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Be Well - March 2012


Feature: Gallstones – From Mummies to Mommies

Feature: Gallstones – From Mummies to Mommies

 

Gallstones were first found in a mummified Egyptian priestess. Today they are found in people all over the world.

Gallstones affect adults at different ages and stages, from young expectant mothers to middle-aged couch potatoes. The risk factors include:

  • Being over 40
  • Having high cholesterol
  • Being overweight
  • Leading a sedentary life
  • Being pregnant
  • Taking estrogen or oral contraceptives
  • Experiencing recent weight loss
  • Fasting extensively
Why gallstones form

The gallbladder, a pear-shaped organ located just beneath the liver, plays a role in digestion. Its job is to store and release bile, a substance made in the liver. When you eat, your gallbladder sends bile through a duct into the small intestine to help digest fats.

Bile is made mostly of cholesterol and a substance called bilirubin. Gallstones can form when there is too much of either substance. They are usually discovered by accident when abdominal scans are performed for a different problem.

“Gallstones in the gallbladder are mostly harmless and don’t cause symptoms, even when they are big,” explains Cleveland Clinic gastroenterologist Mansour Parsi, MD. “It’s the smaller stones that migrate into the bile ducts that we worry about. We go after them because complications can happen.”

Dealing with problem stones

Asymptomatic stones in the gallbladder usually aren’t treated. But stones that lodge in the bile duct can prevent bile from draining. Stones that block the duct leading to the pancreas can cause pancreatitis. Symptoms of blockage include:

  • Steady, severe pain in the upper-right abdomen. Pain can last several hours. Jaundice (a yellowing of the skin and eyes) may or may not occur. For either symptom, call your doctor. You’ll need blood work and an imaging test such as an ultrasound to confirm the presence and location of gallstones.
  • Fever and chills. If fever and chills accompany pain in the upper-right abdomen, infection is likely. Infection of the gallbladder or bile ducts is an emergency. Seek medical help promptly.

If you develop a blockage, you may need to undergo endoscopic retrograde cholangiopancreatography (ERCP for short). This minimally invasive procedure is used to unblock the duct, remove the stone and often place a stent to keep the duct open. “Sometimes without a stent, the problem will not resolve,” says Dr. Parsi.

But the vast majority of painful stones are treated by removing the gallbladder. This is usually a minimally invasive procedure, but some patients require traditional surgery. Gallstones may still form in the bile ducts after the gallbladder is removed. These can be removed with ERCP.

The good news is that you won’t miss your gallbladder; it isn’t needed to digest food. Instead, the liver can squeeze bile through the ducts directly into the small intestine.

If you can’t safely undergo surgery and your stones are made of cholesterol, you can get medication to dissolve them. However, the medication takes a long time to work, and stones are likely to return.

How to lower your risk

The vast majority of gallstones – 80 to 90 percent – are made of cholesterol. So it makes sense that physical activity and a low-cholesterol diet will lower your risk. Some studies have shown cholesterol-lowering statins to be helpful too.

Gallstones have also been linked to infection, so staying healthy is important. Vitamin C and coffee may help to protect against gallstones.

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Tip: How to Avoid the Most Preventable Cancer of All

Tip: How to Avoid the Most Preventable Cancer of All

Colon cancer develops from polyps that tend to form after age 50. Colonoscopy can detect and remove polyps before cancer develops. Schedule a colonoscopy when you turn 50 (or 45, if you’re African-American). Schedule one sooner if colon cancer or polyps run in your family. Removing polyps found during colonoscopy reduces the risk of colon cancer by 70 percent.


Be Well – March 2012 Issue
Feature: Brain Aneurysms True or False Quiz

Feature: Brain Aneurysms True or False Quiz

An aneurysm — a ballooning or bulging out of an artery where the wall is weak — can wreak havoc if it bursts. When aneurysms rupture in the brain, the resulting hemorrhage can cause stroke, coma, brain damage and other problems. Forty percent of ruptured brain aneurysms are fatal, and 66 percent of survivors suffer permanent brain damage.

A better understanding of brain aneurysms, how they are treated and whether or not you are at risk can help you safeguard your health. Start by testing your knowledge with this true-or-false quiz, created with the help of Peter Rasmussen, MD, of Cleveland Clinic’s Cerebrovascular Center:

1. All brain aneurysms need to be treated.

False. Every decision to treat a brain aneurysm involves weighing the risks versus benefits for each patient. The location, size and shape of the aneurysm matter. So do the patient’s personal and family health history. Some small brain aneurysms can simply be monitored.

2. Treatment for brain aneurysms means major surgery.

False. Depending on the patient’s health and other factors, minimally invasive techniques may be used to prevent rupture. Specially trained neurovascular surgeons can guide a catheter containing coils or stents into the intracranial (brain) artery. Coils and balloons can be placed within the aneurysm to stimulate scarring that prevents blood from entering. Stents (expandable scaffolds) can also be placed at the base of the aneurysm. As they scar over, they seal off the aneurysm from the circulation.

3. If brain aneurysms recur, you just have to live with them.

False. Even the most challenging aneurysms can be treated using new technology. Giant aneurysms and aneurysms with a broad base often recur after initial treatment with coils and stents. Pipeline™ embolization is a technology showing promise for these aneurysms. An extra-long, flexible, stent-like device is guided through a catheter and placed along the base of the aneurysm and on either side. As healing occurs, the device scars over and forms a new channel through which blood can flow, bypassing the aneurysm.

4. Men and women are equally at risk for brain aneurysms.

False. The risk of developing an aneurysm is slightly greater in women than in men, and roughly 60 to 65 percent of ruptured aneurysms occur in women. Ruptured aneurysms usually occur between the ages of 30 and 60. Brain aneurysms are rare in children but can occur.

5. Brain aneurysms produce symptoms similar to stroke.

True and false. Most aneurysms are silent. However, aneurysms that become very large may press on brain structures, causing stroke-like symptoms: loss of balance, speech problems and double vision. When an aneurysm ruptures, the hallmark is a sudden, debilitating headache — often described as the worst of one’s life — along with nausea, vomiting, a stiff neck, loss of consciousness or double vision. This is a medical emergency and requires an urgent call to 9-1-1.

6. Aneurysms are too rare to strike more than once in a family.

False. Some aneurysms are related to genetics. Up to 20 percent of those experiencing ruptured aneurysms have a strong family history — in other words, two or more blood relatives who also suffered ruptured aneurysms. If you have a strong family history, it’s important to consult a stroke specialist to see if you are at increased risk of aneurysm development and rupture.

Cleveland Clinic’s Familial Aneurysm Clinic

Cleveland Clinic’s Cerebrovascular Center has established a Familial Aneurysm Clinic for anyone with a strong family history of ruptured aneurysms. Imaging and other studies may be done to see whether an aneurysm is present. If treatment is recommended, we offer a variety of options. We also offer monitoring rather than treatment when the risk of rupture is low. To make an appointment in the Familial Aneurysm Clinic, please call 216.445.1587.

You can lower your risk of aneurysm formation and rupture and stroke with these lifestyle changes:

  • Stop smoking. Smoking is the greatest risk factor of all in aneurysm rupture and is a key risk factor for stroke.
  • Control high blood pressure. Persistently high blood pressure (hypertension) stresses the artery walls.
  • Avoid drug abuse. Cocaine is the worst offender, narrowing blood vessels and increasing blood pressure and heart rate.
  • Avoid alcohol abuse. Moderate to high alcohol consumption — binge drinking in particular — is associated with brain hemorrhage.
Cerebrovascular Center Consultation Service

Cleveland Clinic’s Cerebrovascular Center Consultation Line is available to anyone, anywhere, with an aneurysm or other cerebrovascular condition. Call to ask questions or to relay your concerns; an appointment is not necessary for the initial call. Please call 216.445.1587 or toll-free 800.223.2273, ext. 51587.

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Be Well – March 2012 Issue

Free Guide: Voice Disorders

Free Guide: Voice Disorders

Your voice is your connection to the world. Hoarseness and difficulty speaking make it hard to connect with people. Learn about voice disorders and how the Cleveland Clinic Voice Center team evaluates and treats them.


Recipe: Meatless Chili

Recipe: Meatless Chili

The American Institute of Cancer Research recommends limiting red meat to no more than 18 ounces per week. Consuming more may increase colon cancer risk. Use a meat substitute, such as soy, to enjoy your favorite recipes without the guilt. In a flavorful dish such as this chili, you can’t tell the difference. Soy also is rich in fiber and may provide heart benefits.

Ingredients

2 tablespoons olive oil
1 medium onion, chopped
1∕3 cup chopped green bell pepper
2 tablespoons chili powder
1 teaspoon ground cumin
1 14½-ounce can Mexican recipe stewed tomatoes with juice
8 ounces frozen veggie (soy) crumbles, thawed
1 cup canned red kidney beans, drained and rinsed
¼ cup water
½ cup 2% shredded cheddar cheese
4 tablespoons low-fat sour cream
salt and pepper to taste

Preparation
  1. Heat oil in large heavy skillet over medium-high heat. Add soy crumbles, onion and peppers. Sauté until vegetables are tender and soy crumbles are lightly browned (about 5 minutes). Add chili powder and cumin; stir 1 minute.
  2. Add tomatoes with juice, kidney beans and water. Cook until slightly thickened, breaking up any large tomato pieces and stirring occasionally, about 5 minutes. Season to taste with salt and pepper. Divide chili between 4 bowls; top with cheese and a dollop of sour cream, and serve.

Makes 4 servings

Nutrition

Calories: 306
Total fat: 14 g
Saturated Fat: 3.7 g
Fiber: 9 g
Sugar: 8.7 g
Protein: 19.3 g
Sodium: 748 mg
Calcium: 286.7 mg
Magnesium: 35.9 mg
Potassium: 461.2 mg

Recipe from our Digestive Disease Institute registered dietitians

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Be Well – March 2012 Issue

Let's Move It! Free Mobile App — New & Improved

Let Cleveland Clinic and your mobile phone keep you motivated while tracking your progress on a new, built-in pedometer for the iPhone (Android update coming soon). You can also access Cleveland Clinic exercise videos, a calorie converter and weekly wellness tips.