Oral Cancer – what you need to know

April is here, bringing warm wet weather, Easter egg hunts, and dreams of May flowers.  But April is an important month in other ways, as it is oral cancer awareness month.  That means that now is a great time to learn a little more about the signs, symptoms and causes of this disease.  Maybe not something we all want to talk or think about, but very important. According to the American Academy of Oral and Maxillofacial Surgeons, oral and pharyngeal cancer kills nearly one person every hour of every day of the year. 

Oral and pharyngeal cancer is located in the oral cavity, nose, pharynx, voice box trachea and esophagus.  The mortality rate is higher than other cancers because typically it is not detected early.  The prognosis for patients who have oral cancers is much higher the earlier it is detected.   Oral cancer can be broken into two categories, non-HPV related oral cancers and HPV related oral cancers.

The most common cause of non-HPV related oral cancers are excessive alcohol and tobacco use.  In particular, the combination of smoking and heavy alcohol use increases the risk of oral cancer by 15 times, according to the NIH.  Men are at higher risk than women, as well as those age 55 or older.   Exposure to sunlight can increase the risk of oral cancers of the lip (so don’t forget your sunblock!)

Signs and symptoms of oral cancer caused by tobacco usage and/or excessive alcohol usage may include one or more of the following and are persistent in nature (meaning they do not resolve on their own and linger beyond two weeks:

  • Any sore or ulceration that does not heal within 14 days.
  • A red, white, or black discoloration of the soft tissues of the mouth.
  • Any abnormality that bleeds easily when touched.
  • A lump or hard spot in the tissue, often on the lateral border of the tongue or underneath the tongue.
  • Tissue raised above the area that surrounds it; a growth.
  • A sore under a denture, which even after adjustment of the denture that does not heal.
  • A lump or thickening that develops in the mouth.
  • A painless, firm, fixated lump felt on the outside of the neck that has been there for at least two weeks.

HPV related oral cancers differ slightly form non-HPV cancers.  HPV is the human papilloma virus.  According to the CDC, up to 8-0% of Americans with have an HPV infection during their lifetime, but the great majority (99%) will not develop cancer as their immune system will clear the virus.  Men are affected more than women (approximately 4:1), particularly white, non-smoking men between the ages of 35-55.  The HPV vaccine protects against cancers caused by the virus.  Your child can and should be vaccinated as early as 11 or 12.  The vaccine is recommended for young women through age 26 and young men through age 21.

Signs and symptoms of HPV related oral cancer may include:

  • Hoarseness or sore throat that does not resolve.
  • A painless, firm, fixated lump felt on the outside of the neck, which has been there for at least two weeks.
  • Constant coughing that does not resolve.
  • Difficulty swallowing; a sensation that food is getting caught in your throat.
  • An earache on one side (unilateral) that persists for more than a few days.

In addition to preventing, identifying and treating diseases of the dentition and periodontium, one of the most important jobs your dental team does is screen for oral cancer.  This includes both an extra oral assessment of the head and neck region as well as a thorough assessment of the oral cavity including the lips, tongue, tongue, cheeks, tonsils and throat.  If you have noticed a lesion that you are concerned about, make sure to let your dental team know.  

There is always more to learn about Oral Cancer.  Check it all out at the Oral Cancer Foundation’s web site.

By Dr. Warder, Dental Director

5 Things You Can Do To Prepare for Bloomsday!

  1. Get started on a running or walking program

There are endless options out there to improve your endurance when preparing for a long distance run or walk, so find one that best caters to your needs and goals. Interval training is a great way to get your heart rate up and give your body the boost it needs to keep running during steady periods of time. If you plan on walking, it’s a good idea to get into a weekly or even daily walking routine to prepare your muscles and joints for the 7 mile trek through Spokane streets—it’s also a great excuse to do some sightseeing as the weather begins to warm up!

  1. Join a team or get a partner

Exercising with other people can often be a lot more fun than just going by yourself. When we have a reliable teammate or partner to push us, we tend to reach past our own expectations and reach our goals for efficiently. Find someone who is going to give you that push you need and you may just build a lifelong exerciseship.

 

  1. Increase your water intake

It is recommended that the average person drinks between 5-8 eight ounce glasses of water a day. When preparing for the big race, it’s important to consistently drink water throughout the day and get in the habit of drinking water BEFORE you are even thirsty. Though Bloomsday doesn’t take place during a hot month, 7.5 miles often takes a lot of sweat—refuel and recharge.

 

  1. Visit your physician

Though Bloomsday participants run and walk at all levels, it’s a good idea to visit your health care provider before starting a training program to make sure your heath is not at risk. They can also let you know if your finish time goal is reasonable and give you tips for proper training.

 

  1. Start stretching regularly

It is always good to stretch before and after doing any strenuous physical activity, but daily stretching is great at increasing flexibility to prevent future injury. If you don’t have much experience with stretching, taking up a Yoga class or even finding a TV program that teaches stretching, Yoga or Pilates at home could be beneficial to your Bloomsday experience.

Healthy Recipes: Asian Noodle Salad

Ingredients

Salad:

8 ounces thin spaghetti

One 8-ounce bag julienne/fine-cut carrots (about 1 1/2 cups)
One 6-ounce bag baby sweet peppers, seeded and sliced thinly into rings (about 1 cup)
One 4-ounce bag bean sprouts (about 1 cup)
3 English cucumbers, halved,
seeds removed, and sliced
3 scallions, sliced
Up to 1 bunch fresh cilantro, chopped
1/2 head or more napa cabbage, sliced
1/2 head or more purple cabbage, sliced
1/2 bunch kale, leaves torn off the stalks
and shredded
2 cups peanuts, chopped

Dressing:
1/2 cup olive oil
1/3 cup low-sodium soy sauce
1/4 cup oyster sauce
1/4 cup rice wine vinegar
1/4 cup brown sugar
3 tablespoons chopped fresh ginger
2 tablespoons sesame oil
2 to 3 cloves garlic, chopped

 

For the salad: Bring a pot of water to a boil. Cook the spaghetti to al dente according to the package directions. Drain, rinse and let cool. Mix together the cooked spaghetti, carrots, peppers, bean sprouts, cucumbers, scallions, cilantro, napa cabbage, purple cabbage, and kale. Add the peanuts and toss together.

For the dressing: Whisk together the olive oil, soy sauce, oyster sauce, rice wine vinegar, brown sugar, ginger, sesame oil and garlic in a medium bowl.
Pour the dressing over the salad and mix together with tongs or your hands. If the salad seems a little dry, just mix up a little more of the wet ingredients of the dressing and throw it in. It’s a very organic process.

Transfer to a large platter and serve.

By Erica Baty, RD, CDE

Press Release: CHAS Health Opens Clinic for People Over Age 60

Spokane, WA. December 27, 2018 – CHAS Health has opened a new clinic that offers primary care services, with an emphasis on individuals over 60 years of age. The new CHAS Health North Central Clinic located at 914 W. Carlisle Ave. in Spokane, offers medical, behavioral health, and pharmacy services under one roof, with a team that is experienced in geriatric medicine.

Some of the services available at the clinic include: age-appropriate preventive screenings; immunizations; chronic disease management; fall risk assessment and risk-reduction tools; Medicare Annual Wellness Visits; nutritional evaluations; activity and exercise evaluation; comprehensive cardiovascular risk reduction; blood clot and Anticoagulant medication care; comprehensive geriatric assessments; advance care planning; and dementia assessment and care.

There is a clinical pharmacist on-site, to work closely with patients and help them manage medications. Behavioral Health services are provided in partnership with Lutheran Community Services Northwest, to ensure coordination of care with the primary care provider. The renovation was accomplished thanks to funding support from the City of Spokane. Patients can schedule an appointment by calling 509.444.8200.

About the providers:

Dr. Jeremy Graham is a Diplomate of the American Board of Internal Medicine, and of the American Board of Clinical Lipidology. He has special interest in wellness behaviors, prevention of stroke and heart attack, and medicine based on the best evidence for older adults.

 

Amanda Bailey received her BSN from University of Alabama at Birmingham and her MSN from South University. She is an Adult Gerontology Nurse Practitioner, who recently joined the CHAS Health team. Her nursing background is in critical care medicine. She is excited to address the health needs of older adults in the Spokane community.

 

About CHAS Health

CHAS Health is a local, non-profit organization that provides high quality health care to everyone, regardless of insurance status. Our mission is to improve the overall health of the communities we serve by expanding access to quality health and wellness services. Those services include medical, dental, behavioral health, pharmacy, and health education.  Visit www.chas.org for more information.

 

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Back to School

We can’t believe that summer is nearing its close and fall and school are rapidly approaching. Back-to-school time can be an exciting and nerve racking time for both kids and parents. Time for fun. Time for learning. Time for cooler temperatures. We hope you are excited for the new school year. Here are a few tips to make sure you and your kids are healthy for back to school.

Annual Checkup
Annual checkups are an important part of everyone’s health, but especially kids. When you bring your child in for a check-up, you can expect a check of vital signs, measurements, physical examination, immunizations, and a chance to discuss concerns or to ask questions. Schedule you and your kid’s annual exam. At the same time, bring all your forms for school: sports physical, asthma, allergies, and medication administration.

First Day Worries
Many children (and parents) are worried about the first days and weeks of school. You can ease these anxieties by meeting the teacher before the first day and touring the classroom. Knowing what to expect can help kids be less nervous.   Another thing you can do is to talk about the exciting things school brings (new and old friends, learning exciting new things, a new backpack).

Make Time for Healthy Choices
It is important to build time in the morning for a healthy breakfast. Studies have shown that eating breakfast helps children and teens perform better, focus better and have more energy during the school day. Encourage them to eat something with protein, to help them stay full longer. Make sure to plan out the week’s lunches to help ensure your child is eating healthy choices they will love (and while you are making their lunch, make your own too!).

Schedule
Children need schedule and routine. The school year is a big transition, so be sure to start a sleep schedule now to be prepared for school. It’s also important to schedule afternoon time that includes homework. Some kids benefit from timers, planners, checklists or supervision to help them feel successful.

Questions? Your child’s pediatrician can discuss more concerns with back to school.

Pork Carnitas

Pork Carnitas

Servings: 10 – 12

Ingredients

5 lb / 2.5 kg pork shoulder (pork butt), skinless, bone-in (4lb/2kg without bone) (Note 3)

1 onion, chopped

1 jalapeno, deseeded, chopped

1 1/2 tsp salt

1 tsp black pepper

4 cloves garlic, minced

2 oranges, juice only (or sub with 3/4 cup fresh orange juice)

Rub

1 tbsp dried oregano

2 tsp ground cumin

1 tbsp olive oil

Instructions

  1. Rinse and dry the pork shoulder, rub in salt and pepper.
  2. Combine the rub ingredients then rub all over the pork.
  3. Place the pork in a slow cooker (fat cap up), top with the onion, jalapeño, minced garlic (don’t worry about spreading it) and squeeze over the juice of the orange.
  4. Slow Cook on low for 8 to 10 hours or on high for 6 hours (or 1h 30 m in an electric pressure cooker on high. If using stovetop pressure cooker, please see notes).
  5. The meat should be tender and falling off the bone. Remove from the slow cooker and let cool slightly. Then shred the pork using two forks.
  6. Skim off the fat from the juices remaining in the slow cooker and discard the fat. Then if you are left with a lot more than 1 1/2 to 2 cups of juice, then reduce it (either in the slow cooker on the sauté setting with the lid off, or in a saucepan). The liquid will be SALTY, it is the seasoning for the pork. Set aside.

To Serve

  1. Heat 1 tbsp of oil in a large non stick pan over high heat. Place shredded pork into the pan, drizzle over some juices. Wait until the juices evaporate and the bottom side is golden brown and crusty. Turn and just briefly sear the other side – you don’t want to make it brown all over because then it’s too crispy, need tender juicy bits.
  2. Repeat in batches (takes me 4 batches) – don’t crowd the pan.
  3. Remove pork from skillet. Drizzle over more juices and serve immediately (if you are using defrosted carnitas, this is not applicable as the juices are already on the meat – see Note 4c).
  4. If you are reheating the carnitas (Note 4), then flip and cook the other side briefly just to warm through. I really recommend only making one side crusty and leaving the other side juicy and moist.

Recipe Notes

  1. If you are using a piece of pork that is not the size I use, you MUST reduce the salt accordingly. If your pork is more than 1 lb / 0.5 kg larger or smaller than the prescribed size, ensure you adjust the other ingredients accordingly as well, not just the salt.
  2. To make this in the oven, add 1 cup of water to the braising liquid. Place in 325F/160C oven for 2 hours, covered, then roast for a further 1 to 1.5 hours uncovered. Add more water if the liquid dries out too much. You should end up with 1 1/2 to 2 cups of liquid when it finishes cooking.

If you make this recipe in the oven, you could skip the pan frying step because you will get a nice brown crust on your pork.

  1. Use pork with the skin removed but leaving some of the fat cap on. The fat adds juiciness to the carnitas!
  2. Taco Fixing suggestions: Diced avocado or make a real proper Guacamole, Pico de Gallo or salsa. Also try pickled red onion, cabbage, lettuce, tomato,
  3. MAKE AHEAD:
    1.  For overnight or up to 3 days, the best option is to shred the meat without pan frying, keep the juices separate, refrigerate, then pan fry to make it golden and reheat the meat, pouring juices over while it is browning per recipe.
    2.  To brown the meat ahead, the meat actually holds up pretty well in terms of staying crispy. It’s even pretty good refrigerated overnight – but a) is definitely better. Keep the juices separate and pour it over just before reheating the pork. You can reheat in the microwave, quickly reheat in the pan or if you have loads, in a foil covered roasting pan in the oven at 180C/350F for around 8 – 10 minutes.
    3.  To FREEZE: This holds up great in the freezer. Pour the juices over the pulled pork (pre browning) and store in ziplock bags or airtight containers. Freeze in small batches for convenience. To use, defrost completely before following the recipe to brown the pork.
    4. STOVETOP PRESSURE COOKER – use a rack to elevate it from the base OR add 3/4 cup of water. Then once the pork is cooked, remove it then simmer to reduce to around 2 cups of liquid.

15 minute Cauliflower Fried Rice

prep time: 10 mins

cook time: 5 mins

total time: 15 minutes

yield: 4 servings

Ingredients

 

1 medium-sized head of cauliflower OR 1 10oz bag of pre-riced cauliflower

2 tablespoons sesame oil

1 bag frozen peas and carrots

2 garlic cloves, minced

1 cup frozen edamame

2 beaten eggs (use scrambled tofu for vegan)

3 tablespoons low sodium soy sauce (use tamari for GF)

6 green onions, minced

Instructions

PREP CAULIFLOWER: Shred cauliflower using the largest side of a grater OR by just pulsing some rough cut pieces in a food processor; the end product should resemble smallish grains of rice OR steam the pre-riced cauliflower according to package instructions.

STIR FRY: Heat 1 tablespoon sesame oil in a large skillet over medium low heat. Add the carrots and garlic and stir fry until fragrant, about 5 minutes. Add the cauliflower, edamame, and remaining sesame oil to the pan; stir fry quickly to cook the cauliflower to a soft (but not mushy) texture.

FINISHING TOUCHES: Make a well in the middle, turn the heat down, and add the eggs. Stir gently and continuously until the eggs are fully cooked. Stir in the soy sauce and green onions just before serving.

NOTES

For the sauce on top, whisk equal parts soy sauce, honey, sesame oil, and oyster sauce together and drizzle it over top with sesame seeds.

Heart Pearls – Statins

In honor of February being American Heart Month, I’m sharing pearls from my conversations with family members about cardiovascular disease. Even though I am an Ivy-League trained nurse practitioner with nearly two decades of experience of keeping patients healthy, I’ve found that even my loved ones doubt my perspective until it is validated by their own medical providers, the CDC, or even (shudder) a celebrity interview.

 

“Ask for a statin,” I said to my husband.  His cholesterol had been climbing on his annual work health screening and starting a regular exercise program hadn’t done anything to bring it down.  Long-term research about statins not only shows that they are proven to reduce incidents of heart attacks and strokes, but that they also reduce the incidence of certain types of cancers.  They are not for everybody (especially women at risk of pregnancy), but my experience has shown that very few people have side effects while on statins. Those that do can usually reduce their side effects by taking a daily CoQ10 supplement  along with the statin.

 

Even small amounts of extra cholesterol can accumulate in the blood vessels over the years and lead to hardening of the arteries, so treat slight elevations just as aggressively as very high elevations. When it comes to cholesterol management, it is worth investing in your long-term health.

 

As for my husband, he eventually had a conversation with his own provider, and I had a happy-dance when he came home with a Pravachol prescription.

 

By Ginger Blake, ARNP at North County Clinic

Healthy Recipes: Simply Delicious Chili

Simply Delicious Chili

Prep Time: 20 mins Cook Time: 40 mins

Total Time: 1 hour  Yield: 4 to 6 servings

 

Ingredients

2 tablespoons olive oil

1 medium red onion, chopped

1 large red bell pepper, chopped

2 medium carrots, chopped

2 ribs celery, chopped

1/2 teaspoon salt, divided

4 cloves garlic, pressed or minced

2 tablespoons chili powder

2 teaspoons ground cumin

1 1/2 teaspoons smoked paprika

1 teaspoon dried oregano

1 large can (28 ounces) or 2 small cans (15 ounces each) diced tomatoes*, with their juices

2 cans (15 ounces each) black beans, rinsed and drained

1 can (15 ounces) pinto beans, rinsed and drained

2 cups vegetable broth or water

1 bay leaf

2 tablespoons chopped fresh cilantro, plus more for garnishing

1 to 2 teaspoons sherry vinegar or red wine vinegar or lime juice, to taste

Garnishes: chopped cilantro, sliced avocado, tortilla chips, sour cream or crème fraîche, grated cheddar cheese, etc.

Instructions

In a large Dutch oven or heavy-bottomed pot over medium heat, warm the olive oil until shimmering. Add the chopped onion, bell pepper, carrot, celery and 1/4 teaspoon salt. Stir to combine and then cook, stirring occasionally, until the vegetables are tender and the onion is translucent, about 7 to 10 minutes.

Add the garlic, chili powder, cumin, smoked paprika (go easy on the paprika if you’re sensitive to spice) and oregano. Cook until fragrant while stirring constantly, about 1 minute.

Add the diced tomatoes and their juices, the drained black beans and pinto beans, vegetable broth and bay leaf. Stir to combine and let the mixture come to a simmer. Continue cooking, stirring occasionally and reducing heat as necessary to maintain a gentle simmer, for 30 minutes. Remove the chili from heat.

For the best texture and flavor, transfer 1 1/2 cups of the chili to a blender and blend until smooth, then pour the blended mixture back into the pot. (Or, you can blend the chili briefly with an immersion blender, or mash the chili with a potato masher until it reaches a thicker, more chili-like consistency.)

Add the chopped cilantro, stir to blend, and then mix in the vinegar, to taste. Add salt to taste, too—I added 1/4 teaspoon more at this point. Divide the mixture into individual bowls and serve with garnishes of your choice. This chili will keep well in the refrigerator for about 4 days (I haven’t tried, but I bet it would freeze well, too).

Watch how it’s made below: