Medical Education vs Medical Journalism

Posted on April 16, 2011 by Ryan Madanick, MD

Medical educators (sometimes called clinician educators or academic clinicians) often think of their* jobs as teaching our own students…those who are in medical school, residency, fellowship…as well as those who attend lectures and conferences…etc.

Sometimes the best educators are not even known beyond their own school, because they are so focused on teaching their own local students that they have omitted the ultimate reach in medical education, the broad base of physicians, patients, and other interested parties that can benefit from their knowledge and expertise. So who has capitalized on this? Medical journalists. I have no problem with medical journalists for the most part, as they play an integral role in the dissemination of important health information to the general public.  Medical journalists have learned how to do this, and what skills are needed to do it effectively, whereas most medical educators come about it by picking up skills over time without formal training.

Somehow the twain need to come together. The explosion of social media, blogs, Twitter, and so forth, and their uses in healthcare (#hcsm) has provided an amazing opportunity for medical educators to learn about medical journalism. In this sense, I am not talking necessarily about publishing within scientific journals (as often those who publish here are NOT the best educators). #hcsm is just a natural extension of the broad role that medical educators have played over the last several decades. Let us embrace it.

*Even though I use the “third person” in this blogpost, it could really be written in the first person (either singular OR plural)!!

Posted in medical education | Tagged , , , , | 1 Comment

The Ups and Downs of Swallowing Problems

Posted on April 12, 2011 by Ryan Madanick, MD

As a doctor who specializes in dysphagia, I often see patients who get referred from other gastroenterologists and otolaryngologists because they have been unable to figure out or resolve the patients’ swallowing problems.  Sometimes there is a known, structural problem (like a stricture) or a non-achalasic motility disorder (such as “ineffective esophageal motility”), but still patients have incomplete resolution despite attempts at therapy.

With that in mind, I advise my patients on what I call the “Ups and Downs” of Swallowing.  These pointers are the recommendations to make swallowing less uncomfortable, even if the dysphagia still exists.

  • Sit UP when eating: Sitting up will allow the esophagus to gain the most benefit out of one of nature’s most basic principle, gravity.  Paying attention to posture will also help straight the esophagus.
  • Slow DOWN, do not rush when eating
  • Chew UP your food very carefully
  • Drink DOWN a full glass of water with your pills
  • Cut UP your food into very small pieces
  • Cut DOWN on tough foods to chew (meats)

I remind patients that:

  1. The problem itself hasn’t gone away.  Like arthritis or post-stroke patients, behaviors often have to be adapted to health issues, since not all health issues are completely remediable.  However, just like physical therapy, we can work together to make things better.
  2. The lack of medical or surgical therapy means neither that I will abandon them nor that I “have nothing else” for them.  Even if I cannot offer cure, I can offer care.

Dysphagia is just one situation of many that often cannot be cured, but with a patient-centered approach, it can be managed.

Posted in Esophagus | Tagged , , | 1 Comment

A Physician’s View about Medical Necessity

Posted on March 10, 2011 by Ryan Madanick, MD

“Doc, do I really NEED this medication?”

In my practice, I seem to hear this question (or something like it) on a daily basis.  The question is not always about a medication, maybe it’s about a lab test or a scan, a procedure, or even a surgery.  But I still hear similar questions quite often.  Granted, my practice is quite a different type of practice than most, but more about this is a minute.

The answer to the question really speaks to the heart of what “medical necessity” actually means.  Is medical necessity only defined as something that will attempt to save the patient’s life or limb? What about protecting a major organ from future failure or damage? Is the treatment a means of preventing something unexpected or life-threatening from happening a month or a year from now? Maybe 10 years or 30 years from now??? Continue reading →

Posted in GERD, patient care | Tagged , , , , , , | 2 Comments

When the Doctor Becomes a Patient

Posted on March 6, 2011 by Ryan Madanick, MD

Today I became a patient.  If you follow me on Twitter, then by now you know what happened.  Yes, I am embarrassed by what happened, but I’ll relinquish my HIPAA right to privacy for this moment.

This afternoon I swam nose-first into the sidewall in the pool.  [I haven’t been swimming in awhile and I forgot to bring goggles, so I wasn’t really looking.  Laugh all you want…]  It didn’t hurt all that much, and I wouldn’t have even noticed any issues for a little while if blood hadn’t come gushing out.  Jane, the lifeguard at the Y, was very helpful in getting me settled on the side of the pool while I held pressure.  After holding the icebag on it for 10 or 15 minutes, I was able to palpate the bridge of my nose, and then it hit me.  There was a dent in the side and a small bulge on the opposite side.  Yep, I had broken my nose.

With two little kids, I didn’t want my wife to have to bring them to the ER, so I drove home, grabbed some books, and headed to the ER at the hospital where I work.  I figured I’d be there all night.  I mean, a broken nose is nothing compared to the typical emergency room traffic.

I parked in my usual lot and walked toward the ER.  By a stroke of luck, I ran into an ENT colleague on my way in [he was heading home for the day].  When I told him I was heading to the ER for what I thought was *laugh* a broken nose, he took a quick look and agreed.  He gave me a quick rundown of what could be done, since I really didn’t know [we GI docs rarely deal with nasal fractures…].

I was triaged and put into a room within 15 minutes.  Within the next 15 minutes, a financial representative and 2 nurses had come in, none of whom really had any idea that I work at the hospital.  As the second nurse was getting all of my information, 3 ENT residents (a 4th year, a 3rd year, and an intern) walked in.  If I wanted my nose reset, they offered to do it right there with local anesthesia, or I could have waited a few days and had it done under sedation in the OR.  I was a bit nervous about having my nose reset without sedation, but I decided to go ahead and get it done while I was there.  This is basically what it sounded like I was going to get done to me… [Click here if you want to read about closed reduction.  This is a video of the very same procedure I had; you may want to turn the sound off for this].

As they told me, the local anesthesia was definitely the most uncomfortable part.  It was not a fun experience by any means, but it was only a few minutes.  By the time the anesthetic had fully numbed my bridge and septum we were ready.  Less than a minute later it was done.  All I felt was a pop, as if I had cracked my knuckle.  I expected much worse.

Within three hours I had left the ER.  Three hours?  It is quite possible that I set a record for fastest overall ER visit and successful management of a nasal fracture.  Maybe it was just a slow day in the ER, but it was more than just the rapidity of my treatment that impressed me.

They engaged me as a participant in the decision-making and treated me like a person, not a like a guinea pig, which we have probably all seen.  Whenever I was uncomfortable the 4th yr ENT resident stopped to ask me how I was.  He took the opportunity to teach the intern what should be done at key steps [If you have never been a patient when one doc is teaching a junior doc about your condition, it is quite interesting!]. Everything about his bedside manner was what I would expect from a seasoned doc.  The entire team of health care professionals impressed me.

With everything we hear about the lack of professionalism in the current state of medicine, it was quite a comforting experience to witness firsthand the professional comportment of the nurses and the residents.  Although I have no idea if this was the same way that every patient gets treated, I hope it is.

Posted in medical education, patient care | Tagged , , , , | 2 Comments

Would You Like Some Cyanide in Your Herbal Therapy?

Posted on February 28, 2011 by Ryan Madanick, MD

Like most allopathic physicians, I have no formal training in herbal medicine.  Nonetheless I tend to think that I have an open mind to non-Western therapies.  I do not discount their effects in various conditions, but they are not the end-all-be-all of disease treatment and prevention, as some “health experts” would have you believe.

Unfortunately, terms such as natural or herbal have become synonymous with healthy and safe.  Many people who tout the benefits of such products virtually always do so because they are concerned about the man-made (aka, non-natural) chemicals that allopathic medicine practitioners often prescribe, and believe (often without question) that natural treatments are better.

In allopathic medical schools, physicians are taught to critically analyze the scientific data that supports diagnosis and treatment.  In current parlance, this is known as “evidence-based medicine.”  I will certainly admit that much of what happens in medicine, in my own practice as well, is not fully backed by evidence, usually because not every detail of diagnosis and treatment has been rigorously tested, especially with more complex problems.  Yet scientists, researchers, and clinicians involved in medicine try to find the answers and incorporate our experience with the scientific data, and when it does not exist or is uncertain, we need to use our best judgments.

This type of care is in stark contrast with the vast majority of natural therapy, which I will call CAM (for complementary and alternative medicine) from here on out for simplicity [even if there are other terms for CAM, I am using the blogger’s prerogative here].  CAM advocates who decry allopathic medicine usually tout their own wares based on experience and the report(s) of their patients or their mentors. This type of “proof” is the weakest type in science.  A testimonial report of benefit is equivalent to a case report, whereas allopathic physicians depend on randomized, blinded, placebo-controlled trials to make our best decisions.

Few CAM therapies have actually been subjected to this type of scientific investigation, and when they are, most of the time they are no better than placebo.  Although this is not universally true, it is one of the reasons that allopathic physicians maintain healthy dose of skepticism for CAM therapies.

I began this blog by saying that I have an open mind about CAM, and I really do.  Most of the time therapies are generally safe.  If they are safe but not markedly effective, the only real harm is to the pocketbook of the patient.  Nonetheless, it is my responsibility to make sure I at least understand what the compound is, so I do what I can to look it up.

Recently someone asked me about a cough treatment, wild cherry bark, which her husband had purchased from a local organic store for his own cough.  Knowing nothing about its composition or effects, I looked it up.  Much to my surprise the active component is…HYDROGEN CYANIDE.  Yes, the natural herb wild cherry bark consists of a poison.

Now its concentration in the herb may not be as high as it is in the pesticide or in the air of the gas chambers it’s used in, but I ask you…when did cyanide become safer and healthier than man-made chemicals that are tested in thousands of people before they are approved for distribution to the public?

Posted in CAM, gastroenterology, patient care | Tagged , , , | 2 Comments

But I Have Reflux…

Posted on February 24, 2011 by Ryan Madanick, MD

When I first started this blog, I promised topics about gastroenterology and esophageal problems.  So let me talk about one today.  I consider this the most fundamental issue I see in my office on a regular basis: the difference between heartburn and reflux.  I have told many of my trainees this: “Patients are not allowed to complain of reflux.”  Usually they look at me funny, until I explain myself…

There are plenty of terms that reflux also goes by.  Acid reflux, hiatal hernia, esophagitis, GERD (which stands for “gastroesophageal reflux disease”).  Decades ago, these were terms that only medical professionals used. In years past people complained of heartburn, but now many of my patients complain of reflux.  What is the difference?

If you just want a simple answer, this is it:

Heartburn is a symptom, not a disease; GERD [reflux] is a disease, not a symptom.

If that makes sense to you, great!  You’ve achieved something that medical students, nurses, doctors, and researchers cannot seem to always grasp.  Continue reading →

Posted in Esophagus, gastroenterology, GERD, Heartburn | Tagged , , , , , , | 1 Comment

What Has Happened to Gastroenterology Training?

Posted on February 16, 2011 by Ryan Madanick, MD

The state of gastroenterology training and education in the United States today can be summarized in one word: endoscopy.

Gone are the days of the cognitive gastroenterologist, discussing the character, smell, texture, and color of a patient’s stool in an effort to deduce the pathology that lies within the vast expanse of bowels that could not be explored.  The 24-hour stool collection and analysis is a punchline during Grand Rounds, a figment of the collective imagination of only the most senior attendings, who remember with painstaking vividness the rank smell of the diarrhea they scrutinized.  They stained it, they described it, they looked for meat fibers in it.  Not just for themselves or for their patients, but with the hope that one day they will set the course for future gastroenterologists to better understand the ailments facing their patients.

“A gastroenterologist is an internist first.  Gastroenterology is my hobby, and endoscopy is merely a tool.”  One of my former attendings and mentors, a consummate clinician and educator, a former President of the American College of Gastroenterology, often used this statement as a means to remind his trainees that a true gastroenterologist needed to have a strong base of medical knowledge to be a great clinician.  Anyone could be trained to do endoscopy, but the revered gastroenterologist should be more savvy with his/her brains than with his/her hands.

Unfortunately the current state of affairs among many fellowship programs does not reward the great thinkers and diagnosticians anymore.  “Numbers” is the crucial word.  “What are your numbers?” “How many ERCPs have you done?” “How fast do you get to the cecum?” These are all important markers of experience, but endoscopic talent has become the benchmark by which fellows gauge success.  The “interesting” cases are moreso complex endoscopic procedures and less the diagnostic and management dilemmas followed over a period of time in the outpatient clinic.

Gastroenterology has become the surgical field of internal medicine, and it is not far off before the two fields will see the lines blurred even more with the development of NOTES.  Many gastroenterologists have a surgical inclination and likely considered a surgical career at some point.  There is certainly nothing wrong with being a great endoscopist or a great surgeon.  But there is so much more to gastroenterology that has become relegated to the textbooks.  It is not unusual to find a senior GI fellow who does not know the 4 basic stages of lipid assimilation but knows that the duodenum should be biopsied in cases of chronic diarrhea.

Emphasis on the basic physiology that underlies gastrointestinal disorders needs to be brought back to the forefront of trainee education.  When a discussion about physiology and pathophysiology is occurring on rounds, medical students and residents commonly show much more interest than the fellows do, unless the outcome is, “So when are we scoping?”

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Why do Pharmacies Sell Tobacco? Let’s Join Together and Tell Them to Stop

Posted on February 7, 2011 by Ryan Madanick, MD

Many years ago, I asked the manager at a local chain pharmacy why they sold cigarettes.  His response? “Umm…I don’t know.”

I would venture to say that most managers don’t know the answer to that either.  Do you?  I certainly don’t.  I would love to say that it is because tobacco products are big moneymakers for pharmacies, but tobacco products account for less than 1% of these stores’ profits.

Pharmacies are charged with promoting the health of their patrons.  Tobacco certainly does not contribute to this mission.  They sell smoking cessation aids, like nicotine gums and patches, yet these products are frequently placed directly next to the products they are trying to replace.

A few cities in the US have already prohibited tobacco sales in pharmacies, but they are in the great minority.

We can finally do something about it.  Click on this link (or go to http://www.change.org/petitions/tell-pharmacies-to-stop-selling-tobacco-products) and sign my petition to tell pharmacies that you want them to stop selling tobacco products.  I have a goal of 10,000 signatures by Independence Day.  Please help me get there and tell companies like CVS and Rite Aid to make sure all of their stores stop selling tobacco.

Posted in cancer | Tagged , , , , , | 10 Comments

Doctor as Teacher: A Life Lesson to Future Doctors

Posted on February 4, 2011 by Ryan Madanick, MD

I do a lot of teaching.  Truth be told, it is what drew me to stay in academic medicine.  As a subspecialist, I am fortunate enough to have multiple opportunities to lecture, train, and educate in a number of venues.  The word “doctor” is actually derived from the Latin word “docere” which means “teach”.  I truly enjoy the privilege, and it is just one of the reasons that I have started this blog as well.

Teaching moments can come at times that are completely unexpected, even outside of the classroom or away from the clinical setting.  Sometimes, the teacher can learn from the teaching moment as well.  In a rare situation, a teaching moment affects some of the learners so greatly that the impact is felt immediately and the teacher gets the amazing satisfaction of learning how important the moment was.  This was one of those occasions…

A few years back I became the Course Director for the MS2 (“second year med student”) GI course.  As part of the class we decided to invite a patient with ulcerative colitis to come speak to the class about her disease.  This particular patient is very memorable for the students because she is a candid, engaging young lady, around the age of many of the medical students themselves, who has actually published several articles about her disease, and how it has affected her, in a major newspaper.

The session lasts for about an hour and is the last large group teaching session (aka lecture) of the course.  As part of the preparation for the session, I post her articles for the students to read.  During the session, one of my colleagues spends a few minutes asking her about how she presented, how she was treated, etc.  Then they discuss some issues about how both her disease and the treatment affected her and how she dealt with it.  They also go into various issues relating to her interactions with several of the doctors she encountered–some good, some not so good.  Finally the students have the opportunity to ask her questions, and some of these questions tend to be quite probing–moreso than they will probably ever ask many of their future patients.

Traditionally the first 2 years of medical school have been dedicated to the so-called “basic sciences,” whereas the second 2 years have been based around the “clinical sciences.”  That is to say, the first 2 years are traditionally based on biochemistry, pharmacology, physiology, anatomy, and so forth, with students getting involved in patient care when they matriculate to their third year.  Of course, this paradigm has shifted over the last decade or two, and clinical medicine is being introduced earlier and earlier in the curriculum.

So in a course like this that teaches the very basic concepts underlying gastroenterology, what could the students possibly get out of such a session? Even at this level, the medical licensure board expects students to have an understanding of how medical illnesses affect patients, and how patient factors (gender, ethnicity, etc) can play a role in medicine.

The assessment of a student’s comprehension and competency in such areas poses a particular problem on multiple choice tests, which (unfortunately) our tests must be. Because the final exam for the course has to be completed before this session occurs, I choose to take a very simple approach to assessment by asking the students a single question about the themes of the articles she wrote.  This makes sure that the material on the exam was definitively covered in some manner even if it weren’t discussed in the presentation.

I asked one question on the exam…out of 60.  Worth one percentage point on their final grade.  That’s it.  Even though it might have been the most important hour overall they spent in the course…hearing about how a patient reacted to her disease, to the therapy, and to the doctors… Everything else is in the medical textbooks, but in that one hour, they heard about topics that are completely overlooked throughout most of medical school.  Topics like how she had to deal with telling her new boyfriend about her disease and how she reacted mentally to gaining weight when she was taking steroids to treat her UC.  These are issues that most doctors rarely hear or inquire about.

She is such an engaging, enthusiastic woman that the students virtually all love that session.  You would think that the time spent there was invaluable since the students for the most part came to medical school with the intent of taking care of patients… Unfortunately there are always a few rotten apples in the bunch…

After each course is over, a few students form a “focus group” to meet with the various Course Directors and review the course…what worked, what didn’t, how to make it better, etc.  It was at that meeting this year, just a few days after the final, that I heard a comment that seemed to emanate more out of a high school student’s mind than a future doctor’s.  The anonymous comment went something like this:

The hour we spent listening to the patient talk about her disease what not worth my time because all we had to know for the test was what she wrote.  I could have spent that hour trying to read more about the actual diseases.

After I heard this comment, I decided to send the class a short note at the tail end of another email that discussed some changes to their test scores.  The subject line of the email said: “Test scoring changes and a piece of advice”.  Here is what I told them:

Lastly, one final piece of career and life advice…and this is geared toward responding to some of the post-exam concerns specifically…For those of you who are mad that the hour you spent listening to the patient discuss how her disease affects was “not worth” your time because all you had to do “for the test” was read the articles, then you need to re-evaluate your priorities.

You are in medical school to help patients, not to get a good grade on a test, which in 2 years won’t mean more to anyone than the scratch paper you used to work through the questions.  If you don’t start to see that now, you might be unhappy in your career selection as a physician.  Stop asking what you “need to know” and start trying to learn what being a doctor is about.  Keep a record of all the times you complain about hearing about material that “won’t be on the test” (or how often you hear others do it).  If you keep track, when you get into residency you will eventually look back and laugh at how silly it sounds to you at that point.

I didn’t think much about that email after I sent it.  I certainly didn’t expect any responses.  Boy was I wrong!

The next day, student after student sent me apologies.  Not for themselves, but BECAUSE OF THEIR CLASSMATES! They were actually embarrassed that their classmates would behave and complain in such a way.  I was touched.  But it wasn’t until a month later that I got the final compliment: the email had somehow made its way to a colleague, the Course Director for another class, who told me that my message to the students should be “printed and framed in the lobby” of the medical school building.

Even though the note was directed at just a few students, it became clear that the message hit home to many, even me.  The students seemed to realize that their teachers actually do have their futures in mind. For those who took it to heart, these students will have great careers in medicine.

As for me, I saw the impact of what it means to be a medical educator.  In our best of times and in our worst of times, we can truly shape the future physicians.  Not only do we teach the science but we are also role models.  Usually we never know how much of an impact we maked…but sometimes the impact is more than we can imagine.

Posted in gastroenterology, IBD, medical education, patient care, ulcerative colitis | Tagged , , , , | 6 Comments

My Friend’s Endoscopy, Part II

Posted on January 20, 2011 by Ryan Madanick, MD

Sorry for the delay in the next blog post.  Family vacation called!

In my last blog, my friend Alan, a healthy 39-year old man, had just gotten an upper endoscopy and a colonoscopy for reasons that were “soft” as we say…

So the first major question that I want to ask is :

Should Alan have had these procedures?

Let me make sure I get this out there.  I am not saying outright that Alan should not have had the procedures.  But this piece is really meant to spur thinking among those of you out there in the medical blogosphere who are reading my blog.

The answer to the question depends on whom you ask.  Apparently his doctor thought so.  (Who am I to judge what his doctor thought?  Just a peer)  And so did his mother.  Or maybe it was the other way around.

First his mother thought so. She asked him go to the doctor because she was worried, and she went with him to make sure that he got the best treatment. Perfectly reasonable approach for any parent to be worried about their child. But it is possible that her presence actually strengthened the doctor’s resolve to do the tests.  Mothers can have such a convincing effect on doctors.

I do not know what the interaction was that ensued, but I am certain that her presence was convincing enough for the doctor to squelch any question in his mind about whether or not to scope Alan.  He had no symptoms and he is young.  Thus, the procedure was being done for screening purposes only.

In general, screening for esophageal cancer in a patient with no symptoms is an effort in futility.  This is not to say that some patients may not benefit, but it is not like screening for breast cancer or colon cancer.  Esophageal cancer is an uncommon enough disease in the US that the cost-effectiveness of screening is poor.  One of the principal reasons for this is that there is very little evidence that any intervention — medical, surgical, dietary, homeopathic, etc — has any effect on the natural history of esophageal cancer.  Once a suspicious lesion is found, periodic surveillance is undertaken, but the likelihood of a suspicious lesion becoming cancerous (malignant) is quite low.

Are there populations that are at higher risk?  Probably, but this group tends to have symptoms of GERD (gastroesophageal reflux disease), like heartburn and acid regurgitation.  They may have a history of smoking or drinking alcohol.  There are other risk factors, but just having family history of esophageal cancer is a debatable risk factor.

And of course, there are grades of strength to a family history.  Suffice it to say, a first-degree relative (parent, sibling, child) with cancer is stronger than a second-degree relative (grandparent, aunt/uncle, etc.).  However age of the relative also plays a role, and physicians often overlook this.  I get much more concerned when someone tells me that their parent got cancer in their 40’s than if they got it in their 60’s or beyond.  Again, this is not to say that genetics is not important.  But as people age there are so many additional factors that play into cancer developing at older ages that the relative contribution of genetics fades out as the decades progress.

Couple an asymptomatic patient with an already low yield of screening.  In my mind, the fact that his father was diagnosed with cancer (in his 60’s I believe) would not signficantly change Alan’s risk.  He also is 20 years (or more) younger than the age his father got cancer.  I did not even go into the colonoscopy, or the risk for colon cancer, but as far as I am concerned, neither procedure seemed to be significantly indicated (needed).

So then…Why did he get the endoscopies?  I can give you 2 “F”s that will help explain it: Fear and Finances.  (Certainly Fun would not be the third F).

  1. Fear: Fear drives a lot that happens in medicine.    Actually, Alan wasn’t scared.  His mother was scared.  The doctor was scared.  Scared that he might miss a cancer.  Doctors fear missing a cancer probably more than anything else.  Scared that he might miss a precancerous lesion that could prevent something down the road.  What would happen if 10 or 15 or 20 years from now, Alan develops cancer? Could it have been prevented? Would he be sued?
  2. Finances: Alan had insurance.  Procedures cost money.  More often than not, there are financial incentives on the doc to do more procedures and less face-to-face patient care.  More talking means less money.  More explaining why a test is not necessary means less money in my pocket as a doctor.  I am not defending the justification, but this does come into play.  Fortunately, as Alan told me, the insurance company would cover it.  (Well isn’t that reassuring!!  If I were the insurance company exec I would deny paying the doc unless he could cogently explain why I should spend thousands of dollars for a low-yield exam.)  And doubly fortunately, these procedures are generally safe.  In summary, Alan passed what is affectionately known in some circles as the “wallet biopsy”.

Was the doc really afraid that Alan’s health might suffer if he didn’t get the procedures?  It’s highly unlikely.  Would he have gotten the endoscopy if Alan didn’t have insurance?  Maybe.  But would Alan have really paid hundreds (if not thousands) of dollars for a screening test?  Would you?  In actuality, the benefit was really in reassuring the mother.  But now there are more problems:

What are the ramifications of the results of the procedure?

As I said in the last blog, he was instructed to take a medication every day; stop drinking soda; and return in 5 years for another check–because he might develop cancer.  Now he also has a “diagnosis” (esophagitis) that could be used against him if he applies for life insurance or other health insurance.

Does he need to follow the instructions he was given?

All Alan really cared about was drinking his soda.  I am not going to advocate drinking soda (even though I do it too much as well).  Is drinking soda really going to lead to cancer?  Moreso, is stopping going to prevent cancer?  And how much is that medication going to change his long-term outcome?

It is very difficult to estimate someone’s lifetime risk of developing a certain type of cancer for numerous reasons.  What might his lifetime risk be? Five percent (a one-in-twenty chance)? Ten percent (a one-in-ten chance)?  Or is it more?  This is extremely unlikely considering that esophageal cancer in the United States is a fairly rare tumor.   One source (Kubo and Corley, Am J Gastroenterol 2004) estimated that the annual risk in a Caucasian male is about 1 in 10,000.  And that estimate is not taking age into consideration.  If Alan lives another 40 years, his lifetime risk is about 40 in 10,000 (not exactly, but almost).  That equates to a chance that he will ever get esophageal cancer of less than one half of one percent.

I don’t really believe that Alan’s risk of esophageal cancer is going to change all that much with any of the interventions proposed.  And I certainly don’t think he needs to go back in 5 years.  How much risk is acceptable to him?  That is for Alan to decide.  Granted, drinking multiple sodas a day is not the epitome of a healthy lifestyle, and limiting the soda may help him in other ways.

Posted in Endoscopy, Esophagus | Tagged , , , , , , | 6 Comments