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Posts Tagged ‘surgery’

For today’s consideration I offer up some statistics and information about two cancers common in both men and women, bladder and colorectal, along with some pointers about risk and detection.

For starters, how about a little definition of what exactly we’re talking about. First, the bladder. If you remember anything of biology or health and fitness classes, you might recall that the bladder stores urine until certain signals tell you it’s “full,” and then it contracts to help push the urine down the urethra and out of the body. Secondly, the colorectal area. Since they are connected physically and work in tandem as part of the digestive system, the colon and rectum are often grouped under the collective “colorectal” description. Essentially, the colon is the large intestine, and the rectum is the last six inches or so before the anus.

Okay, with the anatomy lesson over, lets get to the bits that actually matter. Bladder cancer is one of the more common cancers found in men and women but is rarely publicized. According to the American Cancer Society (ACS), in 2009 some 52,810 new cases of bladder cancer were expected in men. Using Census Bureau population estimates, that means any given man had a 0.00035% chance of being diagnosed with a new bladder cancer. Those are whopping odds, I know; and, ladies, you’re numbers are even lower. For 2009, any given woman had a roughly 0.00012% chance of being diagnosed with a new bladder cancer. The 18,170 estimated new cases of bladder cancer in women in 2009 means that men are several times more likely to develop bladder cancer than women are. In fact, the ACS reports that “bladder cancer incidence is nearly four times higher in men than in women and more than two times higher in white men than in African American men.” Sorry Team Blue.

But don’t let the numbers get you down. For men, the cumulative chances of developing bladder cancer remain less than 1% until age 70 and beyond. Lifetime odds are less than 4%. And the odds of dying from it? One-fifth the chance of developing it. Women, as the earlier numbers indicated, have even less to worry about: bladder cancer odds never breach 1% by age group and is only 1.2% over the course of a lifetime. So not exactly a raging pandemic by any means. Which is especially good because bladder cancer has no good method of early detection. The most effective assessment of bladder cancer involves running an endoscope up the urethra and taking a look around. For obvious reasons, this is a procedure to be avoided unless you happen to fall among a high-risk group and or show troubling signs (especially painful urination or bloody urine). For the vast majority of us, this will never be a problem, so don’t concern yourself over it too much.

Colorectal numbers are higher. The ACS expected 75,590 new cases in men and 71,380 new cases in women in 2009, making it “the third most common cancer in both men and women.” Those numbers are also fairly even between the sexes, unlike bladder cancer. However, like bladder cancer and prostate cancer and breast cancer and most other cancers as well, the highest odds come later in life. “91% of [colorectal cancer] cases are diagnosed in individuals aged 50 and older,” reads the ACS statistics release. But it also related that in both men and women, the odds of developing colorectal cancer are less than 1% until age 60. Again, little reason to worry.

But if the 5 – 5.5% chance of developing colorectal cancer over your lifetime have you on edge, there are several methods of early detection. Most of us are familiar with the colonoscopy procedures as described (and sometimes filmed) on TV, where an endoscope is run through the large intestine in search of suspicious lesions or polyps. But if that’s too invasive for your tastes, you might consider a sigmoidoscopy, where physicians examine the rectum and lower third of the colon for abnormalities through a thin device called a flexible sigmoidoscope. It takes about 15 minutes, is less invasive, and can still take biopsies of anything suspicious. It’s recommended every five years and, like conventional colonoscopy, can occasionally (but not commonly) cause bleeding or tears in the intestinal walls, both requiring surgery to repair.

If those don’t fit your fancy, perhaps a double-contrast barium enema (DCBE) would do the trick. Recommended every five to 10 years, it involves a very thorough barium sulfate enema that physicians use to examine the lower digestive tract via x-ray. It exposes the patient to less radiation than a typical CT scan (also called CAT scan) and is somewhat less invasive than colonoscopies or sigmoidoscopies. However, if you don’t mind an enema or the slightly higher radiation of CT or MRI scans, you might opt for the virtual colonoscopy. After an enema, a small tube pumps air into colon (for better differentiation) while CT or MRI scans provide images of the intestinal tract. It’s still less invasive than traditional colonoscopies but does not allow for biopsies or as thorough an internal view. However, it does allow for imaging of surrounding tissues and produces more accurate images than DCBEs.

But if you’re not fond of any foreign materials up the backside, you might just opt for the simplicity and complete non-invasiveness of fecal blood tests. There are two types but both are quite accurate and inexpensive. One type, called FOBT (fecal occult blood test), tests feces for the heme blood component (“heme” as in hemoglobin, part of our red blood cells). The other, called FIT (fecal immunochemical test), is more sensitive and tests for the globin blood component. Pre-cancerous polyps in the colon or rectum often bleed into the fecal matter passing through the digestive tract, which can be detected by these tests. They are simple enough to do at home and are sometimes handed out free of charge at proctology centers, clinics, and other medical service providers. Doctors recommend triple-testing to reduce false positives as the body expels small amounts of blood in feces under normal circumstances. But the tests return positive results for bleeding anywhere between the mouth and anus, so don’t automatically assume colorectal cancer even if there is blood. These fecal blood tests are considered a line of primary identification, as are the similar fecal DNA tests, but for conclusive diagnoses you’re still expected to see a doctor and perhaps choose a colorectal treatment of a more invasive kind.

I think the most important thing to remember is how unlikely these cancers are. And being diagnosed with cancer is a long way from dying of it. So keep an eye on yourself, and get your regular medical check-ups if you like, but don’t waste time and energy worrying about something so unlikely. No matter what you hear on the news.

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You may have heard about the plight of a small delta town called Jericho and its assistant fire chief Don Payne. It’s had a few mentions on the news networks and a couple appearances on the AP feed … and I dedicated a post to the story a couple weeks back (Holy Jericho).

For a quick re-cap of events: while in a court hearing over a traffic ticket issued to his son, Don Payne and at least one member of the Jericho Police Department got in an argument stemming from illegal traffic tickets issued to Payne and other residents of Jericho. A scuffle ensued and Payne was shot in the hip by Officer Eric Pharr of the Jericho Police Department. He was hospitalized in Memphis and underwent a five-hour surgery to remove the .40 caliber bullet which had lodged in his hip bone. He was recently released in good health but still requires the use crutches. Following the shooting, Jericho Police Chief Willie Frazier temporarily disbanded the police force and the entire department remains under investigation.

But no charges have been filed against Officer Eric Pharr, who fired on an unarmed Don Payne in front of six other police officers and presiding judge Tonya Alexander (who quickly resigned her post). The Crittenden County Sheriff’s Office, which began investigating other questionable Jericho police acts, has reported no progress in the investigation and has shared little of the information collected about the courtroom incident.

Unfortunately, a gunshot wound was only the beginning for Mr. Payne. Days after being released from the hospital, Jericho Mayor Helen Adams officially dismissed him as assistant fire chief. “As it comes to my attention of the improper behavior that you displayed,” she wrote in his letter of termination. “You have disgrace my name as Mayor.” And to top it off, arrest warrants were issued for his arrest. Let me repeat that: the police issued warrants for the arrest of Don Payne after he was shot by a police officer during court proceedings about the legality of the police department’s actions.

And Officer Pharr, who wounded another officer in the shooting, has not received so much as a reprimand. In fact, he’s back on the beat, writing tickets and patrolling the city as usual. Despite Police Chief Frazier’s promise to disband the police force until the investigation was completed, the department re-assembled after little more than a week apart and resumed their “duties.”

The decision not to prosecute Officer Pharr apparently fell to West Memphis City Prosecutor Lindsey Fairley, who supported the officers’ right to detain the former assistant fire chief. Apparently by whatever means necessary. It was also Fairley who decided to levy the charges on Don Payne. The charges – two counts of felony battery – allege that Payne assaulted Police Chief Willie Frazier by shoving him backward, and then reached for Officer Eric Pharr’s weapon. Which Payne vehemently denies. Thomas Martin, the chief investigator for the Crittenden County Sheriff’s Department heading up the on-going investigation of Jericho’s police force, confirmed not only that the warrants had been issued but that the police claimed Don Payne was reaching for Eric Pharr’s weapon when he was shot. Early reports noted that the bullet struck Don Payne from behind, which was corroborated in the wound as seen in this video (at the :30 mark). But that angle of approach would make reaching for the pistol improbable if not impossible, a particular of the case that no one in authority has yet commented on.

And although the arrest warrants have been issued, they have not been served. Jericho police are back on the streets and are clearly aware of Don Payne’s residence but have made no attempt to take him into custody. “I’m sitting right here just waiting,” Mr. Payne shared from his front porch during a short interview with one Memphis reporter. “I’m not a fugitive.”

Randy Fishman, of the Memphis law firm Ballin Ballin and Fishman, was secured as Don Payne’s legal counsel shortly after the shooting and maintains that the police were not acting in the public’s best interest. “I think an officer should be trained in not only how a weapon should be used but when a weapon should be used,” Mr. Fishman said. He reiterated that pulling a pistol on an unarmed civilian surrounded by police showed poor judgement, and that firing it was negligent at best. “If anyone should be charged with a felony here, it should start with the officer who pulled the gun.” He has also stated that they are prepared to fight any charges arising from this unfortunate circumstance.

And though he is no longer Jericho’s assistant fire chief, the rest of the Volunteer Fire Department fully support him. All 19 members quit the department en masse on hearing of Payne’s dismissal.

On September 9th, the mayor and city council had a “secret meeting” but none will speak to the press about that meeting, the incident, or even the original allegations of police corruption in Jericho. Various reporters have attempted to speak with city officials but met stiff opposition, including a police response.

With a bit of digging, I unearthed the phone number of Jericho City Hall and repeatedly rang it myself … to no avail. The same was true of the Crittenden County Sheriff’s Office. (I hate to think if I lived in the county and tried to ring their offices with an actual problem.) But I take this as a good sign. Because if they aren’t talking, it means they are concerned, and if they are concerned then – just maybe – they have something be concerned about.

I intend to follow this case and update on it when news becomes available. And in the meantime, godspeed to Mr. Payne and Mr. Fishman.

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Related articles and information:

CBS News

Memphis ABC News

KAIT 8 short and video

Original AP article

Payne’s Wife Speaks

Jonathan Turley’s Blog

Jericho City Hall Phone Number: 870-739-3884

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