• 

This week, we learned of the passing of beloved Chadwick Boseman, known for his role in movies such as Black Panter, 42, Marshall, Da 5 Bloods, and many others. I personally learned that in recent months, Chadwick had been bullied on social media for his gaunt appearance. Little did many know, Chadwick was sick. He had been diagnosed with colon cancer stage 3 in 2016, which had progressed to stage 4. He died August 28th, 2020. His weight loss was in fact a consequence of his illness. Before you comment on people’s weight loss, realize that it may be completely unintentional; you never know what people are going through behind the scenes.

Did you know that colon cancer – also known as colorectal cancer – excluding skin cancers, is the third most common cancer diagnosed in both men and women in the United States. There are major health disparities in colon cancer incidence, with non-Hispanic Black individuals experiencing far greater rates of colon cancer than other racial ethnic groups.

“During 2009-2013, CRC incidence rates in
blacks were about 20% higher than those in non-Hispanic
whites (NHWs) and 50% higher than those in APIs. The
disparity for mortality is twice that for incidence; CRC death
rates in blacks are 40% higher than in NHWs and double
those in APIs. Reasons for racial/ethnic disparities in CRC
are complex, but largely reflect differences in socioeconomic
status. According to the US Census Bureau, 24% of blacks
lived in poverty in 2015, compared to 11% of Asians and 9%
of NHWs. People with the least education (used in studies
to estimate socioeconomic status) are 40% more likely to be
diagnosed with CRC than those with the most education.
Close to half (44%) of the socioeconomic disparity is
attributed to differences in the prevalence of behavioral
factors associated with CRC (e.g., smoking, obesity). (See
page 11 for information on risk factors for CRC.) A similar
proportion (42%) of the racial disparity in incidence is
estimated to be due to differences in CRC screening, which
combined with lower stage-specific survival accounts for
about half of the racial disparity in CRC mortality.”

Click to access colorectal-cancer-facts-and-figures-2017-2019.pdf

What is colorectal cancer?

Colorectal cancer often begins as a growth called a polyp inside the colon or rectum. Finding and removing polyps can prevent colorectal cancer. Some cancers start in the colon and others start in the rectum. The majority occur in the colon.

The following information is from the Mayo Clinic. Additional information can be found here: https://www.mayoclinic.org/diseases-conditions/colon-cancer/symptoms-causes/syc-20353669

“Symptoms – What should you look for?

Signs and symptoms of colon cancer include:

• A persistent change in your bowel habits, including diarrhea or constipation or a change in the consistency of your stool
• Rectal bleeding or blood in your stool
• Persistent abdominal discomfort, such as cramps, gas or pain
• A feeling that your bowel doesn’t empty completely
• Weakness or fatigue
• Unexplained weight loss

Causes

Doctors aren’t certain what causes most colon cancers.

In general, colon cancer begins when healthy cells in the colon develop changes (mutations) in their DNA. A cell’s DNA contains a set of instructions that tell a cell what to do.

Healthy cells grow and divide in an orderly way to keep your body functioning normally. But when a cell’s DNA is damaged and becomes cancerous, cells continue to divide — even when new cells aren’t needed. As the cells accumulate, they form a tumor.

With time, the cancer cells can grow to invade and destroy normal tissue nearby. And cancerous cells can travel to other parts of the body to form deposits there (metastasis).

Risk factors

Factors that may increase your risk of colon cancer include:

• Older age. Colon cancer can be diagnosed at any age, but a majority of people with colon cancer are older than 50. The rates of colon cancer in people younger than 50 have been increasing, but doctors aren’t sure why.
• African-American race. African-Americans have a greater risk of colon cancer than do people of other races.
• A personal history of colorectal cancer or polyps. If you’ve already had colon cancer or noncancerous colon polyps, you have a greater risk of colon cancer in the future.
• Inflammatory intestinal conditions. Chronic inflammatory diseases of the colon, such as ulcerative colitis and Crohn’s disease, can increase your risk of colon cancer.
• Inherited syndromes that increase colon cancer risk. Some gene mutations passed through generations of your family can increase your risk of colon cancer significantly. Only a small percentage of colon cancers are linked to inherited genes. The most common inherited syndromes that increase colon cancer risk are familial adenomatous polyposis (FAP) and Lynch syndrome, which is also known as hereditary nonpolyposis colorectal cancer (HNPCC).
• Family history of colon cancer. You’re more likely to develop colon cancer if you have a blood relative who has had the disease. If more than one family member has colon cancer or rectal cancer, your risk is even greater.
• Low-fiber, high-fat diet. Colon cancer and rectal cancer may be associated with a typical Western diet, which is low in fiber and high in fat and calories. Research in this area has had mixed results. Some studies have found an increased risk of colon cancer in people who eat diets high in red meat and processed meat.
• A sedentary lifestyle. People who are inactive are more likely to develop colon cancer. Getting regular physical activity may reduce your risk of colon cancer.
• Diabetes. People with diabetes or insulin resistance have an increased risk of colon cancer.
• Obesity. People who are obese have an increased risk of colon cancer and an increased risk of dying of colon cancer when compared with people considered normal weight.
• Smoking. People who smoke may have an increased risk of colon cancer.
• Alcohol. Heavy use of alcohol increases your risk of colon cancer.
• Radiation therapy for cancer. Radiation therapy directed at the abdomen to treat previous cancers increases the risk of colon cancer.

Prevention

Screening colon cancer

Doctors recommend that people with an average risk of colon cancer consider colon cancer screening around age 50. But people with an increased risk, such as those with a family history of colon cancer, should consider screening sooner.

Several screening options exist — each with its own benefits and drawbacks. Talk about your options with your doctor, and together you can decide which tests are appropriate for you.

Lifestyle changes to reduce your risk of colon cancer

You can take steps to reduce your risk of colon cancer by making changes in your everyday life. Take steps to:

• Eat a variety of fruits, vegetables and whole grains. Fruits, vegetables and whole grains contain vitamins, minerals, fiber and antioxidants, which may play a role in cancer prevention. Choose a variety of fruits and vegetables so that you get an array of vitamins and nutrients.
• Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount of alcohol you drink to no more than one drink a day for women and two for men.
• Stop smoking. Talk to your doctor about ways to quit that may work for you.
• Exercise most days of the week. Try to get at least 30 minutes of exercise on most days. If you’ve been inactive, start slowly and build up gradually to 30 minutes. Also, talk to your doctor before starting any exercise program.
• Maintain a healthy weight. If you are at a healthy weight, work to maintain your weight by combining a healthy diet with daily exercise. If you need to lose weight, ask your doctor about healthy ways to achieve your goal. Aim to lose weight slowly by increasing the amount of exercise you get and reducing the number of calories you eat.

Colon cancer prevention for people with a high risk

Some medications have been found to reduce the risk of precancerous polyps or colon cancer. For instance, some evidence links a reduced risk of polyps and colon cancer to regular use of aspirin or aspirin-like drugs. But it’s not clear what dose and what length of time would be needed to reduce the risk of colon cancer. Taking aspirin daily has some risks, including gastrointestinal bleeding and ulcers.

These options are generally reserved for people with a high risk of colon cancer. There isn’t enough evidence to recommend these medications to people who have an average risk of colon cancer.

If you have an increased risk of colon cancer, discuss your risk factors with your doctor to determine whether preventive medications are safe for you.”

Colorectal cancer can be treated and survival rates are high if caught early. I realize many are worried about health checks during the COVID pandemic, but if you are due for a check or have any of the symptoms mentioned above, make sure you don’t delay those health checks.

One of my favorite things to do all year is watch my boys play rec little league baseball. They love it, they’re good at it, they have fun, and overall it’s a great way to get some physical activity and socialization in.

A lot changed when COVID-19 became a worry in our lives five months ago. One of the thing that changed the most for my kids – and other kids across the US – was that they were unable to play baseball for some time. While little league baseball did eventually resume, we opted out for the remaining of the season this summer. The main reason: I wanted to see what safety measures were going to be put into place, considering local numbers.

As we contemplate a return this fall, I wondered, what are the recommendations for a return to play? While the NCAA has issued guidance for collegiate sports, less was known about what recreational leagues should do to safely resume play. Several teams across the US reported cases among kids and coaches, both in rec leagues of all ages (eg, here, here, and here to list a few) and in collegiate sports. Unfortunately, no teams at the recreational level are implementing sentinel testing, so teams have to rely on self-report of covid-positive status and or symptoms. We know now that kids of all ages are susceptible to covid, but can also transmit it, but most importantly, that asymptomatic spread is a major concern for COVID-19.

All summer I looked for guidance, only to find very limited information about what should and should not happen upon resumption to play. Luckily, a league from Mercer Island (MI) in Washington State came up with some guidance that has since been adapted by the national Little League organization. Two main documents you should read (and share with your local leagues) are:

Best Practices for Creating a Local Little League® Social Distancing Plan

and

Mercer Island Little League Social Distancing Plan

Among the main points:

• Regular cleaning and disinfecting of shared equipment and surfaces
• Spreading out of schedules for practices and games (to minimize crowding and overlapping teams/individuals at one time)
• Limiting spectator attendance (streaming games or keeping up with games via GameChanger recommended)
  • All spectators should follow best social distancing practices — stay six feet away from individuals outside their household; wear a cloth face covering; avoid direct hand or other contact with players/managers/coaches during play.
  • Local Leagues may choose to minimize the exposure risk to spectators by limiting attendance to only essential volunteers and limited family members.
  • Spectators should bring their own seating or portable chairs when possible
• Bathrooms: “one-in-one-out” bathroom policy (with regular disinfecting/cleaning in between uses)
• No concession stands; families encouraged to provide their own food/drink
• Players should not use the dugout unless 6′ distancing between players inside the dugout is possible
• Meetings at the plate should be eliminated OR 6′ distancing should be implemented, with masks on
• Practices should be limited to the managers/coaches and players
• Press boxes should not be utilized
• No handshakes at end of game; no huddling at culmination of game
• IF dugouts are used: players should wear cloth face coverings when in close contact areas and in places where recommended social distancing is challenging or not feasible, such as in dugouts

We all want life to return to normal. Recreational sports brings communities together, but can also be a source of infection if people are not careful. Proper safety regulations are therefore necessary to avoid further spread of COVID-19, especially in states where case numbers remain high. To engage in activities like outdoor sports like little league baseball while implementing harm reduction strategies, for example, you must:

1. Avoid crowds: doable with crowd control regulations.

2. Avoid close contact: doable with physical distancing.

3. Avoid closed spaces: sports is outdoors, but you have to worry about and try to avoid bathrooms, carpools, press boxes, dugouts (especially non-well ventilated ones), indoor dining after sports, and concession stands (if any are indoors, but especially for workers).

4. Wash your hands frequently: Hard to do in park bathrooms safely, so consider having hand sanitizer available.

5. Wear your mask: Especially when 6′ distance between players/spectators/coaches, etc cannot be maintained.

6. Watch your distance: Physical distancing between all individuals at the park is essential, especially between people who are not from the same household.