Imaging News

Metatarsalgia

“Metatarsalgia” is a nonspecific term that refers to pain over the balls of one’s feet. The metatarsals are the foot bones that correspond to this area. High-level dancers, track-and-field athletes, and baseball catchers are commonly affected, due to the repetitive “bursts” of impact or quick transfers of force to the forefoot, which can lead to overloading the metatarsals. In addition, exaggerated or abnormal foot mechanics, such as the demi pointe position in ballet dancers, can lead to excessive pressure on to the bones and ligaments in this area.

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Building Strong Bones for Life

Bone health is a bit like saving for your pension: hard to get excited about when you’re young but the sooner you start, the better.

Taking care of your bones is a lifelong investment that will pay dividends by helping you to stay fit and independent later in life.

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CTMH announces publication in Surgery Journal

Two doctors at CTMH, Dr. Yaron Rado, Chairman of the Board and Chief Radiologist, and Dr. Christopher Bromley, General Surgeon, published a Case Report entitled A Case of a Chronic Pancreatic Pseudocyst Causing Atraumatic Splenic Rupture without Evidence of Acute Pancreatitis. This case report, published in Case Reports in Surgery, was studied and written in collaboration with three doctors from the UK who were shadowing our doctors at the time of the incident:

  • Dr. Parisa Moori – University of Liverpool Medical School, Liverpool, UK
  • Dr. Edward J. Nevins – University Hospital Aintree, Liverpool, UK
  • Dr. Thomas Wright – University Hospital Aintree, Liverpool, UK

The case report explores the rare complication of a pancreatic pseudocyst (PP) in a male patient admitted to CTMH. It explains what PP is, and how this case developed. A splenic rupture is a life-threatening complication and due to the tight collaboration between the departments of CTMH, the patient’s life could be saved.

“A 29-year-old male, with a history of excessive alcohol intake and chronic pancreatitis, presented to the emergency department at The Chrissie Tomlinson Memorial Hospital, Cayman Islands. He exhibited a 24-hour history of abdominal pain, which was increasing in intensity, without a history of significant trauma…” – https://www.hindawi.com/journals/cris/2016/2192943/

Both Dr. Rado and Dr. Bromley have extensive years of experience in their respective fields, through this case, and their years of experience, they were able to postulate that when specific findings occur in a patient under the circumstances discussed in the case, what may happen next. Given this insight, these exceptional doctors worked together to prepare this report to share this information with others in the medical field. They hope that by raising awareness, they will be enabling other emergency departments to diagnose similar cases.

You can read the entire case report on the Journal’s website at: ­https://www.hindawi.com/journals/cris/2016/2192943/

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Lung Cancer Prevention and Early Detection

Signs and symptoms of lung cancer

Most lung cancers do not cause any symptoms until they have spread, but some people with early lung cancer do have symptoms. If you go to your doctor when you first notice symptoms, your cancer might be diagnosed at an earlier stage, when treatment is more likely to be effective. The most common symptoms of lung cancer are:

  • A cough that does not go away or gets worse
  • Coughing up blood or rust-colored sputum (spit or phlegm)
  • Chest pain that is often worse with deep breathing, coughing, or laughing
  • Hoarseness
  • Weight loss and loss of appetite
  • Shortness of breath
  • Feeling tired or weak
  • Infections such as bronchitis and pneumonia that don’t go away or keep coming back
  • New onset of wheezing

If lung cancer spreads to distant organs, it may cause:

  • Bone pain (like pain in the back or hips)
  • Nervous system changes (such as headache, weakness or numbness of an arm or leg, dizziness, balance problems, or seizures), from cancer spread to the brain or spinal cord
  • Yellowing of the skin and eyes (jaundice), from cancer spread to the liver
  • Lumps near the surface of the body, due to cancer spreading to the skin or to lymph nodes (collections of immune system cells), such as those in the neck or above the collarbone

Most of these symptoms are more likely to be caused by something other than lung cancer. Still, if you have any of these problems, it’s important to see your doctor right away so the cause can be found and treated, if needed.

Some lung cancers can cause syndromes, which are groups of very specific symptoms.

Horner syndrome

Cancers of the top part of the lungs (sometimes called Pancoast tumors) sometimes can affect certain nerves to the eye and part of the face, causing a group of symptoms called Horner syndrome:

  • Drooping or weakness of one eyelid
  • A smaller pupil (dark part in the center of the eye) in the same eye
  • Reduced or absent sweating on the same side of the face
  • Pancoast tumors can also sometimes cause severe shoulder pain.

Superior vena cava syndrome

The superior vena cava (SVC) is a large vein that carries blood from the head and arms back to the heart. It passes next to the upper part of the right lung and the lymph nodes inside the chest. Tumors in this area can press on the SVC, which can cause the blood to back up in the veins. This can lead to swelling in the face, neck, arms, and upper chest (sometimes with a bluish-red skin color). It can also cause headaches, dizziness, and a change in consciousness if it affects the brain. While SVC syndrome can develop gradually over time, in some cases it can become life-threatening, and needs to be treated right away.

Paraneoplastic syndromes

Some lung cancers can make hormone-like substances that enter the bloodstream and cause problems with distant tissues and organs, even though the cancer has not spread to those tissues or organs. These problems are called paraneoplastic syndromes. Sometimes these syndromes can be the first symptoms of lung cancer. Because the symptoms affect organs other than the lungs, patients and their doctors may suspect at first that a disease other than lung cancer is causing them.

Some of the more common paraneoplastic syndromes associated with lung cancer are:

  • SIADH (syndrome of inappropriate anti-diuretic hormone): In this condition, the cancer cells make a hormone (ADH) that causes the kidneys to retain water. This lowers salt levels in the blood. Symptoms of SIADH can include fatigue, loss of appetite, muscle weakness or cramps, nausea, vomiting, restlessness, and confusion. Without treatment, severe cases may lead to seizures and coma.
  • Cushing syndrome: In this condition, the cancer cells may make ACTH, a hormone that causes the adrenal glands to secrete cortisol. This can lead to symptoms such as weight gain, easy bruising, weakness, drowsiness, and fluid retention. Cushing syndrome can also cause high blood pressure and high blood sugar levels (or even diabetes).
  • Nervous system problems: Lung cancer can sometimes cause the body’s immune system to attack parts of the nervous system, which can lead to problems. One example is a muscle disorder called the Lambert-Eaton syndrome, in which the muscles around the hips become weak. One of the first signs may be trouble getting up from a sitting position. Later, muscles around the shoulder may become weak. A rarer problem is paraneoplastic cerebellar degeneration, which can cause loss of balance and unsteadiness in arm and leg movement, as well as trouble speaking or swallowing.
  • High blood calcium levels (hypercalcemia): This can cause frequent urination, thirst, constipation, nausea, vomiting, belly pain, weakness, fatigue, dizziness, confusion, and other nervous system problems
  • Excess growth or thickening of certain bones: This is often in the finger tips, and can be painful.
  • Blood clots
  • Excess breast growth in men (gynecomastia)

Again, many of these symptoms are more likely to be caused by something other than lung cancer. Still, if you have any of these problems, it’s important to see your doctor right away so the cause can be found and treated, if needed.

Source: American Cancer Society

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Risk & Prevention of Stomach Cancer

Some of the factors that may increase the risk for development of gastric cancer include: Age, gender, ethnicity, smoking, family history, diet and h. pylori. H. pylori is a common, treatable infection which leads to stomach inflammation and may increase the risk of developing gastric cancer. In the United States, gastric cancer is more common in Asians, Hispanic Americans and African Americans than in non-Hispanic whites.

Risks of Stomach Cancer

Some risks cannot be controlled, but others can be REDUCED by focusing on one’s health and choices. Review these lists and see what your risks and options might be:

Behavioral/Lifestyle Risks

  • Tobacco use
  • Obesity
  • Diets rich in smoked, salted and pickled foods
  • Diets low in fresh fruits and vegetables
  • Environmental exposure to dusts and fumes

Risks for Personal Awareness

  • Age 50 and over
  • Male gender
  • Having blood type A
  • Long term inflammation of stomach
  • Helicobacter pylori (H. pylori) bacterial infection
  • Megaloblastic (pernicious) anemia
  • History of stomach polyps or stomach lymphoma
  • Race (more common in Asians, Pacific Islanders, Hispanics, and African Americans than in non-Hispanic Caucasian Americans)
  • Family history of hereditary non-polyposis colorectal cancer, familial adenomatous polyposis or BRCA1 or BRCA2 mutations
  • Family history of stomach cancer (inherited cancers)

Preventing Stomach Cancer

Early detection is the key to surviving stomach cancer.
Lifestyle changes, such as smoking cessation and eating a diet rich in fruits and vegetables, can potentially reduce the risk of stomach cancer.
Treatment of H. pylori infection (a common bacterial infection of the stomach) can decrease the risk of stomach cancer development.
Knowing your family history and discussing it with your healthcare provider can help determine if you are at risk for inherited cancer syndromes.

Screening

Screening means testing seemingly healthy people, those who have no symptoms, for early stage cancer. The ability to screen for any type of cancer requires an accurate and reliable test to use, one that will identify cancers that are there. It must not give a positive result in people who do not have cancer.

In countries such as Japan, where stomach cancer is very common, mass screening of the population has helped in detecting cancers at an early, curable stage. Screening involves barium swallow x-rays and endoscopy screening. This may have reduced the number of people who die of this disease, but this has not been proven. It is still not clear whether the screening reduces the number of people who eventually develop advanced stomach cancer.

Presently there are no effective screening methods for stomach cancer or programs focused on prevention or early detection in the United States. The same holds true for Canada and the United Kingdom.

Studies in the United States have not found routine screening to be useful for those at average risk for stomach cancer, because the disease is not as common. However, people with certain stomach cancer risk factors may benefit from screening.

For patients and families with clinical features suggestive of Hereditary Diffuse Gastric Cancer (HDGC), but without a germline CDH1 mutation, intensive endoscopic surveillance in an expert centre for first-degree relatives of patients meeting criteria for HDGC is advised. This is also the case for patients and families who carry a CDH1 variant of uncertain significance. Standardized endoscopic surveillance in experienced centres is recommended for those who have a CDH1 mutation but have opted not to undergo total gastrectomy at the present time. Learn more about HDGC in Families.

Advocate for Yourself

If you have symptoms that don’t go away, remember to advocate for yourself and be persistent. If you feel that something isn’t right and you are not getting the answers you need, don’t give up pursuing a diagnosis. Continue to seek answers and don’t stop until you get them. Go with your gut!

Know your family history. Review and update your family history regularly with your primary care provider to determine if genetic counseling is appropriate for you.

Source: No Stomach for Cancer

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Recurrent & Metastatic Breast Cancer

We know you really don’t want to be here, reading about breast cancer recurrence or metastasis. If you’ve had breast cancer, the possibility of recurrence and metastatic breast cancer stays with you. You may be here because you fear this possibility. Or you may be here because it’s already happened.

Keep in mind that a recurrence of breast cancer or metastatic (advanced) disease is NOT hopeless. Many women continue to live long, productive lives with breast cancer in this stage. It is also likely that your experience with treatment this time will be somewhat different from last time. There are so many options for your recurrent or metastatic breast cancer care and so many ways to chart your progress as you move through diagnosis, treatment, and beyond.

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Addressing the prostate problem among men of colour

According to the United States Centre for Disease Control and Prevention, men of African descent have the highest rate of prostate cancer in the USA. They also, of course, have the highest rate of death from prostate cancer than all other ethnic groups, followed (not very closely) by Caucasians, Hispanics, American Indians and finally Asians.

Apart from the ethnic factors there is age. The older that one gets, the more likely it is that one will develop prostate cancer. It is advocated by the scientific pundits that at 40 one has a 40% chance of getting prostate cancer, at 50 one has a 50% chance of getting prostate cancer etc. Family history (genetics) is also of great importance as well as diet.

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A Longstanding Commitment to Serving the Country and Improving Healthcare

When Dr. Steve Tomlinson founded Chrissie Tomlinson Memorial Hospital (CTMH) in May 2000 it was always with the intention, vision and dream of bringing exceptional healthcare to the residents of the Cayman Islands.  His intentions have been so successful that CTMH has grown to encompass three community clinics, one in Savannah and the other in West Bay and the Visiting Specialist Clinic in George Town. 

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Introducing Breast Tomosynthesis: A Three-Dimensional Mammogram

CTMH | Doctors Hospital Imaging celebrate the official opening of their Pain Free 3D Mammography Centre today. Patients who undergo routine mammograms at CTMH now have the latest diagnostic technology available to them, digital breast tomosynthesis to perform three-dimensional mammography. CTMH is the first health care provider in the Caribbean Region to feature the state-of-the-art system, Selenia™ Dimensions from Hologic™.

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