Diverticulitis Diet: A Low Residue Diet

As we age, little bulging pockets may develop in large intestine's lining.  This condition is called diverticulosis.  When these pockets, medically known as diverticula, become inflamed and infected, the condition is called diverticulitis. Fortunately, sufferers can find relief by eating the right foods.

A low-residue diet, aka low-fiber diet, is usually recommended during the flare-up periods of diverticulitis to decrease bowel volume so that the infection can heal. An intake of less than 10 grams of fiber per day is generally considered a low-residue diverticulitis diet. If you have been on a low-residue diet for an extended period of time, your doctor may recommend a daily multivitamin supplement.

Diverticulitis Diet

You may be asked to start with a clear fluid diet at the onset of diverticulitis. After a few days, you may incorporate the following low fiber foods (less than 10 g per serving) that are mild enough to be eaten during a diverticulitis flare-up.

Grain Products:

  • enriched refined white bread, buns, bagels, English muffins
  • plain cereals e.g. Cheerios, Cornflakes, Cream of Wheat, Rice Krispies, Special K
  • arrowroot cookies, tea biscuits, soda crackers, plain melba toast
  • white rice, refined pasta and noodles
  • avoid whole grains

Fruits:

  • fruit juices except prune juice
  • applesauce, apricots, banana (1/2), cantaloupe, canned fruit cocktail, grapes, honeydew melon, peaches, watermelon
  • avoid raw and dried fruits, and berries.

Vegetables:

  • vegetable juices
  • potatoes (no skin)
  • alfalfa sprouts, beets, green/yellow beans, carrots, celery, cucumber, eggplant, lettuce, mushrooms, green/red peppers, potatoes (peeled), squash, zucchini
  • avoid vegetables from the cruciferous family such as broccoli, cauliflower, brussels sprouts, cabbage, kale, Swiss chard, onion, etc

Meat and Protein Choice:

  • well-cooked, tender meat, fish and eggs
  • avoid beans
  • avoid all nuts and seeds, as well as foods that may contain seeds (such as yogurt)

Dairy:

  • as directed by your healthcare providers

Drinks:

  • juices
  • tea and coffee (check with doctor about cream)
  • avoid alcohol

Diverticulitis: After a Flare-Up

When symptoms of diverticulitis improve, you may ease off of the low-residue diet and gradually add more fiber back into your diet. A high-fiber diet is very important in preventing future diverticulitis attacks. As you increase your fiber intake, don't forget to increase your fluid intake as well. If you have challenges eating a diet with higher fiber content, your doctor may suggest a fiber supplement like Metamucil. In addition, you may also heard from others that nuts should be permanently avoided.  In the past, the medical community indeed recommended patients to avoid hard foods like nuts and seeds, fearing that these foods get stuck in between the pockets and become inflamed.  However, modern studies really didn't find such recommendation to be clinically valid.

Stay Healthy: Breast Exam

How to Do a Breast Self-Exam
Adapted from American Cancer Society Recommendations
• Lie down and place your right arm behind your head.
• Use the finger pads of the three middle fingers on your left hand to feel for lumps in the right breast. Use overlapping dime-sized circular motions of the finger pads to feel the breast tissue.
• Use three different levels of pressure to feel all the breast tissue:
– Light pressure to feel the tissue closest to the skin.
– Medium pressure to feel a little deeper.
– Firm pressure to feel the tissue closest to the chest and ribs.
A firm ridge in the lower curve of each breast is normal. If you’re not sure how hard to press, talk with
your doctor or nurse. Use each pressure level to feel the breast tissue before moving on to the next spot.
• Move around the breast in an up-and-down pattern —start at an imaginary line drawn straight down your side from your underarm. Move across the breast to the middle of the chest bone (sternum or breastbone).

Be sure to check the entire breast area—going down until you feel only ribs and up to the neck or collar bone (clavicle).

There is some evidence to suggest that the up-anddown pattern (sometimes called the vertical pattern)
is the most effective pattern for covering the entire breast without missing any breast tissue.
• Repeat the exam on your left breast, using the finger pads of your right hand.
• Stand in front of a mirror. Press your hands firmly down on your hips. Look at your breasts for any changes of size, shape, contour, dimpling, pulling, or redness or scaliness of the nipple or breast skin.
(The pressing down on the hips position contracts the chest wall muscles and enhances any breast changes.)

Continue to look for changes with your arms down at your sides. Then look for changes with your arms raised up over your head with your palms pressed together.
• Examine each underarm while sitting up or standing. Raise your arm only slightly so you can easily feel in this area. Raising your arm straight up tightens the tissue in this area and makes it difficult to examine.

Note From American Cancer Society:
This procedure for doing breast self-exam is different from previous procedure recommendations. These changes represent an extensive review of the medical literature and input from an expert advisory group. There is evidence that the woman’s position (lying down), area felt, pattern of coverage of the breast, and use of different amounts of pressure increase the sensitivity of breast self-exam, as measured with silicone models, and of clinical breast exam, using patient models with known small, noncancerous lumps in their breasts.

Provided as an educational resource by Merck

What Is Breast Cancer?

There are many kinds of cancer. Cancer means the growth and spread of cells that are not normal. Each of us has trillions of cells that allow our body to perform normal functions like breathing, walking, and thinking. When cells stop behaving normally, they can become cancer cells.

Your breasts, like all parts of your body, are made up of cells that are too small to see. These cells can form a mass called a “growth” or a “tumor” (TOO-mer). Most tumors do not contain cancer, but sometimes they do. When this happens in your breast, it is called breast cancer.

Early breast cancer may have no symptoms at all— there will be no pain and nothing will look or feel wrong. That is why it is so important to be screened (screening is when you or your doctor look for cancer even if you don’t have any symptoms).

Breast cancer is one of the most common cancers in women. Most doctors feel that finding breast cancer early through screening saves thousands of lives.

These are changes in the breasts that may be warning signs of cancer:
• A lump in or near your breasts or under your arms
• A change in size or shape of one of your breasts
• A discharge from nipples or nipple pain
• One of your nipples turns inward
• The skin in your breast area has ridges or pitting, like the skin of an orange
• Changes in the skin of your breast, your nipples, or the area around your nipples—for example, if an area is red or the skin is scaly

These symptoms most often are not a sign of cancer. They are usually a sign of another less serious health problem. But it is important to get them checked by a doctor as soon as you can.

The earlier breast cancer can be found, the more likely treatment will work. If cancer is found in your breasts, your doctor will talk to you about what type of treatment is right for you.

Who Gets Breast Cancer?
As you get older, your chances of getting breast cancer increase—about 80% of breast cancer is in women who are 50 or older. You also have more chance of getting breast cancer (you are at higher risk) if:
• Your sister, mother, or daughter has had breast cancer. A family history nearly doubles your risk.
• You have had breast cancer before.
• You have gained weight after the change of life (menopause) or after turning 60.
• You have been on combined hormone replacement therapy (estrogen and progesterone) for several years. Talk to your doctor about the risks and benefits of your current hormone replacement therapy.
• You have had radiation treatment to your chest area in the past.

There are some things you can do to lower your risk:
• Get a mammogram every year if you are 40 or older (the American Cancer Society recommends this). Speak to your doctor if you have had a family history of breast cancer to see if you should have a mammogram done at a younger age.
• Have a breast exam done by your doctor every year.
• Learn how to do a breast self-exam and do it monthly. Have your doctor or nurse show you how to do this.
• Add healthy habits to your routine: Cut down on the red meat you eat and eat more fruits and vegetables. Cut down on how much alcohol you drink. Be more active—do more walking and try to exercise more. Lose extra weight.
• See your doctor regularly.

Provided as an educational resource by Merck

What Is Colorectal Cancer? Who Is Affected?

Your colon and rectum make up what is called your large intestine (in-TES-tin). The large intestine is the final place where food is processed after you eat. It is also where stools are formed. In the United States
about 1 in 15 people get colorectal cancer. Your chances of surviving colorectal cancer when it is caught early are very high—more than 90%. Talk to your doctor about what tests you should have to check or screen for colorectal cancer.

What Is Cancer?
There are many kinds of cancer. Cancer means the growth and spread of cells that are not normal. Each of us has trillions of cells that allow our body to carry on normal functions like breathing, digesting, and thinking. When cells stop behaving normally, they can become cancer cells.

What Can I Do to Prevent Colorectal Cancer?
Screening can save lives—colorectal cancer is one of the most preventable and curable cancers if found early. Start getting screened at age 50, or earlier if there is colorectal cancer in your family or if you have had colorectal cancer before. Other ways to prevent cancer include eating a healthy diet, being more active, and losing extra weight.

Colorectal cancer is when a tumor grows in the large
intestine. The large intestine is a long tube (4 to 5 feet
long). The longest part of this tube is called the colon;
the last few inches of the tube is the rectum.

Who Gets Colorectal Cancer?
Age is the number-one risk factor for colorectal cancer (it increases your chances of getting cancer). You should be screened (tested) at age 50.
You also have a greater chance of getting colorectal cancer if:
• Your parents, brothers, sisters, or children have had colorectal cancer. Your doctor may recommend screening or testing at a younger age if this is the case.
• You have polyps (PAH-lips), which are small balloon-shaped pouches in the colon or rectum that may contain cancer cells. Polyps usually don’t cause symptoms (a symptom is a change in the body due to illness) but can be felt or seen if your doctor tests for them. If polyps are found, your doctor can remove them. Polyps are not always cancerous.
• You have had colorectal cancer or polyps that are cancerous before.
• Have ulcerative colitis (UHL-ser-uh-TIV koh-LI-tiss) or Crohn’s (Kronze) disease, which cause inflammation in the colon or small intestine.
• You are African American.

There are over 1 million survivors of colorectal cancer in the United States. The most powerful weapon against colon cancer is screening or testing.

Some Signs of Colorectal Cancer
These are some of the symptoms of colorectal cancer:
• A change in bowel habits, such as diarrhea or constipation
• You feel like you still have to go after you’ve had a bowel movement
• Blood in your stool (bowel movement)
• Stomach cramping or bloating
• Unexplained weight loss
• Feeling tired or fatigued all the time
Keep in mind that there are many other conditions that may cause these symptoms. Make sure you see your doctor.

Provided as an educational resource by Merck

What Is a Mammogram?

One way to be screened for breast cancer is to get a mammogram (MAM-o-gram). A mammogram is a special type of X-ray of the breast.

Mammograms: Providing a Closer Look
Mammograms are one of the best screening tools to detect cancer before it has grown and spread. This makes it more likely that cancer treatment will be a success.

Women who are 40 and older should have a mammogram once a year. If you are a woman who is at high risk of getting breast cancer, talk to your doctor about whether you should start getting mammograms before age 40. Remember, a mammogram may find cancer before you or your doctor can see or feel anything wrong in your breast.

Breast cancer is the second most common cancer in women. A mammography (mam-AH-gruh-fee), a special breast X-ray, lowers the number of deaths from breast cancer.

When you go in for a mammogram, you will undress above the waist and wear a hospital gown. You will stand in front of an X-ray machine. The mammogram technician will help get your breasts into the right position on the X-ray plates. Then pictures of your breasts will be taken.

What else can you do to help prevent breast cancer?
• Improve your health by eating healthy and exercising.
• Get screened regularly.

Know Your Risk Factors
What increases a woman’s chance of getting breast cancer?
• Age. About 8 out of 10 breast cancers occur in women older than 50.
• Genetics. About 10% of breast cancer can be linked to certain changes in genes.
• Family history. The risk increases for a woman with close blood relatives who have had breast cancer.
• Personal history. Cancer in one breast can increase the likelihood of cancer in the other.
• Race. White women are at a slightly higher risk of getting breast cancer. African American women have a higher death rate from breast cancer.
• Menstrual periods. The risk increases if a woman started menstruating before the age of 12 or menopause occurred after the age of 55.
• Alcohol. 2 to 5 alcoholic drinks per day increase the risk 1.5 times compared with women who do not drink.
• Weight. Overweight women have a greater risk of breast cancer, especially women who have gained weight after the change of life (menopause) or after turning 60.

Do all you can to help detect breast cancer early. Besides getting regular mammograms:
• Do regular breast self-exams.
• Have your breasts examined by your doctor regularly.

If my mammogram results are abnormal, does this mean I have cancer?
No. Many times results from mammograms are not normal. If this happens, you will be called to come in for more testing. Most of the time, the results of these further tests show that there is no cancer.

Provided as an educational resource by Merck

Colon Cancer Screening: What Can I Expect?

Colorectal (KOH-loh-REK-tul) cancer is cancer of the colon or rectum

Your colon and rectum make up what is called your large intestine (in-TES-tin). This is a long tube that absorbs water and cleans your body of waste. The large intestine is the final place where food is processed after you eat. It is also where stools are formed. If you find colorectal cancer early, your chances of surviving are high. The best way to catch it early is to get screened or tested.

Did you know?
• Most people have no symptoms in the early stages of colorectal cancer. It can grow for years without your feeling any pain or discomfort.
• About 1 in 15 people get colorectal cancer.
• If colorectal cancer is caught in its early stage, it is up to 90% curable.

Who Should Get Screened for Colorectal Cancer?
You should get screened for colorectal cancer if you:
• Are over 50 years old.
• Have had polyps (PAH-lips), which are small balloon-shaped pouches in the colon or rectum that may contain cancer cells.
• Have had colorectal cancer before.
• Have parents, brothers, sisters, or children who have had colorectal cancer.
• Have ulcerative colitis (UHL-ser-uh-TIV koh-LI-tiss) or Crohn’s (Kronze) disease, which cause inflammation in the colon or small intestine.
• Are African American.

Provided as an educational resource by Merck

What You Need to Know About Colon Cancer

How Is Colorectal Cancer Found?
You may have had tests to look for (screen) colorectal (KOH-loh-REK-tul) cancer. Two of these tests are called “sigmoidoscopy” and “colonoscopy.” In these, the doctor uses a scope (a small hollow tube) to look inside your rectum and colon. The doctor looks to make sure your colon is healthy and also looks for polyps or anything that doesn’t look normal. Usually the doctor can remove polyps and send them to the lab, where they will look for cancer.

Colorectal Cancer Is Cancerof the Colon or Rectum
The colon and rectum form a long tube that absorbs water and cleans your body of waste. In a sigmoidoscopy (sig-moid-AH-skuh-pee) or a colonoscopy (co-lun-AH-skuh-pee), your doctor looks at your rectum and colon with a lighted instrument. Polyps (PAH-lips) are small balloon-shaped pouches in the colon or rectum that may contain cancer cells.

What If the Doctor Tells Me I Have Cancer?
If cancer is found, your doctor will talk to you about the best treatment for you. That will depend on where the cancer has been found and if it has spread. Your doctor will use one or more of these ways to treat your cancer:
• Surgery
• Radiation therapy
• Chemotherapy

Surgery
Surgery is the main form of treatment for cancer in the colon and rectum. During surgery for colon cancer, the parts of the colon that have cancer are cut out and the colon is sewn back together. For rectum cancer, sometimes part of the rectum that needs to be cut out is close to the anus, and sometimes the cancer is growing in organs close by. In these cases, the doctor needs to make an opening in the abdomen (AB-do-men) for stool to pass through it. This is called a colostomy (co-LOSS-tuh-me). For colon cancer, a colostomy is sometimes needed but in
most cases can be closed up later.

Radiation Therapy
In radiation therapy, cancer is killed or shrunk with high-energy rays. Radiation may be used as the main treatment for the cancer. It may also be used to shrink the area of cancer before you have surgery or to kill cancer cells after surgery.

Chemotherapy(key-mo-THER-uh-pee)
In chemotherapy (often just called “chemo”), cancer is killed by strong drugs that you take by mouth or that get injected into a vein.

What’s Next?
If you find out you have cancer, you will have a lot of questions. Don’t be afraid to ask your doctor all the questions you have about what treatment is best for you. Keep a notebook of what your doctor says so you can look at it when you are at home. Your doctor will also be able to tell you about support groups for people who have been diagnosed with cancer.

Provided as an educational resource by Merck

Colorectal Cancer – Support Patient Education

Talking to Your Senior Patients About Colorectal Cancer

Many of your senior patients are at risk of developing colorectal cancer. Apart from skin cancer, it is the third most common cancer found in both men and women in the United States. As you know, the good news is that if it is caught in its early stages, colorectal cancer is up to 90% curable. Unfortunately, many of your patients are not screened: In a recent CDC study of Americans over 50, only 41% reported that they had received colorectal screening through fecal occult blood test (FOBT) or sigmoidoscopy as recommended by current guidelines.

You can help save lives by encouraging your patients to get tested—if you don’t talk to your patients about colorectal screening, they may think they don’t need it. You play the most important role in successful screening.

Of all racial groups in the United States, African Americans have the highest incidence and mortality rates for colorectal cancer.

Supporting the Guidelines
The American Cancer Society makes these recommendations:
Beginning at age 50, men and women who are at average risk of developing colorectal cancer should have 1 of the 5 screening options below:
• A fecal occult blood test (FOBT)* or fecal immunochemical test* (FIT) every year**, OR
• A flexible sigmoidoscopy every 5 years**, OR
• Annual FOBT* (or FIT*) and flexible sigmoidoscopy every 5 years, OR
• A double-contrast barium enema every 5 years**, OR
• A colonoscopy every 10 years

High-Risk Patients Need to Be Screened Earlier and More Often
Patients who have chronic inflammatory bowel disease, a history of colorectal cancer or adenomatous
polyps, a strong family history of colorectal cancer or polyps, or a family history of hereditary colorectal cancer syndromes are considered at increased or high risk.

Help Overcome Barriers to Patients Getting Tested
Many of your patients are not aware they need to be screened for colorectal cancer. You can help teach patients about the importance of testing:
• Ask your patients what their concerns are about the procedures.
• Talk to your patients about the test method that will work best for them.
• Assure patients that a test may be uncomfortable but not painful.
• Initiate a letter-writing and phone-call campaign to encourage your patients 50 and over and high-risk patients to get screened.
• Follow up with a patient if something abnormal is found during screening. Explain next steps that may require further testing and answer any questions they may have.
• Provide the names of specialists in the area or make an office referral for testing.
• Emphasize that screening doesn’t just find early cancer, it can prevent cancer.

Screening Plus Lifestyle Changes Are Powerful Tools
Let your patients know that half of all colon cancer is preventable through screening and lifestyle changes. A 1999 Harvard Center for Cancer Prevention report found that:
• Regular colorectal screening after 50 can reduce the risk of dying from colorectal cancer by over 30%.
• Adults who get regular exercise are half as likely to develop colorectal cancer as adults who are not active.
• Eating one serving of red meat per day is associated with a 50% increase in risk of colorectal cancer.

Talk to your patients about which test is best for them. Talk the options over with your patient. Choose a testing method most appropriate for your patient.

Provided as an educational resource by Merck

Breast Cancer Screening Helps Save Lives

Breast cancer is one of the most common cancers in women. It is the second most common after skin
cancer. The good news is that many women are surviving breast cancer. Doctors feel that finding breast cancer early through screening helps save thousands of lives every year. Screening is when you or your doctor look for cancer even if you don’t have any symptoms.

1-2-3: Complete Screening
These are three ways of screening for breast cancer:
1. When you examine your own breasts for lumps.
2. When your doctor examines your breasts. This is called a clinical breast exam.
3. When you get a mammogram (MAM-o-gram).
This is a special type of breast X-ray.
The three of these together are the most complete way to screen for breast cancer.

Breast Self-Exam
Ask your doctor to go over with you how to do a self-exam. If you do a monthly breast self-exam at home, you will get to know how your breasts look and feel. This makes it easier for you to notice a change. If there is a change in how your breasts look or feel, see your doctor right away.

Clinical Breast Exam
Women in their 20s and 30s should have their breasts examined by a doctor or nurse when they go in for regular exams. The American Cancer Society recommends every three years. After age 40, women should have their breasts examined every year.

In a clinical breast exam, your doctor will ask you to undress from the waist up. He or she will look at your breasts for changes in size or shape. Your doctor will also look for skin changes, dimpling, or redness. Then your doctor will ask you to lie on your back with your arms behind your head so he or she can feel for lumps or other changes.

Breast cancer screening helps to find cancer at an early stage, when there is a better chance that cancer treatment will work. You can also make changes in your life that may help you prevent getting breast cancer:
• Lose extra weight.
• Cut down on red meat. Eat more fruits and vegetables.
• Cut down on alcohol.
• Be more active. Do more walking.
Try to exercise more.

Breast cancer is the second leading cause of death by cancer in women. You can lower your risk by doing self-exams, having regular breast exams from your doctor, and getting a yearly mammogram starting at age 40.

Provided as an educational resource by Merck