Archives for June 2015

Chances are, if you’ve had your blood taken in the past, the doctor or nurse practitioner may have ordered a BMP to be done on that blood specimen.  What is a BMP, exactly?  A BMP, or basic metabolic panel, is actually 8 tests that measure your kidney function, fluid balance, and blood sugar. Abnormal results may indicate a problem that needs to be addressed.

The BMP includes the following tests:

Kidney Tests:

• BUN (blood urea nitrogen):  A waste product filtered out of the blood by the kidneys.  An elevated BUN may indicate abnormal kidney function, liver disease, or heart failure.  A low number may indicate malnutrition.
• Creatinine:  A waste product produced in the muscles, also filtered out of the blood by the kidneys.  The creatinine level is another indication of kidney function.  A low value may indicate low muscle mass or malnutrition.  A high value may indicate a chronic or temporary decrease in kidney function.

Fluid Balance (Electrolytes):

• Sodium:  One of the major salts in the body fluid. It is important for the body’s water balance and nerve and muscle function.  A low value may indicate the use of diuretics, diarrhea or adrenal insufficiency.  A high value may indicate kidney dysfunction, dehydration, or Cushing’s syndrome.
• Potassium:  Vital to cell metabolism and muscle function.  A low value may indicate the use of diuretics or corticosteroids such as prednisone or cortisone.  A high may indicate acute or chronic kidney failure, Addison’s disease, diabetes, or dehydration.
• Chloride:  Helps to regulate the amount of fluid in the body and maintain acid/base balance.   A low value may indicate emphysema or chronic lung disease.  A high value may indicate dehydration, Cushing’s syndrome or kidney disease.
• CO2 (Carbon Dioxide):  Used to help detect and/or monitor electrolyte imbalances.  A low value may indicate kidney disease, toxic exposure or severe infection.  A high value may indicate lung disease including COPD.
• Calcium- Is a light alkali metal which can be associated with malnutrition, osteoporosis, and malignancy. It is essential for development and maintenance of healthy bones and teeth. Calcium is also important for normal function of muscles, nerves and blood clotting.  A low value may indicate Calcium, Magnesium or Vitamin D deficiency, malnutrition, pancreatitis, or neurological disorders.  High values may be associated with kidney disease, hyperparathyroidism, cancer, or excessive vitamin D intake.
• Glucose- Also known as blood sugar, is the body’s energy source. A relatively constant level of glucose must be maintained in the blood. This test is used to identify and/or monitor diabetes.

These tests can rapidly indicate several common acute conditions requiring immediate medical treatment, such as dehydration, diabetic shock, hypoglycemia, or renal failure, to name a few.  The BMP is a smaller version of the CMP (comprehensive metabolic panel), which includes these tests, plus tests for liver function. The CMP will be discussed at a later date.

Green Bay Oncology is dedicated to reducing hospitalizations through patient education and prompt triage. We understand that patients usually prefer to be in the comfort of home and loved ones. We strive to maintain a low hospitalization rate.  Every attempt is made to keep patients educated and prepared in the event that a new or unusual side effect appears.  In case of a life threatening emergency, we encourage patients to call 911 or go to their nearest emergency room.  For non-life threatening emergencies often times patients can be evaluated and treated at GBO, thus helping avoid emergency room visits and hospitalizations as often as possible.

Contacting our office as early in the day as possible allows GBO a better opportunity to review patient concerns and address them in clinic.  We have a dedicated team of triage nurses trained to evaluate patient needs promptly and effectively. These nurses have direct lines of communication with all of the Green Bay Oncology providers.

Some examples of when to call GBO include:

• Temperature above 101 or shaking chills
• Inability to drink or retain four 9 oz glasses of liquid in a twenty-four hour period
• Uncontrolled pain
• Persistent nausea and vomiting
• Sudden onset of shortness of breath or a change in your normal breathing status
• Unusual bleeding or bruising
• Uncontrolled diarrhea

In many cases, patients can be seen by the doctor or nurse practitioner and be treated with supportive measures such as intravenous fluids for rehydration purposes or medications to control stomach upset.  It is our goal to get all patients safely through treatment. By keeping patients and their care team educated on when to contact Green Bay Oncology, we can together reduce unnecessary hospital admissions, emergency room visits, and continue to strive for a symptom-free or an improved clinical state.

I recently came across a great review article from the UK titled “Aspirin in Gastrointestinal Oncology: New Data on an Old Friend” and I wanted to share some insights I learned from this review.

Aspirin has been around for over 100 years and had been used for a long time to treat pain, inflammation and fever. It later was discovered that it is a powerful inhibitor of blood platelets which subsequently made it one of the most important components in the treatment and prevention of heart attacks and strokes. In tissue cells and in blood platelets it blocks an enzyme called cyclooxygenase.

There is good evidence that aspirin reduces the risk of colon and other gastrointestinal cancers. One study from the UK with more than 20 years of follow-up evaluated over 7500 patients who had taken aspirin for the prevention of stroke and heart attacks. Once the follow-up period passed the 10-year mark, it became evident that patients who had taken aspirin once daily for 5 years or more, had a reduced risk of colon cancer. Subsequent large studies also showed that aspirin reduced the risk of getting stomach or esophageal cancer as well as the risk of dying from stomach or esophageal cancer. However these benefits did not manifest themselves until 8 to 10 years after starting aspirin. This observation is similar to what was seen with aspirin and colon cancer prevention and explained by the fact that it takes a long time for gastrointestinal cancer to progress from a precancerous growth to an obvious cancer.

An  exception to this is a condition called Lynch syndrome where patients develop colon cancer and other cancers at a younger age. Here the protective effect of aspirin is already noted after 4 to 5 years.

Once a cancer has formed, a big concern is that it will spread to other places in the body forming sister growths (metastases). In an analysis of all the large British aspirin prevention studies it was noted that patients who developed colon cancer while on aspirin had a substantially lower risk of forming metastases which brings me back to  blood platelets. One intriguing hypothesis is that platelets may protect circulating tumor cells from being detected by the immune system and by aspirin disrupting this process, circulating colon cancer cells could be eliminated by the body’s own immune cells.

We can expect more research data to be presented in the future how our old friend aspirin protects against cancer.

Low red blood cells or hemoglobin called anemia is the most common blood disorder world-wide.  However, some patients have hemoglobin that is too high called polycythemia.  Polycythemia can be caused by a bone marrow disorder caused polycythemia vera or from other causes outside the bone marrow called secondary polycythemia.  Distinguishing between the two became much easier about ten years ago with the discovery and testing for Janus Kinase 2 (JAK-2) mutations.  Janus was the Roman god of gates and this protein regulates the production of red bloods cells.  When is mutated, red blood cells are continuously produced causing a high hemoglobin.  Treatment of polycythemia vera is removal of the extra blood in a process called phlebotomy.

Secondary polycythemia can be caused  by conditions that cause low oxygen levels in the blood.  Extra red blood cells are then produced as a compensation.  Common causes include tobacco smoking and sleep apnea.  Other causes can include congenital heart disease, carbon monoxide exposure and being born with an abnormal type of hemoglobin.  The best treatment for secondary polycythemia is treating the underlying condition such as smoking cessation or the treatment of the sleep apnea.