White and Blue Fingers and Toes? What’s the Cause?

Posted by Brigham and Women's Hospital February 24, 2015

Raynaud’s disease can lead to severe pain in the fingers and toes.

Contributors: Paul F. Dellaripa, MD, is a rheumatologist in the Division of Rheumatology, Allergy and Immunology at Brigham and Women’s Hospital and an Associate Professor of Medicine at Harvard Medical School. Aaron B. Waxman, MD, PhD, is a pulmonologist in the Division of Pulmonary and Critical Care Medicine at Brigham and Women’s Hospital and an Associate Professor of Medicine at Harvard Medical School. They collaborate as part of a multidisciplinary team in the Raynauds Disease Clinic at Brigham and Women’s Hospital.

For some people, extreme cold or emotional or physical stress can quickly turn their normally flesh-colored fingers and toes white and/or blue – sometimes leading to very painful digits.

The discoloration and pain is often caused by a condition called Raynaud’s disease or Raynaud’s phenomenon. For many, it is mild and can be addressed with simple lifestyle changes, such as wearing gloves and warm socks or slippers during the winter months. For others, though, the discoloration and pain can be long-lasting, sometimes even resulting in sores and the ultimate loss of portions of fingers and toes.

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Lung Cancer Screening Helps Current and Former Smokers

Posted by Brigham and Women's Hospital November 5, 2014

Dr. Francine Jacobson

Lung cancer, the most frequent cause of cancer death in this country and around the world, continues to be an important public health epidemic. The American Cancer Society projects that by the end of this year alone, there will have been 224,000 new cases of lung cancer diagnosed in the U.S., and 159,000 Americans will have died from the disease.

Most, but not all, cases of lung cancer are attributable to smoking. Thus, the most important thing that people can do to reduce their risk of developing lung cancer is to quit smoking, or better yet, never start.

For current or former long-term smokers, lung cancer screening should be a priority. Research has shown that new screening guidelines for the use of low-dose computed tomography (CT)  should significantly reduce the number of deaths from lung cancer by improving early detection. In the following video, thoracic radiologist Dr. Francine Jacobson provides more details about the benefits of low-dose CT scans and who should get screened.

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Twenty-Two Years and Counting – Brigham and Women’s Hospital Ranked on U.S. News Honor Roll

Posted by Brigham and Women's Hospital July 31, 2014

BWH has been named to the U.S. News & World Report’s 2014 Honor Roll of America’s Best Hospitals.

For the twenty-second year in a row, Brigham and Women’s Hospital (BWH) has been named to the U.S. News & World Report’s Honor Roll of America’s Best Hospitals, ranking ninth. The Honor Roll highlights just 17 hospitals, out of nearly 5,000 nationwide, for their breadth and depth of clinical excellence.

We’ve gathered a few recent blog posts in our top ranked clinical categories to recognize the dedication and accomplishments of our doctors, nurses, researchers, and other members of our clinical teams.

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Study Shows Smoking Bans Benefit Kids

Posted by Brigham and Women's Hospital July 17, 2014

Passive smoking is linked to premature births, birth defects, asthma, and lung infections.

We know that smoking cigarettes is bad for adults, but a 2014 intercontinental study demonstrates how beneficial public smoking bans are for children.

Nearly half of the world’s children are regularly exposed to second-hand smoke. Passive smoking is linked to premature births, birth defects, asthma, and lung infections. Studies also have suggested that being exposed to second hand smoke during childhood may have long-term health implications, contributing to the development of chronic diseases, like heart disease and diabetes, in later life.

Laws that prohibit smoking in public places, such as bars, restaurants, and workplaces, are proven to protect adults from the health threats associated with passive smoking. In the first comprehensive study to look at how anti-smoking laws are affecting the health of children, researchers from Brigham and Women’s Hospital, Harvard Medical School, the University of Edinburgh, Maastricht University, and Hasselt University found that the introduction of new laws that ban smoking in public places in North America and Europe has been followed by a decrease in rates of premature births and hospital visits for asthma attacks in children. These findings were published in March 2014 in The Lancet.

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LAM Research: From Puzzle to Treatment

Posted by Brigham and Women's Hospital July 2, 2014

Dr. Elizabeth P. Henske, Center for LAM Research and Clinical Care

LAM stands for lymphangioleiomyomatosis, a rare disease that causes extensive cystic destruction of the lungs. LAM can lead to shortness of breath, collapsed lungs, and early death. LAM typically strikes young, non-smoking women. LAM has one of the strongest gender predispositions of all human diseases, occurring almost exclusively in women. As many as 30,000 to 50,000 women worldwide may be suffering from LAM; however, many of these women may be undiagnosed due to the vagueness of symptoms, which include shortness of breath, fatigue, and a lack of energy.

Dr. Elizabeth P. Henske, Director of the Center for LAM Research and Clinical Care at Brigham and Women’s Hospital, describes current treatments for LAM and research focused on identifying new therapies that will not only stop the growth of LAM cells, but will potentially rid the body of LAM cells altogether.

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Deep Vein Thrombosis: A Silent and Life-Threatening Condition

Posted by Brigham and Women's Hospital February 4, 2014

DVT is a blood clot that develops in a deep vein in the body, typically in the pelvis, thigh, or lower leg.

What do long trips, surgery, and pregnancy have in common? They all increase risk of deep vein thrombosis (DVT), a serious condition affecting between one and two million Americans each year.  Other risk factors for DVT include obesity, smoking, oral contraceptive use, cancer, being sedentary, and injury or illness.

DVT is a blood clot that develops in a deep vein in the body, typically in the pelvis, thigh, or lower leg. It often has no symptoms, though it sometimes causes pain, heat, or swelling at the site of the clot. The most serious complication from DVT is pulmonary embolism (PE). For patients stricken by PE, the DVT clot breaks off from the wall of the deep vein, enters the bloodstream, and travels to the lungs, blocking blood flow and causing severe shortness of breath and chest pain. PE can lead to heart failure and to serious kidney and liver damage.  It can be fatal.

“PE accounts for 100,000 to 200,000 deaths per year in the United States alone,” says Dr. Samuel Z. Goldhaber, director of the Thrombosis Research Group at Brigham and Women’s Hospital (BWH) and founder of the North American Thrombosis Forum (NATF). “The good news is that DVT and PE can be treated, if recognized early, and risks can be minimized to prevent these conditions.”

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Lung Cancer – Five Things You Need to Know

Posted by Brigham and Women's Hospital November 25, 2013

A low-dose CT (computed tomography) scan is an important tool for detecting lung cancer early.

Contributor: Pasi Janne, MD, PhD, Director, Lowe Center for Thoracic Oncology at Dana-Farber/Brigham and Women’s Cancer Center and Professor of Medicine at Harvard Medical School.

More than 228,000 new cases of lung cancer will be diagnosed in the United States in 2013, according to the National Cancer Institute.  Dr.  Janne answers some key questions about the disease:

1.    What are the different types of lung cancer?

Lung cancer develops in the tissue of the lung, usually in the cells that line the air passages. There are several types of lung cancer:

  • Non-small cell lung cancer — Non-small cell lung cancer is named for the size of the cells when viewed under a microscope. It begins when epithelial cells inside the lining of the lungs grow rapidly or uncontrollably, often forming a tumor. This is the most common form of lung cancer.
  • Small cell lung cancer — Small cell lung cancer also is named for the size of the cells when viewed under a microscope. Affecting approximately 15 percent of lung cancer patients, it typically starts in the bronchial passages.
  • Mesothelioma — Although it is not technically a lung cancer, mesothelioma shares many of the same symptoms as lung cancer. Malignant mesothelioma is a disease in which cancer cells form in the linings of the organs, most often the pleura and sometimes the peritoneum.

2.    What are the risk factors for lung cancer?

The Centers for Disease Control and Prevention estimates 90 percent of lung cancers are caused by cigarette smoke. However, there also are other risk factors:

  • Smoking pipes or cigars
  • Exposure to second-hand smoke
  • Being treated with radiation therapy
  • Being exposed to asbestos, radon, chromium, nickel, arsenic, soot, or tar. Specifically, exposure to asbestos can increase risk of developing malignant mesothelioma.
  • Living where there is air pollution
  • Family history of lung cancer

3.    What are the symptoms of lung cancer?

Some of the more common symptoms include a cough that does not go away, trouble breathing, chest discomfort, wheezing, hoarseness, and streaks of blood in mucus. Other symptoms can include loss of appetite, weight loss for no reason, and unusual tiredness.

Patients with mesothelioma may notice lumps, pain or swelling in their abdomen, or pain under the rib cage.

4.    How do doctors diagnose lung cancer?

When lung cancer is suspected, patients typically have a CT scan, MRI, or PET/CT scan to produce a detailed image of their lungs. If a mass is detected, either a fine needle biopsy, core needle biopsy, bronchoscopy, or endobronchial ultrasound (EBUS) will be done to remove a piece of tissue from a node or tumor. If necessary, surgeons may remove a tissue sample. If so, a pathologist will examine the tissue to determine whether cancer is present and, if so, the type and stage of the cancer.

5.    What are the treatment options for lung cancer?

In the case of non-small cell lung cancer, patients in early stages first undergo surgery to remove tumors. After surgery, patients may go on to chemotherapy and/or radiation treatments, depending on the stage and type of cancer. In some cases, radiation therapy may be used to eliminate early-stage tumors, instead of surgery.

Patients with small cell lung cancer typically have chemotherapy and/or radiation therapy. This is because the disease often does not have symptoms and is diagnosed at a more advanced stage where surgery would not have an impact on the progress of the cancer. Chemotherapy and/or radiation also are often the first steps for more advanced stages of non-small cell lung cancer.

A combined approach of surgery, radiation therapy, and chemotherapy are used to treat mesothelioma, as there is not one universally accepted standard for treatment of the disease.

Researchers also are developing several new treatment approaches for lung cancer, including immunotherapy and targeted therapy options.  All lung cancer patients at DF/BWCC have their cancer analyzed for several genetic alterations; the results can help identify whether a targeted therapy is the most appropriate treatment. Through clinical trials, some of these new treatments are now available for lung cancer patients. Dana-Farber is currently offering 32 clinical trials for lung cancer and the NCI maintains a list of clinical trials at clinicaltrials.gov.

This post originally appeared on Insight, the blog of Dana-Farber Cancer Institute.

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Great American Smokeout – Benefits of Going “Cold Turkey”

Posted by Brigham and Women's Hospital November 21, 2013

Your health is immediately improved when you quit smoking and these improvements continue for many years.

Today’s post is from Brigham and Women’s Hospital thoracic (chest) radiologist Francine Jacobson, MD, MPH, who specializes in lung cancer prevention and screening. Dr. Jacobson serves as a lung health resource for both her patients and their physicians.

Today marks the 36th annual Great American Smokeout, held annually in the US on the third Thursday in November. Public support for the willpower and the example set by not smoking, even for just one day, is a powerful accomplishment with which to embark on the holiday season – opened by the counting of blessings and overeating on Thanksgiving and closed by resolutions for self-improvement in the New Year.

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LAM: Helping Young Women Overcome a Rare and Debilitating Lung Disease

Posted by Brigham and Women's Hospital November 12, 2013

Dr. Elizabeth Henske is hoping to change the lives of young women suffering from LAM.

Contributor: Dr. Elizabeth Henske, Director of the Center for LAM Research and Clinical Care at Brigham and Women’s Hospital and Professor of Medicine at Harvard Medical School. Her interests include improving diagnosis and development new treatments for LAM and studying the genetics of lung disease.

A young woman is out of breath after walking up a half flight of stairs. Her symptoms appear to be that of emphysema, yet she has never smoked (the leading cause of emphysema). She does not have any risk factors for emphysema, and her chest X-rays appear normal. How could she ever suspect a serious lung disease?

LAM (lymphangioleiomyomatosis) is a rare lung disease caused by a gene mutation that mostly affects women in their childbearing years (ages 20 to 40). The disease begins when abnormal, muscle-like cells from other parts of the body invade the lungs. Once in the lungs, these LAM cells metastasize (grow out of control), eventually destroying normal lung tissue.

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Thornton House: A Home Away from Home

Posted by Brigham and Women's Hospital August 13, 2013

The Thornton House is a refuge for patients being treated for mesothelioma or other severe lung and throat conditions.

Let’s face it. Going to the hospital, especially for lengthy stays, isn’t pleasant for patients or their families.

Not only are they often dealing with serious injury or illness, but they also are feeling the stress and sadness that comes with being away from home. The Thornton House (Mesothelioma House), however, helps resolve some of that unpleasantness by providing a temporary home away from home.

Since 2008, nearly one thousand patients and family members from more than 35 states and eight countries have stayed at the Thornton House. Nestled among a row of quaint houses located just steps away from Brigham and Women’s Hospital (BWH), the home is a convenient, comfortable, and affordable refuge for patients being treated for mesothelioma or other severe lung and throat conditions.

An average visit is approximately 19 days, but one family stayed for more than 10 months. Fortunately, thanks to subsidies from generous donors, the fees for these long-term stays are very affordable.

I once visited the house at 48 Francis Street in 2011 to meet a brave teenager from New Jersey, Brianna Ranzino, and her mother, Lisa Ranzino. Brianna had been through a lot. After undergoing a series of surgeries at hospitals throughout the eastern US, Brianna came to BWH in 2010 for an innovative procedure to remove a large tumor from within her chest wall and repair her trachea and esophagus.

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