Dr. Robert Madoff

Patients with ulcerative colitis may be at a higher risk for colon cancer.  According the National Institutes of Health, five percent of people with the condition will develop colon cancer.  But the risk depends on the amount of damage done to the colon over time.  Ulcerative proctitis, however, carries a different risk.  Ask the Doctor panelist Dr. Robert Madoff explains that colon cancer screening recommendations may vary in patients with proctitis.

Get Your Rear in Gear reader: I have been diagnosed with ulcerative proctitis for the last 35 years. My last colonoscopy in June indicated it was not active, however, I had my first two ademous polyps removed. My mother was diagnosed with colon cancer at age 59 (I’m 57) and she died at age 61. My brothers also have polyps. My new doctor said not to have a repeat for 5 years. What are your recommendations? Previously I have been checked every 2 years since my 30′s. This is also the first time I was told my proctitis was not active. Yet I have some symptoms.

Dr. Robert Madoff: Overall, there is no increased risk of cancer for proctitis, as opposed to colitis that extends higher in the colon.  But some experts think that very longstanding proctitis like yours may require more frequent examinations.  Given your family history alone, you should be colonoscopied every 5 years.  Yours is not a clear cut case.  Your doctor’s recommendation is reasonable but other doctors might recommend a more aggressive surveillance program like you were on before.

Robert Madoff, M.D., F.A.C.S. is a Professor of Surgery and Chief of the Division of Colon and Rectal Surgery at the University of Minnesota, and holds the Stanley M. Goldberg, MD Chair in Colon and Rectal Surgery. He is Editor-in-Chief of Diseases of the Colon & Rectum, and has served as a Co-Editor of the journal from 2001-2007

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Learn more:

• Mayo Clinic: Ulcerative Colitis
• Crohns Colitis Foundation of America
• Mayo Clinic: Proctitis:
• National Institutes of Health: Ulcerative Colitis
• National Institutes of Health: Proctitis

A recent post by comedienne and author Brenda Elsagher is a perfect example. Elsagher is the author of Bedpan Banter, Medical Stories of Humor and Inspiration, which gained acclaim for helping patients to manage serious medical conditions with courage and humor. She shared a YouTube video on the Get Your Rear in Gear Facebook page. The song, a hilarious homage to the colorectal surgeon, was given a nod by the American Society of Colorectal Surgeons at their 2006 conference.

• Visit the official Get Your Rear in Gear Facebook page and view the video.

Fitness expert Chris Freytag

Maintaining a healthy body weight is important for optimal health and disease prevention.  Several of the Get Your Rear in Gear Ask the Doctor panelists point to good exercise and nutrition habits as important elements in the prevention of many cancers, including colon cancer.  But weight loss can be a challenge.  Recently, this reader contacted us during her journey to get fit.  Her efforts to lose weight have hit a plateau and she contacted Ask the Trainer fitness experts for advice.

Get Your Rear in Gear reader: I started working with a personal trainer in April.  My first assessment was in June.  I lost 4.7 fat and gained 4.7 lean.  Today, in August, my assessment revealed that I lost 4.3 fat and gained 4.3 lean, worse than my assessment in June.  I have only lost 9.6 lbs.  I work out five days per week and weight train.  Instead of resting, I run ladders or run laps or jump rope etc.  I sweat like crazy yet I am not losing weight.  My diet is good. At  breakfast I eat oatmeal, and  scrambled egg whites, for lunch, baked chicken with brown rice and steamed broccoli, and for dinner baked chicken or fish and broccoli.  My snacks are fresh almonds or cottage cheese.  My diet is pretty good.  Why am I not losing weight?  I hope you can give me a clue of what I am doing wrong.

Chris Freytag: Hmmm – sounds like you’ve hit a plateau.  Plateaus are as inevitable as rainy days and just about as welcome. A plateau simply means that you’ve reached a state of equilibrium and balance is usually a good thing…except when it comes to weight loss.

A plateau is your signal to change it up.   Although I don’t know how much weight you had to lose or how much more you have to go….these two strategies usually will help you get weight loss back on track:

1. Try a new exercise routine:  Your body is used to your routine.  Try adding more cardio for a while to burn up calories.   Change up your strength exercises.  Try a few group fitness classes.  Add in circuits or intervals.  Bottom line – you need a change and you probably would benefit from a surge of intensity for a few weeks.
2. Portion control. If the scale isn’t budging, your portions may be to blame. Sounds like your food choices are healthy.  Just make sure that the overall portions aren’t out of whack.  I’m always surprised how much I’m eating when I measure my servings.  On the flip side, if you aren’t eating enough, that can back fire too. Journaling is always the best way to figure out what’s really going on.   Most of the time we can’t remember every single thing we ate and often the calorie counting in our head isn’t always correct.   Documenting the facts supplies the truth.

So, if you’ve hit a plateau, don’t get discouraged.  Just change it up to re-ignite your weight loss.

Chris Freytag is a nationally known fitness expert on NBC-TV, the fitness expert for Prevention magazine, and author of 3 books. Chris holds a BA in Journalism and is a certified Group Fitness Instructor, Personal Trainer and Lifestyle and Weight Management consultant.  Visit her website for more information about her products or exercise DVDs.

Submit a fitness question to the trainers!

Read more:

• Mediterranean diet reduces cancer risk
• Benefits of metabolic testing for older exercisers
• Keep fitness goals on track with 3 high intensity workouts
• Research supports common sense dieting

• See the full WebMD video.

Coalition president Kristin Tabor interviews Tom Alden

ABC’s Boston Med recently featured 59 year-old Tom Alden during his journey through colon cancer diagnosis and surgery. In this video, Alden speaks to Kristin Tabor, the president and founder of the Colon Cancer Coalition, at the organization’s Get Your Rear in Gear 5K in Colchester, Vermont. They discuss the importance of going to the doctor and getting a colonoscopy.

Alden credits a colonoscopy with saving his life.  He traveled from Fairhaven, Massachusetts to the Colchester event to help educate others about the importance of the procedure.  According to Tom, his cancer diagnosis was “totally unexpected.”  At 59, he had discussed the issue of having a colonoscopy, but didn’t consider having the procedure done until stomach cramps landed him in the hospital. It was at that point that a colonoscopy revealed a treatable form of cancer.

Alden and his wife Judy participated in the Get Your Rear in Gear 5K Run/Walk in Colchester. He hopes to bring an event to his own town soon.  Currently, there are over 40 Get Your Rear in Gear events scheduled in 2011 throughout the United States.

Read more:

• Top four reasons people avoid a colonoscopy
• Colon Cancer Coalition president receives national honor
• How to get the best colon cancer care: an interview with oncologist Neal Meropol, M.D.
• A legacy of colon cancer becomes a gift of life

Fitness Expert Matt Haugen

Whether you are training for a Get Your Rear in Gear 5K or or prepping for a marathon, an effective warm up will put your best foot forward during training runs.  This Ask the Trainer question comes from a runner who wants to be sure he is doing the best possible exercises before he hits the pavement.

Get Your Rear in Gear reader: I’ve read both forward and reverse lunges are good warm-ups for runners. I do both. But is one better than the other? Or do they work different muscles?

Matt Haugen: I would not recommend lunges for a running warm-up, unless they are completed in a slow, controlled motion, and held in a static position for 15+ seconds. You are going to help stretch all of the upper and lower muscles of the legs for sure. For the most effective warm-up, my best choice would be a warm-up that includes slow running for 10 minutes, then some static stretching of the hamstrings and calves (holding each posture for 30 seconds), then return to running and gradually pick-up the pace for another 5 minutes before your key run workout begins. When your run session is complete, include some standing and sitting range of motion stretches (when your muscles are more warmed-up).

Get Your Rear in Gear:  Both forward and reverse lunges work the same muscles, however most fitness experts agree that  a reverse lunge places less stress on the knee.  By stepping backward, you keep the forward knee safely placed over the ankle which allows you to maintain proper alignment.  Check out the links below for video instructions on performing a proper lunge and more pre-and post run exercises.

Submit a fitness question to the trainers!

Matt Haugen is a full-time coach who has trained thousands of athletes since 1980. On the community, high school, collegiate, national, and Olympic levels, he has guided athletes to podium finishes and personal best accomplishments.  Matt holds a B.A. in Psychology, and M.S. Exercise Science/Sport Psychology from Penn State, and Ph.D. studies (A.B.D.) in Kinesiology/Sport Psychology from the U of Minnesota. He currently trains athletes of all levels through Performance Power (P2) based in St. Paul Minnesota.

Read More:

• How to perform a basic lunge exercise (video)
• Four stretches every runner should know
• Marathoner raises funds for the Colon  Cancer Coalition
• Is weight training important for a runner?
  

Submit a fitness question to the trainers!

Get Your Rear in Gear reader: I am 67 years old.  I think I’m in above average physical shape for my age.  I have been doing high intensity Zumba Classes 3 to 4 times per week for 6 months and haven’t lost a pound.  Along with this cardio, I weight train two to three days a week (machines only).   I have been going to a whole health clinic since March and am following a very healthy eating plan along with dietary supplements.  I use a heart rate monitor and my heart rate during cardio averages 145-148.  I know this is above the scale for my age but I am not winded and don’t have trouble talking with heart rate this high.  In the past two years, I’ve gone from 184 to 144 lbs and am really trying to get the other 4-6 lbs off.  I just don’t know what I’m doing wrong.  I try to stay within the 1200 calorie range because if I go over that, I gain.  Do you have any recommendations for me?

Kris Wayne: Congratulations on your huge weight loss! That is a major accomplishment and I can understand your frustration with the last few pounds. I lost 105 pounds when I was 19 (forty years ago!) and understand what that battle involves in terms of exercise and lifestyle change. If you have been eating only 1200 calories and yet exercising a lot you may have inadvertently slowed your metabolism down. If we exercise regularly and eat minimally, our bodies respond by conserving fuel. My best recommendation is to have metabolic testing done with New Leaf for resting and exercise metabolic rates. This test takes very little time and will accurately tell you exactly “what it costs you to live” (resting metabolic rate) and the precise heart rate where your body burns fat most efficiently (exercising metabolic rate). Often, people work too hard and burn sugar or glycogen for fuel and not fat as the energy substrate. With metabolic testing, you take the guesswork out of the exercise process, so you are getting the best bang for your buck and not spinning your wheels. There are many places you can have this test done – including many of your local YMCAs. There is a charge for this test, but it maximizes the likelihood that the energy you are expending is getting you closer to your goals. I hope this is helpful!

Kris Wayne is the Generations Fitness Specialist for the Metropolitan Minneapolis YMCA. As part of this program she develops fitness programming for baby boomers and senior populations in the areas of Pilates, Group Fitness and Personal Training. Her program, “Functional Fitness” concentrates on undoing what occurs during the aging process and daily life. Kris is a certified presenter and fitness instructor through the American Council on Exercise and is a National Academy of Sports Medicine certified personal trainer.

Read more:

• Am I exercising too hard to get results?
• Ask the trainer: MUFAs reduce body fat
• Three methods of measuring heart rate during exercise
• When are you too old to start a running program?

ASCRS President Dr. David Beck (left) and Public Relations Committee Chair Dr. Harry T. Papaconstantinou present the David Jagelman, MD, Award for Advocacy in Colorectal Cancer to Colon Cancer Coalition founder Kristin Tabor.

Colon Cancer Coalition founder and president Kristin Tabor accepted the David Jagelman, MD, Award for Advocacy in Colorectal Cancer, which was presented recently by the American Society of Colon and Rectal Surgeons.  At their annual meeting in May, ASCRS presented two new awards to recognize colorectal cancer advocacy efforts and journalistic excellence in reporting on the disease.  The Jay Monahan Award, which honors outstanding reporting that promotes greater public understanding of colon and rectal cancer, was given to Dennis Douda, medical reporter at WCCO-TV in Minneapolis, MN.

According to the ASCRS News, Public Relations Committee Chair Dr. Harry Papaconstantinou praised Tabor for founding the Colon Cancer Coalition and leading its rapid growth to a major colon cancer advocacy group.  “Kristin’s achievement deserves recognition in the tradition of patient advocacy pioneered by our own Dr. David Jagelman,” Dr. Papaconstantinou said.  Dr. Jagelman, an ASCRS member and chair of the Department of Colorectal Surgery at the Cleveland Clinic Florida, was a widely admired patient advocate who founded and directed the Cleveland Clinic’s Familial Polyposis Registry.

ASCRS Annual Meeting attendees played a key role in the success of this year’s Twin Cities Get Your Rear in Gear 5K Run/Walk, which is presented annually by the Colon Cancer Coalition.  Physicians, staff, and family members attended the race to help raise funds for colon cancer screening and awareness programs, and for the ASCRS Research Fund.  According to Papaconstantinou, ASCRS hopes to bring a Get Your Rear in Gear event to the next annual meeting in Vancouver, British Columbia, Canada.  If the event takes place, it will be the first international race for the Colon Cancer Coalition, which currently has over 40 Get Your Rear in Gear races scheduled across the United States in 2011.

Matt Carrera will run his first marathon to raise awareness of his father's illness

When Matt Carrera made plans to run his first marathon, he knew he would use the opportunity to raise funds for charity.  He never realized that the charity would become a personal mission.  But shortly after beginning his training, Matt got unexpected news.  His father was diagnosed with colorectal cancer.  Now, the 32 year-old runner and chiropractor from Rhode Island is training to run the 2011 Walt Disney World Marathon to raise funds for awareness and screening programs through the Colon Cancer Coalition.

In 2009, Matt and his family visited Disney World, a favorite vacation spot for his family.  At that time, Matt set a goal to run the marathon and knew that, as part of his training,  he would raise funds for a cause. But a knee injury sidelined his plans and he back burned the goal.  In early 2010, after recovery from knee surgery, he registered for the 2011 Walt Disney World Marathon, this time, with more support from his family. Matt registered for the full 26.2 miles, his brother-in-law Ken registered for the Half Marathon, and their wives committed to the Family Fun Run 5K.  Even the kids got excited to participate in the Kids’ Dash.  Training began, plans were made, and goals were set.  Then Matt’s dad was diagnosed with cancer.

The cancer diagnosis

Matt’s father, Jeff, had experienced no symptoms that would have made him concerned about a major illness.  But after experiencing some rib pain, he visited the doctor to investigate the cause.  He thought it would be a routine visit.  A series of tests revealed a mass in his colon, which began a confusing journey.  The determination included a diagnosis of adenocarcinoma of the cecum with neuroendocrine markers.  But according to Matt, “the diagnosis was unclear because there were many different possibilities for where the cancer originated.”  Jeff began his cancer treatment last month and is faring well.  “So far, there have been no major side-effects,” Matt says, “but my dad gets tired.”  Jeff will continue to get one chemotherapy treatment every two weeks for two months, then diagnostic tests will help physicians evaluate how to proceed.

His father’s illness has inspired Matt to train harder and get the word out about the importance of colon cancer screening and awareness programs.  He contacted the Colon Cancer Coalition, a non-profit organization which produces Get Your Rear in Gear 5K races around the country to raise funds and awareness for colon cancer.  He asked if he could use his marathon experience to raise funds and spread the word.  With the Coalition’s help, Matt set up a fundraising page and has begun raising money.

Running expert Matt Forsman

The fitness training plan

To get in shape for the marathon, Matt will begin working with Matt Forsman, USATF/RRCA certified marathon coach and Ask the Trainer fitness expert.  Forsman provides marathon coaching services through his website MarathonMatt.com and specializes in training runners who are raising money for charity. Together they will formulate a plan to help Matt Carrera reach a goal of completing the 26.2 miles in less than fours hours.  The Get Your Rear in Gear blog will follow Matt’s training and fundraising efforts.  Check out Matt’s fundraising page to learn more about his personal mission and to get more information about his father’s diagnosis.  Then continue to visit the Get Your Rear in Gear blog.  We will provide updates about Matt’s dad and follow Matt’s Forsman’s custom training plan to track Matt’s journey to the starting line.

Are you interested in running your own personal race? Contact the Colon Cancer Coalition to find out more about setting up your own fundraising page and setting your own fitness goals.  Visit MarathonMatt.com for information on marathon coaching and services.

Running expert Matt Forsman

Measuring heart rate is an effective way of monitoring intensity during exercise.  It helps the exerciser know if they are working too hard or not hard enough.  But determining the correct target heart rate can be confusing. This question comes from a reader who is using a heart rate monitor and needs to know if he is achieving the best results.  Ask the Trainer fitness expert Matt Forsman responds.

Get Your Rear in Gear reader: I am starting to exercise more regularly.  I want to work harder, but feel like my heart is pounding.  So I bought a Polar FT60 heart rate monitor.  It indicates my highest heart rate for TRAINING is 150 (I am 54 years old, though in better shape than many people, not seriously overweight).  The problem is that my heart gets up to 150 with VERY little activity.  If I walk at only 3.7 mph, my heart is already in the 3rd of 3 training zones on the Polar, whereas it says I should be mostly in zone 2.  I’m not out of breath.  So is this my fate?  It seems no matter how much exercise I do, my heart rate still climbs into that 3rd range or above even at a very moderate level.  The exercise videos all yell at me to try harder, but if I do, my heart rate will be 170 or even above.  It never improves, seemingly, no matter how much I exercise.  Do I really need to keep it down in the 130s?

Matt Forsman: Before I delve into the heart rate monitor question, if you feel like your heart is pounding all the time you are likely pushing too hard during your workouts.

Granted, in order to become more fit, you do need to challenge yourself ‘periodically’. But, pushing yourself hard ALL THE TIME increases the chance of injury/aggravation. You may not be doing this, but it’s worth mentioning.

According to Polar’s website, they recommend determining your max heart rate by taking 220 and subtracting your age. Using this equation, your max heart rate should actually be 166 and NOT 150 as you indicated.

With this in mind, your Level 3 ‘moderate range’ should be between 70-80% of this or 116-133 approximately.

Bear in mind, that the formula provided by Polar is a ‘general’ way of evaluating your max heart rate and/or target training zones. In fact, Polar says, “Lastly, the most precise and accurate way of determining your individual maximum heart rate is to have it clinically tested by a cardiologist or exercise physiologist through the use of a treadmill or bicycle maximal stress test. If you are over the age of 40, overweight, have been sedentary for several years, or have a history of heart diseases in your family, clinical testing is recommended.”

Given that you are 54 and it ‘sounds’ like the maximum heart rate suggested by Polar (presumably derived from the formula they provide) doesn’t ‘feel’ like a maximal effort, a more substantive clinical test to determine your ‘true’ maximum heart rate may be the best bet to better determine the appropriate training ‘zones’ for you.

Matt Forsman (‘Marathon Matt’) is a USTAF/RRCA certified professional running coach based in San Francisco, California. His passion for running has enabled him to help thousands of runners in the SF/Bay Area achieve and exceed their running goals. Matt’s group training programs have grown from 30-40 in 2005 to over 200 today. Additionally, Matt supports a myriad of San Francisco/Bay Area non-profit organizations. Get more information about Matt Forsman’s programs at MarathonMatt.com

Submit a fitness question to the trainers!

Read more:

• Three methods of measuring heart rate during exercise
• Physical fitness tests help exercisers set and reach fitness goals
• How do I make the most out of my workout?
• Benefits of metabolic testing for older exercisers