Grey's Preventable Cancer

The lesson from last night's Grey's Anatomy? Don't let one of the most preventable cancers get you!

In last night's episode there was a young girl who was diagnosed with stage 4 cervical cancer. She likely didn't have proper cervical cancer screening and she didn't follow up on an abnormal Pap smear because she had no health insurance (a great topic for another week).

With a Pap smear and the recently approved human papillomavirus -- HPV -- vaccine (more on this later), your weapons against cervical cancer have never been better.

The American Cancer Society estimates that over 11,000 women will develop cervical cancer in 2007 and about a third of those will die. Thankfully the rates of cervical cancer have dropped significantly over the last 50 years largely due to increased screening with the Pap smear.

I fully understand -- even though I'm not a woman -- that the Pap smear is one of the most unpleasant medical exams a woman should have. Some women may put the mammogram above the Pap smear on the list of worst medical tests due to the pain it can cause.

But the Pap smear is also one of the most effective screening tests. It can detect precancerous cells before they have a chance to develop into invasive cervical cancer. It can also find cervical cancer in its early stages when it is nearly 100% curable.

In other words, a few minutes of unpleasantness -- I know, easy for me to say but at least men have that little rectal exam thing we have to deal with for our prostates -- can save your life.

So what about the HPV vaccine? This is truly the first vaccine we've had to prevent cancer. It's a vaccine against the human papillomavirus (HPV), which is the cause of most cervical cancers.

Experts believe the vaccine -- called Gardasil -- will help prevent 70% of cervical cancers. The vaccine is recommended for girls 11 to 12 -- before they become sexually active.

HPV is a common sexually transmitted virus (certain strains can also cause genital warts). That's why it's best to get the vaccine before becoming sexually active. The American Cancer Society just released a report saying that the vaccine may be given to girls as young as 9.

Girls 13 to 18 should be given a "catch-up" vaccine if they never received their vaccine, or did not complete the three-shot series.

However, unlike the CDC and the American College of Obstetricians and Gynecologists, the American Cancer Society (ACS) does not recommend routine vaccination for women 19 to 26. Confused? Talk to your doctor and the two of you can decide if the HPV vaccine is right for you -- or your daughter.

In addition, here's what you should do regarding the Pap smear -- or at least what I hope you will do:

• Have a Pap smear about 3 years after the first time you had sex -- but no later than 21 years old. Depending on the type of test used, the Pap smear should be repeated every 1 to 2 years.

• Once you're 30 and have had 3 normal Pap smears in a row, most women can get tested every 2 to 3 years. Testing should continue throughout life.

• The American Cancer Society also says it's reasonable for women over 30 to get tested every 3 years if they have Pap smear plus testing for the HPV virus.

• Women 70 years or older who have had 3 or more normal Pap smears in a row and no abnormal Pap results in the last 10 years may choose to stop cervical cancer screening. Talk to you doctor to determine if that's right for you.

• If you've had a hysterectomy including removal of the cervix (this is an important point) you and your doctor may decide you don't need cervical cancer screening unless it was done as a treatment for cervical cancer.

Related Links: 15 Facts about the HPV vaccine

TV Medicine Scores at the Globes

The gold was flowin' as two of the medical shows we often pick and pan here on WebMD's TV Checkup won accolades at the 2007 Golden Globe Awards on Monday, Jan. 15.

House's Hugh Laurie came away with the Globe for Best Performance by an Actor in a Television Series - Drama. Laurie was up against Dr. McDreamy himself, Patrick Dempsey, for his role on Grey's Anatomy. Sorry, Patrick. Better luck next year! However, Grey's was not to be forgotten, winning the Golden Globe for Best Television Series - Drama. Congrats to all!

And, here's a shout out to some others (often objects of our scrutiny) who were nominated but, alas, did not bring home the statues this year:

Ellen Pompeo (Dr. Meredith Grey, Grey's Anatomy) was nominated for Best Performance by an Actress in a Television Series - Drama.

Zach Braff (Dr. John "J.D." Dorian, Scrubs) was nominated for Best Performance by an Actor in a Television Series - Musical or Comedy.

Katherine Heigl (Dr. Isobel "Izzie" Stevens, Grey's Anatomy) was nominated for Best Performance by an Actress in a Supporting Role in a Series, Mini-Series or Motion Picture Made for Television.

We want to compliment these fine folks for a job well done this year. You've had us on the edge of our seats with suspense, intrigue, drama, anticipation, laughter and romance (or maybe it was just the sex). You've kept us on our toes and given us fertile fodder for this blog. We look forward to the rest of 2007 and beyond!

The WebMD TV Checkup Blogging Team

Technorati Tags: 2007 Golden Globes, House, Grey's Anatomy, Scrubs

Grey's: Score Another One for the Researchers

Grey's researchers have done another excellent job of bringing a rare and unusual medical condition to the attention of the public. This time, it's VATER syndrome (or VATER association), a series of birth defects of yet unknown cause which have been described as occurring together, highlighted in the episode "Six Days," part 1.

VATER is an acronym that stands for the specific birth defects: Vertebral abnormalities, Anal atresia or imperforate anus (defects in the anal opening), TracheoEsophageal fistula (a connection between the trachea, or windpipe, and the esophagus), and Renal (kidney) abnormalities.

Sometimes heart (Cardiac) problems and Limb anomalies (particularly developmental problems with the bone in the arm known as the radius) also occur with these defects; in this case the acronym is changed to VACTERL.

In this episode, an unfortunate patient of Izzie's has the VATER association. She has severe scoliosis (curvature of the spine) as a result of the congenital defects in her vertebrae, but she's in the hospital for treatment for kidney stones (which can occur with the improperly developed kidneys). Like all children born with these defects, she probably doesn't have all of the conditions in the association, and the range of severity of the individual defects varies widely among people with the condition. In fact, since the manifestations of the various defects are so different, along with the fact that not all of the defects are present in every case, an exact determination of the number of people affected with this condition is nearly impossible.

But of course, we know it's rare. As is Derek's proposed treatment for her scoliosis, of which all we know now is that it involves "removing her spine." Presumably this means an experimental treatment involving the resection of part of her vertebrae. We'll know more about this next week, but if there are any spine surgeons who'd like to comment on what you believe he proposes to do, by all means enlighten the rest of us!

Finally, we can end with another vocabulary lesson. When George discusses his dad's surgery with Burke, he says he's worried because the procedure is associated with a 50% "morbidity" rate, and Burke agrees, saying that yes, only 50% survive the procedure. Not quite correct.

"Morbidity" refers to complications of a procedure (such as excessive bleeding or infection following an operation); "mortality" refers to the actual death rate from the procedure. So the correct phrase would have been "this operation has a 50% mortality rate."

We're hoping this lovable character won't become a statistic, but it doesn't look too good for him.

Related Links:

• The Top 5 Genetic Birth Defects

House Deleting Memories

Memories, pressed between the pages of a patient's mind.

Last night House centered on making and erasing memories, and how those memories can be a shock to someone's health. Electroconvulsive therapy was the star of the show.

Without totally recapping the episode, a patient was finally diagnosed with a spinal meningioma, a tumor that can grow on the dura, one of the membrane that cover the spinal cord and brain.

The tumor was causing the patient to believe a woman, with whom he was secretly in love, was engaged to be married to his brother. The stress of this unrequited love was so great it induced a string of heart attacks that had to be controlled. Oh, and the brain tumor was troubling as well.

So was his lady friend engaged to his brother? No... and House called it a false memory, a delusional side effect the spinal tumor. And yet, how do you stop someone from believing something that's so vividly real for them that it causes a heart attack at the thought?

An off-label use of ECT, apparently. ECT uses electric currents, administered with electrodes placed on the scalp, to send a current through a brain for about 8 seconds. Side effects can include short and long-term memory loss.

By shocking his brain, House erased the patient's memories of the lady and the love he bore. And his brother. And why he was in the hospital. And probably other things we can't know because the patient forgot them, too.

Dr. Melissa Conrad Stoppler, one of our medical experts here at WebMD, says this use of ECT is a bit creative on House's part, because there is no way to know if the right memories would be gone...if any.

"Can ECT affect memory? Absolutely. But can you use ECT to 'obliterate' specific memories? No. ECT can affect memory in different ways. Some people undergoing ECT have a partial loss of memory of events that occurred before treatment began, but most commonly; this involves memory of the weeks or months prior to treatment.

Some people do have problems with recollection of more distant past events, but it is not possible to predict how a given individual will react and what type (if any) of memory deficits will occur as a result of the procedure. The memory problems usually improve within a few weeks to months after the procedure, with return of the majority of the 'lost' memories."

So for House, the cure for a broken heart, delusional or not, is shock therapy. I wonder what he'd prescribe for road rage?

Related Topics: Broken Heart Syndrome

ER -- Losing Part of Yourself

When you've lost your house, your husband, the city you grew up in, how can you bear to lose anything else? That's the question a Katrina survivor must ask when she finds herself in the County General ER faced with amputation of two of her toes.

On last week's episode of ER -- Breach of Trust -- an African-American woman is brought in after falling down on the sidewalk. Her sugar is high and she has what appears to be a chronic infection at the base of one of her toes. An X-ray shows Osteomyelitis -- a bone infection -- in the bones of her second and third toes.

The woman has been taking antibiotics, but they aren't working. When Dr. Kerry Weaver tells her that the only way to stop the spread of infection is to amputate her toes, the woman refuses and leaves the ER.

WebMD's Dr. Brunilda Nazario says that this is right on target, "Osteomyelitis in people with diabetes is usually associated with heart disease or vascular insufficiency (blood vessels not functioning properly or delivering vital nutrients and oxygen to tissue and working as channels for blood flow to other areas of the body). It commonly occurs in the foot and ankle regions and antibiotics usually fail to cure the affected site. Poor blood flow to the area results in low oxygen to tissues which continue to die off leading to ulcerations of the skin, increased infection risk, and seeding of the underlying bone with bacteria."

Dr. Louise Chang concurs, "People with diabetes are at risk for foot infections. This is because they may have nerve problems related to the diabetes (diabetic neuropathy) which makes it difficult to feel that they have a sore or wound on their foot and then a small wound can become a more serious infection, i.e. reaching to the bone -- osteomyelitis or blood stream. Diabetics also have problems with wound healing so they can develop very bad wounds which might have started out as very small (a blister) but become more complicated."

Kerry follows the woman to the bus stop and finally garners her trust, convincing her to go back inside and consent to the surgery. When she gets up to walk back into the ER, she steps down and cries out in pain.

Dr. Nazario thinks this may have been a bit of added TV drama. "Pain in these patients is usually absent because of one of the most devasting complications of DM -- nerve damage or neuropathy," she says. "People with chronic infections may also have a resulting anemia -- the issue raised here is could her fall have been a complication of both neuropathy and the weakness/fatigue of anemia?"

As the plot thickens, we find out that this woman is from New Orleans and is a survivor of Hurricane Katrina. Her fear of loss seems to be complicated by the trauma she has already endured in her life. Because of her background and subsequent fear of the dark, Kerry tells her that she can stay awake during the surgery rather than have general anesthesia, much to the chagrin of the surgeon who will be doing the procedure.

Unfortunately, a complication during surgery means they end up having to put the woman under anyway, and they also discover that the infection has spread farther than they thought. They are going to have to amputate from below the knee.

In the end, we see a woman coming to grips with the loss of part of her leg. She explains how she and her husband refused to leave New Orleans and were finally trapped in their house by the rising water. They escaped by making a hole in the roof and climbing out and then slogging through the contaminated water to look for help. Sometime during all this she injured her foot, which is probably where the initial infection began.

She is angry. The ER writers and the actress did a good job of portraying the anger, sadness, and distrust that someone in her place would no doubt still be feeling, even more than a year after this tragedy. It also seems she is angry with herself.

Kerry suggests that her life and her experiences are a gift and she should use them to make sure that no one ever forgets what happened during Hurricane Katrina. I have to admit that I found the sentiment a little to canned after all this woman has been through. Her reactions seem to be right in line with someone experiencing post traumatic stress. And, after losing so much, would you want to lose a part of your body as well?

It was kind of nice to see one of the medical shows addressing the emotional and physical effects that disasters such as Hurricane Katrina can continue to cause for years after.

Related Topics:

Resilience Lets Katrina Survivors Cope

Laser Prevents Diabetes Amputation

Technorati Tags: ER, diabetes, Katrina, amputation

Scrubs Does House

Who is the most ornery doc on television? It's a toss-up: House's maverick medical genius Dr. Gregory House or Scrubs's hot-headed Resident Director Dr. Perry Cox. You tell me.

Thanks to their similar bedside manner, it was only natural (and quite funny) that Scrubs would skewer House with Dr. Cox paying an homage to the man who can solve any medical mystery. He even adopted a cane and House's trademark limp by the end of the episode. To pit the two curmudgeonly docs in a head-to-head match, Dr. Cox faced a trio of medical mysteries, each one worthy of an episode of House. So how'd Dr. Cox do? Let's grade him to find out.

1) For Dr. Cox's first medical mystery, he must determine why a man's skin has turned orange. Like House, he gathers the interns into a conference room for a brainstorm. Is it jaundice? Nope, that turns skin yellow. Could it be tanning cream? No foreign soils were found on his skin.

Thanks to a mishap with two paint colors and a trip to the cafeteria, he uncovers the culprit. The patient gorges himself on carrots and tomato juice. Carotene is a substance found in carrots that can turn one's skin yellow. The condition is called carotenemia. One well-known case involves actress Susan Dey who developed an eating disorder and only ate carrots. Tomatoes, on the other hand, contain the substance lycopene, which turn skin red if eaten in abundance. It's called lycopenemia. Thus combined, they'd turn his skin orange. Seriously?

In fact, there is a documented medical case of a plumber who turned orange from overeating carrots and tomatoes. It is detailed in a chapter titled "The Orange Man" of the book The Medical Detectives by journalist Berton Roueche, who wrote the "Annals of Medicine" feature in the New Yorker magazine from the 1940s until the 1980s. It is the first recorded case of carotenemia-lycopenemia, and there have been other victims since. Grade: B

2) Behind curtain #2, a young woman with no coronary issues has a failing heart. What's wrong with her? Reviewing her chart, Dr. Cox sees that she is single, but he also notices that she's wearing a wedding ring. Taking her further history, he learns that her husband recently died. So he quickly diagnoses her with stress cardiomyopathy, AKA broken heart syndrome.

How'd he do on this one? Pretty good. Broken heart syndrome is an actual phenomenon observed at several Hopkins hospitals. Researchers found that extreme emotional stress can release large doses of stress hormones and other chemicals into the bloodstream, which can stun the heart muscle, producing symptoms similar to a heart attack. Grade: A

3) The final medical mystery hits close to home: Why is new mom Carla refusing to leave the hospital? Although Dr. Cox doesn't know that she's crying at night, he should have realized that by remaining at the hospital she's expressing an inability to care for herself and the baby. These are actual symptoms of a postpartum depression. Other symptoms include sleep problems, mood swings, weight change, and in severe cases thoughts of death and suicide. Unfortunately, Dr. Cox doesn't make the diagnosis. Grade: F

Reviewed By Michael Smith, MD

Related Topics:

The Heart Speaks (Are You Listening?)

Out of the Blue: Brooke Shields' Struggle with Postpartum Depression

Technorati Tags: Scrubs, House, TV Doctors, Postpartum Depression, Broken Heart Syndrome

House at WebMD

The January/February issue of WebMD Magazine has debuted, and it features the fabulously hunky Hugh Laurie, who plays Dr. Gregory House. Be sure to look for it in your doctor's office!

In the issue, Laurie chats about growing up with his doctor-dad and shares how he really feels about the medical profession and his role on House.

Also, funny lady Roseanne Barr gives us her personal take on motherhood, aging and health, while Law and Order's S. Epatha Merkerson kicks off the New Year by discussing her campaign for lung cancer screening.

You'll also find updates on our WebMD Fitness RX Challengers, Jeff and Stefanee. How are they doing? Keep track by visiting their WebMD Blogs.

We even feature a real, live WebMD community member -- Cindy Michalewsky -- who brings us along on her journey through depression.

WebMD Magazine is just chock full of wonderful health and wellness information. Come see what it's all about.