Husband Starting Radiation Treatment
DEAR DR. ROACH: My husband is about to start radiation treatment for stage one cancer on his vocal chord. Does radiation negatively affect the immune system the same way chemotherapy does? Should I be looking out for people who don’t vaccinate? — H.T.
ANSWER: Radiation can affect the immune system when it is given to large areas of the body, since the immune system cells are largely sensitive to radiation. Whole-body radiation rarely is used now, except in people planning for bone-marrow transplant. By contrast, localized radiation does not adversely affect the immune system to anywhere near the degree that chemotherapy can, since the bone marrow, where the immune system cells live, is diffuse throughout the large bones of the body.
As far as avoiding unvaccinated individuals, people who are unvaccinated and who are healthy do not pose a risk. It is in an outbreak of vaccine-preventable disease (there have been localized outbreaks of measles and mumps in the past year, and there are seasonal outbreaks of influenza) that unvaccinated people are much more likely to be infectious. So anyone with immune system disease (such as chemotherapy or whole-body radiation) should avoid people with potentially infectious illness. Caregivers of people with severe immune disease certainly should be immunized according to current guidelines. Even elderly people whose caregivers are immunized for flu get flu less than those whose caregivers are not.
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DEAR DR. ROACH: I know women who have had double mastectomies in order to reduce the risk of cancer. It seems extreme, but I guess it depends on the evaluation of risk. Are prophylactic hysterectomies done for similar reasons? It used to be routinely done when a woman had passed her reproductive years. I’m interested in your take on this. Will health insurance cover these types of surgeries, and if not, how expensive are they? — S.B.
ANSWER: Prophylactic mastectomies — that is, surgery to remove the breasts in order to avert a breast cancer diagnosis — are a reasonable choice for some women at very high risk of breast cancer, especially those with a family history of breast cancer who have an identifiable genetic predisposition, such as one of the BRCA gene mutations. This decision should be made carefully and in consultation with her doctors, usually an oncologist and a genetic counselor. I have very little experience with this in my own patients, fortunately, but I understand that in the case of women with very high genetic risk, it usually is covered by insurance, if it is the consensus of the treating physicians and the patient that she
Hysterectomy — the removal of a uterus — is not done routinely today, the way it was decades ago. They are removed for disease, either benign or malignant. However, the removal of both ovaries and Fallopian tubes, called a bilateral oophorectomy and salpingectomy, is performed in some women at high risk for ovarian cancer. In fact, women with the BRCA mutations may consider both a prophylactic double mastectomy and a prophylactic bilateral oophorectomy and salpingectomy, since BRCA mutations increase risk of breast cancer and ovarian cancer (as well as other cancers).
The cost of surgery in the United States varies dramatically depending on where it is done, but in general it is very expensive.
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Dr. Roach regrets that he is unable to answer
individual questions, but will incorporate them
in the column whenever possible.
Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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According to the National Fire Protection Association, between 2013 – 2017 U.S. fire departments responded to approximately 173,200 structure fires per year due to cooking. That’s around 470 fires per day due to cooking. More and more people are cooking from home these days due to recent world events. This increases the chances of a fire occurring in the home. Here are some safety tips to help decrease the chances of a cooking fire from occurring.
ALWAYS stay in the kitchen when you are cooking. This includes frying, grilling or even broiling foods. A fire can happen in the blink of an eye and if you walk away for just a second, things can happen. If you must leave for any reason remember to shut the oven and/or stove off. Also, remove the pan from the burner or oven as they remain hot for some time and the residual heat could still start a fire.
Never store anything combustible or flammable near heating sources such as the stove. Oven mitts, food packaging, towels, curtains, etc., could make contact with a burner accidentally and catch on fire. In some instances, a burner could be left on accidentally or get bumped in the “ON” position. If there are combustibles near the burner, after some time, these combustibles can and will start on fire.
If you do have a pan that starts on fire, use a fire extinguisher to extinguish the fire or you can place a lid on top of the pan and turn the burner off. This will smother the fire causing the flames to go out. Leave the lid on until the pan has had time to cool. If you have a fire in the oven, shut the oven off and keep the door closed. And always 911. Even if you extinguish the fire, it’s always best to have the fire department come and make sure the fire did not extend into the walls or other areas.
If you have any questions or would like further information I can be reached at
563-589-4195 or at Dpaulson@cityofdubuque.org.
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