FOOT, HEEL and ANKLE PAIN
Are you suffering from pain in your ankle, heel or foot in general? Foot pain has many, many causes. Some are very serious, too.
The medical specialty that involves treatment of the foot is called podiatry.
A doctor of podiatric medicine (DPM) has completed four years of medical school and after that, has completed the required internships (as all medical doctors do), and then a residency in podiatry.
“Most foot, heel and ankle pain can be attributed to overuse,” says Bruce Pinker, DPM, who specializes in sports medicine and surgery of the foot and ankle.
“Foot pain can often be due to bunion pain, or hammertoe pain (associated with a corn on top of the toe).
“Ankle pain is often due to a sprain or strain from too much activity, especially if running on uneven surfaces.
“Many ankle sprains occur while running or participating in sports or while walking and stepping off a curb irregularly or stepping into a pothole on the street.
“Heel pain is extremely common, often due to plantar fasciitis or a heel spur on the bottom of the heel bone.
Shutterstock/Alila Medical Media
“The pain is usually due to overuse, as the plantar fascia ligament is elastic in nature and will stretch and contract.
“When it contracts, after inactivity for as little as one to six or seven hours, it contracts and tightens, leading to difficulty walking.
“Usually, conservative treatment resolves heel pain, but some cases can be challenging.
“Physical therapy, orthopedic strappings, cortisone injections and custom-made orthotics often resolve the issue.
“Occasionally, shock wave therapy may need to be utilized, or even surgery, to address the condition.”
Please visit the links below to read numerous articles on foot pain.
Dr. Pinker is with Progressive Foot Care, which provides state-of-the-art, full diagnostic testing and treatment of the foot. He’s a professional foot and ankle health and wellness speaker who delivers many original seminars annually such as “Keep On Running.”
Lorra Garrick is a former personal trainer certified through the American Council on Exercise. At Bally Total Fitness she trained women and men of all ages for fat loss, muscle building, fitness and improved health.
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Top image: Shutterstock/ Elvira Koneva
Fast Resting Pulse in Fit People Who Exercise: Danger
What does it mean if a physically fit person has a fast resting heart rate?
Do you exercise a lot, consider yourself physically fit, but have a fast resting heart rate and wonder if this will negatively affect your risk for all-cause mortality or heart problems?
A resting heart rate of between 60 and 100 is normal. However, the question is this:
Is mortality affected if someone’s pulse is usually around 85 versus 65, even if that person exercises?
Does it make a difference if that individual’s resting pulse is towards the higher end of normal as opposed to the lower end of normal?
Researchers wanted to find out if resting heart rate influenced a person’s risk of mortality, regardless of fitness level.
The Study
For the study, the health of almost 3,000 Caucasian men was tracked for 16 years.
All sorts of vitals were measured, including aerobic fitness (cycling test), height, weight, blood fats, blood sugars and blood pressure. And of course, resting heart rate.
As expected, men who had a high resting heart rate also tended to have the lowest levels of physical fitness, plus hypertension and more blood fats.
Physically fit men tended to have lower resting pulses.
But the results can’t be denied:
The faster the resting heart rate, the greater was the risk of mortality. And this result was independent of fitness level.
What about factors that could influence results? These were adjusted for.
– A resting heart rate of 51-80 bpm was tied to a 40-50 percent increased death risk.
– Between 81 and 90 bpm doubled the mortality risk, when compared to men with the lowest rate.
– Above 90 bpm meant a tripled risk.
Every 10-22 additional bpm increased mortality by 16 percent, overall.
The paper points out that regardless of a study participant’s level of fitness, those with a high resting heart rate fared much worse than those with a lower RHR.
In other words, a high RHR is an independent risk factor for a shortened lifespan.
What should you do?
First off, re-evaluate your exercise habits. It’s a well-known fact that a regular exercise program lowers resting heart rate.
It’s also a well-known fact that many people unknowingly inflate their perception of just how much they exercise.
“I get plenty of exercise” is an assertion spoken by many men and women who — in actuality — don’t even have a regular, consistent workout regimen.
Many belong to the “any movement counts towards exercise” camp.
“Any movement,” to these men and women, may include standing in one spot for 10 minutes tossing a rubber toy for their dog to fetch, or doing basic housework.
This just isn’t enough to effectively train the heart to be more efficient.
A second point to consider, regarding this study, was that the population involved was very limited: white middle aged men.
“So you can’t assume the same would be true for, say, young women from a different ethnic group,” says Dr. David Beatty, MD, a retired general practitioner with 30+ years of experience and an instructor of general medicine for 20+ years.
Other than fitness, the following factors can affect RHR, says Dr. Beatty:
• Anemia
• Valvular heart disease
• Stress / anxiety / emotional factors
• Hormone factors such as a raised thyroid hormone
• Pregnancy (not relevant to this study)
“It’s conceivable that a few of the study group had one of these problems which in turn might have reduced their life expectancy,” says Dr. Beatty.
“For instance, anemia might be due to bowel cancer which causes premature death.
“Someone with aortic or mitral valve regurgitation might pass their ECG test, done at the start of the trial, but it would put extra strain on the heart as the years go by.
“The result of the trial was very clear-cut, so my overall impression is that there is a correlation between higher heart rate and earlier mortality,” in white, middle aged men.
How to Lower RHR with Exercise
To lower resting pulse, you may want to consider high intensity interval training.
This can be done only twice a week, on any cardio equipment or outdoors.
Here is more about high intensity interval training.
Dr. Beatty has worked in primary medicine, surgery, accident and emergency, OBGYN, pediatrics and chronic disease management. He is the Doctor of Medicine for Strong Home Gym.
Lorra Garrick is a former personal trainer certified by the American Council on Exercise. At Bally Total Fitness she trained clients of all ages for fat loss, muscle building, fitness and improved health.
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Top image: Shutterstock/VGstockstudio
Source: heart.bmj.com/content/early/2013/03/21/heartjnl-2012-303375.short?g=w_heart_ahead_tab
Great Responses and Comebacks to Being Told “You Look Tired”
If you’re tired of being told by strangers “You look tired,” here are some really clever and feisty responses and comebacks!
But when a stranger says this to me, or to anyone else — it is just plain rude.
It hasn’t happened that often with me, actually, but the few times that it has, it completely caught me off guard, because in every case I was wide awake!
I wonder if the people who will think I’m being too petty are the same people who’d think nothing of swatting the daylights out of a three-year-old child for a minor infraction. Talk about over-reaction!
Great Responses to “You Look Tired”
#1. “Actually, I’m wide awake.”
State this matter-of-factly and then give a neutral gaze to the stranger as that person tries to deal with the embarrassing realization that they just insulted you.
#2. “Yep, I was up all night having really amazing sex. And you look very well-rested.”
#3. “Wow, your powers of observation are stunning!”
#4. “Must be the cancer.”
#5. “And your point?”
#5. “Yep, I’m tired of rude comments by total strangers.”
#6. “Really? Can you explain what it is about my face that looks tired?”
(This will embarrass them perhaps more than the cancer response, as they are now being requested to point out a stranger’s wrinkles, sagging mouth, dark eye circles, etc.)
Being told you look tired should not be ignored.
When an adult makes an inappropriate comment to a stranger, they should be called on this.
If children should be corrected on being ill-mannered, why shouldn’t adults?
You should never feel the stress or pressure to enhance your face before every venture into the public just so you can look wide-awake for strangers.
If I look tired, that’s nobody’s business except that of my loved-ones.
Why would a stranger have a true, sincere concern if you look tired?
I think these are people who are desperate for a social connection and lack the cognitive prowess to come up with anything less lame than “You look tired.” They deserve a good response.
The fact that they mean no harm is beside the point. The child who makes a disrespectful comment to an adult may also mean no harm, yet as mentioned already, most people would be quick to correct the child, some of them going as far as a scolding or even corporal punishment.
So why should ADULTS get away with insolvent comments to strangers?
“You look tired” may, in a very small percentage of cases, trigger a conversation between two strangers in an elevator, in a long line or on a bus. But that’s beside the point.
If you want conversation, say something neutral or make a comment about the latest national headlines.
It’s just plain rude to make a negative comment about a stranger’s face.
You’ll lose nothing by refraining from telling a stranger “You look tired.”
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: ©Lorra Garrick
Why Do Red Wine Daily Limits Differ for Women & Men?
There’s a reason why the wine consumption recommendations for women are just one glass a day while men get to have two.
That seems unfair, right? If you enjoy red wine and are a woman, you might already know that the American Heart Association, as well as other medical organizations, cite the limit of one glass a day for women…but then raise it to two for men.
Many women weigh as much as the average man, and many men are small in stature and slightly built.
Yet this rule of “one glass of wine a day for women and two for men” stands as universal—a one box fits all.
“Alcohol is metabolized differently in women and men,” says Suzanne Steinbaum, MD, a New York cardiologist for 20+ years and founder of SRS heart — a groundbreaking program for womens’ holistic health prevention.
“In general, women have a smaller amount of body water, and simply adding alcohol to less water saturates the system greater.
“Women also have a lower activity of the alcohol metabolizer in the stomach, causing a larger proportion of alcohol to reach the bloodstream.”
Does this apply to tall, active, muscular women with fast metabolisms, and to short, underweight, inactive men?
Dr. Steinbaum responds, “Clearly, different sizes of people and body types play a role in how the body will respond to alcohol, but in general, women simply can’t process it as efficiently.”
The rule of one glass of wine a day for women and two for men is generalized so that it’s easier to follow, and so that it leaves little room, if any, for confusion or misinterpretation.
Interestingly, this rule rarely comes with the definition of “glass.”
However, here it is: One “glass” of wine = four ounces. That’s half a cup.
The rule, in a more refined presentation, is as follows: Women should limit their daily wine consumption to four ounces, and men to eight ounces.
Dr. Steinbaum has been awarded a New York Times Super Doctor, a Castle and Connolly Top Doctor for Cardiovascular Disease, and New York Magazine’s prestigious Best Doctors in the New York edition. She is on the NYC Board of the American Heart Association.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Best Responses to Why Don’t You Have Kids? & Rude Comments
If you’re childless by choice, ever get asked, “Why don’t you want kids?”
Here are many great comebacks to this never-ending question.
Obviously, “Why don’t you want kids” is asked after the childless by choice woman or man announces that she or he does not want kids. Even people you just meet will ask, “Why don’t you want kids?” upon finding out your choice to stay childfree.
“WHY DON’T YOU WANT KIDS?”
“Not my thing and besides my dog’s allergic.”
“Didn’t you hear? I’m actually due February 30th! I can’t believe no one told you. I’m so excited!!”
“Oh, no one under 14 is permitted in my house. It’s a rule!”
Then there’s the question: Well, what are you going to do when you are old??
“Die, just like everyone else.”
“Hire someone to care for me.”
“Hang out with friends, travel, do whatever I want. The same like now.”
“Pose nude!!”
“No kids, no pets, no plants.”
“When I was kid my mother always told me that when I grew up I would be just like her!”
“WHEN Are You Going to Have Kids?”
“After I make my first billion.”
“When it stops being illegal to leave them alone for 8 hours a day with a cold bowl of water and a toy.”
“When I can stand to be around a kid or a parent for more than 10 minutes without wanting to either kill them or myself.”
One Last Point About Being Asked Why You Don’t Want Children
Sometimes, this question is asked because the person is sincerely interested in knowing your reason, and is not out to judge you.
It could very well be that she — or he — chooses to remain childfree, and is always interested in learning why others make the same lifestyle choice.
There is a difference between being asked, “Why don’t you have children,” (asker doesn’t know if you want them or not), and, “Why don’t you want children” (asker knows you wish to stay childfree).
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: ©Lorra Garrick
Smith Machine 20-Rep Killer Squat Workout for Burning Fat
You’ll burn loads of fat with the 20-rep killer squat workout with a Smith machine.
Though Smith machine squats aren’t the best for building huge quad muscles, this equipment can fire up your body’s fat burning engines.
Smith Machine Workout
Perform 20 parallel (half) squats with a rapid pace. Pay very close attention to your thighs to make sure they actually hit parallel.
The rapid pace may fool some folks into thinking they’re hitting parallel when in fact, they’re falling just short of it. Explode up from each squat.
It’s not necessary to rise all the way back up after each squat. If you come up a little short, that’s fine; your muscles are under constant tension this way.
However, if your style is to go all the way back up, do not lock out the knees and do not hang there, either; immediately come back down into the next squat.
Do the 20 reps as quickly as possible while hitting parallel for every rep and keeping your lower back arched.
At the end of 20 reps, you should be breathless, like you just ran fast up a hill.
Rest 45 seconds and repeat four more times for five total sets, with 45 seconds in between each one.
This doesn’t mean that at the end of 45 seconds is when you step under the bar to get positioned. This means that the time it takes you to get set under the bar is included in the 45 seconds.
These short rests are crucial for maximal fat burning. The breathlessness is also a key feature of optimizing the fat burning process.
And though the routine can be completed in about five minutes, the fat burning will continue afterwards: post-exercise fat-burning.
What if you’re not breathless?
Then the bar didn’t have enough weight on it. You will need to experiment with this. The rapidity of the reps makes the exercise more difficult.
Hitting parallel will also make things harder for people used to doing incomplete half squats.
You should be so out of breath that you can’t complete a sentence.
This Smith machine killer squat routine is NOT for beginners, no matter how badly they want to burn off the fat.
These type of Smith machine squats, with their short rests, are for conditioned people.
Don’t assume that it doesn’t make any difference if you’re a few inches above parallel.
For 20 explosive reps, coming a few inches short makes a whopping difference.
So either use a heavier weight load for the next set (and this may take several sets to figure out; you don’t want to go too heavy), and/or hit parallel for every rep.
If the resistance is too heavy, you won’t be able to explode. You may be able to complete 20 reps, but they’ll lack rapidity and thrust.
The explosiveness yields the cardio component and is key to burning fat.
Though the emphasis is on burning fat, you’ll find that this Smith machine killer squat routine will dramatically strengthen your legs and knees, plus shape and contour the muscles.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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Top image: Shutterstock/Auttapol Sangsub
Melanoma: Blistering Sunburn & Family History Biggest Risks
A dermatologist answers the questions you have about melanoma including appearance and vaccines.
I asked Ellen S. Marmur, MD, Chief, Division of Dermatologic & Cosmetic Surgery at Mount Sinai Hospital in New York, the following questions about melanoma, which kills close to 10,000 Americans every year.
Name the two greatest risk factors for melanoma.
Dr. Marmur: Family history (defined as greater than two first degree relatives with melanoma) and sun exposure (blistering sunburns in childhood).
Other risk factors: many moles; lots of sun-tanning; living at high altitudes; fair complexion, especially “peaches and cream” tone/blonde or red hair, blue eyes
We are always told to pay attention to the ABCDE’s of mole checking (asymmetry, border, color, diameter, and evolving).
This implies that a mole or body mark that’s smaller than a certain diameter isn’t anything to be concerned about.
The ABCDE’s have been a guideline for patients and doctors for many years.
Studies are showing that even regular-appearing moles can be more dangerous than irregular ones.
New or changing lesions (ulcerating, bleeding, itching) are the most suspicious. Continue using the ABCDE’s when doing self-skin exams—it’s still helpful and the routine of self exams is invaluable.
What percentage of melanomas spring up from pre-existing moles?
Unknown, probably the majority.
It is said that most DNA damage from the sun occurs before age 18.
Is this because it’s assumed that people get most of their sun exposure as children playing for hours in the sun, while as adults they are cooped up all day indoors?
Or is it because a child’s DNA is more vulnerable to damage than is the adult’s DNA?
Both, due to the amount of sun damage accumulated as children, plus the mechanism of carcinogenesis—which requires several insults to the DNA before it leads to unregulated cell growth.
The body is constantly holding these bad cells in check, using the immune system. Sun exposure impairs the immune system.
A sun damaged adult who gets more sun damage might lose the ability to fight off melanoma formation; whereas, a sun damaged adult who is careful might successfully fight off the melanoma.
Suppose a person has one blistering sunburn before age 18. Aside from that, only a few burns and as an adult, minimal sun exposure.
Is this person at all “screwed” just from one blistering event? How much risk can that one incident have in this particular case?
Unknown! Here is also where genetics probably plays a big role. Some people get skin cancer with very little sun exposure compared to others.
Though melanoma can appear anywhere on the body, does a blistering sunburn on one side of the body, increase melanoma risk on the other side that wasn’t exposed to the sun?
Probably, because that event causes full body immunosuppression. But unlikely.
What percentage of melanoma patients have darker skin?
More and more patients with skin of color are developing all forms of skin cancer.
Is it true that once melanoma reaches a certain size, it’s going to have a lot going on with it, like crusting, bleeding, oozing, weird colors, etc.?
Or can a melanoma be 5 millimeters and not have much visible abnormality to it?
New studies show that small size and regular colors and borders may still be high risk melanomas.
Large size however reflects a radial growth phase that is thought to precede the vertical, or invasive, growth phase.
It’s recommended that people do a mole check every month. How much can a melanoma change in appearance, from month to month?
The kinetics of melanoma growth are just being described. Monthly checks give the patient time to have a spot biopsied and treated hopefully before it becomes dangerous.
Once a person gets melanoma, will he or she likely be getting them all throughout the rest of his/her life?
One skin cancer (including basal cell and squamous cell carcinomas) means an exponentially higher risk of developing other skin cancers. Rarely is it a singular event.
There are cases in which a person was “cured” of melanoma, but then some years later, it “came back,” killing the patient. How is this possible if the patient does monthly self-exams?
The #1 site of origin of metastatic melanomas of unknown origin is the uvea inside the eye. Skin exams are necessary. Eye exams are necessary.
It is said that, if caught early, melanoma is 90-95 percent curable. What about the other 5-10 percent of early catches? Why would they be fatal?
Early melanoma is defined by its depth of penetration in the skin. In situ melanomas have a 100 percent cure rate at five years.
Minimally invasive melanomas may have single cell metastasis that are undetectable at the time of excision.
These have already started to circulate away from the skin and rely on the body’s immune surveillance system.
This is why a melanoma vaccine would change the world. When I worked on the melanoma vaccine I had the idea that if we could “personalize” vaccines for each person using their own cell “fingerprints,” it would be successful. Some researchers are attempting to perfect this idea, but it is for patients who already have melanoma.
Some dermatologists recommend that moles at least 5 millimeters in diameter be electively removed. Why doesn’t this recommendation begin at, say, 3 millimeters?
Sounds logical, but it would be a huge cost to insurance companies, and it may not pick up the small ones that look normal but are aggressive melanomas.
Dr. Marmur has received rewards for outstanding research in melanoma vaccines.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
Sore Abs After a Workout: Three Things You Should Know
Just because your abs didn’t get sore, doesn’t necessarily mean that you didn’t work them effectively.
You may have worked them quite efficiently, but … due to these muscles being adapted to the routine, they didn’t respond with any soreness.
So how important is it for abs to get sore after an abdominal workout?
If your abs are sore after a workout that targeted these muscles, then this is a good indication that, indeed, you succeeded at targeting these muscles, and in a challenging way.
However, what if your abs don’t get sore after a workout (“after” meaning the day following)?
- Did the routine used to make your abs sore?
- And now they don’t get sore? Yes, the muscles have adapted.
It’s time to up the ante with the routine if you’re not satisfied with the results.
On the other hand, what if a workout has never made your abdominal muscles sore?
Shutterstock/FXQuadro
This often (but not always!) means that the workout was never effective in the first place. You chose an exercise routine that was never challenging.
In my case, I never experienced sore abs after doing cable crunches, yet this particular routine is amazing and gave me definition within 30 days.
So here was an exercise that never made my abs sore, yet produced results within a month.
And it continued producing more definition thereafter, plus greatly increased core strength. The cable crunch (when done properly) is probably the best exercise for the abs.
Do cable crunches right, and it doesn’t matter if you get sore.
If you’re not satisfied with your abs, then shock them with a routine that your body isn’t used to.
Force your body to re-adapt by imposing a movement or volume that the muscles aren’t familiar with.
You can up the ante by holding the sticking point for a 2-count before releasing.
If you do crunches on a bench, keep your hands off the bench for a change.
If this is too easy, place a light dumbbell between your feet, or a medicine ball between your lower legs, and see how the crunches feel.
Tuck in all the way; squeeze tightly into a crunch position before each release.
If you spend a lot of time working your abs, they probably won’t get sore.
You don’t need to spend a lot of time on abs to bring out definition and even a six-pack.
Overall-body training, with sound nutrition, will keep body fat stripped down low enough to reveal your ab muscles.
You can keep ab routines at the top of the training pyramid and still maintain core toning and strength.
Bottom line: Sore abs post-workout are not a marker for eventually developing a six-pack, and lack of soreness is not an indicator that you’ll never get that dream midsection, either.
Lorra Garrick is a former personal trainer certified through the American Council on Exercise. At Bally Total Fitness she trained women and men of all ages for fat loss, muscle building, fitness and improved health.
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Top image: Shutterstock/CHAjAMP
Treatment for Night Rotator Cuff Pain
Night pain from rotator cuff problems can be ugly, definitely enough to awaken people and keep them awake much of the night.
Certainly there has to be something you can do to minimize night pain from rotator cuff issues.
Night pain from rotator cuff problems is common, says Edmond Cleeman, MD, a board certified orthopedic surgeon who specializes in sports medicine and arthroscopic surgery of the shoulder, knee and hip.
“We tell patients to try not to sleep on that shoulder,” he explains.
“My experience has been that most patients are aware that they are sleeping on the bad shoulder, but habit makes it difficult to change.” Sleep on your back as much as possible.
Do not sleep on your stomach, as this is the worst position for the rotator cuff and is likely to bring on pain during the night.
“Most pain is if sleeping on injured shoulder, and when sleeping on stomach when arm is in a position over the head, such as arm under pillow.”
If you are unable to psych yourself into staying on your back, then position some pillows on either side of you that will prevent you from rolling over. Another option is to sleep on a couch or very reclined chair.
Keep your palms up, facing the ceiling, while in bed. To ensure they stay that way, tuck part of your palm-up hand under a pillow.
“The palm-up position leaves the joint space in the shoulder open, freeing up irritated rotator cuff tendons, giving them more room,” says Dr. Cleeman, founding member of TRIARQ, a community of orthopedists and physical therapists.
“Palms down reduces space in the joint cavity and can bring a frayed tendon in contact with bone.”
Night pain from rotator cuff problems can be minimized also by what you do for the shoulder during the day.
“Controlling the inflammation in the bursa can be achieved with anti-inflammatory medications (NSAIDS) or steroid injection,” says Dr. Cleeman.
“Some patients may not be able to take these medications and should check with their physician.
“Steroid injections can be very helpful and usually start working within a week.
“The steroid, a strong anti-inflammatory medicine, is injected into the inflamed bursa.
“Too many injections are to be avoided because it can weaken the remaining rotator cuff tendon tissue.”
In addition, if you’re struggling with rotator cuff pain in the middle of the night, then seek treatment from an orthopedic physician whose specialties include the shoulder. The doctor should prescribe physical therapy.
Rehab exercises should involve both stretching and strengthening, which your doctor or physical therapist can show you.
Furthermore, “A home exercise program is also essential,” says Dr. Cleeman.
“Using a heating pad before stretching or doing the stretches in a warm shower can help.”
Dr. Cleeman is a highly experienced orthopedic surgeon and sports medicine specialist at Manhattan Orthopedics. He is committed to performing advanced minimally invasive procedures, allowing his patients to go home the same day.
Lorra Garrick is a former personal trainer certified through the American Council on Exercise. At Bally Total Fitness she trained women and men of all ages for fat loss, muscle building, fitness and improved health.
Ovarian Cancer Symptoms: Q & A with Doctor
Got questions about ovarian cancer you can’t find online the answers for?
Ovarian cancer is known as the “stealth killer,” because it silently stalks its victims without even giving the courtesy of an early symptom warning.
Today’s medical technology fails to effectively screen for this most deadly of all gynecological cancers.
Classic symptoms of ovarian cancer are: bloating, feeling full after small meals, gas, indigestion, low back pain, sometimes even leg pain, and weight loss but a growing stomach.
For this article I interviewed Dr. David A. Fishman, MD, a gynecological oncology surgeon with Weill Cornell Medicine in NYC.
Questions Answered about Ovarian Cancer Symptoms
When a woman begins developing symptoms of OC, is it possible she can be experiencing only one symptom for quite a while, or will multiple symptoms begin appearing at the same time?
Dr. Fishman: That’s a great question. Unfortunately, every woman will experience a different set of symptoms, and the question that arises is, “Are there symptoms that are unique to early stage cancer, versus early symptoms of advanced stage cancer?”
As we know, not all women have the same symptoms when they ovulate – it’s the same for ovarian cancer.
The problem we have is in determining if there are unique symptoms associated with only advanced stage ovarian cancer, or if there is a subset of symptoms associated with early stage cancer.
Is it possible to rank the symptoms of OC, in order of most common to least common?
It is possible to rank symptoms, but the symptoms are so varied, and the consistent symptoms that all would agree on are seen with advanced stage disease.
The majority of the symptoms that are consistent with cancer are due to tumor masses causing pressure, and associated signs and symptoms such as fluid in the abdomen, abdominal bloating, and weight loss.
My suggestion is that any woman experiencing abdominal discomfort for more than 5-7 days should have a thorough medical evaluation. In the course of the evaluation, the question should be asked: “Are my ovaries ok?”
Shutterstock/Emily frost
Many people will be seen by their family practitioner, gynecologist and internist, and each physician brings a different skill-set and focus on patient care.
If the cause of the discomfort is not found, I don’t think it’s inappropriate for a patient to ask, “Are my ovaries ok?”
Different doctors have a different focus. The best care a person can receive is by being a knowledgeable health care consumer and also being aware of their own body and what feels right and doesn’t feel right.
If their doctor can’t determine the problem, they certainly will be able to refer to the appropriate health care provider.
Would the symptoms necessarily be near-constant, continuous? Or can they be intermittent? Can they come and go, with days of normalcy in between?
The symptoms can be extremely variable and do not have to be persistent. It can be such a stealth disease – both to the patient and the healthcare provider.
It comes, it goes, it can be persistent, it can be intermittent, and it is almost always highly variable.
By the time a woman has symptoms, she usually has an advanced stage of the disease.
In the National Cancer Early Detection Program, we have found women who had no symptoms of cancer and had advanced disease.
I’m not saying that the symptoms don’t exist, but they can be extremely variable. Awareness is critical. If you don’t feel right, your ovaries must be formally evaluated.
Shutterstock/Olena Yakobchuk
We have evaluated over 8,000 women in our high-risk program with normal ultrasounds and normal examinations.
They were having prophylactic surgery (surgery done to prevent disease) because of their genetic predisposition placing them at a higher risk than the general population, which is a highly selective group.
Yet we found four women who had microscopic cancers in stage 1. These women had no symptoms, and two had cancer of the ovaries and two had fallopian tube cancer.
In our program, over 99% of women were normal, even in the very high risk group. We did multiple surveys to discuss various symptoms.
Surveys can be highly problematic, as there is a tremendous recall bias.
We found that most women with normal sized ovaries with early stage disease had no symptoms. Not even all women with advanced stage had symptoms.
But symptoms didn’t always correlate with the volume of disease. Some women can have horrific disease and feel fine, while others can have several small 1 cm nodules and be very symptomatic. The variability in symptoms is quite large.
The take-home message is if you don’t feel right, go seek appropriate medical care and ask your physician to include an evaluation of the ovaries, fallopian tubes and uterus.
Lower back ache is an OC symptom. Is there data out on what kind of pain this feels like (short of asking an ovarian cancer survivor)? There are different kinds of back “pain.”
Does it resemble menstrual lower back ache? Or more so the pain from a strained lower back from improperly lifting something? Or some other kind of pain?
If you have a mass pressing in your pelvis on the nerves, backache can be a vague symptom of the mass.
The ovaries in a pre-menopausal woman are about 2 inches in size – they are almond-shaped.
Also, inside the abdomen and pelvis are 23 feet of small bowel lying right on top of the ovaries, 9 feet of colon lying adjacent to the ovaries, and a uterus that is the size of a fist.
In the abdomen and pelvis, your ovaries are the smallest organ in size. Just by virtue of what’s in that area, ovaries are the hardest to detect.
That’s also why it is so common to misinterpret ovarian cancer symptoms for GI problems.
The pelvis is a bowl and the ovaries are very small. You can see why it can be such a diagnostic dilemma.
There is no specific type of back pain that I can tell you to look out for – the pain can be the result of poor posture, kidney stone or infection. It’s nondescript.
What percentage of OC patients experience vaginal bleeding?
Very few. Vaginal bleeding is not a symptom that is consistent with ovarian cancer. It is consistent with cancer of the cervix or uterus.
What kind of symptoms would a woman specifically have, that early OC would give off? I know that there have been a few studies focusing on “early” symptoms.
Yes, there are certainly symptoms – abdominal discomfort, frequent urination, change in bladder and bowel habits, losing weight while the abdomen is getting bigger, not being able to eat that much, fatigue, leg swelling – these are all signs of advanced stage disease.
The real question is, “Are there symptoms that are unique to early stage cancer?” We would make a tremendous difference in outcome if we could identify women with early stage disease.
Are there symptoms associated with helping us detect early stage disease before it spreads throughout the abdomen? The answer to that is, “I don’t know.”
The symptoms can be so varied and so subtle that the key is really being aware of your body, and if you don’t feel right and it persists for more than 5-7 days, go seek formal medical evaluation and make sure that includes a formal gynecological evaluation of the ovary.
That may be performed by a pelvic recto/vaginal examination or diagnostic imaging using a pelvic ultrasound, CT scan, MRI, whichever imaging study the healthcare provider feels would be the best evaluation for the symptoms.
The symptom of weight loss is a never quite clarified. Is the weight loss the result of the suppressed appetite? Or can it happen even if the woman continues to eat as she always has?
This is caused by the cancer itself; as it becomes more numerous, the tumor cells produce factors that suppress appetite, such as cachexia (weight loss in someone not trying to lose weight) factors. Factors from the tumors themselves suppress a person’s appetite.
Also, weight loss occurs, but the belly gets bigger. This is a symptom of advanced cancer.
Does the appetite suppression come on overnight, boom, like that? Or is it insidious?
None of these will “boom” overnight. Cancer is a living entity, and the symptoms are often a reflection of the volume of cancer growing in a person, none of which occur overnight.
Just as the cancer doesn’t become a detectable mass overnight, it can easily take several months to over a year before it is appreciated.
None should be an acute change. Some women come in and they’ve often had symptoms for a year, but they may perceive it as having happened over the course of 24 hours.
This disease is an act of God, not a disease that one can create. It’s not like smoking where you increase your risk…it’s a horrible disease that at present is not preventable, short of surgical removal of the ovaries as in prophylactic surgery. Unfortunately, as of today, it’s purely luck when you find it early.
Does the “bloating” sensation symptom ever occur in the upper abdomen? Or is it necessarily always in the lower abdomen?
No; the abdomen and pelvis are one giant cavity. The symptoms in the lower abdomen affect the upper abdomen. Imagine your belly having 7 liters of fluid – when you stand up it goes down and when you lay down, it goes up.
This is the symptom of fluid in the abdomen. There are many different symptoms while you are standing up and lying down.
Is there anything about OC symptoms that makes them uniquely different than symptom groups of other conditions whose symptom groups can mimic OC, such as irritable bowel syndrome?
If a woman has irritable bowel syndrome or diverticulitis, that makes it even harder to attribute her symptoms to ovarian cancer.
It could be a flare from GI disease or advanced ovarian cancer, and the symptoms can be similar.
Ovaries need to be included in the abdominal workup, and leave it up to your health care provider to determine the best tool.
I think even the most healthcare educated person who is the most knowledgeable about her body can easily be fooled by the symptoms of ovarian cancer.
That’s what makes this so difficult – none of the symptoms are distinguishable…where a patient can say, “I should’ve known,” when diagnosed in the late stage.
The main message is that if something doesn’t feel right, you should receive formal medical evaluation.
Is fever ever a symptom?
Fever can be a symptom associated with advanced disease.
Is there any medical impracticality or medical risk, for a woman, who’s not in a high-risk group, to have prophylactic ovary removal, so that she never has to worry about OC?
Assume she already has had children, or doesn’t desire any.
This is a highly controversial question. Certain women who are at very high risk due to inheritance of genetic mutations predisposing them for the development of breast, ovarian, colon and other cancers, may benefit from prophylactic surgery — but at what age?
This question must be answered on an individual basis with appropriate expert medical consultation.
The answer for some will be yes and for others will be no. It’s not an easy question to generalize.
Why is it so important that women be aware of the symptoms of ovarian cancer?
If symptoms are made more commonly aware, women can become better healthcare consumers. If you don’t feel right, make the ovaries part of the medical evaluation.
When a physician orders a CT scan of the abdomen and pelvis, the radiologist evaluates all components and organs; they look at everything.
The bottom line is that healthcare providers can provide much more effective medical care if they are aware of the symptoms associated with diseases.
If you feel fine, and a doctor does an exam and everything feels normal, it would be unlikely that a doctor would offer a CT scan.
However, if the patient’s complaints were not explained by the exam, further imaging studies would be suggested.
It needs to be a two-way discussion between the doctor and patient, where the healthcare provider and patient are working together as a team.
Hopefully, we can stimulate unification of patient and physician so ovaries are considered a routine part of the evaluation for abdominal/pelvic discomfort.
Our bodies are fascinating. As we develop new cancer specific blood tests, anything abnormal within our body produces unique proteins in the blood; which may be a new key to early detection.
We need further research and support to develop new techniques and validation of these tests to save lives.
Symptoms are wonderful at telling us there is a problem, but it would be far better to detect precancerous changes such that no one would develop ovarian cancer.
And that’s the goal of our program and the National Cancer Institute, to find changes before it becomes cancer, and save lives.
Dr. Fishman is an internationally recognized gynecologic oncologist known for innovative research on the regulation of ovarian metastasis and the development of new methods for risk assessment and detection of early stage ovarian carcinoma.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
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