Pumping Irony

Craig Cox, EL’s managing editor and resident geezer, explores the joys and challenges of aging well.

Posts Tagged cancer

Experience Life Magazine

Another Silver Bullet

The big health news today seems to be that taking a multivitamin will help geezers like me avoid dying of cancer — or not.

The study earning big headlines followed nearly 15,000 men for 14 years and found that those who took a daily multivitamin “modestly, but significantly, reduced the risk of total cancer.” This should be heartening to anyone hoping to dodge the big C as they coast into their golden years, but when you look more closely at the study’s results you’ll notice that washing down a multivitamin every morning with your orange juice didn’t actually have much of an effect on the incidence of prostate cancer, colorectal cancer or other “site-specific” cancers. Last time I looked, those were pretty much the most deadly cancers guys my age tend to face.

And even if the study showed that my daily multivitamin might have a more positive effect, I’m not the sort to pay much attention. I’ve got nothing against multivitamins; I take one every morning along with a little fish oil. What bugs me is this notion that doing any one thing — whether it’s eating certain foods or taking certain supplements or relying on the latest pharmaceutical miracle — is going to protect you from an untimely illness and an early death.

I suppose we’d all like some sort of tool or technique that would guarantee us good health, but that way of thinking is what has pushed conventional medicine into the awkward position it now finds itself. Everybody wants their doctor or surgeon or pharmacist to “fix” what’s wrong with them — to make them healthy. But to my way of thinking, it’s really up to us. And it shouldn’t be that complicated: Eat a healthy diet, get plenty of exercise, keep an upbeat attitude, cultivate community, and you ought to roll into your twilight years in pretty good shape.

We shouldn’t need any studies to get us moving in that direction, should we?

Experience Life Magazine

Playing the Lottery

The old colonoscopy debate was renewed again last week, when researchers at Memorial Sloan-Kettering Cancer Center in New York released a report claiming that the popular screening method (in which pre-cancerous polyps are removed from the colon) cut colorectal cancer–related deaths by 53 percent.

The results, according cancer researchers, prove that colonoscopies save lives. “This is a very big deal,” Robert Smith of the American Cancer Society told The New York Times.

This is good news to all of my buddies and brothers who have been encouraging me for the past decade to get into the gastroenterologist and get ‘scoped. I am, as I have noted in these pages, a skeptic about these sorts of invasive screening procedures, and that skepticism tends to confound folks who swear by its death-defying powers.

I am not in the least bit qualified to critique these sorts of studies, but I am struck by the numbers involved: For more than 20 years, researchers followed 2,602 people who had undergone colonoscopies during which pre-cancerous polyps were removed. Doctors estimate that 25.4 deaths from colorectal cancer should’ve been expected from this number of patients. Only 12 died, hence the 53 percent reduction in deaths.

So, if my math is correct, even if you were never screened, your chance of succumbing to colorectal cancer is slightly less than 1 in 100 (about the same as your chances of dying in a car accident). Getting screened and having polyps removed drives those odds down to a bit less than 1 in 200. As one oncologist told the Times, that’s a “very robust reduction.” But it’s all relative, isn’t it? If I currently have a 1-percent chance of dying from some disease and an expensive and somewhat risky procedure (the results of which depend greatly upon the skill of the doctor performing the procedure) may cut those odds down to .5 percent, is it worth it?

I know what you’re thinking: Yeah, if I’m one of those 12 who survived as a result, then it’s definitely worth it!

But what if you were told that two out of every 1,000 patients who undergo colonoscopies or sigmoidoscopies suffer major complications? That’s .2 percent. Pretty good odds, right? Yeah, I’m not going to be one of those two.

This is what Dr. Nortin Hadler refers to as the “Lottery Mindset” — the notion that, no matter what the odds, we’ve got a good chance of winning. This mindset tends to govern many of our decisions about health care as we age. “In America, the psychology of the lottery has been so well inculcated that it commonly makes sense to apply it to another challenging win-lose exercise: betting on our health,” Hadler writes in Rethinking Aging. “It drives the ‘I know the chance is slim, Doc, but let’s go for it’ response when we or our loved ones are sick. It also drives many other choices related to our health, including our willingness to undergo screening.”

For the record, Hadler is not opposed to colorectal screening for “high-risk” patients (those with a first-degree relative who developed colorectal cancer before age 50, and those with ulcerative colitis or Crohn’s colitis), but he’s not convinced that the screening is particularly effective. He cites a UK randomized controlled trial of 170,000 patients between the ages of 55 and 64 who underwent a one-time sigmoidoscopy from 1994 to 1999 and were followed ever since. “There may be a slight reduction in death from colon cancer; the Number Needed to Treat is calculated at nearly 500 [about .3 percent], but it’s far from a robust effect,” he writes.

Thankfully, we each get to determine how we’re going to respond to the health risks we encounter in middle age and beyond. So, if you’re persuaded by the latest research that a colonoscopy will offer you some peace of mind, then I say go for it. Whatever works.

I’m going to pass, though. I’ll try to eat right, get some exercise every day, keep my stress levels in check, stay positive, enjoy the moment. I’m not one to play the lottery, but I figure the odds are pretty good that I’m going to be around for a while.

Experience Life Magazine

Redefining Cancer

The other day, I was playing golf with my two older brothers and a friend — all retired — and overheard my senior sibling mention that he had just been in to see his doctor. This is none of my business, of course, but when he mentioned that he’d been subjected to 10 biopsies of his prostate during that visit, and was headed back in a week for more of the same, I couldn’t help but comment about the story in that morning’s newspaper arguing, rather convincingly, that this sort of thing is pretty much a waste of time and soft tissue.

Typically, my opinions about conventional medicine are seen as fairly goofy among this group. (They’re constantly trying to convince me that I am essentially committing suicide because I refuse to have a colonoscopy.) But on this occasion, they actually seemed to be agreeing with me. According to this most recent research, they noted, prostate screening seldom prolongs life and often leads to “false positives” that persuade suddenly panicky men to accept surgical procedures that result in all sorts of nasty side effects, not the least of which are incontinence and impotence.

And the kicker, they said, is that even if you do have prostate cancer when you hit your 60s or so, it’s probably not going to kill you, because it’s a very slow-growing cancer. So why even bother with the screening and treatment?

My big brother took this all in and even joked that his doctor kept calling for more biopsies so he “could pay for a new boat.” But I could tell that he wasn’t likely to question anything on his next visit. That’s the way it goes between doctor and patient for the most part. Especially when there’s a whiff of cancer in the air.

So I wasn’t surprised a couple of week later, at our monthly poker game, when he reported that his doctor had done two more biopsies. The good news is that everything was benign, but what if it hadn’t been? What do you do when your doctor hits you with the “C” word and you have to decide whether to submit to treatment that more likely than not is going to mess with your plumbing in ways you may find rather discouraging?

And how do you make that decision when you’re regularly buffeted with information about conventional medicine that can’t help but erode your trust in the whole system? Just last week, for instance, the University of Minnesota School of Public Health reported that the flu vaccine we’re all supposed to be getting in order to keep us alive through the winter only works in about six out of 10 cases. And you may recall the study a couple of years ago that suggested mammograms may not be as reliable as we’d all been told. In fact, as Gina Kolata reported recently in The New York Times, any kind of cancer screening may be not just unnecessary, but harmful.

“Cancer experts say they cannot ignore a snowballing body of evidence over the past 10 years showing over and over that while early detection through widespread screening can help in some cases, those cases are small in number for most cancers,” Kolata writes. “At the same time, the studies are more clearly defining screening’s harms.”

This is, obviously, a huge shift in the way we think about cancer treatment in particular and the whole notion of invasive medicine in general. But — primarily due to the alarming rise in health-care costs — it’s a discussion that has moved from integrative and alternative health advocates into the mainstream of the medical establishment. Even Dr. Otis Brawley, chief medical officer of the American Cancer Society, admits that doctors are “backing away from” the accepted notion that any sign of cancer is a death sentence — a view that has governed most conventional cancer treatment since 1845.

In fact, researchers now believe that the vast majority of cancers “grow very slowly or stop growing altogether,” Kolata writes. “Some even regress and do not need to be treated — they are harmless.”

As Brawley puts it, “We are going from an 1845 definition of cancer to a 21st-century definition.”

Both of my parents went through that 1845 version of cancer treatment: surgery, radiation, chemo. My father lasted about a year; my mother went from a vibrant 80-year-old to a helpless invalid within a couple of years. I can’t say for certain whether they would’ve lived longer without that treatment, but I know they would’ve lived better. And I hope my big brother will think twice before deciding to go down the same road.

Experience Life Magazine

Snooze or Lose

Sleep is a wonderful thing. Indeed, as I’ve grown older and levels of a certain hormone have subsided, it is from time to time preferable even to that other word that begins with the letter “s” and describes an activity that often occurs in the bedroom.
I know what you’re thinking: How can you prefer sleep to sit-ups?
It’s actually more complicated than you may think. This winter I’ve been generally avoiding the after-work gym routine that I’d been practicing pretty religiously for the past four years. I won’t bore you with all the excuses. Let’s just say it lost its allure. Kind of like sit-ups. To compensate, I began incorporating a little kettlebell workout into my morning routine. Not too intense, just a nice way to get the blood pumping before breakfast. Trouble is, creating that window of opportunity before work requires that I arise at a certain hour.
I don’t know if this happens to you, but there are mornings when I climb out of bed knowing that I have no business being vertical. And, while it doesn’t usually take too long to shake out the cobwebs and get on with my routine, I almost always pay a price later in the day. So, lately, I’ve been paying more attention to my level of fatigue when I first open my eyes in the morning, and opting to snooze right through my workout time if my body’s telling me it’s not fully rested.
As a result, I’ve lately found myself skipping my morning workout for lack of time, but still feeling plenty of energy because I’m not scrimping on my sleep. It’s a reasonable trade-off, it seems to me, given that sleep is so important to our overall health. As Kermit Pattison notes in this EL piece, “sleep is vital for sustaining peak mental performance, stabilizing mood, bolstering immunity, coping with stress, repairing our tissues, rebalancing our biochemistry and maintaining healthy metabolism. Hundreds of biological processes occur while we snooze — all of which allow us to be more productive, alert and healthy during our waking hours.”
I’m particularly intrigued by how a good night’s sleep boosts my aging immune system. Pattison reports that sleep deprivation has been linked to an increased risk of colon and breast cancer, heart disease and diabetes. That’s because, when you’re conked out, levels of cancer-killers like interleukin-1 and tumor necrosis factor rise by tenfold over your waking levels.
Even a mild case of sleep deprivation can increase inflammation in your body, and that can cause real problems. Here’s how Alexandros N. Vgontzas, MD, director of the Sleep Research and Treatment Center at Penn State University in Hershey, puts it:
“You develop a condition of low-grade inflammation, and we know that low-grade inflammation is a pathway to cardiovascular problems and decreased longevity. Several studies show that when these markers are high, people are at higher risk for hypertension, heart attacks, strokes and decreased longevity.”
That rings true for me, because it’s almost guaranteed that I’ll catch a cold if I’m tossing and turning for a few nights in a row. Thankfully, that doesn’t happen too often these days. Even without my morning workout, I’m still walking a couple of miles a day and squeezing in an occasional evening workout with Mr. Parkour and My Lovely Wife, and we all know that nothing sparks a good night’s sleep more than a generous amount of exercise during the day. Which, at least in theory, would then allow me to awaken refreshed and ready for my morning workout.
All of which reminds me that it’s time for bed.

Experience Life Magazine

Are Desk-Jockeys Doomed?







After WWII, my
father found a job delivering beer to bars and restaurants and liquor stores in
St. Paul. This involved schlepping a lot of heavy kegs and cases from his truck
to coolers every day, an activity that, over the years, made him a pretty
strong dude. I was thinking about that today, after reading a piece in the NY Times that warned desk-bound office
workers like myself that our comfy office chairs could be negating the benefits
of our workout routines.

 

Here’s how
Olivia Judson put it:

It doesn’t matter
if you go running every morning, or you’re a regular at the gym. If you spend
most of the rest of the day sitting — in your car, your office chair, on your
sofa at home — you are putting yourself at increased risk of obesity, diabetes,
heart disease, a variety of cancers and an early death. In other words,
irrespective of whether you exercise vigorously, sitting for long periods is
bad for you.”

 

Judson points to
recent studies showing that, among healthy people, those who sit for fewer
hours each day had slimmer waists and healthier levels of blood pressure and
blood sugar than those who parked their butt longer. Why? Because certain
molecules (lipoprotein lipase, for example) that play a primary role in helping
the body process fat are only produced when your muscles are contracting.

 

Obviously, the more you move, the better, but if you buy
Judson’s argument, then my father, who spent eight hours a day hauling
Grain Belt Beer throughout St. Paul, should’ve been a lot healthier than his
third son (that’s me), who hits the gym two or three times a week, but sits at
a desk all day — and lounges in his favorite chair most evenings while catching
up on the work he didn’t finish during the day or (sometimes) enjoying a good
book. That, unfortunately for my dad, was not the case. He carried an extra 50
pounds around his waist and suffered two heart attacks before he was 51. Cancer
claimed him at 60.

 

Now, I don’t
claim to be a paragon of good health, but, at 58, I’ve managed to avoid all the
health problems my dad had encountered — while spending the last 30-some years
sitting at a desk. So, obviously, there are factors involved here that Judson’s
choosing to ignore: small things like diet, stress management, smoking and
other lifestyle choices. And that’s too bad, because when people read stuff
like this, they tend to just give up on their exercise regimen. I mean, if
sitting at a desk is what you do to make a living and you read that all that
sitting basically renders any exercise program moot, what are you going
to do — quit your job?

 

The fact is,
regular exercise — along with a healthy diet and . . . well, you know the drill
– has been shown in study after study to be the key to long-term vitality, no
matter how many hours you log behind a desk each day. To suggest otherwise, it
seems to me, is pretty irresponsible.