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Dr. Dale A. Prokupek, MD
Dr. Dale A. Prokupek, MD's posts

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This is interesting. High fiber is always very important.

I love this story. G E T...C H E C K E D!

I could go on and on about all the different times unexpected things like this have happened in my office.

Don’t be scared, friends.  I got you.

– Dr. Dale

The Miami Herald
Posted on Mon, Feb. 03, 2014

By Lisa Gutierrez
The Kansas City Star

<br />
Colon cancer survivor Danielle Ripley-Burgess, of Lee’s Summit, Mo., supports an organization that takes an educational traveling exhibit about the disease. It features a 40-foot-long model of a colon that young and old can crawl through, as seen Dec. 14, 2013, at New Summit Church in Lee’s Summit. </p>
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<div>FRED BLOCHER / MCT</div>
<div>Colon cancer survivor Danielle Ripley-Burgess, of Lee’s Summit, Mo., supports an organization that takes an educational traveling exhibit about the disease. It features a 40-foot-long model of a colon that young and old can crawl through, as seen Dec. 14, 2013, at New Summit Church in Lee’s Summit.</div>
<div id=She couldn’t tell her mom that something was wrong because it was way too embarrassing.She didn’t even like to walk down the toilet paper aisle at the grocery store.
So when Danielle Ripley-Burgess, 30, of Lee’s Summit, Mo., was in junior high school and began finding blood in the toilet after going to the bathroom, “I didn’t say anything about it for a long, long time. I was mortified.”

When she finally did, she and her mom, at first, did their own research on the Internet and figured that because Danielle was so young, the problem had to be something benign, like hemorrhoids.


Just a few weeks after her 17th birthday in 2001 she was diagnosed with stage 3 colon cancer, going from prom plans to hospital stays in the blink of an eye.

Today, at 30, she’s a wife and mother running a marketing firm – Semicolon Communications, wink, wink – and doing what she can to get people talking about what she once feared.

She’s not above using props, either. Big ones. In early December she arranged to have a 40-foot crawl-through model of a colon trucked into town.

The message? Being afraid to talk about what happens in the bathroom could kill you.

Colorectal cancer is the second-most deadly cancer, but the majority of cases are preventable with the use of a common screening procedure called a colonoscopy.

Precancerous growths found during a colonoscopy – recommended every 10 years beginning at 50 – can be removed on the spot. That’s important because those growths, or polyps, can stick around in your colon for years and become full-blown cancer.

“This is the only situation in all of medicine where the test used to screen for a cancer is also the method for preventing that same cancer,” said Larry Geier, a genetics oncologist at the University of Kansas Cancer Center and one of Ripley-Burgess’ doctors.

“In all other situations – mammogram, Pap smear – the screening test may be effective for early detection but provides no ability to prevent the cancer itself.”

And yet, people fear the colonoscopy. Statistics show that only half of Americans older than 50 have ever had one, or any other type of colorectal cancer screening process.

The ick factor is high. Here are the excuses patients give Geier.

• “I don’t like the idea of a doctor sticking a scope up my rectum. I am too modest for that.”

• “I hear the preparation for the test is very difficult, and I don’t want to do that.”

• “I am not having any symptoms, therefore I don’t have cancer.”

• “I just don’t have time for that.”

“I have heard each of these reasons too many times over the years, and none of them are worth taking the chance, or what I consider to be playing ‘Russian roulette’ with your colon,” Geier said.

Only 10 percent of all people diagnosed with the disease are younger than 50.

But while cases of colon cancer among adults 50 and older are falling, rates among younger adults like Ripley-Burgess are rising, according to the Colon Cancer Alliance.

“There is definitely a trend toward younger age at the time of diagnosis of colon cancer over the last two decades,” Geier said. “Changes in diet, better screening and more awareness of early symptoms may each have a role but still don’t provide adequate explanation.”

What happened to Ripley-Burgess was rare. She was diagnosed with colon cancer at 17 and again at 25, when all but a foot of her large intestine had to be removed.

“I have to be kind of careful with what I eat, when I eat.” No big chili dogs for lunch, for example. “It’s normal for me now.”

It was her bad luck to be, Geier put it, “genetically programmed” to develop colon cancer at such a young age. She has a genetic trait known as Lynch syndrome, which affects about 1 in every 4 to 5 Americans and is largely underdiagnosed.


Colon Cancer Warning Signs



• Blood in the stool (frequently not visible to the naked eye), a change in stool habits, a gradual decrease in the size of the stool, increasing abdominal pain, unexplained weight loss



• Those symptoms are much more likely to occur when the tumor is in the rectum or the very last part of the colon. Cancers that are higher up in the colon frequently don’t signal their presence with these symptoms until the tumor is quite large. That’s why screening for the cancer when there are no symptoms is critical.


• Anyone with one or more of these symptoms should tell their doctor.

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In the latest Director’s Briefing video, CDC Director Dr. Tom Frieden talks about the importance of testing to prevent colon cancer. About 23 million adults haven’t gotten the life-saving tests they need to find colon cancer early. Testing can find precancerous growths and saves lives. People are encouraged to talk with their doc about testing options. The best test is the test that gets done.

What?? A new way to treat HEMORRHOIDS?!

There are alternatives!  BUT WHAT ARE THEY??

Surgery isn’t the only option:

* creams
* high fiber diet
* if CREAMS and HIGH FIBER DIET don’t work…
* then we go to Banding (get’s rid of 80% in office) (*COVERED UNDER INSURANCE)
* if BANDING doesn’t work…
* then we go to THD, where the hemorrhoids are sewn, in office, with minimal discomfort, and back to full activity inside of 4 days (*COVERED UNDER INSURANCE)

THD is a proven solution to painful Hemorrhoids.

What’s THD?  Transanal Hemorrhoidal Dearterialization

But what does that mean??

THD is indicated for symptomatic internal hemorrhoids that fail conservative management.

THD uses a doppler to locate the terminating branches of the hemorrhoidal arteries. Once the artery is located the surgeon uses an absorbable suture to ligate or “tie-off” the arterial blood flow. The venous “out flow” remains to “shrink” the cushion. This is done without excision of tissue. If necessary the surgeon will perform a hemorrhoidopexy to repair the prolapse. Again, this is done with suture and no excision of tissue. This repair restores and “lifts” the tissue back to its anatomical position.

The entire procedure is performed above the dentate line so that there is minimal discomfort. The procedure takes about 20 minutes and is offered as an out-patient surgery. 


– Dr. Dale

Alternatives to the Colonoscopy

So, guess what?  Colorectal cancer is the second-leading cause of cancer deaths in the U.S. for men and women combined, the illness is highly curable when detected early.

BUT, there are alternatives to the often uncomfortable colonoscopy.

Virtual (CT Scan)

no sedation
still have to drink the “prep drink”
misses polups less than a centimeter, which means the results could lead to a false sense of security.
Blood Stool Test

have your doctor test your stool for blood.
very good to DETECT colon cancer hopefully at an early stage, but does NOT prevent colon cancer.
I got you.

– Dr. Dale


We all know smoking is bad.  But why can't we stop?  
We wear a seat-belt in the car.  We wear a jacket during blizzards.  Day-to-day we protect ourselves from harm.

We diet to appear healthy.  We exercise to feel healthy.  And we read articles to stay healthy.  
Yet smoking, one of the most harmful addictions, is just too hard to quit.

Should this article influence you to stop smoking, speak with me for how I can help.  There are certain medications that can double your chances of quitting for good.  From there you'll cut cravings, cut withdrawals and save money.  Along with your life.
I got you.

-- Dr. Dale

 Check out:

A surgeon general's report expands the death toll and list of diseases caused by smoking.

Liz Szabo, USA TODAY

A new report from the surgeon general finds that smoking causes even more physical and financial damage than previously estimated, killing 480,000 Americans a year from diseases that include diabetes, colorectal cancer and liver cancer.

The report, released today, represents the first time the surgeon general has concluded that smoking is "causally linked" to these diseases. The report finds that smoking causes rheumatoid arthritis, erectile dysfunction and macular degeneration, a major cause of age-related blindness. Smoking causes inflammation, impairs immune function and increases the risk of death from tuberculosis, an infectious disease. Smoking also harms pregnant women and their fetuses by causing birth defects called cleft lips and palates and by causing ectopic pregnancy, which occurs when a fertilized egg implants in the fallopian tubes instead of the uterus.


The new report — issued 50 years after the first surgeon general report on smoking — finds that exposure to secondhand smoke, previously linked to cancer and heart attacks, also causes strokes.

"Amazingly, smoking is even worse than we knew," says Thomas Frieden, director of the Centers for Disease Control and Prevention. "Even after 50 years, we're still finding new ways that smoking maims and kills people."

In spite of 31 previous surgeon general reports on smoking, "the battle is not over," says acting Surgeon General Boris Lushniak. "The problem isn't solved. We still have 18% of our adult population smoking. And 5.6 million kids who are alive today will die early unless we take immediate action."

If it undertakes aggressive measures — such as educational campaigns, tax increases and bans on smoking in public places — Lushniak says the USA has the potential to "create a tobacco-free generation."

The report raises the annual death toll from smoking by about 37,000 additional lives lost, noting that tobacco has killed 20 million Americans since 1964, when the first surgeon general report on smoking was released. The higher death tolls reflect new science about how tobacco harms the body, the report says.

Nearly 2.5 million of those premature deaths were in non-smokers exposed to secondhand smoke. An additional 100,000 were babies who died of sudden infant death syndrome (SIDS) or complications from prematurity, low birth weight or other conditions caused by parental smoking.

Edward McCabe, the March of Dimes' chief medical officer, says he hopes the report will give women even more motivation to quit smoking before becoming pregnant. Nearly 21% of women of childbearing age smoke, although many quit at least temporarily after learning they're pregnant.

The American Diabetes Association has long advised diabetics to avoid tobacco smoke, says Robert Ratner, the group's chief scientific and medical officer. Smoking impairs how the body responds to insulin, he says.

Ratner says the science on smoking and diabetes is not clear-cut. Though population-based studies show smokers have an increased risk of diabetes, Ratner says, "I am unaware of any data which directly links smoking to causing diabetes."

Smoking exacts a huge financial toll, as well, costing the country nearly $286 billion a year in direct medical costs of smokers and those exposed to secondhand smoke, as well as in lost productivity due to premature deaths, the new surgeon general report says.

The report notes that the country has made major progress in combating tobacco since the 1964 report. Adult smoking rates have fallen by more than half since then to about 18%. In 2011, for the first time, a Gallup poll found that a majority of Americans supported a ban on smoking in all public places.

David Sutton, a spokesman for Altria, the parent company of tobacco giant Philip Morris USA, says he doesn't contest the scientific evidence that cigarettes cause cancer and other diseases.

"As we've said for some time, there is no safe cigarette," Sutton says. Philip Morris supports strong FDA regulation of tobacco, as well as tobacco-free products, such as electronic cigarettes. "FDA regulation has the potential to reduce the harm caused by smoking."

A spokesman for R.J. Reynolds Tobacco, a leading cigarette maker, declined to comment.

The American Lung Association and other health groups say the USA should aim to reduce adult smoking rates to less than 10% within the next 10 years.

The lung association outlined several steps to achieve this goal:

•The White House should release long-awaited rules regulating all tobacco products, including e-cigarettes and cigars. The group called on the White House to ensure all smokers have access to approved smoking-cessation medications and counseling.

•Congress should increase federal tobacco taxes and close loopholes, so all tobacco products are taxed equally.

•The Food and Drug Administration should remove menthol-flavored cigarettes from the market as a way to reduce the number of new smokers.

•States should fully fund anti-smoking efforts. States receive about $80 per person a year from the Master Settlement Agreement of 1998, between tobacco companies and state attorneys general, Frieden says. Although the CDC recommends that states spend at least $12 per person annually on tobacco control, states spend an average of $1.50. In comparison, Frieden says, the tobacco industry spends an average of $28 per person each year to promote its products.


I love hearing about HPV awareness in our nation, and how great it is.  However, if only those who I see day after day with diagnosed-HPV had been as educated.

I want to stop this cycle of amazing and brilliant people getting hurt solely by not being informed.  HPV education and prevention wasn’t taught in school back in the days.  So now it’s up to us to share the message.  And it’s up to doctor’s like me to lead the pack.   Let’s do this.

I got you.

– Dr. Dale


By Shereen Jegtvig

NEW YORK (Reuters Health) – Americans are more aware that there is a test for the human papilloma virus (HPV) than counterparts in the UK and Australia, according to a new study, but few people knew much more than that.

“Awareness of HPV has tended to be low but has been rising since the introduction of testing and vaccination,” said Jo Waller, the study’s senior author.

People seem to be more aware of HPV vaccination than testing, however, which is not surprising given the publicity around the vaccine, added Waller, a public health researcher at University College London.

The Pap test, used to look for abnormal cell changes in the cervix, is much older and generally familiar to most people, but the newer HPV test looks for the virus that causes those changes, Waller said.

The HPV test was only introduced in the 1990s and it’s used a little differently in each of the countries that were included in the new study, Waller pointed out.

In the U.S., HPV testing is used as a screening tool in women over the age of 30. In both the U.S. and the UK, HPV testing is also used along with the Pap test to determine the next steps in treatment – for instance, biopsy.

In the UK and Australia, the HPV test is also used to monitor treatment results.

Waller said that many studies have attempted to assess the public’s knowledge about HPV and HPV testing, but they all used different methods and asked questions in different ways, so it’s hard to compare the findings.

“We wanted to use the same questionnaire to look at knowledge across three countries where HPV testing is used in different ways,” she told Reuters Health in an email.

The researchers used an online survey to find out if participants in the U.S., UK and Australia were aware of HPV testing and HPV in general.

The first question asked was ‘Before today, had you ever heard of HPV?’ Participants who responded ‘yes’ were then directed to 15 general questions about HPV.

Participants were then asked ‘Have you ever heard of HPV testing?’ Those who responded ‘yes’ were asked six more questions about the test.

Of the 2,409 men and women who answered the survey, about 61 percent had heard of HPV, Waller’s team reports in the journal Sexually Transmitted Infections.

Among those who had heard of the virus, only half were aware of the HPV test. Awareness of the HPV test was higher in the U.S. than in the UK and Australia.

The participants who had heard of HPV testing, on average, answered less than half of questions about details of testing correctly. Overall, women knew more than men.

Most of the survey participants did know, for example, that the HPV test can be done at the same time as the Pap test, and that a positive HPV test doesn’t mean a woman will definitely get cervical cancer.

But they didn’t know a negative HPV test indicates a low risk of cervical cancer. Few also knew that the HPV test is not an indicator of whether the HPV vaccine is needed.

“It’s also important for people to understand that although the HPV vaccine protects against HPV, it’s still really important for women to have screening, to check for (virus) types not covered by the vaccine,” Waller said.

Women who are screened and found not to have the HPV virus should be reassured that their risk of developing cervical cancer over the next five years is extremely low, Waller added.

SOURCE: Sexually Transmitted Infections, Online January 9, 2014.


"To avoid the boredom of spirit that sometimes accompanies profound changes you're trying to make on yourself, here are some simple strategies for staying motivated"

Check in with your priorities.
Learn from the discomfort.
Laugh and play more.
Go easy on your expectations.
Self-reflect every day.
Be grateful.
-- Dr. Dale


When Self-Improvement Gets Boring, Try These 6 Motivational Strategies

Posted: 01/26/2014
Written by: Brant Secunda and Mark Allen
As human beings, we're always striving to be better. The most common self-improvement goals people set, particularly this time of year, are things like losing weight, improving our cholesterol numbers or blood pressure, or getting in shape for a marathon. These are body goals. They are concrete and easy to understand. Because we have metrics to measure things like weight loss, for example, it's easy to track our progress and stay motivated.
Making "soul resolutions" is more challenging. These are the deeper aspects of self-growth. These would be things like trying to be less critical, more loving, more patient, or more optimistic. Soul resolutions are not so easy to measure.

And that can be a problem. Too often, when it comes to changing profound aspects of our attitudes, behavior, and character, we can get bored, uninspired, and discouraged after a while. We can't really tell sometimes if our efforts are "paying off."

To avoid the boredom of spirit that sometimes accompanies profound changes you're trying to make on yourself, here are some simple strategies for staying motivated.

Check in with your priorities. What's really important in your life? This is a question that will get you back on track quickly. Make changes in how your spend your time so that you can keep strengthening the behaviors that will reinforce your soul resolutions.

Learn from the discomfort. Trying to be a better person is challenging, difficult, and uncomfortable. It can even be painful and cause you to suffer -- particularly if you have to do things like apologize, change your friend group, or do a lot of self-examining. When things get hard to take, embrace the discomfort and ask yourself what it's teaching you.

Laugh and play more. It can be boring and tedious to be always working on self-improvement. Add pleasurable, fun activities to your life. The more you laugh, the better you'll feel. Laughter is good for the soul, and an important antidote to all your hard work.

Go easy on your expectations. There are times when you might think you should have already attained a particular goalpost, yet find that you're still struggling to get there. Instead of becoming impatient with your journey, make whatever it is you're doing in the now be the priority, instead of focusing on the end result. Let your present state be exactly where you want to be for the moment, and find fulfillment in it.

Self-reflect every day. Staying on track with transformations of the soul are most easily seen by reflecting on one's day-to-day actions. Were you kind in your interaction with a family member today? Did you stop and change a limiting thought into a supportive one when you felt doubt yesterday?

Be grateful. When we give thanks and feel gratitude, our soul is free to live. You can always find at least one thing to be grateful for. Gratitude is the "fix" for boredom and discouragement while you're on the road to becoming a better person.

Make working toward changes of your soul a daily practice. This is one way to redesign who we are from the inside out.

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7 Things Only Gluten-Free People Understand

Aside from specializing in Anal Warts (HPV), Hemorrhoids and Colonoscopies, as I'm also a gastroenterologist I handle hundreds of celiac cases each month.  Many of my patients who are suffering from "celiac" and "non celiac gluten sensitivity" are afraid of the life before them should they decide to change their eating habits.  As gluten-free alternative have matriculated into our grocery stores (even Ralph's sells gluten free), and at our sandwich shop (Mendocino Farms is the best), it's become much easier to have gluten-free offered to you versus digging to find it.

-- Dr. Dale


7 Things Only Gluten-Free People Understand

Despite the trendiness of going gluten-free, only about 1 in 133 people truly have celiac disease, an autoimmune disorder that causes damage to the small intestine when gluten is ingested. Another small group have a condition doctors call "non-celiac gluten sensitivity" that can also produce symptoms.

In addition to the stomach trouble, joint pain, mood swings and other symptoms, people who don't eat gluten often also face seemingly-endless peeving comments like, "I could never give up bread!"

But dealing with both uncomfortable symptoms and uncomfortable situations has a silver lining: There are certain lessons learned by only those who eat gluten-free. We asked our Twitter followers and Facebook fans to share some of those truths with us. Here are a few of our favorites.
If you're gluten-free, you know...
1. That there are so many other yummy, yummy alternatives! --Tara Francy Brown

gluten free alternatives
2. That the people serving, selling and distributing your food really have no clue how it is made, and what is in it. --Dylan Armstrong
3. Processed foods have taken over. --Optamus Primel

gluten free processed foods
4. How much gluten can affect both physical and mental wellbeing. --Laura B. Russell
5. Gluten is hidden in soy sauce, beer, some mocha powders in coffee shops and many salad dressings. --Elizabeth Paul

soy sauce gluten
6. How good you feel without it!! --@FayeWoodhead
7. That's there's tons of food that I can eat. --Debbie Cronrath Hassel
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