced it is, chemotherapy can be used for different goals:

* To cure the cancer. Cancer is considered cured when the patient remains free of evidence of cancer cells.
* To control the cancer. This is done by keeping the cancer from spreading; slowing the cancer's growth; and killing cancer cells that may have spread to other parts of the body from the original tumor.
* To relieve symptoms that the cancer may cause. Relieving symptoms such as pain can help patients live more comfortably.

Is Chemotherapy Used With Other Treatments?

Sometimes chemotherapy is the only treatment a patient receives. More often, however, chemotherapy is used in addition to surgery, radiation therapy, and/or biological therapy to:

* Shrink a tumor before surgery or radiation therapy. This is called neo-adjuvant therapy.
* Help destroy any cancer cells that may remain after surgery and/or radiation therapy. This is called adjuvant chemotherapy.
* Make radiation therapy and biological therapy work better.
* Help destroy cancer if it recurs or has spread to other parts of the body from the original tumor.
Which Drugs Are Given?

Some chemotherapy drugs are used for many different types of cancer, while others might be used for just one or two types of cancer. Your doctor recommends a treatment plan based on:

* What kind of cancer you have.
* What part of the body the cancer is found.
* The effect of cancer on your normal body functions.
* Your general health.

What About Clinical Trials?

Clinical trials, also called cancer treatment studies or research studies, test new treatments in people with cancer. Clinical trials test many types of treatments such as new drugs, new approaches to surgery or radiation therapy, new combinations of treatments, or new methods such as gene therapy. The goal of this research is to find better ways to treat cancer and help cancer patients. There are different types of clinical trials, called Phase I, Phase II, and Phase III trials. Each is one of the final stages of a long and careful cancer research process. If your doctor does not suggest you take part in a clinical trial, you may want to ask about clinical trials as a treatment choice for you.

Possible benefits of clinical trials include:

* Clinical trials offer high-quality cancer care.
* If a new treatment approach is proven to work and you are taking it, you may be among the first to benefit.
* By looking at the pros and cons of clinical trials and other treatment choices, you are taking an active role in a decision that affects your life.
* You have the chance to help others and improve cancer treatment.

Possible drawbacks:

* New treatments under study are not always better than, or even as good as, standard treatment.
* Even if a new treatment has benefits, it may not work for you.
* In a study, if you are randomly assigned to have standard treatment instead of the new treatment being tested, it may not be as effective as the new approach.
* Health insurance and managed care providers do not always cover all patient care costs in a study.

Before deciding to join a clinical trial you will want to ask important questions such as: What are the possible short- and long-term risks, side effects, and benefits to me? How could the study affect my daily life? Will I have to pay for any treatment, tests, or other charges?

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Antinuclear Antibody Test

What are antinuclear antibodies?
We normally have antibodies in our blood that repel invaders into our body, such as virus and bacteria microbes. Antinuclear antibodies (ANAs) are unusual antibodies, detectable in the blood

that have the capability of binding to certain structures within the nucleus of the cells. The nucleus is the innermost core within the body's cells and contains the DNA, the primary genetic material. ANAs are found in patients whose immune system may be predisposed to cause inflammation against their own body tissues. Antibodies that are directed against one's own tissues are referred to as auto-antibodies. The propensity for the immune system to work against its own body is referred to as autoimmunity. ANAs indicate the possible presence of autoimmunity and provide, therefore, an indication for doctors to consider the possibility of autoimmune illness.

How is the ANA test designed? What is it for?

The ANA test was designed by Dr. George Friou in 1957. The ANA test is performed using a blood sample. The antibodies in the serum of the blood are exposed in the laboratory to cells. It is then determined whether or not antibodies are present that react to various parts of the nucleus of cells. Thus, the term anti-"nuclear" antibody. Fluorescence techniques are frequently used to actually detect the antibodies in the cells, thus ANA testing is sometimes referred to as fluorescent antinuclear antibody test (FANA). The ANA test is a sensitive screening test used to detect autoimmune diseases.
What are autoimmune diseases?

Autoimmune diseases are conditions in which there is a disorder of the immune system characterized by the abnormal production of antibodies (auto-antibodies) directed against the tissues of the body. Autoimmune diseases typically feature inflammation of various tissues of the body. ANAs are found in patients with a number of different autoimmune diseases, such as systemic lupus erythematosus, Sjogren's syndrome, rheumatoid arthritis, polymyositis, scleroderma, Hashimoto's thyroiditis, juvenile diabetes mellitus, Addison disease, vitiligo, pernicious anemia, glomerulonephritis, and pulmonary fibrosis. ANAs can also be found in patients with conditions that are not considered classic autoimmune diseases, such as chronic infections and cancer.

What other conditions cause ANAs to be produced?

ANAs can be produced in patients with infections (virus or bacteria), lung diseases (primary pulmonary fibrosis, pulmonary hypertension), gastrointestinal diseases (ulcerative colitis, Crohn's disease, primary biliary cirrhosis, alcoholic liver disease), hormonal diseases (Hashimoto's autoimmune thyroiditis, Grave's disease), blood diseases (idiopathic thrombocytopenic purpura, hemolytic anemia), cancers (melanoma, breast, lung, kidney, ovarian and others), skin diseases (psoriasis, pemphigus), as well as in the elderly and those people with a family history of rheumatic diseases.
Can medications cause ANAs to be produced?

Many medications can sometimes stimulate the production of ANAs, including procainamide (Procan SR), hydralazine, and dilantin. ANAs that are stimulated by medication are referred to as drug-induced ANAs. This does not necessary mean that any disease is present when these ANAs are "induced." Sometimes diseases are associated with these ANAs, and they are referred to as drug-induced diseases.

ANAs are defined in certain patterns. What does this mean?

ANAs present different "patterns" depending on the staining of the cell nucleus in the laboratory: homogeneous or diffuse; speckled; nucleolar; and peripheral or rim. While these patterns are not specific for any one illness, certain illnesses can more frequently be associated with one pattern or another. The patterns then can sometimes give the doctor further clues as to types of illnesses to look for in evaluating a patient. For example, the nucleolar pattern is more commonly seen in the disease scleroderma. The speckled pattern is seen in many conditions and in people who do not have any autoimmune disease.

Are ANAs always associated with illness?

No. ANAs can be found in approximately 5% of the normal population, usually in low titers (low levels). These people usually have no disease. Titers of lower than 1:80 are less likely to be significant. (ANA titers of less than or equal to 1:40 are considered negative.) Even higher titers are often insignificant in patients over 60 years of age. Ultimately, the ANA result must be interpreted in the specific context of an individual patient's symptoms and other test results. It may or may not be significant in a given individual.

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Complete Blood Count

What is the complete blood count test?

The complete blood count is the calculation of the cellular (formed elements) of blood. These calculations are generally determined by specially designed machines that analyze the different components of blood in less than a minute.

A major portion of the complete blood count is the measure of the concentration of white blood cells, red blood cells, and platelets in the blood. The complete blood count (also called CBC) is generated by testing a simple blood sample.

What are values for a complete blood count?

The values generally included are the following:

* White blood cell count (WBC). The number of white blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4,300 and 10,800 cells per cubic millimeter (cmm). This can also be referred to as the leukocyte count and can be expressed in international units as 4.3 - 10.8 x 109 cells per liter.

* Automated white cell differential. A machine generated percentage of the different types of white blood cells, usually split into granulocytes, lymphocytes, monocytes, eosinophils, and basophils.

* Red cell count (RBC). The number of red blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4.2 - 5.9 million cells/cmm. This can also be referred to as the erythrocyte count and can be expressed in international units as 4.2 - 5.9 x 1012 cells per liter.


# Hemoglobin (Hb). The amount of hemoglobin in a volume of blood. Hemoglobin is the protein molecule within red blood cells that carries oxygen and gives blood its red color. Normal range for hemoglobin is different between the sexes and is approximately 13 - 18 grams per deciliter for men and 12 - 16 for women (international units 8.1 - 11.2 millimoles/liter for men, 7.4 - 9.9 for women).

# Hematocrit (Hct). The ratio of the volume of red cells to the volume of whole blood. Normal range for hematocrit is different between the sexes and is approximately 45 - 52% for men and 37 - 48% for women.

# Mean cell volume (MCV). The average volume of a red cell. This is a calculated value derived from the hematocrit and red cell count. Normal range is 86 - 98 femtoliters.

# Mean cell hemoglobin (MCH). The average amount of hemoglobin in the average red cell. This is a calculated value derived from the measurement of hemoglobin and the red cell count. Normal range is 27 - 32 picograms.

# Mean cell hemoglobin concentration (MCHC). The average concentration of hemoglobin in a given volume of red cells. This is a calculated volume derived from the hemoglobin measurement and the hematocrit. Normal range is 32 - 36%.

# Red cell distribution width (RDW). A measurement of the variability of red cell size. Higher numbers indicate greater variation in size. Normal range is 11 - 15.

# Platelet count. The number of platelets in a volume blood. Platelets are not complete cells, but actually fragments of cytoplasm from a cell found in the bone marrow called a megakaryocyte. Platelets play a vital role in blood clotting. Normal range varies slightly between laboratories but is in the range of 150,000 - 400,000/ cmm (150 - 400 x 109/liter).

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Hemoglobin

What is hemoglobin?

Hemoglobin is the protein molecule in red blood cells that carries oxygen from the lungs to the body's tissues and returns carbon dioxide from the tissues to the lungs. The iron contained in hemoglobin is responsible for the red color of blood.

How is hemoglobin measured?

Several methods exist for measuring hemoglobin, most of which are done currently by automated machines designed to perform several different tests on blood. Within the machine, the red blood cells are broken down to get the hemoglobin into a solution. The free hemoglobin is exposed to a chemical containing cyanide which binds tightly with the hemoglobin molecule to form cyanmethemoglobin. By shining a light through the solution and measuring how much light is absorbed (specifically at a wavelength of 540 nanometers), the amount of hemoglobin can be determined.

What are normal hemoglobin values?

The hemoglobin level is expressed as the amount of hemoglobin in grams (gm) per deciliter (dl) of whole blood, a deciliter being 100 milliliters.

The normal ranges for hemoglobin depend on the age and, beginning in adolescence, the sex of the person. The normal ranges are:

* Newborns: 17-22 gm/dl
* One (1) week of age: 15-20 gm/dl
* One (1) month of age: 11-15gm/dl
* Children: 11-13 gm/dl
* Adult males: 14-18 gm/dl
* Adult women: 12-16 gm/dl
* Men after middle age: 12.4-14.9 gm/dl
* Women after middle age: 11.7-13.8 gm/dl

All of these values may vary slightly between laboratories. Some laboratories do not differentiate between adult and "after middle age" hemoglobin values.

What does a low hemoglobin level mean?

A low hemoglobin is referred to as being anemic. There are many reasons for anemia. Some of the more common reasons are loss of blood (traumatic injury, surgery, bleeding colon cancer), nutritional deficiency (iron, vitamin B12, folate), bone marrow problems (replacement of bone marrow by cancer, suppression by chemotherapy drugs, kidney failure), and abnormal hemoglobin (sickle cell anemia).

What does a high hemoglobin level mean?

Higher than normal hemoglobin levels can be seen in people living at high altitudes and in smokers. Dehydration produces a falsely high hemoglobin which disappears when proper fluid balance is restored. Some other infrequent causes are lung disease, certain tumors, a disorder of the bone marrow known as polycythemia rubra vera, and abuse of the drug erythropoietin (Epogen) by athletes for blood doping purposes.

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The Benefits of Vitamin C

Vitamin C is one of the safest and most effective nutrients, experts say. It may not be the cure for the common cold (though it's thought to help prevent more serious complications). But the benefits of vitamin C may include protection against immune system deficiencies, cardiovascular disease, prenatal health problems, eye disease, and even skin wrinkling.

A recent study published in Seminars in Preventive and Alternative Medicine that looked at over 100 studies over 10 years revealed a growing list of benefits of vitamin C.

"Vitamin C has received a great deal of attention, and with good reason. Higher blood levels of vitamin C may be the ideal nutrition marker for overall health," says study researcher Mark Moyad, MD, MPH, of the University of Michigan. "The more we study vitamin C, the better our understanding of how diverse it is in protecting our health, from cardiovascular, cancer, stroke, eye health [and] immunity to living longer."

"But," Moyad notes, "the ideal dosage may be higher than the recommended dietary allowance."

How Much Vitamin C Is Enough?

Most of the studies Moyad and his colleagues examined used 500 daily milligrams of vitamin C to achieve health results. That's much higher than the RDA of 75-90 milligrams a day for adults. So unless you can eat plenty of fruits and vegetables, you may need to take a dietary supplement of vitamin C to gain all the benefits, Moyad says. He suggests taking 500 milligrams a day, in addition to eating five servings of fruits and vegetables.

"It is just not practical for most people to consume the required servings of fruits and vegetables needed on a consistent basis, whereas taking a once-daily supplement is safe, effective, and easy to do," Moyad says. He also notes that only 10% to 20% of adults get the recommended nine servings of fruits and vegetables daily.

Moyad says there is no real downside to taking a 500-milligram supplement, except that some types may irritate the stomach. That's why he recommends taking a non-acidic, buffered form of the vitamin. "The safe upper limit for vitamin C is 2,000 milligrams a day, and there is a great track record with strong evidence that taking 500 milligrams daily is safe," he says.

Still, American Dietetic Association spokeswoman Dee Sandquist, RD, suggests doing your best to work more fruits and vegetables into your diet before taking supplements.

"Strive to eat nine servings of fruits and vegetables daily, because you will get a healthy dose of vitamin C along with an abundance of other vitamins, minerals, and phytochemicals that are good for disease prevention and overall health," she says.

While a cup of orange juice or a half-cup of red pepper would be enough to meet your RDA for Vitamin C, here are all the foods and beverages you'd need to consume to reach 500 milligrams (mg):

• Cantaloupe, 1 cup: 59 mg Vitamin C
• Orange juice, 1 cup: 97 mg
• Broccoli, cooked, 1 cup: 74 mg
• Red cabbage, 1/2 cup: 40 mg
• Green pepper, 1/2 cup, 60 mg
• Red pepper, 1/2 cup, 95 mg
• Kiwi, 1 medium: 70 mg
• Tomato juice, 1 cup: 45 mg

The Health Benefits of Vitamin C

According to recent research, vitamin C may offer health benefits in these areas:

1. Stress. "A recent meta-analysis showed vitamin C was beneficial to individuals whose immune system was weakened due to stress-- a condition which is very common in our society," says Moyad. And, he adds, "because vitamin C is one of the nutrients sensitive to stress, and [is] the first nutrient to be depleted in alcoholics, smokers, and obese individuals, it makes it an ideal marker for overall health."

2. Colds. When it comes to the common cold, vitamin C may not be a cure. But studies show that it can help prevent more serious complications. "There is good evidence taking vitamin C for colds and flu can reduce the risk of developing further complications, such as penemonia and lung infections," says Moyad.

3. Stroke. A recent study in the American Journal of Clinical Nutrition found that those with the highest concentrations of vitamin C in their blood were associated with 42% lower stroke risk than those with the lowest concentrations. The reasons for this are not completely clear. But what is clear is that people who eat plenty of fruits and vegetables have higher blood levels of vitamin C.

"People who consume more fruit and vegetables will not only have higher [blood] levels of vitamin C, but higher intake of other nutrients potentially beneficial to health, such as fiber and other vitamins and minerals," study researcher Phyo K. Myint said in an email interview.

4. Skin Aging. Vitamin C affects cells on the inside and outside of the body. A study published in the American Journal of Clinical Nutrition examined links between nutrient intakes and skin aging in 4,025 women aged 40-74. It found that higher vitamin C intakes were associated with a lower likelihood of a wrinkled appearance, dryness of the skin, and a better skin-aging appearance.

Other studies have suggested that vitamin C may also:

• Improve macular degeneration
• Reduce inflammation.
• Reduce the risk of cancer and cardiovascular disease.

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