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September 27, 1996     Cape Gazette
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September 27, 1996

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,, 38, OAPE- Friday Septembe /20iq,,,, 1996 Melanoma Continued from page 37 whether removing the lymph nodes when the cancer is at a mi- croscopic stage has a survival benefit. Regardless of whether the study will ultimately prove to increase survival rates, the sentinel node biopsy procedure offers patients an accurate measure of the stage of the disease, which in turn deter- mines who can benefit from a par- ticular drug treatment. What is known, he said, is that studies in using interferon, a drug Rheumatologist Continued from page 36 The two primary divisions with- in rheumatology, he said, include inflammatory conditions and soft tissue complaints. Inflammatory conditions may include swollen and tender joints that feel warm andare very painful. Soft tissue complaints usually pertain to the back, shoulders and elbows, said Pando. In either of the two, cases can range from very mild symp- toms to very severe symptoms. With inflammatory conditions, he said, treatments for mild cases may begin with Tylenol. As the condition becomes more severe, drug treatments become stronger. Steroids may be used and eventu- ally patients may require drugs from the chemotherapy family. "The goal is to avoid surgery," said Pando, but if surgery be- comes necessary, rheumatologists make referrals to orthopaedic sur- geons. Soft tissue problems include such conditions as bursitis, ten- donitis, carpal tunnel syndrome, and golfer's or tennis elbow. My- ofascial pain, which involves a deep muscle contraction, is anoth- er common problem, as is fi- bromyalgia, or muscle pain. "There are a lot of people na- tionwide who have fibromyalgia," said Pando. In fact, he said, five to seven percent of the population have symptoms of the disease. Symptoms may include achiness, joint pains, migraine headaches, sleep disturbances and fatigue, low or other back pain, and gas- trointestinal disturbances• In some cases, he said, patients may even experience mild depression• "It presents in various ways," said Pando. "It affects more elder- ly than young people, more fe- males than males." The disease, he said, has many of the same symptoms as sleep apnea. "They go hand in hand sometimes," he said. "The important thing is to differentiate it from sleep apnea." Soft tissue conditions are often treated with more holistic medical approaches. "For soft tissue, there's an important role for chiro- practors and massage therapists," said Pando. Although medication may be a part of treatment, physi- cal therapists, too, are often instru- mental in soft tissue disease treat- ments. With rheumatological condi- tions, unlike with many other dis- used to combat the cancer, has shown a survival benefit for some patients, and the sentinel node biopsy determines which patients are good candidates for the inter- feron treatment. "Interferon basi- cally kills the cancer cells by al- lowing the body's immune system to be more effective," said Spell- man. "At the least, the sentinel node biopsy can be used as a staging procedure for people who could potentially benefit from the use of interferon after having the lymph nodes removed," he said. One re- search project on interferon, he said, studied three groups of peo- eases, little can be done to de- crease risk factors, said Pando. "Most of the conditions are genet- ically induced," he said. "A per- son who has a strong family histo- ry of auto-immune conditions will be at a higher risk of developing one of the diseases that we see, compared to a person who doesn't have a history of auto-immune de- ficiencies." However, Pando said, exercise can be a plus. "Exercise does im- prove conditions," he said, "and swimming is probably the best ex- ercise." Pando uses his personal relationships with patients to per- suade them to engage in good health practices such as exercis- ing. "I love to know the patients in detail because that takes us to a different level in our relation- ship," said Pando. Sometimes, be said, patients will exercise, even if they don't want to, because they don't want to feel that they are disappointing a friend. However, he said, ''he patient is the one who makes the final de- cisions. You offer them the dif- ferent kinds of treatment, and they should be an active part of the de- cision making about which course of therapy should be followed." Pando, a native of Lima, Peru, attended Universidad Nacional Mayor de San Marcos and Univer- sity Autonoma de Guadalajara, where in 1986 he earned his med- ical degree. He is hoard certified in internal medicine and will sit for his rbeumatology board exam- inations in November. He completed a fellowship at Georgetown University Medical Center in June of this year. Dur- ing his tenure at Georgetown, he conducted clinical research with the National Institutes of Health, where from 1993 to 1995 he served as a rheumatology fellow. Pando did his residency at Yale University School of Medicine from 1990 to 1993 in internal medicine and primary care. He al- so studied immunology as a re- search fellow at the University of Miami School of Medicine for two years. Pando is a member of the Peru- vian College of Physicians, the American College of Physicians, the American College of Rheuma- tology and the National Institutes of Health Fellow committee. He has published several papers in professional journals and publica- tions. To make an appointment pie with melanoma. One group had thick lesions - four millimeters or more. The second group had microscopic disease in the lymph nodes, and the third group had obvious, gross signs of the disease. 'q'aken as a whole, the group showed a benefit in survival...and a delay in the re- currence of the disease." Spellman said that although Beebe Medical Center has not been certified to formally partic- ipate in the sentinel node biopsy clinical trial, Cape Region pa- tients may benefit from the proce- dure. "This is up-to-date and on the cutting edge," said Spellman. with Pando in Lewes, call 644- 2633, and in Millsboro, call 934- 5001• Sweet Dreams Continued from page 36 Perhaps he'd had coffee too late in the evening or a late night snack didn't agree with him. "You've got a dozen reasons. You do everything." "In general, people don't bring up sleep problems with their physicians," said Salvatore. How- ever, he said, the recent surge of medical studies on sleep disorders has not only identified a connec- tion between serious medical problems as the direct result of some sleep conditions, it has also paved the way for effective treat- ments. With proper diagnoses and treatments, physicians can offer patients improved general health. Wallace of =Newhart" to share cancer experience To commemorate October as "Breast Cancer Awareness Month,"actress Marcia Wallace will speak at Cape Henlopen High School on Tuesday, Oct. 8 at 7 p.m. in the high school auditorium. Sponsored by the Tunnel Cancer Cen- ter at Beebe Medical Cen- ter, the actress will relate her experience of WALLACE having breast cancer. As a breast cancer sur- vivor, she has been traveling the country speaking to hospital groups, women's groups and com- munities about her experience with breast cancer. Focusing on awareness and early detection, Wallace will discuss the options she faced in terms of treatment and recovery. Best known for her role as Carol Kester on "Bob Newhart Show," Wallacecontinues to act on the stage as well as television. She was nominated for an Em- my Award last year for her work on "Murphy Brown" and is the voice of teacher Ms. Crabapple on "The Simpsons." She has also made guest appearances on sever- al other television shows. Wal- lace's appearance at Cape High is free and open to the public. "This is as new a treatment in melanoma as anyone in the world could have." Spcllman is currently develop- ing a melanoma skin screening clinic. If all goes well, Spellman said the clinic could be operating by the end of October. "If people i have suspicious moles or pig- mented lesions that they're con- cerned about, or if they have a family history of melanoma, they should contact their physicians," he said. "Melanoma, if picked up early, is a curable disease," he said. ASSOCIATES IN MEDICINE, P.A. "Quality Internal Medicine" NANCY A. 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