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New cancer diagnosis? 5 questions to ask your doctor.

Few people are prepared for a cancer diagnosis. Hearing the words ‘you have cancer’ can bring a range of emotions, thoughts and worries. No matter the type of cancer or the stage, there are a few questions that can help you clarify the direction of your care, ease fears and provide a sense of control through what is an often-confusing and complicated process.

1.      “Who is going to be my quarterback?”

Determining the leader who will guide you through the treatment and help you make key decisions about your care is the first priority. The physician who gave you the diagnosis may not be the person who will ultimately be responsible for the direction of your care. The field of cancer care is changing rapidly, and it’s critical to choose a physician who not only specializes in your specific type of cancer but is also passionate about the latest treatments and technologies that will help you win the battle against this disease.

2.      “What is the timeline for beginning treatment?”


Two weeks from diagnosis to treatment is a reasonable goal, although it sometimes takes longer. After diagnosis, there are often many tests, imaging studies and biopsies needed to make an accurate diagnosis. During these early weeks of testing, you will need to dedicate a significant amount of time and make arrangements to your schedule to keep this process moving. Unless you set a timeline, it’s easy for the days and weeks to pass without a clear understanding of the next steps. That’s why it’s important to talk about when treatment will start from the very beginning. It will help hold the medical system accountable for acting in a timely manner and provide greater peace of mind for you and your family.

3.      “What is the detailed name and stage of my tumor?”


This is a question that won’t be answered immediately but is nonetheless very important to keep in mind. Knowing the exact name of your tumor will allow you to more accurately discuss treatment options and put the stage of disease into perspective. Understanding if your cancer is in an early stage, middle of the road, or late stage will drastically impact the course and nature of your treatment. This detailed information should be determined in the initial two-week timeline.  

4.      “Where will I be receiving treatment?"

When you select a physician to lead your cancer team, you’re also making a decision about the medical center where you’ll receive treatment. Not every hospital or treatment center does every specialty well. Cancer specialists are generally affiliated with one system, meaning you’ll interact with that system regularly throughout your treatment – whether it’s for routine blood work, imaging studies to help gauge the effectiveness of treatment, or provide hospital-based care if needed. If surgery is a likely part of your treatment plan, don’t leave the office before knowing where you will have your operation.

5.      “What can I do?”


Most people are relieved to hear that they can do a lot when it comes to preparing for cancer treatment. Although there are many things that will be out of your control, it’s important to focus on what you can control. The first thing I recommend is making a change to your diet, choosing foods that will support your immune system and help you prepare nutritionally for the treatment to come. If you don’t exercise regularly, it’s time to start. For those with lung cancer, activating and strengthening the diaphragm muscles is critical to an optimal recovery. Because your immune system will take a hit with treatment, be diligent in washing and minimizing your exposure to germs. Lastly, now is the time to identify the people – whether it’s family, friends or coworkers – that you can lean on and who will support you during this fight.

For anyone facing a cancer diagnosis, the first reaction is nearly always a feeling of helplessness – and it’s an understandable feeling. I encourage anyone diagnosed with cancer to take an active role – to ask questions, do their research and advocate for the most advanced treatment options. I always remind my patients that they have knowledge at their fingertips and a say so in their team and treatment plan. That’s why choosing the right team and having these basic questions answered is so important. It’s these details that will help you and your family make informed decisions and receive the care that’s right for you.

J. Rob Headrick, MD

Can you boost your immune system? 

Walk into any health food store or local retailer, and you’re likely to see many products that claim to support or improve immunity. It’s true that as we age, our immune response decreases, which may contribute to more infections. People are living longer than ever before, and along with that comes the rise in age-related health conditions.

For people who have been diagnosed with cancer, maintaining and supporting a healthy immune system is even more important as your body works extremely hard to fight cancer cells. Cancer treatment affects your body’s ability to fight infection, so being proactive by choosing the right foods and protecting yourself from germs is key.

The Building Blocks of a Healthy Body

Our bodies need a variety of nutrients to function optimally. Macronutrients are the types of food that your body needs in large amounts to help you feel your best. These include carbohydrates, fat and protein.

Carbohydrates are the body’s main source of energy. Healthy sources include starchy vegetables like potatoes, sweet potatoes, beets and corn; beans and lentils; fruits like apples, bananas, berries, oranges and pears; and whole grains like brown and white rice and oats.  

Fats are used by our bodies to help absorb some vitamins (A, D, E, and K are fat soluble, meaning they can only be absorbed when fat is available in a person’s diet). They’re also the building blocks of our hormones and protect the body’s nervous system tissues. Getting enough is essential for growth and development, but not all fats are created equal. Healthy sources of fat include seed like chia, flax and pumpkin; nuts like almonds, walnuts, cashews; olives and olive oil; avocado; and fatty fish like salmon or trout.

Protein provides the building blocks for cell and muscle structures – including your bones, cartilage, hair, skin and blood. The body uses protein to build and repair tissues and supports a healthy immune system. Good sources of protein include eggs; fish and seafood like crab, oysters, salmon, shrimp, tuna and white fish; poultry; lean pork, beef and lamb; and tofu.

Say “Yes” to Super Foods

Some foods pack an especially powerful nutrient-rich punch. Although we don’t know if they specifically improve your immune system’s response, they are chocked full of the essential nutrients we do know your body needs.

Strawberries – For only 50 calories per cup, this sweet swing treat meets the daily vitamin C needs for most adults, which helps your body repair damaged tissue. One key antioxidant in berries is anthocyanin, which may also reduce the risk for heart attacks in some women.

Oats – A study by the Journal of the American College of Nutrition found a bowl of warm, fiber-rich oatmeal satisfies you more than cold cereal does. The filling fiber, called beta-glucan, may also lower cholesterol.

Chia seeds – Tiny, but mighty, chia seeds contain omega-3 fatty acids, fiber, protein, antioxidants and minerals. When included in a healthful diet, research suggests they may help lower blood pressure, cholesterol and triglycerides, a type of fat found in your blood. Sprinkle ground or whole sees on cereal, rice or yogurt.

Asparagus – This versatile veggie may help prevent cancer – each serving dishes up antioxidants that could reduce your risk. It’s also rich in vitamins A and K.

Leafy greens – Spinach, kale, swiss chard, collard greens and mustard greens are a good source of vitamins A and C, calcium, and several chemicals produced by plants that positively impact your health. These greens also add fiber, protein and several antioxidants to your diet.

Salmon – The 2015-2020 Dietary Guidelines for Americans (link source), recommends you eat seafood at least two times a week. This heart-healthy fish includes significant amounts of omega-3 fatty acids, protein, vitamin B-12 (important of healthy blood and nerve cells), vitamin D, selenium and vitamin B-6 (which has been shown to support nervous and immune systems).

Your immune system’s job is to protect you from infectious agents that exist in our environment. People who are malnourished are at a greater risk of contracting infectious diseases, which can be especially dangerous for people with cancer. Although we don’t fully understand it, there seems to be a connection between nutrition and healthy immunity. If you’re fighting cancer (or love someone who is), proper nourishment is critical in maintaining your health and strength now and in the long term. 

Strengthen Your Immune System with a Healthy Lifestyle

You’ve heard it before, and you’re hear it again – choosing a healthy lifestyle is the best way to keep your body in top condition. At any or stage of life, these healthy living strategies will help you feel better inside and out:
  • Exercise regularly.
  • Eat a healthful diet that includes fruit and vegetables at every meal.
  • Maintain a healthy weight.
  • Prioritize sleep.
  • Minimize stress where possible.
  • Don’t smoke or stop smoking if you do.
  • Wash hands regularly and cover your mouth when you cough.
  • Drink alcohol in moderation.

J. Rob Headrick, MD

Source: https://health.gov/dietaryguidelines/2015/guidelines/

Smoking cessation. Finding what works for you

Smoking and tobacco use is a major risk factor for many kinds of cancer – including lung cancer and every oral cancer such as mouth, lips, tongue, larynx, sinuses and tonsils. But the addiction to smoking is real – it’s considered one of the most difficult habits to break. Although most people understand many of the health risks associated with smoking, they still find it extremely difficult to quit. Family members of my patients often ask about strategies or classes or medications. Unfortunately, the motivation to quit must come from the smoker themselves, not out of obligation or to please another person.

To quit smoking once and for all, you need a valid reason. This could be a decision you make to better your health overall, or a desire to stop coughing in the morning when you wake up, or to see your granddaughter grow up and participate in her life. This reason is different for every person.

Quitting smoking is hard, and smokers enjoy their smoke breaks. They like drinking and smoking with other smokers. Husbands and wives enjoy sitting on their back deck and smoking together. That’s why asking anyone to quit smoking is really difficult. Like a recovering alcoholic who wouldn’t hang out in a bar at happy hour, giving up smoking means changing the places you go and the things you do.

Anyone who’s quit smoking knows it’s not easy, and there’s no one way to quit. You have to find what works best for you. Here are a few tips that can help make that transition from smoker to non-smoker a little easier.

  1. Set yourself up for success. That means surrounding yourself with people who understand and support what you’re trying to do. Enlist your friends and family members to help keep you accountable.
  2. Change your environment. Old habits are hard to break. Limit or avoid altogether the places you usually smoke and find something to hold or do that serves as a distraction when you would normally reach for a cigarette.
  3. Occupy your brain (and your hands). Sitting still and muscling through a craving isn’t going to work for most people. Some hold toothpicks or pencils in their hands. Use gum to keep your jaw moving. When smoking is your first instinct, take a walk around the block. Exercise has been shown to reduce or alleviate the impulse to smoke when you are in the heat of a craving.
  4. Remove all forms of temptation. There’s no need to hold onto that last pack of cigarettes. If you’re tempted to smoke, it will be too easy to reach into your desk draw in a moment of weakness. If you have to drive to the store first, you’ll have time to reconsider.
  5. Use prescription drugs wisely. There’s no medication that will cause you to quit if your mindset hasn’t changed. But when you’ve made a serious commitment to quit, medications are available to help support you and make the transition more manageable.
  6. Consider a class. Just like group exercise classes that hold you accountable in your weight loss journey or an AA meeting for those struggling with alcohol addiction, it’s better if you don’t do it alone.

CHI Memorial’s Rees Skillern Cancer Institute offers the American Lung Association’s Freedom From Smoking program, ranked one of the most effective programs in the country. CHI Memorial leads the eight-session program that includes step-by-step plans for quitting smoking and teaching evidence-based techniques that can be tailored for each individual.  Freedom From Smoking covers every aspect of quitting – including the health benefits of quitting, recognizing triggers, helpful relaxation therapies and an open forum to talk about the stress that quitting can cause.

Are you ready to make that first step and quit smoking for good? Call the Rees Skillern Cancer Institute at (423) 495-7778 today to learn available classes in your area.

J. Rob Headrick, MD

Esophageal Cancer

We all know someone who lives with constant heartburn and indigestion. More than just the irritation that acid reflux or gastroesophageal reflux disease (GERD) can cause, these conditions may lead to a much more serious health issue – esophageal cancer. An estimated 150 million people have acid reflux, which puts a large portion of the population at risk for eventually developing the disease. That’s why controlling the effects of acid reflux or GERD is about more than alleviating pain and discomfort – it’s about cancer prevention, too. 

Many people ignore the symptoms of acid reflux or think it’s something they just have to live with. Since there is no recommended screening for esophageal cancer, the discovery of disease is led by symptoms. There’s one sign in particular that shouldn’t be ignored – difficulty swallowing.

Food getting stuck in your esophagus doesn’t necessarily mean cancer – you may be experiencing a stricture or narrowing due to another cause. As the condition worsens, people often change their eating habits without realizing it. Any change in your ability to swallow is a preliminary sign warning sign for esophageal cancer that should be evaluated right away. 

Why is this kind of cancer on the rise?

When you go back 50 years, most esophageal cancers were a different type and in a different location than we are seeing today. Squamous cell carcinoma, which usually occurs in the middle of the esophagus, was due in part to nitrates in meats and preservatives in other foods. Excessive alcohol use and smoking were almost always associated.

Today, nearly all the esophageal cancers are adenocarcinomas – located at the bottom of the esophagus and directly related to acid reflux and the rise of obesity. There’s a been change in the last 30 years in the number of people who are obese and in the way people eat. Along with an increase in caffeine, chocolate, alcohol, and fatty food consumption, people are eating food in larger quantities. These factors could be leading to an evolutionary change that’s having an impact on the number of people diagnosed.  

Digging a little deeper, there’s a valve at the bottom of the esophagus that connects to the stomach and keeps the acid inside contained. It’s called the lower esophageal sphincter. When this valve doesn’t function properly, it stays open and allows acid reflux to occur. People feel this when they eat a huge meal, burp or have indigestion. It usually feels even worse when you lie down because gravity is working in the wrong direction, letting acid move upward.

Some people are born with a dysfunctional esophageal sphincter, which also allows the stomach acid to creep up – and we don’t know what causes it to happen. But no matter the reason – a deformity or as a result of poor eating habits – we do know when acid comes from the stomach into the esophagus and throat repeatedly, you’re more like to develop a condition called Barrett’s Esophagus. This precancerous condition causes the normal lining of the esophagus to change – resembling more closely the lining of the intestines. When you have Barrett’s Esophagus, you’re at increased risk of developing esophageal adenocarcinoma.

When should I see a specialist?

If you have a sore throat, you know something isn’t right. When you twist an ankle, you know it needs attention. But if you wait for those typical warning signs of pain in the lungs or esophagus, it’s going to be too late for effective treatment. No one can feel those types of sensations in their chest, and that’s what makes early detection so difficult.

It’s important to see a gastrointestinal specialist immediately for further evaluation if you:

  • have a history of cancer, especially cancers of the chest, and are living with constant heart burn or GERD.
  • have heart burn and food isn’t going down like it should. Trouble swallowing is never normal and should evaluated.
  • experience discomfort or pressure in your chest or worsening heartburn and indigestion that isn’t helped by a change in diet or medication.
  • are constantly hoarse or have a chronic cough in combination with acid reflux.

Most of the time, esophageal cancers don’t cause symptoms until they are in an advanced stage – when they are more difficult to treat. Paying more attention to subtle changes is the first step in finding – and beating – this disease.  

J. Rob Headrick, MD

Lung Cancer Stages: A Simple Explanation

If you’ve been recently diagnosed with lung cancer or know someone who has, the topic of staging has likely come up in the conversation. Correct staging is important and different for each type of cancer. What methods we use to treat lung cancer depends on where the cancer began and where it’s moved inside the body. Doctors determine staging through a history, physical and imaging studies.

Because lung cancer is complicated – and emotional – my goal is to talk with my patients and have a two-way conversation about treatment rather than give a speech about staging and treatment modalities. The easiest way to think about cancer staging is to imagine a city like Chattanooga.

If we find the cancer when it’s in the city limits of Chattanooga – or confined to one specific location – this is stage 1. The cancer is within the boundaries of one area, and it’s fairly straightforward to remove the cancer completely with surgery.

Stage 2 is similar to Stage 1 in terms of where the cancer has moved. The cancer is still within one main area like the city center but has begun to move to one or more of the surrounding communities like East Ridge or Signal Mountain. Within Stage 2, the cancer has moved to these areas through well-defined pathways (no back roads were taken). Again, surgery is the first approach to treatment.

Things get a little more complicated at Stage 3. The cancer cells that were originally in Chattanooga have moved farther down the road – to Dalton or Nashville or Knoxville. But in this stage, the cancer hasn’t necessarily stayed on the interstates. In fact, it’s likely used many backroads, with twists and turns we can’t predict and are harder to contain. It’s in Stage 3 that the benefits of surgery begin to fall off, and we think about chemotherapy or radiation therapy as our first line of treatment. Sometimes surgery is used later after these methods have done their work.

In Stage 4 lung cancer, what started in Chattanooga has now traveled a long distance – to Chicago, or Los Angeles or New York. Because of the multitude of ways to travel and the miles in between each location, cancer that has spread this far is much harder to treat. In this stage, chemotherapy is our main line of defense. 

Proper Staging Leads to Effective Treatment
Staging is a valuable tool that sets the benchmark or standard for determining your ability to fight cancer and the best treatment options. I work with each of my patients to help them understand their cancer in simple terms and find a way to fight it most effectively. What we do is personalize care.

If you’ve received a diagnosis you don’t understand, we’d like to talk with you. Call our Second Opinion Clinic at (423) 495-5864 (LUNG) to schedule an appointment.  

J. Rob Headrick, MD

Esophageal Cancer

We all know someone who lives with constant heartburn and indigestion. More than just the irritation that acid reflux or gastroesophageal reflux disease (GERD) can cause, these conditions may lead to a much more serious health issue – esophageal cancer. An estimated 150 million people have acid reflux, which puts a large portion of the population at risk for eventually developing the disease. That’s why controlling the effects of acid reflux or GERD is about more than alleviating pain and discomfort – it’s about cancer prevention, too. 

Many people ignore the symptoms of acid reflux or think it’s something they just have to live with. Since there is no recommended screening for esophageal cancer, the discovery of disease is led by symptoms. There’s one sign in particular that shouldn’t be ignored – difficulty swallowing.

Food getting stuck in your esophagus doesn’t necessarily mean cancer – you may be experiencing a stricture or narrowing due to another cause. As the condition worsens, people often change their eating habits without realizing it. Any change in your ability to swallow is a preliminary sign warning sign for esophageal cancer that should be evaluated right away. 

Why is this kind of cancer on the rise?

When you go back 50 years, most esophageal cancers were a different type and in a different location than we are seeing today. Squamous cell carcinoma, which usually occurs in the middle of the esophagus, was due in part to nitrates in meats and preservatives in other foods. Excessive alcohol use and smoking were almost always associated.

Today, nearly all the esophageal cancers are adenocarcinomas – located at the bottom of the esophagus and directly related to acid reflux and the rise of obesity. There’s a been change in the last 30 years in the number of people who are obese and in the way people eat. Along with an increase in caffeine, chocolate, alcohol, and fatty food consumption, people are eating food in larger quantities. These factors could be leading to an evolutionary change that’s having an impact on the number of people diagnosed.  

Digging a little deeper, there’s a valve at the bottom of the esophagus that connects to the stomach and keeps the acid inside contained. It’s called the lower esophageal sphincter. When this valve doesn’t function properly, it stays open and allows acid reflux to occur. People feel this when they eat a huge meal, burp or have indigestion. It usually feels even worse when you lie down because gravity is working in the wrong direction, letting acid move upward.

Some people are born with a dysfunctional esophageal sphincter, which also allows the stomach acid to creep up – and we don’t know what causes it to happen. But no matter the reason – a deformity or as a result of poor eating habits – we do know when acid comes from the stomach into the esophagus and throat repeatedly, you’re more like to develop a condition called Barrett’s Esophagus. This precancerous condition causes the normal lining of the esophagus to change – resembling more closely the lining of the intestines. When you have Barrett’s Esophagus, you’re at increased risk of developing esophageal adenocarcinoma.

When should I see a specialist?

If you have a sore throat, you know something isn’t right. When you twist an ankle, you know it needs attention. But if you wait for those typical warning signs of pain in the lungs or esophagus, it’s going to be too late for effective treatment. No one can feel those types of sensations in their chest, and that’s what makes early detection so difficult.

It’s important to see a gastrointestinal specialist immediately for further evaluation if you:

  • have a history of cancer, especially cancers of the chest, and are living with constant heart burn or GERD.
  • have heart burn and food isn’t going down like it should. Trouble swallowing is never normal and should evaluated.
  • experience discomfort or pressure in your chest or worsening heartburn and indigestion that isn’t helped by a change in diet or medication.
  • are constantly hoarse or have a chronic cough in combination with acid reflux.

Most of the time, esophageal cancers don’t cause symptoms until they are in an advanced stage – when they are more difficult to treat. Paying more attention to subtle changes is the first step in finding – and beating – this disease.  

J. Rob Headrick, MD

The dangers of radon. Are you at risk?

Radon is an odorless, colorless gas that is a natural by-product of our environment and soil. It’s produced by decaying uranium and is found in nearly all types of soil. It’s also the second leading cause of lung cancer behind smoking.

Radon can’t be seen or tasted, and you don’t feel its effects – just like the radiation you get from an x-ray. Radiation exposure, like filling up a bathtub, is cumulative. Every radiation exposure adds up over time. When you travel to a higher elevation or fly in an airplane, you’re being exposed to background radiation. Although these small exposures aren’t dangerous, with enough unique exposures the bathtub will overflow.

The biggest challenge with radon is that we don’t see or feel it, and many people don’t know to check for it. Because the amount of radon seeping into your home is likely different than your next-door neighbor, you can’t assume you’re safe. In fact, the Tennessee Department of Environment and Conservation considers radon a serious problem, no matter what county you live in.

Click here for a map of radon zones in Tennessee, based on Environmental Protection Agency Data.

According to the EPA, any radon exposure has some risk of causing lung cancer. Although no amount of radon exposure is considered safe, they’ve set a standard of 4 pCi/L, or picocuries per liter of air. The EPA recommends when radon levels of 2 – 4 pCi/L are present in your home, corrective measures should be taken. The lower level of radon in your home the better, and no amount is considered safe.

A Simple Test

Testing is the only way to know the radon level in your home. Any time you’re buying a home, an inexpensive radon test can tell you a home’s specific radon levels. Radon testing is required in most residential real estate purchases, and it will help you make a decision about whether to purchase the home or if specific radon mitigation must be done to reduce exposure. Many radon problems can be fixed through DIY methods, or you can seek help from a certified radon mitigator.

To learn more about the harmful effects of radon and what to do to protect yourself, visit TN.gov and search “Tennessee Radon Program.” You can also request a free radon test.

Even though we can’t see or feel radon, its effects are real and can lead to lung cancer. Many people have died because they didn’t know they were at risk. Don’t wait – take this free and easy step to protect your and your family’s health today.

J. Rob Headrick, MD

What is a collapsed lung and who is at risk?

For many people, the thought of lung surgery brings up fears and thoughts of worry about a collapsed lung. People often have misconceptions about a collapsed lung because they oversimplify this complex organ. Lungs are less like a balloon and more like a sponge.  They feel spongy because of the millions of alveoli inside them. Alveoli are tiny air sacs that diffuse oxygen. When we breathe in, our lungs expand and filter the oxygen from the air and pass it into our blood. When we exhale, our lungs release carbon dioxide, a gas that your body makes but doesn’t need.

A collapsed lung is when air escapes from the lung and fills the space between the lung and the chest wall. This build up air puts pressure on the lung, keeping it from expanding like it should when you take a breath. A collapsed lung can result from trauma to the chest, broken ribs, a stab wound or bullet, a hard hit in a contact sport like football or a medical procedure like a lung biopsy or central line placement.

In some cases, a collapsed lung is caused by air blisters (blebs) that break open, sending air into the space around the lung. When a collapsed lung occurs, there’s not a popping effect. It’s more like a nail in your tire that slowly releases pressure over time. When the lung is inadvertently punctured, a person may experience chest pain, shortness of breath, fatigue, rapid breathing and heartbeat, and a cough.   

The slow buildup of air in the chest makes it harder to breathe – and it’s important to seal the leak quickly and get the air back inside the lung. Sometimes the lung will re-inflate on its own and make the repair with little intervention. The human body is amazing in its ability to solve its own problems. In these cases, we put in a tube to take the leaked air out of the body, which reduces the pressure on the lung, allowing it to close itself.  

Other non-surgical methods to correct a collapsed lung include supplemental oxygen or needle aspiration to remove air in the chest with suction. When it’s not able to heal through one of these methods, we can go in surgically to remove the damaged area and seal it back up.

People who are at greater risk of a collapsed lung include those with underlying lung conditions like COPD, cystic fibrosis, lung cancer, asthma, emphysema and certain types of pneumonia.  Although there is no way to prevent a collapse lung, you can decrease your risk by quitting smoking or choosing not to smoke.

J. Rob Headrick, MD



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Esophageal cancer

CHI Memorial Buz Standefer Lung Center offers information about protecting your lungs, lung disease warning signs and more