Honoring the beloved ‘Cookie’ Jacobsen

Ellen Townley Cook Jacobsen, MD, ’50 (1919-2013)

Ellen Townley Cook Jacobsen, MD, ’50 (1919-2013)

On Wednesday, November 12 at 3 p.m., Ellen Cook “Cookie” Jacobsen MD and her husband Carlyle “Jake”  Jacobsen PhD will he honored at a dedication ceremony, held in Upstate’s medical alumni lounge, Weiskotten Hall, 766 Irving Ave., Syracuse.

Jake was president of Upstate Medical University from 1957 to 1965. Cookie was a 1950 graduate of the medical school and the first woman faculty member of the College of Medicine. (She retired as a full professor of medicine and psychiatry. )

Together, Cookie and Jake worked to promote academic excellence and a strong sense of community during a period of exceptional growth at SUNY Upstate Medical University.

Even after her husband’s death in 1974, Cookie was referred to as the matriarch of Upstate.  She was a wise counselor to colleagues, deans and university presidents. Few students, residents or clinicians have not benefited from her insight and wisdom.

Cookie’s life was defined by complete selflessness, fierce loyalty, unparalleled listening skills, and lifelong intellectual curiosity. She always had time to help a friend, patient, or colleague and had a special gift for nurturing trusting relationships with people of all ages and ethnicities. She made such extensive contributions to so many people’s lives that saying she is enormously missed is an understatement.

The Upstate community and friends are invited to the dedication of the Carlyle and Ellen Cook Jacobsen Foyer and the establishment of the SUNY Upstate Medical Univerity Archives. Contact Nancy Prott, 315.464.4513, prottn@upstate.edu for more information.

Posted in community, education, entertainment, health care, history, hospital, medical student, mental health, neurology, psychiatry | Leave a comment

What to do about hair loss from cancer treatment

Woman washing her hairMany of the drugs used to fight cancer go after rapidly-growing cancer cells but also wipe out other rapidly-growing cells, which includes hair cells. That means some cancer patients face hair loss ranging from thinning to complete baldness.

The amount of hair that falls out depends on the medication you are taking and the dose, and it may not be limited to the hair on your scalp. Some patients experience the loss of eyelash, eyebrow, armpit, pubic and other body hair.

Regrowth usually happens within three to 10 months after treatment ends, but many patients have hair of a different color or texture, at least at first.

Cancer caregivers encourage patients to plan ahead regarding hair loss and do things that make them feel comfortable before, during and after cancer treatment. This may mean planning for a head covering, whether wigs, scarves or hats.

Nothing has been proven to stop hair loss during or after chemotherapy. But a couple of treatments have been considered:

* Cryotherapy or scalp hypothermia uses ice to lessen the blood flow to your scalp during chemotherapy, so the medications are less likely to have an effect on your scalp.

“Studies of scalp hypotheramia have found it works somewhat in the majority of people who have tried it,” the Mayo Clinic reports. “However, the procedure also causes a small risk of cancer recurring in your scalp, as this area doesn’t receive the same dose of chemotherapy as the rest of your body.”

In addition, patients report headaches and a feeling of uncomfortable cold during cryotherapy.

* Minoxidil – the drug marketed as Rogaine for pattern baldness – is sometimes used to help speed up hair regrowth. Cancer experts say it does not prevent hair loss.

To minimize the frustration and anxiety that may accompany hair loss, hairdressers suggest a gentle touch. No bleach, colors or perms, which can weaken hair. No blow dryers, curling irons or hot rollers. Use a soft-bristle brush, and wash your hair only as often as needed, using a gentle shampoo.

If you opt to shave your head, be prepared to protect your scalp from the sun and cold air with sunscreen or a head covering.

The American Cancer Society says hairpieces that are used due to cancer treatment are tax deductible expenses, which may be at least partly covered by health insurers. The organization advises doctors to write a prescription for a “hair prosthesis” rather than a “wig.”

The Upstate Cancer Center features a boutique called Dazzle in its lobby where head coverings are sold for children, men and women. Owner Lois Ross says some people seek wigs for everyday wear, and others want something to wear just for special occasions. Some prefer hats. She says one popular item is a cap with hair, which can be put into a ponytail or left long.

There are no rules about whether or how to cover your head during cancer treatment, Ross says. “It’s really whatever makes you feel good.”

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Unique surgery treats aggressive bladder cancer

Patient Allan Sustare with his surgeon, Gennady Bratslavsky, MD, in the new Upstate Cancer Center.

Patient Allan Sustare with his surgeon, Gennady Bratslavsky, MD, in the new Upstate Cancer Center. The two men gave an interview about Sustare’s surgery on Upstate’s weekly talk radio program, HealthLink on Air.

Allan Sustare celebrates each day. He is grateful to be alive after coming so close to death from advanced bladder cancer.

He admits that he had no concept of the severity of his disease. He had no pain, just blood in his urine — once.

He wound up undergoing a novel surgery in which a new bladder was fashioned from a portion of his intestine to replace his original bladder, which had to be removed because of cancer.

“I count myself luckier than anybody I know,” says Sustare, 63, of DeWitt. “Between Dr. Seth and Dr. Bratslavsky, I don’t know that anybody could have asked for any better care anywhere in this country.” Rahul Seth, MD, is an oncologist, and Gennady Bratslavsky, MD, is chairman of the Department of Urology.

Sustare served as a medic in the military before attending Syracuse University. A professional artist, he has been a jewelry designer, illustrator and maker of collectible pocket knives. At the ribbon-cutting for the Upstate Cancer Center this summer, Sustare shared his story.

It was May 2011 when he was diagnosed with bladder cancer. Seth told him his options, which included chemotherapy, radiation and surgery to remove his bladder and replace it with an external bag. Sustare thanked the oncologist. Then he ran away.

“I spent most of my inheritance,” he says, describing his time in Houston, in which he pursued alternative treatments. A new tumor had grown by the time he returned to Syracuse. Doctors at the Syracuse VA Medical Center removed what they could of the tumor and then sent Sustare to Bratslavsky.

They knew of Bratslavsky’s surgical prowess and his extensive experience in urologic oncology from his work at the National Cancer Institute. Sustare’s bladder would need to be removed because the cancer had invaded the muscle. But Sustare was adamantly against replacing it with an external bag or urostomy.

Bratslavsky gave Sustare another option. He could create a new bladder out of a portion of Sustare’s intestines. In an operation that would last all day, Bratslavsky and surgeons he is training in the specialty of urology would remove about 60 centimeters of Sustare’s intestine, cut it open lengthwise and configure it into a sphere. It would then be attached to the urethra and kidneys. In addition, the team would remove the bladder, prostate, seminal vesicles, vasa deferentia and 41 lymph nodes.

Such a surgery is not an option for everyone with advanced bladder cancer. But Sustare was a good candidate because he was young, healthy and active, as well as conscientious and responsible, Bratslavsky says.

The men spoke before the surgery in 2012, with Bratslavsky explaining what could go wrong. “The role of a surgeon is to go closely over all the options, and help patients understand what exactly the potential pitfalls may be,” he says.

A patient who chooses this option has to be able to sense if something is not right with his body. He has to realize he may need to use a catheter to empty the new bladder sometimes. And, nighttime urinary incontinence may be an issue.

Sustare remembers Bratslavsky’s talk. “He did not sugar coat it.”

Sustare underwent chemotherapy first. Then the surgery was done laparoscopically, using the DaVinci robot. His largest incision was no more than an inch.

Bladder cancers are prone to recurrence, so Sustare sees Bratslavsky regularly. “It’s only when I get those notices that I have to come in for a CT scan that I even recall that I had cancer,” Sustare says. Between medical appointments, he leads a normal, active life.

Listen to an interview with Sustare and Bratslavsky

Listen to an interview about bladder cancer with Srinivas Vourganti, MD

 

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Estrogen expert will explain how women can maintain health

A model of an estriol molecule. By Getty Images for iStock.

A model of an estriol molecule. By Getty Images for iStock.

A leading expert on estrogen, women’s health and breast cancer gives a lecture Thursday, Nov. 20 at Upstate Medical University that is open to the public.

Richard Santen, MD, a professor of medicine in the division of endocrinology at the University of Virginia, will deliver the Carol M. Baldwin Breast Cancer Research Lecture at 4 p.m. in Weiskotten Hall’s Medical Alumni Auditorium.

“His presence is very important to the community of medical scientists and to the public at large,” says Upstate pharmacology professor Debashis Ghosh, PhD, whose research has been cited by Santen.

Santen has been researching aromatase, an estrogen-producing enzyme, since it was discovered in the 1960s. Estrogen, an essential hormone in men and women, is linked to up to 80 percent of breast cancers in post-menopausal women.

“Estrogen is life-sustaining, but it’s a double-edged sword,” says Ghosh. “It’s life-giving and life-depriving. We need to know how aromatase makes estrogen and how to make it stop when it’s not needed.”

In his lecture, Santen will talk about his ongoing research and promising new treatments for breast cancer. He’ll also discuss what menopausal and post-menopausal women can do to maintain their health and quality of life.

Ghosh published his research on the structure of the aromatase molecule in a 2009 article in Nature. When Santen read the article, he contacted Ghosh and included that work in a historical review of aromatase. “That made the story complete,” Ghosh says.

That publication is one of more than 400 manuscripts and chapters written by Santen, most related to the role of estrogen in breast cancer development and treatment. Ghosh describes Santen as a “very thorough basic scientist” whose work has received funding from the National Institutes of Health consecutively for more than three decades.

“He is the ideal lecturer for the Baldwin Foundation,” Ghosh says. “He wants to distribute his knowledge to the people so they can benefit from his great knowledge, which he has accumulated for many years.”

Hear an interview with Ghosh about aromatase inhibitors

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Brain expertise: Stroke care depends on physicians, nurses, therapists and more

Patients who are wheeled into Upstate University Hospital’s emergency department suffering from stroke are likely to receive acute treatment and rehabilitative care under the same roof, followed by the same ensemble of providers.

The hospital, the first designated stroke center in Central New York, features the region’s only specialized neuroscience and rehabilitation floors, with three levels of specialized nursing care. The neurologists, neurosurgeons and emergency physicians train students and conduct research that improves our understanding of how the brain works and how best to treat stroke. But they are always on call to care for patients with stroke.

From iStockPhoto.

From iStockPhoto.

Since becoming a stroke center, Upstate has also taken care of hundreds of complicated stroke patients who were too sick to be cared for at other hospitals in Central New York.

The hospital’s stroke team works together to determine what treatment is best for each individual patient.

Before arrival

When paramedics report a possible stroke patient, the team is summoned to the emergency department. This includes an emergency physician, a neurologist, a stroke coordinator and emergency department nurses. In addition, the nursing supervisor alerts the pharmacy, laboratory and radiology departments.

In the ED

Blood tests are done as soon as the patient arrives, and a doctor conducts a neurological exam. A variety of imaging tests may be used in the diagnosis, along with blood flow measurements and tests to detect clots. The staff also assembles a medical history.

Ischemic strokes — those caused by clots — may be treated with an intravenous clot-busting medication, but sometimes, the blood clot is too big or the patient can not be given the medication because of other medical concerns. Fortunately, Upstate has specialists such as Amar Swarnkar, MD who can take the clot out using special catheters inserted in the patient’s groin.

The treatment of a hemorrhagic stroke — caused by a bleed — depends on its location and severity. Sometimes it is managed with medications to carefully control blood pressure, says Gene Latorre, MD. Other times, surgery is indicated. Surgeons may place clips at the base of the aneurysm, or they may place platinum micro-coils inside the vessel to act as a mechanical barrier to blood flow.

Hypothermia is employed in the treatment of some patients. Others may undergo brain tissue oxygen monitoring.

In the ICU

Upstate has a 14-bed neuroscience intensive care unit, plus 35 additional beds devoted to patients with neurological problems on other units. Patients are transferred as their conditions improve, but nurses with special training in the care of neurological patients continue to monitor and implement the plan or care for each patient.

Rehabilitation

Physical, occupational and speech therapists and a psychiatrist evaluate each stroke patient within 24 hours of admission, and rehabilitative therapy begins almost immediately.

Upstate offers an inpatient rehabilitative unit, where patients may be moved once they are able to handle three hours per day of therapy.

Rehabilitative counselors offer support for patients in returning to work or school.

The outcome of acute stroke care is tightly connected to how quickly appropriate emergency treatment is initiated, and the quality of the overall management provided. At Upstate, it is not unusual for patients with severe stroke to go home after three days, with minimal or no evidence of lasting stroke effects.

Posted in community, emergency, neurology, neurosurgery, nursing, stroke | Leave a comment

What a patient with Ebola experiences

sextonA patient who survives Ebola suffers through some nasty symptoms, and then his or her body regroups to muster a fight against the virus.

“One of the big problems with this disease is it impairs adaptive immunity. You don’t develop an antibody response initially, so you’re not killing off the virus appropriately,”

James Sexton, MD, an assistant professor of medicine in pulmonary and critical care at Upstate University Hospital, told medical staff Tuesday in a lecture about the disease that’s on everybody’s mind.

Infectious disease precautions are part of standard training for doctors, nurses and other hospital staff. They have been practicing how to care for a patient with Ebola since before Upstate was designated one of eight hospitals in New York State that would handle Ebola patients.

People who arrive at Upstate are asked whether they have traveled to West Africa or had contact with anyone who has been diagnosed Ebola. “The priority here is identification and safe handling of that patient and protection of our staff,” explains Christopher Dunham, Upstate’s director of emergency management. Anyone suspected of having Ebola would be placed in an isolation room. Then as their treatment began, a doctor from Upstate would confer with Onondaga County and state health officials, and the Centers for Disease Control and Prevention.

Part of the preparedness training at an academic medical center such as Upstate includes educating staff in the science of the disease, which is what Sexton’s lecture accomplished.

He said most people develop symptoms five or six days after they are infected, although the incubation period for Ebola is considered 21 days. Some people have developed symptoms beyond those 21 days.

An infection with this outbreak of Ebola has typically begun with flu-like symptoms of fatigue and fever. Initially, the virus affects white blood cells called macrophages and the dendritic cells, which are part of the immune system.

The diarrhea that develops can be severe, with patients losing up to 10 liters per day. “Obviously you’re going to have all sorts of problems from fluid and electrolyte losses if you’re putting out that much diarrhea,” Sexton said.

Ebola also causes vomiting, loss of appetite, headache, abdominal pain and muscle aches. Weakness comes from dehydration.

Patients have reported nonproductive coughs and sore throats with the sensation of a lump in the throat. Some have developed eye infections, and some have seen their mouths become dark red in color.

A rash may develop that later peels.

A patient who is pregnant when she is infected is likely to miscarry.

Some patients struggle with a low platelet count, which impacts their blood’s ability to coagulate. Bleeding, however, is not a common symptom.

People are not infectious until they have symptoms, and Ebola has no respiratory spread. “You can only catch it if infected fluids contact mucous membranes or somehow get direct contact with blood, through breaks in the skin or needle sticks,” Sexton said.

He said the virus damages the tissue of the liver, adrenal glands and spleen. Even though the body at first does not create antigens, it does mount an inflammatory response. Cells that are damaged release chemicals that cause swelling, which helps insulate the tissues from the virus.

“When you do develop an antigen response is really when you start to get better, if you’re going to get better,” Sexton said. “People who never develop an antigen response die.”

Improvement or death usually occurs between day 6 and day 16. People who die from Ebola suffer multiple organ failure and septic shock, a full body infection that leads to a dangerously low blood pressure.

People who survive Ebola face a lengthy convalescence. Weakness, muscle aches and fatigue are liable to linger, and weight regain can be difficult. Sexton said there may be hair loss and extensive sloughing of skin. Also, the virus may remain present in semen and breast milk for weeks or months.

People who survive Ebola likely develop an immunity to that strain of Ebola, Sexton said. “No one, as far as I know, has been exposed to the disease a second time, but because you now have an antibody response, you may not be able to get the disease again.

Sexton said experts believe “the antibody response is key. Once you develop that, you get over the disease,” he said. “The big problem with the disease is you don’t develop that for so long — until it’s gotten so bad that it’s caused all these other problems.”

Christopher Dunham explains how the hospital has prepared for Ebola

Timothy Endy, MD, tells the science of Ebola

Facts about Ebola

Almost 1.07 million people in Africa do NOT have Ebola.

Ebola belongs to the same order of viruses — called the Mononegavirales — as measles, mumps, rabies and Marburg, a hemorrhagic fever virus.

There are five strains of Ebola. The one grabbing headlines lately is called Zaire, and it is responsible for two current outbreaks — the large one affecting Guinea, Liberia and Sierra Leone as well as a smaller outbreak in an isolated village in the Congo.

The mortality rate for the large outbreak, through Oct. 26, is 49 percent. Of 10,207 people infected, 4,971 have died.

The virus is not a respiratory virus. It enters the body through the mucus membranes or a break in the skin. Cases of transmission have also been reported through needle sharing and through the ingestion of meat from bats, monkeys or primates that carried the disease.

The blood, feces and vomit of someone with Ebola are most infectious. Urine, semen and breast milk are less so. Saliva and tears may be infectious. Sweat is probably not.

Posted in community, education, emergency, Health Link on Air, public health | Tagged | Leave a comment

Brain expertise featured in Physicians Practice publication

PhysiciansPractice1114The stroke care and brain expertise available at Upstate is showcased in the November issue of Physicians Practice magazine, distributed to doctors throughout Central New York. Also included is an article about new breast reconstruction options, the importance of occupational history, the connection between health care workers and liver cancer, and more.

Browse all of the Upstate content.

 

 

Posted in cardiac, community, emergency, neurology, neurosurgery, stroke, surgery, women's health | Leave a comment

Blood in urine is never normal

Image from iStockPhoto.

Image from iStockPhoto.

Blood in the urine does not necessarily indicate bladder cancer, but it does warrant a visit to a urologist, says Srinivas Vourganti, MD, an assistant professor of urology at Upstate.

Bladder cancer occurs mostly in older people, and smokers are three times as likely to be diagnosed as nonsmokers. Also, men are three or four times more likely than women to get bladder cancer during their lifetime. The usual first symptom: blood in the urine.

Patients are evaluated through a combination of X-rays, urine and blood tests and a procedure called cystoscopy that allows a doctor to visualize the inner lining of the bladder. Any abnormal growths are removed and examined to identify cell type, aggressiveness and how deep the tumor was attached.

About half of bladder cancers are confined to the smooth mucosal lining of the bladder, but the cancers can spread into the deeper layers, or beyond the bladder. “Each depth of invasion is associated with worse outcomes,” Vourganti explains.

Treatment varies. The more advanced diseases may require radiation therapy and/or medications, or the removal of the bladder. Tumors confined to the lining can be removed, but they are like weeds with a tendency to grow back. Vourganti says that is why bladder cancer has the largest economic impact among cancers. “There is an intensive surveillance that has to happen to prevent its progression,” he says.

Cigarette smoking or exposure to industrial chemicals called aromatic amines contributes to many bladder cancers. (Aromatic amines are sometimes used in the dye industry; workers at high-risk for exposure include makers of rubber, leather, textiles or paint products, painters, machinists, printers, hairdressers and diesel truck drivers, according to the American Cancer Society.)

With every heartbeat, our kidneys make small amounts of urine, which is stored in our bladder until we void. Since many toxins in our body are filtered out through the urine – including the carcinogens from cigarettes and aromatic amines — the bladder is exposed to these toxins.

That makes smokers who work with cancer-causing chemicals at especially high risk of developing bladder cancer.

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Are you at risk for on-the-job cancers?

Asbestos was strong, durable and heat resistant, “so it was used in lots of products,” says mesothelioma lawyer Joseph Belluck. “Every year we learn about more and more products that asbestos was used in.”

Belluck was among the speakers at the 10th annual Upstate Cancer Symposium, which focused on occupational cancers. He pointed out that asbestos is still used industrially today, “and there are still many people being exposed to asbestos every day in this country.”

Jerrold Abraham, MD, provided this image from a paper he co-authored in 2002 in the American Journal of Respiratory and Critical Care Medicine, from a case about someone who died from asbestosis 50 years after a brief exposure in a Vermiculite expansion plant.

Jerrold Abraham, MD, provided this image from a paper he co-authored in 2002 in the American Journal of Respiratory and Critical Care Medicine, from a case about someone who died from asbestosis 50 years after a brief exposure in a Vermiculite expansion plant.

Lung cancer, bladder cancer and the aggressive cancer of the lining of the lungs and abdomen called mesothelioma account for the majority of work-related cancers in America. Belluck told symposium attendees that patients diagnosed with mesothelioma in the United States have the cancer because of asbestos.

Because mesothelioma has a lengthy latency period, people may not develop symptoms for 10 to 40 or more years after exposure. An estimated 27.5 million people were exposed to asbestos from 1940 to 1979. Early symptoms can be vague: pain in the lower back or side of the chest, shortness of breath, cough, fever, excessive sweating, fatigue, weight loss, trouble swallowing and swelling of the abdomen, face or arms.

Some 3,000 people from a variety of occupations are diagnosed with mesothelioma each year. Among them are shipworkers, construction workers and people who worked in steel mills and factories, but also school teachers, carpenters and electricians.

Michael Lax, MD, medical director of Upstate’s Occupational Health Clinical Center, says that assessing a person’s exposure to cancer-causing chemicals including asbestos over a lifetime is tricky to do with accuracy. He says at least 24,000 to 60,000 deaths per year are thought to be attributable to occupational carcinogens.

Listen to an interview on this subject

“The estimates we have should be considered under-estimates,” Lax says, because only 2 percent of chemicals are tested for carcinogenity before they are put into use. He says that makes American workers unwitting participants in a giant experiment to determine which workplace chemicals may lead to disease. While other organizations recognize more than 110 substances as carcinogenic, the federal Occupational Safety and Health Administration regulates only 27 as cancer-causing.

Lax and Belluck say it’s important for doctors to recognize if a cancer is work-related so that patients can seek treatments that may be effective and compensation to pay future medical bills. Also, such documentation can help researchers trace cancer causes, and possibly lead to safer workplaces.

The first asbestos-related death was documented in 1906, Belluck says, adding that today’s laws regarding workplace safety make companies responsible not just for what they knew, but for what they should have known. The link between asbestos and mesothelioma has been clear since the 1960s, and the link between asbestos and lung cancer since the 1930s, says pathology professor Jerrold Abraham, MD, another speaker at the symposium that attracted cancer specialists and medical students.

Patients may be aware of asbestos exposure, and that should make a doctor aware of the risk for developing mesothelioma, which is diagnosed with imaging tests such as X-rays and computerized tomography, and biopsies. Abraham emphasized that occupational exposures may be evident in patients’ biopsy tissues, but may go unnoticed by inexperienced pathologists.

Hopefully soon, a blood test will be able to aid in diagnosis.

Upstate Cancer Center Medical Director Leslie Kohman, MD introduced a mesothelioma expert at the symposium by saying, “Imaging and history are important, but they will eventually be eclipsed by what we can learn from blood biomarkers.”

Harvey Pass, MD, chief of thoracic oncology at New York University Langone Medical Center, spoke of his dream to be able to screen people for asbestos-related diseases such as mesothelioma before they develop symptoms, or to determine which genes make one susceptible to the disease.

“The earliest we will actually have a validated biomarker is probably within the next four or five years,” Pass told the symposium group.

Already, a molecule has been identified that promotes the growth of mesothelioma. A blood test can tell the difference between someone who was exposed to asbestos and someone with mesothelioma. And, 25 percent of patients with the disease have been found to have a particular genetic mutation.

So, progress is being made.

Listen to an interview on this subject

27 cancer-causing chemicals

The Occupational Safety and Health Administration regulates these substances as cancer-causing:

  • asbestos
  • 4-Nitrobiphenyl
  • alpha-Naphthylamine
  • Methyl chloromethyl ether
  • 3,3′-Dichlorobenzidine (and its salts)
  • bis-Chloromethyl ether
  • beta-Naphthylamine
  • Benzidine
  • 4-Aminodiphenyl
  • Ethyleneimine
  • beta-Propiolactone
  • 2-Acetylaminofluorene
  • 4-Dimethylaminoazobenzene
  • N-Nitrosodimethylamine
  • Vinyl chloride
  • Inorganic arsenic
  • Hexavalent chromium
  • Cadmium
  • Benzene
  • Coke oven emissions
  • 1,2-dibromo-3-chloropropane
  • Acrylonitrile
  • Ethylene oxide
  • Formaldehyde
  • Methylenedianiline
  • 1,3-Butadiene
  • Methylene chloride

Silica is one example of a substance that is not on the list, despite the World Health Organization and the Centers for Disease Control and Prevention saying it can cause cancer.

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How to avoid constipation during cancer treatment

Since everyone is different, the side effects to cancer treatment vary from person to person. One common problem is constipation. Registered dietitian nutritionist Maria Erdman provides these possible solutions:

* Choose foods that are high in fiber for your meals and snacks. Shoot for 20 to 35 grams of fiber each day. Some suggestions from the Mayo Clinic:

FRUITS

1 cup raspberries = 8 grams fiber

1 medium pear, with skin = 5.5 grams fiber

1 medium apple, with skin = 4.4 grams fiber

1 medium banana or orange = 3.1 grams fiber

1 cup strawberry halves = 3 grams fiber

GRAINS, CEREAL & PASTA

1 cup whole wheat cooked spaghetti = 6.3 grams fiber

1 cup pearled barley, cooked = 6 grams fiber

¾ cup bran flakes = 5.3 grams fiber

1 medium oat bran muffin = 5.2 grams fiber

1 cup instant cooked oatmeal = 4 grams fiber

LEGUMES, NUTS & SEEDS

1 cup split peas, cooked = 16.3 grams fiber

1 cup lentils, cooked = 15.6 grams fiber

1 cup black beans, cooked = 15 grams fiber

1 cup lima beans, cooked = 13.2 grams fiber

1 cup baked beans, vegetarian, canned, cooked = 10.4 grams fiber

VEGETABLES

1 medium artichoke, cooked = 10.3 grams fiber

1 cup green peas, cooked = 8.8 grams fiber

1 cup broccoli, boiled = 5.1 grams fiber

1 cup turnip greens, boiled = 5 grams fiber

1 cup Brussels sprouts, cooked = 4.1 grams fiber

* Introduce fiber into your diet slowly, with a few additional grams every couple days. Otherwise, it may cause stomach upset.

* Keep hydrated with plenty of liquids, and if you are increasing your fiber intake, increase your fluid intake, too.

* Stay active with exercise, as you are able.

* Eat at roughly the same times each day.

* Eat breakfast when you start your day, and include both high-fiber foods and coffee, hot tea or hot water with lemon. Hot beverages may act as stimulants.

 

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