Health Watch

Unsightly scars

Treatment is key to minimizing their appearance

by Dr. H. Christopher Coley

 

 

Do you have a scar from a procedure or injury that you wish you could erase? Fortunately, with today’s technology there’s something you can do to prevent and minimize its appearance.

 

A scar is formed as a natural healing response to an injury. This healing process and scar remodeling can last for months. Depending upon the depth of injury, scars can be mild or severe. They vary in their characteristics, including shape, size and color.

 

Common types of unsightly scars include hypertrophic scars, stretch marks and keloids. Hypertrophic scars are those that are slightly wide, raised or thick in appearance. Typically, they’re confined to the original injured area and are formed by excess collagen formation. Stretch marks are caused by the stretching of the skin during pregnancy, bodybuilding or excess weight gain. Keloids are a type of hypertrophic scar that continue to grow outside the boundary of the original injury and can become large and unsightly.

Different areas of the body scar differently, with better scars occurring in areas where the skin is thin such as the face and neck. Areas where the skin is thicker, such as the back and trunk, generally scar worse. Genetics also can play a factor in scarring.

 

Minimizing scars

Surgical scars can be minimized in several ways. The key factors to help prevent surgical scars include delicate handling of tissue during repair, avoiding excess tension on the repair, and using proper technique and supplies. Removal of stitches and staples at the proper time also is important. Good wound care after the injury is just as important. It helps prevent infection, avoiding excess drying or moisture, limiting motion, and protecting the incision from the sun.

 

Some scars are inevitable due to circumstances surrounding the injury or condition. In some cases, incisions can be placed to help camouflage the scar in a natural skin fold. Other surgical techniques also can be used to minimize scarring.

 

To further minimize scarring, there is evidence that gentle compression through taping or a specialized bandage can aid in preventing hypertrophic scarring. Because hypertrophic scars essentially are excess inflammation and collagen, an injection with a steroid — a potent anti-inflammatory — or a topical steroid can prevent or correct a hypertrophic scar.

 

Other common scar remedies include topical antioxidants such as vitamins C and E. There are numerous other additives and home remedies that can help with scar formation as well. One of the best and well-known is silicone, which has been shown to prevent hypertrophic scars and improve the appearance of older scars. Two popular formulations available are Scarguard and Hybrisil, both of which are available by prescription.

 

Other ways to treat hypertrophic and unsightly scars include surgical excision or scar revision, laser resurfacing, and dermabrasion. Current research also suggests that there might be a role for radiation and treatment of severe hypertrophic scars and keloids with some potent medications and even chemotherapeutics.

 

If you have an unsightly scar, then obtain a consultation with a cosmetic surgeon to discuss your options.

 

Dr. H. Christopher Coley, board-certified and fellowship-trained in both cosmetic and hand surgery, is owner and chief surgeon of the Coley Cosmetic & Hand Surgery Center in Greensboro. To learn more, call (336) 617-8645 or visit www.coleycosmetic.com.

Breast health 101

Know your risk factors

by Emily Koon

 

October is National Breast Cancer Awareness Month, the ideal time for women of all ages to begin determining their risk for breast cancer. More than 200,000 new cases will be diagnosed in the U.S. this year. But the good news is that with early diagnosis and treatment, the five-year survival rate for breast cancer patients now is 96 percent.

 

“To be among that 96 percent, there are a number of steps that even younger women can begin taking,” says Dr. Judith Hopkins, an oncologist with the Derrick L. Davis Forsyth Regional Cancer Center at Forsyth Medical Center in Winston-Salem.

 

“The first step is finding out what your risk is,” she adds. “Being aware of your risk factors means that you and your physician can form a plan of action to monitor your breast health more closely. If breast cancer does develop, then it can be caught early, and that gives patients the best chance for successful treatment.”

 

Hopkins recommends looking at the following risk factors and discussing them with your doctor:

  • Age. Are you 60 or older?
  • Family history. Do you have a family history of breast cancer? Specifically, did your mother, sister or grandmother develop the disease before age 40?
  • Race. Caucasian women generally are at a higher risk for breast cancer than Latin American, Asian and African-American women.
  • Reproductive factors. This includes menstruation before age 12, later-onset menopause after age 55 and being older than 35 when you have your first child.
  • Activity level. Being physically inactive or obese increases your risk.

While most of these factors are out of your control, Hopkins says there still are steps you can take to lower your risk. Most importantly, begin getting annual mammograms at 40, or earlier if you’ve been determined to be at a higher risk.

 

Women of all ages, regardless of their risk factors, also should get into the habit of performing monthly self exams to identify any changes in the breast, such as:

  • A change in how the breast or nipple feels, such as a lump or thickening in the breast or underarm
  • Tenderness in the breast or underarm
  • A change in the appearance of the breast or nipple, such as size or shape; scaly, red or swollen skin; or a nipple that is turned inward
  • Nipple discharge

Simple lifestyle changes can lower the risk for breast cancer and other diseases. These include:

  • Exercising at least 30 minutes daily
  • Maintaining a healthy weight
  • Eating a healthy, low-fat diet that includes at least five servings of fruit or vegetables each day
  • Avoiding tobacco
  • Limiting alcohol consumption

Another valuable tool in the fight against cancer is genetic counseling if you have a family history of breast cancer. A genetic counselor can help you develop a family health tree to highlight cases of breast cancer that can raise your risk, and a simple blood test can identify possible genetic links to breast cancer if your risk is high enough.

 

“The important thing to remember is that when it comes to breast cancer, there is no such thing as too much information,” Hopkins says. “If you think you might be at risk, then develop a three-generation family history and discuss your concerns with your doctor.”

 

For more information on breast cancer and your risk factors, contact the Forsyth Regional Cancer Center at (336) 277-0198 or visit www.forsythmedicalcenter.org/cancer.

Unsightly scars

Treatment is key to minimizing their appearance

by Dr. H. Christopher Coley

 

 

Do you have a scar from a procedure or injury that you wish you could erase? Fortunately, with today’s technology there’s something you can do to prevent and minimize its appearance.

 

A scar is formed as a natural healing response to an injury. This healing process and scar remodeling can last for months. Depending upon the depth of injury, scars can be mild or severe. They vary in their characteristics, including shape, size and color.

 

Common types of unsightly scars include hypertrophic scars, stretch marks and keloids. Hypertrophic scars are those that are slightly wide, raised or thick in appearance. Typically, they’re confined to the original injured area and are formed by excess collagen formation. Stretch marks are caused by the stretching of the skin during pregnancy, bodybuilding or excess weight gain. Keloids are a type of hypertrophic scar that continue to grow outside the boundary of the original injury and can become large and unsightly.

 

Different areas of the body scar differently, with better scars occurring in areas where the skin is thin such as the face and neck. Areas where the skin is thicker, such as the back and trunk, generally scar worse. Genetics also can play a factor in scarring.

 

Minimizing scars

Surgical scars can be minimized in several ways. The key factors to help prevent surgical scars include delicate handling of tissue during repair, avoiding excess tension on the repair, and using proper technique and supplies. Removal of stitches and staples at the proper time also is important. Good wound care after the injury is just as important. It helps prevent infection, avoiding excess drying or moisture, limiting motion, and protecting the incision from the sun.

 

Some scars are inevitable due to circumstances surrounding the injury or condition. In some cases, incisions can be placed to help camouflage the scar in a natural skin fold. Other surgical techniques also can be used to minimize scarring.

 

To further minimize scarring, there is evidence that gentle compression through taping or a specialized bandage can aid in preventing hypertrophic scarring. Because hypertrophic scars essentially are excess inflammation and collagen, an injection with a steroid — a potent anti-inflammatory — or a topical steroid can prevent or correct a hypertrophic scar.

 

Other common scar remedies include topical antioxidants such as vitamins C and E. There are numerous other additives and home remedies that can help with scar formation as well. One of the best and well-known is silicone, which has been shown to prevent hypertrophic scars and improve the appearance of older scars. Two popular formulations available are Scarguard and Hybrisil, both of which are available by prescription.

 

Other ways to treat hypertrophic and unsightly scars include surgical excision or scar revision, laser resurfacing, and dermabrasion. Current research also suggests that there might be a role for radiation and treatment of severe hypertrophic scars and keloids with some potent medications and even chemotherapeutics.

 

If you have an unsightly scar, then obtain a consultation with a cosmetic surgeon to discuss your options.

 

Dr. H. Christopher Coley, board-certified and fellowship-trained in both cosmetic and hand surgery, is owner and chief surgeon of the Coley Cosmetic & Hand Surgery Center in Greensboro. To learn more, call (336) 617-8645 or visit www.coleycosmetic.com.

Life after cancer

Survivorship programs focus on wellness, support

by Ginny Gaylor

 

When you receive a cancer diagnosis, odds are you don’t spend much — if any — time thinking about what life will be like once you’re done with treatment. You worry about chemotherapy or radiation, or if the cancer will go away. You think about how it will affect your family, your savings and your job. You might even think about losing your hair. So when treatment is done and your cancer is in remission, you suddenly realize, now what?

 

You are not alone. But Triad area cancer patients are fortunate. With five major hospitals to choose from, treatment is never far away. Best of all, each of these medical centers has programs geared toward guiding cancer patients and survivors through each stage: diagnosis, treatment and survivorship. From support groups to exercise classes, each provides a range of activities to support cancer patients.

 

Celebrating survival

Sometimes it’s important to simply celebrate survival, and that’s what programs at Forsyth Medical Center and Wake Forest Baptist Medical Center offer. Forsyth’s program, Feel Good Fridays, takes place the first Friday of every month. During the program, survivors can get haircuts, manicures and massages; practice reiki; and enjoy crafts and food.

 

“The event is a day for survivors and their families to enjoy,” says Laurie Mathis, a breast oncology nurse navigator with the hospital system.

 

Judy Dobson, a breast cancer patient, enjoyed participating in Feel Good Friday so much that she ended up volunteering to decorate tables for the event.

 

“It’s one of my favorite support systems there,” she says. “Just being around people who understand more about the situation I’m in helps, and I really do like the atmosphere.”

 

Wake Forest Baptist Medical Center (WFUBMC) offers a similar program on a quarterly basis called Just 4 You Day. The event includes breakfast, lunch and snacks, and offers professional chair massages, makeovers from Belk’s cosmetic artists, haircuts, manicures, live music, a DJ, and door prizes. Area military staff as well as personnel from Coldwater Creek and Home Depot also have stepped in to help out during events.

 

“They have shown tremendous enthusiasm for being a part of this special day for our survivors,” says Marcy Poletti, MSN, RN, the hospital system’s oncology service line program administrator.

 

Finding a new normal

At Moses Cone Health System, Finding Your New Normal (FYNN) is an eight-week program geared toward people who have completed cancer treatment. The program was built on a wellness concept using a model developed by a UNCG professor of counseling.

 

“We combine a focus on issues survivors need to know about and are affected by, and introduce some kind of exercise each week,” says Terry Moore-Painter, the hospital systems’ chaplain.

 

She adds that FYNN groups tend to bond pretty closely and often continue to meet even after formal sessions are over.

 

Fran Rinehuls knows firsthand the benefits of the FYNN program, although she was reluctant at first.

 

“I remember when I finished with my treatment, I expected to be me again, and it doesn’t quite work that way,” says Rinehuls, a breast cancer survivor.

 

“I thought about going, but I hesitated,” she adds. “I thought it was going to be really depressing. I had this preconceived notion of what a support group was going to be.”

 

Fortunately, her idea of what a cancer support group was and the reality were worlds apart.

 

“Within five minutes of the group starting, I thought, ‘This is just wonderful.’ I fit in immediately,” Rinehuls says. “All of us were in the phase of getting our hair back, so we all had the same haircut.”

 

During the first session, Rinehuls recalls an instant connection and empathy among the group’s members.

 

“We knew what the other person was going through. There was no need for explanations,” she says. “We still get together.”

 

Helping hands

Alamance Regional Medical Center in Burlington takes a slightly different approach with Wings to Recovery, a cancer survivorship program that pairs a cancer survivor mentor with a current cancer patient.

 

“We try to match diagnosis to diagnosis,” says Rosa Davis, a chemotherapy-certified registered nurse and the program’s coordinator.

 

“We even try to match mentors and patients on specific types of treatment,” she adds. “The mentor is someone who has been through it, walked down that path and knows how the new patient feels.”

 

Mentor Dave Forsyth wishes this kind of program existed when he began receiving treatment for multiple myeloma.

 

“I think the most encouraging part is to see someone who has survived cancer. That gives them hope,” he says. “Not in words, but just to see someone nine years after treatment walking, talking, functioning — that is the greatest thing about the program. Things may well have changed, but there’s still life after treatment.”

 

Fit to fight

Many of the area’s hospital systems offer fitness and exercise programs geared toward cancer patients and survivors, but the one at High Point Regional Health System is slightly different.

 

“We have the only medically certified fitness center,” says Janet Forrest, the hospital’s oncology program planning liaison.

 

Cancer Fit, one of the center’s programs, is a guided 12-week exercise workshop run by an exercise physiologist. The idea is to increase stamina and decrease cancer-related fatigue. While the program does have a fee, there are scholarships available.

 

“It shouldn’t be closed to anyone because of finances,” Forrest says.

 

Cancer Fit also is designed to help build bonds with other survivors.

 

“We have mini classes and discussions,” Forrest says. “We also go on outings together because the classes have bonded so much.”

 

Ginny Gaylor is a freelance writer based in Greensboro.

 


Shining lights

While there are various programs available at area hospital systems for cancer survivors, there are two nonprofits specifically designed to help women prevent and live with breast cancer. Friends for an Earlier Breast Cancer Test focuses on prevention of the disease, while Alight Inc. — a new group — focuses on helping newly diagnosed patients.

 

For the past 15 years, Friends for an Earlier Breast Cancer Test has worked toward funding research for an earlier biological test to detect the disease. It also celebrates survivors during its annual lunch and dinner events each October.

 

“We get a lot of folks who come and bring a friend who’s a survivor,” says Kara McBurney, the organization’s events coordinator. “They come as a group of survivors, or they purchase a table in memory or in honor of someone.”

 

Cynthia Holliday, Alight’s executive director, says the organization’s first goal is to make sure local women focus on treatment and wellness.

 

“We have an emergency assistance fund to help if someone is having issues like paying their utilities, job loss or child care so that they can come to treatment,” she explains. “We don’t want anyone to forgo treatment or not focus on wellness because of finances.”

 

The group also provides patients with tote bags that contain a breast cancer treatment book, notebook with community resources and pillow to use during treatment.

“Alight is a different piece of the puzzle,” Holliday says. “We help people right now, locally, today.”

The celiac facts

Options increasing for those living with the disease

by Leslie Mizell

 

If you’re one of the many people in the Triad living with celiac disease, the bad news is that you have to say farewell to fast-food burgers, deep-dish pizza, and hot dogs and beer at the ballpark. The good news is that you won’t have to take daily fistfuls of pills or incur large medical expenses — and that there are tasty new sandwich, pizza, and beer substitutes coming out every day.

 

Living with celiac disease takes a significant lifestyle adjustment, but it’s quite possible to lead a normal existence with it — although admittedly, one in which grocery shopping takes at least twice as long.

 

The facts on celiac

Celiac disease is a condition in which a person’s immune system reacts to the protein gluten — found in wheat and other cereal grains — resulting in a cell-mediated inflammation of the lining of the small intestine. Unlike a wheat allergy in which there’s a rapid response to the product, celiac is a chronic illness that continues unabated as long as gluten is part of the sufferer’s diet.

 

Because it’s caused by ingestion of gluten, the only treatment is a gluten-free diet. This means eliminating barley, brewer’s yeast, malt, oats, rye and wheat. Once gluten has been eliminated, symptoms generally go away. Undiagnosed or severe celiac disease, however, can result in several complications.

 

“Celiac causes damage to the lining to the small bowel, where we absorb all of our nutrients,” says Dr. Tom Orli, a gastroenterologist with Forsyth Medical Center in Winston-Salem.

 

“A variety of nutrient deficiencies can result,” he adds. “Common ones include iron deficiency, which can lead to anemia, and low calcium, which can lead to osteoporosis.”

 

Knowing no bounds

An equal-opportunity disease, celiac occurs worldwide, striking both men and women, children and adults.

 

“Celiac prevalence seems to be about 1 in 300 in the U.S.,” Orli says. “It’s much more common in Caucasians, and heredity does play a role. Several gene locus have been identified that pre-dispose people to the disease.”

 

Those with a high risk include people with another autoimmune disorder such as hypothyroidism, Type 1 diabetes or Down syndrome. Celiac sufferers also frequently have osteoporosis, iron-deficiency anemia, nervous-system disorders or liver disease.

 

“A year after I was diagnosed with Type 1 diabetes, I was listening to ‘The People’s Pharmacy’ on National Public Radio,” says Shelby Soderlund, a blogger with Gluten Free Greensboro (glutenfreegreensboro.blogspot.com).

 

“I had never heard of celiac disease, but they said it was highly correlated with Type 1 diabetes, and the long list of multi-systematic symptoms sounded a little familiar,” she adds. “I asked my doctor to test me for it, and the rest is history.”

 

A complicated diagnosis

The official diagnosis of celiac disease is the easy part: a blood test, which if it’s positive is followed by an upper endoscopy and biopsy of the small intestine.

 

However, celiac’s dozens of broad symptoms mimic so many diseases, disorders and ailments that it often takes years before the list is narrowed down. In fact, the National Foundation for Celiac Awareness reports that approximately 3 million people in the U.S. have celiac disease, but only 120,000 have been diagnosed.

 

“There is now very good and accurate testing available for celiac, but a physician first has to think about the disease being a possibility before it can be diagnosed,” Orli says.

 

“Because of increased awareness, this is happening more.”

 

Classic symptoms include diarrhea, bloating, abdominal discomfort and weight loss. Less common symptoms can include constipation, mood and nervous-system disorders, and skin problems. Maddeningly, celiac disease also can be asymptomatic.

 

“I think I’ve had the disease since puberty, and I’m 35 now,” Soderlund says.

 

“I linked some of my symptoms together, but it was laughingly that I asked my doctor to test me.”

 

Orli recommends that patients be evaluated if they’re suffering from chronic diarrhea, unexplained weight loss, abdominal pain and fatigue. Parents — especially those with a family history of celiac disease — also should have their children screened if they notice symptoms such as frequent diarrhea, weight loss or poor growth.

 

Dietary changes

Within the past decade, it’s become increasingly easier to stick to a gluten-free diet as a virtual flood of products has found its way onto grocery shelves. Soderlund took gluten out of her diet in September 2009 following a last hurrah of pizza, sandwiches and other foods she expected to miss. Her first year has had its ups and downs — she misses tomato sandwiches, hearty 12-grain bread, pizza, and beer — and grocery shopping has become not only more expensive but also more time-consuming.

 

“Gluten is hidden in places you wouldn’t expect, like salad dressings, soy and barbecue sauces,” she says.

 

“It’s also hidden in some cheeses, deli meats, beef and sausage.”

 

To help those adjusting to a gluten-free diet, Greensboro’s Earth Fare hosts a gluten-free support group and recipe swap on the third Wednesday of each month. It also offers a tour of its store, including taste tests of some of its gluten-free products.

 

Restaurants are a different story. People with celiac disease share horror stories of getting sick after ordering from a supposedly gluten-free menu. The problem is that most people don’t fully comprehend how little gluten it takes to make a celiac sufferer ill. It can be something as simple as a dinner roll bumping up against another, or a salad being tossed in a bowl that recently held croutons.

 

“Some people with celiac will bring the manager to the table and make a big deal about it to make sure the food is being handled properly,” Soderlund says.

 

“I made the mistake of not going with my instincts when I doubted the gluten-free menu at a steakhouse in Chicago, and I paid for it,” she adds. “I got sick and was miserable for three or four days.”

 

Hidden dangers

While it would be nice to think that eliminating a majority of carbohydrates from your diet would have a positive impact on your weight, that’s not necessarily the case. Soderlund switched from Cheerios to Rice Chex after her diagnosis, but she soon discovered that it was lower in fiber and higher in carbs. She advises those who don’t begin to see improvements on a gluten-free diet to check out their medicine cabinets in addition to their pantries.

 

“There’s actually hidden gluten in a lot of medications,” she says.

 

“Because medications aren’t required to include the ingredients on their labels like food and beverages are, the only way to find out if the medication is safe is by calling the company that manufactures it.”

 

Leslie Mizell is a freelance writer based in Greensboro.

A tasty alternative

Lindy Clark has never bought a gluten-free packaged mix. Diagnosed with a wheat allergy in February 2008 in which she must also avoid eggs, dairy and soy, the cooking enthusiast hit the pots and pans and began working up her own gluten-free recipes. By November 2009, she had more than 100 collected in her self-published “Lindy’s Gluten-Free Goodies and More!,” available at local and online bookstores as well as directly from www.glutenfreebylindy.com.

 

The book contains illustrated recipes for everything from soups and sandwiches to desserts, with an emphasis on the latter. Each item was taste-tested by folks on both typical and gluten-free diets.

 

“A lot of people didn’t think they had an option to packaged food,” she says. “I got an e-mail from one woman who said my gluten-free pizza crust had given her hope. That kind of feedback thrills me to death.”

 

Clark, who moved from Ohio to High Point with her husband, Don, to be closer to their daughter, suddenly has found herself in demand for speaking engagements and cooking classes. There’s also a gluten-free restaurant, Lindy’s Goodies, in the works, as well as a second cookbook.

 

Here’s a tasty recipe courtesy of Lindy Clark:

 

Fudge Nut Bars

(makes three dozen)

 

1 cup or 2 sticks butter, softened

2 cups gluten-free all-purpose flour

1/2-cup granulated sugar

3/4-teaspoon xanthan gum

1/4-teaspoon salt

1 14-ounce can sweetened condensed milk

2 cups semi-sweet chocolate chips, divided

1 teaspoon vanilla extract

3/4-cup walnuts, chopped

3/4-cup pecans, chopped

1/2-cup milk chocolate chips

 

Preheat oven to 350 degrees. Grease a 13x9x2-inch baking pan.

 

In a large bowl, beat butter until fluffy. In a separate bowl, whisk together flour, sugar, xanthan gum and salt, and beat until crumbly. Set aside 1 cup for topping.

 

Press remaining crumb mixture into prepared baking pan. Bake for 15 to 20 minutes or until set and edges begin to brown.

 

While the crust is baking, combine milk and 1½ cups semi-sweet chocolate chips in a small saucepan or microwave-safe bowl. Cook — or microwave at 30-second intervals — and stir until chips are melted. Stir in vanilla. Spread the chocolate mixture over the crust.

 

Combine nuts, milk chocolate chips, remaining semi-sweet chocolate chips and reserved crumb mixture. Sprinkle over chocolate layer. Bake for 15 to 20 minutes or until center is set. Cool on a wire rack, then cut into bars.

To learn more

For more information on celiac disease, visit: