Santa Monica Primary Care Blog

Cases of Colorectal Cancer Increasing Among Young People

After decades of declining colon and rectal cancer rates, data published last week shows that these diseases have been increasing among young adults. Colon cancer rates have increased 2.4% annually among adults in their 20s and 1.0% among those in their 30s. For rectal cancer, the increase is even more dramatic: 3.2% among those in their 20s. For those born around 1990 the rates of colon cancer are more than two fold greater (2.4 times) than those born around 1950. Rectal cancer is over 4 fold greater (4.3 times) for those born around 1990 as compared to those born around 1950.

So the question, of course, is why the dramatic rise after decades of declining rates?

When I discuss colon and rectal cancer risks with patients, I often refer to two classic epidemiologic studies. The first study was done by Armstrong and Doll in 1975. It compared incidence and mortality rates for 27 cancers in 23 countries and correlated these with a variety of dietary habits and other variables. Dietary variables, particularly meat and animal protein consumption, was strongly associated with cancers of the colon and rectum. Further, these investigators confirmed prior data suggesting a protective effect of fiber consumption.

The second study to which I refer is actually an earlier study by Dennis Burkitt published in 1971. It was here that the idea that colon cancer could be linked to diet was first advanced. He reported that colorectal cancer was rare among rural Africans and this, he suggested, was because this population had little meat in their diet and instead ate a lot of fiber from fruits, grains, and vegetables.

Obesity and sedentary lifestyles are also associated with colorectal cancer, as are heavy alcohol use and chronic conditions like inflammatory bowel disease and Type 2 diabetes, all of which are on the rise. But experts are not entirely convinced these are the only reasons colorectal cancer is increasing among young people. “It is not surprising that the timing of the obesity epidemic parallels the rise in colorectal cancer because many behaviors thought to drive weight gain, such as unhealthy dietary patterns and sedentary lifestyles independently increase colorectal cancer risk,” the authors wrote.

Of particular concern with rising rates among those in their 30s and 40s is the fact that screening by colonoscopy is only recommended beginning at age 50 for people who are at average risk. The risk is higher among African-Americans, and the American College of Gastroenterology recommends they begin screening at 45.

In terms of advice, I generally stress that maintenance of a healthy weight, reduction of animal protein consumption, limiting alcohol intake and an increase in dietary fiber would also reduce one’s risk. More recently, a 2016 USC study showed that moderate coffee consumption, between one to two servings a day, was associated with a 26 percent reduction in the odds of developing colorectal cancer. Moreover, the risk of developing colorectal cancer continued to decrease to up to 50 percent when participants drank more than 2.5 servings of coffee each day. The indication of decreased risk was seen across all types of coffee, both caffeinated and decaffeinated.

At Santa Monica Primary Care, I have long recommended for my patients 40 and older, an adjunct screening test with a fecal occult blood test kit in which a stool sample is collected at home and mailed back into the office. Whereas this does not replace a colonoscopy in terms of detection, it does represent a relatively non-invasive way in which to begin screening sooner and also between years of colonoscopies. Positive results can be followed up with a colonoscopy. Today there is even a ‘virtual’ colonoscopy which is as accurate as a traditional optical colonoscopy and can be performed at an outpatient imaging center and does not require any anesthesia. With one third of new colorectal cancer cases being diagnosed in those under the age of 55, early initiation of already effective screening techniques simply make sense. Caught earlier, treatment options for colorectal cancers are more effective.

New Medications to Bring Cholesterol Levels WAY Down.

By Dr. Philip Bretsky

Were you aware that there are two new medications approved to treat high cholesterol levels? Traditionally, patients and physicians have relied on the statin class of medication to lower LDL or “bad” cholesterol levels. The most well known of these is Lipitor (you may have seen the commercials). The newer medications are delivered by injection and are in a class called PCSK9 inhibitors.

The new PCSK9 inhibitors can achieve LDL levels far lower than can be achieved by even the highest intensity statins. Whereas one might expect to lower an LDL to under 100mg/ml or under 70mg/ml with Lipitor, studies show that the PCSK9 inhibitors can achieve LDL levels below 25mg/ml. In one study 9% achieved levels under 15mg/ml!

But we must need some cholesterol in the body, right? It must serve some function and, correctly, some researchers are concerned that very low levels of LDL could adversely affect the production of sex steroid hormones and adrenal hormones which rely on cholesterol.

However, a recent study (http://www.onlinejacc.org/content/69/5/471) analyzed 5,234 patients treated for up to 2 years and examined the occurrence of adverse events. There was no increase in a wide variety of conditions including neurologic, memory, kidney, liver or diabetes. However, the authors did see (pun intended) an increase in cataracts among those patients with LDL levels below 25mg/ml.

So is there such a thing as ‘too low’ cholesterol? Other than the risk of cataracts, so far there does not seem to be a downside.

Improving the Connection Between Patients and their Physicians

By Dr. Philip Bretsky

I recently read an article that described the importance of having a strong and trustworthy relationship with your physician. For obvious reasons, this connection leads to better medical outcomes because patients feel more comfortable communicating with their doctors about personal and sensitive topics. I believe that there are a number of intangibles that make a connection more likely. Helpful to me has been a wide array of life experiences that has afforded me the ability to meet and interact with a lot of different people with a variety of lifestyles.  Everything from my Dad’s graduate students when I was a kid, to living in India for two years, to working with the homeless in London and doing clinical HIV research in the early 1990s. Each of these experiences helped me form a non-judgmental approach to medicine and a general understanding of life’s difficulties and challenges.

Also, being independent and not working for an institution reduces the external pressure that I have. I am not working to attain any health system’s stated goals or measures of quality. I’m focused on what the patient wants and what is best for them. Our office is also structured so that when I’m in with a patient, there is no interruption. The time between myself and the patient in the exam room is protected time and allows for open and honest communication.

We also take care of a tremendous number of families – often multi generational – and this adds a layer of understanding and sensitivity to family dynamics and health risks. And because I live and work in Santa Monica, I often see my patients and their families outside of the office during daily activities. This provides me and my patients a tremendous opportunity to foster good feelings and mutual respect and caring. By building these connections, I can feel confident that my patients trust me to care for them and provide them with the best possible medical outcomes.

Link to the original article below:

http://www.huffingtonpost.com/2016/03/31/doctor-patient-relationship-relies-human-connection_n_8296046.html

 

 

 

 

Additional Medical Insurance Plans Accepted At Santa Monica Primary Care

“We are excited to be able to welcome even more patients into our practice!”

At Santa Monica Primary Care, we believe that the best primary care on the Westside should be accessible to as many people as possible. That’s why we’re contracted with so many different medical insurance plans, including Medicare and most major private medical insurance PPO plans. In an era where physicians typically seek to go ‘out of network’, how often do you hear that an office will take new insurance plans?

Effective January 1st, 2015, Santa Monica Primary Care will begin accepting:

  • All Blue Shield Individual and Family PPO plans.
  • All Blue Shield Individual and Family EPO plans.
  • All Blue Shield Individual and Family PPO and EPO plans purchased through a private broker.
  • All Blue Shield Individual and Family PPO and EPO plans purchased through the Covered California website.

We will also continue to accept all Blue Shield Group PPO plans as well.

At Santa Monica Primary Care you will find a personalized, friendly and comfortable environment in contrast to the institutional care that may not be as personal. Our office is pleasantly appointed, well-staffed, and offers compassionate and academically trained providers. We offer our patients an extensive array of medical services right here in our office, from blood draws to skin procedures to cardiac stress testing. We believe that you should have the ability to receive comprehensive medical care without having to travel to multiple offices.

For appointments, insurance plans, services, or information about our staff, please check out our website at SantaMonicaPrimaryCare.com or give us a call at the office at 310-828-4411. Welcome to our practice.

NOTE: For more information regarding Covered California and the various insurance options available, please visit CoveredCA.com. The open enrollment period for 2015 non-employer provided health insurance is November 15th, 2014 through February 15th, 2015

Welcome Blog


Santa Monica Beach

Welcome to our new website! Information about our services, our office, and our team of providers can be found in the menu above. You will also find useful information about a variety of conditions that we treat, and we’ve included some basic insurance information as well. We’ve also made some of our paperwork available in the Forms section for your convenience. Feel free to print out the forms and bring them with you to your appointment. We will also be updating our events and office policies in the News section. Please check back later this fall for some exciting announcements!

Finally, this blog will provide a more personal and casual look into our office. Here we will be providing additional information about significant medical advancements, tips for staying healthy, and a look into the Santa Monica/Westside area. We want to stay connected with our patients, and share some things that we find special and unique. We are proud to be a part of this community, and we look forward to serving your healthcare needs with care and compassion. Please don’t hesitate to call our office with any questions, concerns, or if you’d like to schedule an appointment. Thank you for visiting. We appreciate it.