A Buyer's Guide: Thermometers

To find a thermometer that produces accurate readings and doesn’t bust your budget, consider the following shopping secrets from the American Academy of Family Physicians (AAFP) and ConsumerReports.org.

• Go digital. Simply put, digital thermometers are easy to read. Buyers beware: The AAFP advises against use of mercury thermometers because mercury is an environmental toxin. Call the Contra Costa County Household Hazardous Waste Program, (800) 646-1431, for tips on proper disposal of a mercury thermometer.
• Check features. Some of today’s digital models beep or have soft or curved tips to let you know when they’re properly placed or displaying a final reading. Note: If your child is younger than 3 years, a rectal thermometer gives the best reading; to shop longterm, go with a model that can be used rectally and orally.
• Be savvy about quality vs. price. ConsumerReports.org found that “you don’t always get what you pay for. Thermometers can be pricey, but the best cost less than $15.”

FACT VS. MYTH: LABOR AND DELIVERY

Attention pregnant women: Have you heard the old wives’ tale that cautions against eating spicy foods or pineapple because they can trigger early labor, or conversely, that suggests eating these foods as a home remedy for inducing overdue labor? If you have, you can put that advice in your circular file. Scientific evidence doesn’t support the notion that what a pregnant woman eats has an effect on her delivery date. Even so, experts still don’t fully understand what triggers the onset of labor, nor is there any way to predict exactly when it will start.

Update on Breast Cancer Treatment - Targeted Radiotherapy Zaps Cancer Cells with Fewer Side Effects

There was a time, not so long ago, when a breast cancer diagnosis meant major surgery. How times have changed. Today, breast cancer treatment is more effective and less invasive, often requiring just a few days in the hospital and follow-up treatments. Many women can begin easing back into their normal daily lives—gardening, working, exercising—sooner than ever before.

Nowadays, doctors favor smaller surgeries, often combined with postsurgical radiation to kill off any straggling breast cancer cells. “Women no longer need to have a mastectomy (removal of the breast) when their breast cancer has been diagnosed early,” says Deborah Kerlin, M.D., a surgeon on staff at John Muir Health. “One of the most common treatments is to preserve the breast by doing a lumpectomy (removal of just the tumor and some surrounding tissue) rather than a mastectomy. We know that the cure rates are the same, provided the patient receives radiation therapy after the lumpectomy. The radiation therapy actually lowers the risk of recurrence in the rest of the breast over her lifetime.”

Just as surgery is becoming more targeted, so is radiation therapy. Long committed to leading-edge breast cancer treatment, John Muir Health has a seasoned team of radiation oncologists and specially trained staff who can provide highly customized radiotherapy for each patient, ensuring the best possible outcome with reduced side effects. Most members of the radiation oncology team radiation treatment. “Her pathology—the have worked together for at least 10 years.

Mapping a plan

The most important step in treating breast cancer? Devising a smart, sound treatment plan. When a patient is diagnosed with breast cancer, she first meets with her surgeon to make a decision about whether she wants to preserve or remove her breast. “We no longer do radical mastectomies, so the recovery time for a mastectomy without reconstruction is now a few days to a week (with up to seven weeks added if reconstruction is done),” Dr. Kerlin says. “The recovery time for a lumpectomy is days, so most women are doing 75 to 90 percent of what they want to do the following day.”

After surgery (or in some cases, beforehand) a patient will also learn about radiation treatment. “Her pathology—the size and characteristics of the tumor(s) and whether the cancer has gone into the lymph nodes—would determine which type of radiation therapy she would be a candidate for,” Dr. Kerlin says.

At John Muir Health, this part of the process is never rushed. Every patient who is a candidate for radiation therapy sits down with one of the hospital’s five board-certified radiation oncologists—most with between 10 and 20 years of experience—to thoroughly discuss the radiotherapy options.

A primary goal is to make sure that the patient has a clear understanding of her diagnosis and treatment options, including the pros and cons. “If a woman chooses to have a lumpectomy, she needs to understand that radiation therapy will probably be needed,” Dr. Kerlin says.

“She may also need systemic treatment such as hormone therapy and/or chemotherapy.” Once the patient has a good understanding of her options, she gets a computed tomography (CT) scan for planning radiotherapy.

“The information from the CT scan is transferred to our computerized planning system, and a radiation plan is specifically designed for that patient,” says Marjaneh Moini, M.D., a radiation oncologist with John Muir Health. “Over the past two decades, radiation treatment planning and delivery have gone through a tremendous evolution. With the use of CT for designing radiotherapy fields, we can now offer the radiation treatment with greater efficacy and safety. At John Muir Health, we have a team of trained dosimetrists (radiation dosage experts) and four physicists. We work hard to create a radiotherapy plan that will minimize the toxicity without compromising the benefits of radiotherapy.”

Smarter Radiotherapy

John Muir Health has long offered traditional radiation, and the hospital—ever on the forefront—now also offers a new, more targeted radiotherapy.

“We use the most modern technology, including intensity-modulated radiotherapy (IMRT), for treatment of breast cancer,” Dr. Moini says. “With IMRT, you can actually modulate how much radiation is given to every point.” This nuanced approach to delivering radiation reduces the likelihood of injuring the skin and improves the quality of life of patients receiving radiotherapy.

Historically, radiotherapy has required five to six weeks of treatment. However, new studies show that some women could be a candidate for either accelerated whole breast radiotherapy (to treat the entire breast) or accelerated partial breast radiotherapy (to treat just the tumor bed and a small rim of surrounding tissue), with shorter courses of treatment. “We discuss the pros and cons of each approach, and the patient decides to go in one direction,” Dr. Moini says.

With accelerated whole breast radiotherapy, 16 treatments are delivered over three weeks, as opposed to 25 to 33 treatments over five to six weeks with traditional radiation. Most patients are candidates for this technique, with the exception of women who have large breasts.

Accelerated partial breast radiotherapy involves 10 treatment sessions over the course of five days. A woman may be a good candidate for this technique if she is over age 45, has tumors that are smaller than 3 centimeters and has lymph nodes and surrounding margins that are negative.

The side effects for accelerated radiotherapy are similar to those of traditional radiation—including fatigue, little aches and pains, and skin reactions—but the more modern techniques appear to minimize the aftereffects. Breast cancer patients should keep in mind, however, that these techniques are new and longterm data is limited. Every patient should have an in-depth discussion with her doctor before committing to any therapy.

Six randomized trials have shown that conservative surgery combined with five to six weeks of breast radiotherapy offers results that are equivalent to those of mastectomy. John Muir Health is currently participating in a randomized trial co-sponsored by the National Surgical Adjuvant Breast and Bowel Project and the Radiation Therapy Oncology Group to compare whole breast radiotherapy and accelerated partial breast radiotherapy, and the initial clinical findings are promising.

“Partial breast radiotherapy is a new modality and can potentially improve the quality of life for patients with early stage breast cancer,” Dr. Moini says. “From everything we see so far, we think it should be safe for a select group of patients.”

Healing the Spirit

While John Muir Health is focused on providing the best possible medical treatments, the team is just as committed to helping patients navigate the emotional ups and downs of breast cancer recovery.

“Sometimes this process is more emotionally challenging than it is physically,” Dr. Moini says. “So after her consultation with the doctor, the patient meets with a nurse, and various aspects of her social and emotional needs are evaluated. We have an on-site social worker who meets with every patient who requests a visit. In addition to that, we have a breast cancer coordinator who’s available to talk to all of our breast cancer patients and address their issues or refer them to support groups.” In some cases, the patient will be referred to a psychologist, who can provide additional support.

Learning you have breast cancer can be daunting, but the team at John Muir Health is committed to providing premium care. “We have a comprehensive program to help take care of patients from diagnosis, to treatment, to ancillary services that provide support for our patients’ physical and emotional needs,” Dr. Moini says. “And we remain committed to state-of-the-art principles and techniques, while continually introducing new modalities to our health system.”