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Location is key for skin cancer

Location is key for skin cancer

Location, location, location is the mantra of the real estate profession. But it’s also a key concept for skin cancer.

From 40 to 50 percent of Americans who live to age 65 will eventually develop at least one skin cancer. It’s by far the most common type. If skin cancer is not on your mind as you head off to the beach this summer, it should be. But what does location have to do with it?

LOCATION–WHERE YOU LIVE: It’s pretty simple: the closer you live to the equator, the higher your risk of skin cancer. The number one risk factor for skin cancer is exposure to ultraviolet radiation. UV rays come primarily from the sun but also from tanning beds.

If you live in a high-risk area, you can lower your risk by protecting yourself from the sun. Stay inside during the mid-day hours when UV rays are at their peak. Wear protective clothing and a broad-brimmed hat to protect your head, face and ears. Apply sun screen with an SPF of 15 or higher every day.

If you live in a low-risk area, the rules are the same–protect your skin. Ultraviolet rays are present and dangerous even on cloudy days.

LOCATION–WHERE YOUR ANCESTORS LIVED: If your ancestors came from a northern climate such as Ireland, Scotland or Scandinavia, you probably have fair skin and maybe freckles. You may complain that your skin tends to burn rather than tan. And you have a higher risk of skin cancer–particularly if you live in a sunny place like Florida or Arizona.

LOCATION–WHERE ON YOUR SKIN ARE CANCERS MOST LIKELY? For nonmelanoma skin cancers, risk is directly correlated with cumulative exposure to ultraviolet radiation. The more time you spend in the sun over your lifetime, the greater your risk. That’s why many skin cancers develop late in life.

You may have noticed that freckles, sun spots and other skin blemishes that develop later in life appear mostly on skin that has been most exposed. These are also the locations where skin cancers are likely to develop: the face, scalp, ears, neck and hands.

Those are the places to protect against the sun. Be sure to apply sun screen daily to your face and hands. A baseball cap will cover your scalp but not your ears or neck. That’s why a broad-brimmed cap is recommended.

Most cancers that develop in these locations are basal cell and squamous cell carcinomas. They rarely kill. And when they spread, it is usually to nearby tissue.

But it’s important to remember that these are locations that represent you to the world. A nasty skin cancer on your nose or ears can usually be removed but may leave an unsightly scar.

LOCATION–HOW ABOUT MELANOMA? For melanoma, the most serious skin cancer, exposure to ultraviolet radiation is a risk factor…but in a less direct way. Frequent severe sunburns, particularly in youth, may pose a greater danger than cumulative exposure over a lifetime. As a result, the location of the cancer is not quite so easy to pinpoint.

Nevertheless, about one third of melanomas occur on the neck. For men, that is a particularly likely area, along with the upper back, chest and anywhere on the trunk. For women, the most common melanoma sites are the lower legs, upper back and arms.

In addition, there are numerous unexpected sites where melanoma can occur. The area between the buttocks is a site that rarely sees the light of day. Yet it’s also a site that must be checked for melanoma. Both melanoma and squamous cell carcinoma may also appear on lips, inside of the mouth, nasal passages and genital tissues.

Other locations include the soles of the feet, the palms of the hand and the nail beds. African Americans and others with highly pigmented skin are relatively unlikely to develop skin cancers. When they do, however, the cancers often develop in these unexpected locations and are likely to go undetected.

All skin cancers, even melanoma, are curable if detected and removed at an early stage. So it’s important to examine your skin on a regular basis and learn to recognize the signs. As one dermatologist put it, “There are many lesions on your skin. Most are harmless. The cancer is usually the new guy on the block who appears out of the blue and doesn’t quite fit in with the others.”

Map out all of the neighborhoods of your body and try to keep track of the spots, freckles, moles and other lesions. When a new one appears or if there is a change in an old one, it’s time to take action.

Early detection is one of the most important factors to surviving cancer. Learn which screenings are right for you.


American Cancer Society, “Skin cancer facts,” last medical review April 13, 2015.
Adelina Espat, “Skin cancer: uncover that mole,” M.D. Anderson Cancer Center.
Dana-Farber, “What are the most common sites for melanoma?” Insight (blog), July 16, 2014.
Laird Harrison, “Sun exposure in adulthood can be risky,” Medscape Medical News, March 23, 2015.
Steven C. Lee, “Salivary gland neoplasms,” Medscape Reference, updated March 6, 2015.
Sarah Lewis, PharmD, “8 most common places to get skin cancer,” HealthGrades.com, medically reviewed by William C. Lloyd III, M.D., FACS, June 6, 2015.
Sarah Lewis, PharmD, “5 unexpected places to check for skin cancer,” HealthGrades.com, medically reviewed by William C. Lloyd III, M.D., FACS, June 4, 2015.
Marcus M. Monroe, M.D., “Cutaneous squamous cell carcinoma,” Medscape Reference, July 10, 2015.
Skin Cancer Foundation, “Skin cancer facts,” last updated February 5, 2016.
Rebecca Tung, “Melanoma,” Cleveland Clinic Center for Continuing Education, August, 2010.
Chris D. Tzarnas, M.D., and Carl H. Manstein, M.D., MBA, “Case challenge: a pigmented nodular growth on the ear,” Medscape Dermatology, December 19, 2014.



When aging legs become restless

When aging legs become restless

You may know the symptoms: uncomfortable itchy or pins-and-needles sensations in the legs, causing an almost irresistible need to move the legs.

A big sleep killer, restless legs syndrome (also known as Willis-Ekbom Disease) can occur at any age–even in young children. But it’s more common with advancing age, and in seniors, poor sleep means an increased risk of accidents, falls and a declining quality of life.

In many cases, RLS that develops in a mild form in early life becomes more severe after age 60. Regardless of age or severity, many patients do not seek treatment, believing they will not be taken seriously.

RLS is often confused with periodic limb movement disorder of sleep (PLMS). Symptoms of PLMS include involuntary leg twitching or jerking movements that occur every 15 to 40 seconds during sleep, sometimes for a good part of the night.

Whereas persons with restless legs syndrome experience symptoms when they are awake and resting, individuals with PLMS are asleep when their leg movements occur.

Some individuals have periodic leg movements during sleep without any RLS symptoms. But 80 to 90 percent of RLS patients eventually develop periodic limb movement of sleep–adding up to double trouble.

Restless legs syndrome is known as a movement disorder because the patient has an overwhelming urge to move her legs, usually (but not always) because of unpleasant sensations such as itching, tingling, aching or pins-and-needles.

Moving the legs temporarily relieves the discomfort, but, to keep the symptoms from returning, the patient sometimes maintains a rather constant movement–pacing the floor, jiggling a foot or leg or tossing and turning in bed.

Symptoms vary in severity and from day to day. In severe cases, they occur more than twice a week and interfere with sleep and normal daytime activities.

Based on a growing body of evidence, most doctors believe that the disorder is related to a dysfunction in the brain circuits that use the neurotransmitter, dopamine–some of the same circuits that are involved in Parkinson’s disease. Among other things, dopamine helps regulate muscle activity and movement.

Restless legs syndrome is associated with other disorders such as kidney failure, diabetes, peripheral neuropathy and low levels of iron in the blood.

Some studies have linked RLS symptoms with underlying varicose veins in the legs. In one study, 98 percent of 113 patients reported relief from RLS symptoms when they were given non-surgical treatment for varicose veins.

Some women have temporary bouts of RLS during pregnancy, usually during the last trimester. Medications that can cause symptoms or make them worse include antinausea medications, antipsychotics, antidepressants that increase serotonin and cold and allergy medications that contain sedating antihistamines.

When RLS symptoms are mild, they may be treated primarily with lifestyle measures: massaging the legs; soaking in a warm bath; applying warm or cold packs; getting regular exercise; reducing use of caffeine, alcohol and tobacco; establishing good sleep habits; relaxing through yoga, meditation or other means; and stretching the calves, quadriceps, hamstrings and hips.

Moderate to severe RLS can be treated with medications that increase dopamine levels in the brain. Those approved by the FDA include pramipexole, ropinirole and rotigotine.

Other drug treatments include prescription painkillers, sleep medications, muscle relaxants and anti-seizure medications. All of the above have side effects, and a drug that has worked for awhile may become ineffective.

Patients who do not need medications or would rather not take them have reported getting better sleep with the Relaxis vibrating pad that been approved by the Food and Drug Administration for the treatment of RLS. Placed under the legs, the device vibrates at different intensities for 30 minutes at a time to act as a counter stimulus to the RLS symptoms.

On its own, restless legs syndrome is not necessarily a serious medical concern, but because patients of both RLS and PLMS find it so difficult to get a good night’s sleep, the disorder can have a serious impact on quality of life.


Affinity Health System Sleep Disorders Labs are state-of-the-art full service sleep labs, which test patients for sleep disorders such as restless legs syndrome. Learn more.

Ministry Health Care offers treatment options for such disorders such as restless legs syndrome. Learn more.



Pauline Anderson, “Restless genital syndrome a variant of restless legs?” Medscape Medical News, November 4, 2014 (JAMA Neurology, October 6, 2014).
Pauline Anderson, “Restless legs syndrome linked to higher mortality,” Medscape, June 12, 2013.
Wayne E. Anderson, D.O., FAHS, FAAN, “Periodic limb movement disorder,” Medscape Reference, updated August 12, 2015.
Nisha Aurora, M.D., et al, “The treatment of restless legs syndrome and periodic leg movement disorder in adults–an update for 2012: practice parameters with an evidence-based systematic review and meta-analyses,” Sleep, Vol. 35, No. 8, 2012.
Ali M. Bozord, M.D., “Restless legs syndrome,” Medscape Reference, updated July 24, 2015.
Megan Brooks, “Severe restless legs syndrome linked to increased stroke,” Medscape Medical News, June 15, 2015.
Sue Hughes, “Restless legs syndrome: new evidence of peripheral mechanism,” Medscape, May 30, 2014.
Susan Jeffrey, “FDA okays first device for restless legs syndrome,” Reuters Health, May 30, 2014.
Daniel M. Keller, Ph.D., “Deep-brain stimulation relieves restless legs syndrome,” Medscape, June 29, 2015.
Mayo Clinic Staff, “Restless legs syndrome,” MayoClinic.com, December 10, 2014.
Nancy A. Melville, “Restless legs, silent cerebrovascular disease linked,” Medscape, October 14, 2015.
National Institute of Neurological Disorders and Stroke, “Restless legs syndrome Fact Sheet,” NIH Publication No. 10-4847, July 27, 2015.
National Sleep Foundation, “Restless legs syndrome (RLS) and sleep.”
S.A. Milligan and A.L. Chesson, “Restless leg syndrome in the older adult: diagnosis and management,” Drugs and Aging,
Mary M. Reilly, “Obstructive sleep apnea, restless leg syndrome and Charcot-Marie-Tooth disease type 1: important associations,” Journal of Neurology, Neurosurgery and Psychiatry, 2014;85(3):245.
William C. Shiel, Jr., M.D., FACP, FACR,
“Restless legs syndrome,” MedicineNet.com, reviewed August 3, 2015.
Sleep Management Institute, “RLS/PLMD,” 2010.
Melinda Smith, M.A., Lawrence Robinson and Robert Segal, M.A., “Restless legs syndrome (RLS),” HelpGuide, last updated August, 2015.
M.J. Thorpy, “New paradigms in the treatment of restless legs syndrome, Neurology, June 28, 2005.



Chia seeds

Chia seeds

When it comes to recent food trends, it is almost impossible to ignore the increased use and popularity of Salvia hispanica L.

Salvia hispani… what? Salvia hispanica L is popularly known as chia seeds. This mint related plant is leaving its mark on the food industry and is ever so prevalent on the internet. If you do a quick google search you will find plenty of recipes using chia seeds; and you are likely to come across this gluten-free seed on Pinterest and other social media networks.

Chia seeds, which date back to the ancient Aztecs, have shot to the top of the “superfood” lists, creating a craze with consumers. You can use chia seeds to make beverages, desserts, crackers, breading and more. The seed can be consumed whole or ground, and may be easily added to foods such as yogurts, smoothies, oatmeal and other cereals.

A unique property of the seed is its ability to turn gelatinous or gummy when soaked, allowing it to be used as a thickening agent in recipes. This feature comes in handy when using it as a substitute for eggs in baking. To use chia seeds instead of eggs, soak 1 tablespoon of ground chia seeds in 3 tablespoons of water for five to 10 minutes. This is usually the equivalent of one egg.

In a study published in the Journal of the American Dietetic Association, it was found that 25 percent of eggs or oil in a recipe could be replaced with the chia gel without affecting the functional or sensory properties of the cake. By using chia seeds instead of oil or eggs, it decreases the caloric and fat content of the final product.

So what are the nutritional claims? Chia seeds are tagged as a good source of fiber, protein, omega-3 fatty acids and antioxidants, such as quercetin and others. Antioxidants are substances that help reduce the effects of free radical damage in the body. Antioxidants counteract free radicals which can cause inflammation, damage to cells, and worsening of certain diseases. Chia seeds provide omega-3 polyunsaturated fatty acid in the form of alpha linolenic acid (ALA), the same fatty acid found in flax seeds. Although the impact of ALA on heart health is less clear than that of other types of omega 3s such as the ones found in fatty fish, they are still beneficial.

One important fact about chia seeds is that they are a complete protein, providing all essential amino acids. This may be beneficial for individuals who choose to live a vegan lifestyle. In comparison to tofu, another commonly used complete protein, chia seeds are much lower in protein when matched for total calories, but contains more than 15 times as much fiber, an important component of nutrition that is often lacking in the American diet.

While considering chia seeds as a super food is up for debate, they do contain some nutritional benefit. It is important to remember however, that chia seeds are not a free calorie food; they do contain almost 75 calories per one tablespoon.

So give chia seeds a try. They are very mild in taste and may add some nutrition to your meals!

Author: Julia E. Salomón, MS, RDN, CD

Activity trackers…what’s next

Activity trackers…what’s next

Since Linda started using her Fitbit, she can often be seen pacing the floor while talking on the telephone or watching TV. She is happy with her activity tracker and feels that it is helping her meet her health and fitness goals.

If you haven’t heard of Fitbit, Jawbone, Garmin or any of the other activity trackers, you are probably in the minority. It’s now estimated that one of five Americans wears a fitness tracker. And a good number of these persons have rather optimistic views of what these gadgets can do for them.

These electronic trackers are basically upgraded versions of pedometers, and early versions such as the original Fitbit introduced in 2009 were clipped to the waist. Compared to pedometers which cost $15 to $20, these devices are expensive, running from $60 to $250 or more. They do, however, have greater tracking ability and include software that enables you to connect with your computer or smart phone.

As activity trackers become more popular, the basic appeal apparently is the ability to visualize your activity on charts and graphs and monitor your progress from day to day and week to week. If you wish, you can use social media to compete with friends.

Two popular and highly rated devices are the Fitbit Charge HR and the Garmin Vivosmart HR. The features are roughly the same: measurement of daily steps, miles traveled, calories consumed, floors climbed, sleep quality and a continuous reading of heart rate. Unlike sports watches with heart rate monitors, such as the Polar FT1 and 4, these trackers don’t require a chest strap.

At this price level (about $150), you can expect to get a watch and activity readout on the wrist band as well as on your smart phone or computer.

In addition, the software tracks active minutes and gives a summary of each workout, charting time, calories consumed and average beats per minute.

At a lower price point (about $100), trackers such as the Jawbone UP2 and the Fitbit Flex have most of the above tracking features except heart rate. The information can be accessed through your computer or smart phone but not on your wrist.

At a higher price point (about $250), devices such as the Fitbit Surge and the Garmin Vivoactive offer a full-size watch plus GPS tracking to go with all of the other features.

The GPS gives an accurate tracking of distance. Without it, you should realize that an activity tracker gives you an approximation of distance based on steps taken and heart rate.

For step tracking, nearly all wrist devices base their calculations primarily on arm movement. If you wave your arms without walking, you get credited with steps. If you push a grocery cart, moving your legs but not your arms, you get very little credit. By comparison, the less expensive Omron pedometer, which attaches to your belt, is more likely to give you an accurate tracking of steps.

Jack was particularly pleased with the sleep information he received from his device. If he woke at 3 a.m. for a bathroom trip, a red line indicated the interruption. White lines indicated when his sleep was restless. And he was happy to discover that these white lines occurred more frequently in the morning as he was preparing to wake up rather than in the middle of deep sleep.

Such information is no substitute for a sleep study to diagnose sleep disorders, but it might indicate the need for such a study if the restless lines were too prevalent.

Heart rate is clearly an important indicator of health and fitness. But, again, it’s important to remember that the activity tracker is not a medical instrument.

A resting heart rate that gets lower over time is a sign that the heart is getting stronger and more efficient. And the software for most wrist monitors will allow you to see this kind of progress.

The major health benefit of an activity tracker is the increased motivation to be active and to maintain healthy habits, including good sleep.

The possibilities are virtually endless, and new wrinkles are being added all the time. Are activity trackers merely expensive toys, or do they provide real health benefits? There is no question that Americans need to be more active, and if these devices motivate people to take more steps and climb more stairs, they may be worth the expense.

How long will the motivation last? And will the couch sitters who stand to benefit the most ever succumb to the temptation? It’s too soon to tell.

Talk to your primary care physician about how you are using your activity tracker. Don’t have a doctor? Find one at Ministry Health Care or Affinity Health System today.



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Marlene Busko, “Walking with pedometer, wireless BP monitor tied to BP lowering,” Medscape, June 18, 2016.
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Madeline Kennedy, “Activity trackers vary in accuracy,” Reuters Health, September 2, 2016.
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Amy Roberts, “The best fitness trackers,” The Wirecutter, last updated January 19, 2016.
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“26 fitness trackers ranked from worst to first,” Time, January 9, 2014.

Lung cancer; what you should know

Lung cancer; what you should know

According to the American Cancer Society, lung cancer accounts for more deaths than any other cancer in both men and women in the United States. An estimated 158,040 deaths were expected to have occurred in 2015 from lung cancer. Wisconsin had an estimated 3,050 deaths from lung cancer.

Prevention: There is no definite way to prevent lung cancer. Not smoking or quitting now and avoiding secondhand smoke can decrease risk. Avoid other risk factors and employ healthy behaviors such as a balanced diet, exercise, stress management and adequate sleep.

Risk factors: Smoking is the top risk factor for lung cancer. Exposure to radon gas is estimated to be the second-leading cause of lung cancer in the US. Other risk factors include exposure to secondhand smoke, asbestos (particularly among smokers), certain metals (arsenic, cadmium, chromium), radiation, air pollution, and diesel exhaust. Occupational exposures that increase risk include rubber manufacturing, paving, roofing, painting, and chimney sweeping. Some, who develop the disease at a young age, may have a genetic susceptibility.

Signs and symptoms: Symptoms do not usually occur until the cancer is advanced, and may include voice changes persistent cough, coughing up blood, chest pain, worsening short­ness of breath, and recurrent pneumonia or bronchitis.

Early detection: In 2013, the American Cancer Society and the US Preventive Services Task Force issued guidelines for the early detection of lung cancer based on a systematic review of research. Those current or for­mer smokers who are 55 to 74 years of age, in good health, and with at least a 30 pack-year history of smoking should consult their health care provider to discuss whether a low dose spiral CT should be completed for screening.

Treatment: Depending on type and stage of cancer, surgery, radiation therapy, chemotherapy, and immunotherapy are indicated.

Survival: Despite these treatment options, the American Cancer Society estimates the 5 year relative survival rate to be 17%.  The American Lung Association estimates that more than half of people with lung cancer die within one year of being diagnosed.

Lung cancer is killing more people than any other cancer in the United States.  It is time to change this statistic by not smoking or quitting and reducing other risk factors, reporting signs and symptoms to a clinician. Early detection may lead to better outcomes. Research is ongoing for successful treatments.

For more information on lung screenings, risk factors or cancer treatment options, please visit ministryhealth.org or call the James Beck Cancer Center in Rhinelander at 715.361.2140.

Early detection is one of the most important factors to surviving cancer. Find out which screenings are right for you.

Author: Tammery Perry is a Ministry Medical Group Nurse Practitioner at the James Beck Cancer Center in Rhinelander.

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