New Screening Recommendations

  • hiermedia
  • June 8, 2018

Every 10 minutes, a person dies from colorectal cancer. With the recent change in recommendations from the American Cancer Society to begin screening for colorectal cancer at the age of 45 instead of 50, we could see a positive change in this number.  The new guidelines published in CA: A Cancer Journal for Clinicians was sparked by research noting, despite overall decreases in the number of deaths from colorectal cancer over the past 25 years, there has a been a 50% rise in rates in those under 50. Other studies have shown those born in 1990 have twice the risk of being diagnosed with colon cancer and 4 times the risk of being diagnosed with rectal cancer. Of those diagnosed under the age of 50, nearly 50% are 45-49 years of age.  Fifty has been the recommended start age for screening in average risk patients, causing many of these patients to unsuspectingly “miss the boat” and be diagnosed too late with more advanced disease being found at the initial presentation.

Colorectal cancer is preventable. It begins as a polyp, which is a small bump formed along the inner lining of the large intestine. If left to grow, these polyps can enlarge, become cancerous, and spread through the intestine to the blood stream, nearby structures, and even distant organs. If diagnosed early, 5-year survival can be up to 95%; however, in cases where the cancer has spread to other areas of the body, survival may be less than 20%.  The goal of colorectal cancer screening is to find and remove these polyps before they reach this stage.

The recently released guidelines suggest doctors offer a choice of screening options to maximize the chance patients will actually undergo screening, While a colonoscopy every 10 years has traditionally been the most commonly recommended colon screening test, several other screening options are recommended in the guidelines: fecal immunochemical test every year; guaiac‐based fecal occult blood test every year; stool DNA test every 3 years; CT colonography every 5 years; and flexible sigmoidoscopy every 5 years. Each of these test have strengths and weaknesses. Patients should discuss these various screening options with their healthcare providers, as ultimately the best test is the test the patient will actually undertake.

This new recommendation of initiating screening at 45 instead of 50 does not change the fact that regardless of age, if symptoms of bleeding, pain, or unexplained changes in bowel habits or weight are present, a colonoscopy should be performed. Also, if a first-degree family member was diagnosed at an early age, screening should begin 10 years before the age of the affected family member. Additionally, this recommendation does not ensure automatic changes in what the various health insurers will pay.  Other national organizations still recommend screening for average risk patients at 50. Even more, the change in recommendations does not answer the “why” in the increase of colorectal cancer in younger patients. But, ultimately, this change presents opportunities to find and remove more precancerous polyps and earlier-staged cancers, thereby decreasing the numbers of patients dying from this preventable disease.

Learn more and see an interactive video here

One Diagnosis Away

  • hiermedia
  • October 19, 2017
“How far you go in life depends on your being tender with the young, compassionate with the aged, sympathetic with the striving and tolerant of the weak and strong. Because someday in your life you will have been all of these.” —George Washington Carver

Earlier this week, I walked into the exam room and introduced myself to a 48-year-old male.  As I generally do, I sat in front of him and asked “how can I help you today?” We talked about bleeding that started one month ago, discussed his concerns about only having a bowel movement every other day and his mother’s bout with colon cancer in her 60’s. We proceeded to the physical exam. During the digital rectal exam, I felt a large, firm, and fixed rectal mass that told me his life was about to change. Now it was my job to tell him how.

I appreciate just how tough it is to be a patient. Fortunately, for most, good health has been their norm, taken for granted while going through life without ever seeing a doctor. Perhaps they suddenly begin having problems they had never experienced (seeing blood on the toilet paper, feeling abnormally tired after a daily walk, or a gnawing abdominal pain they can no longer ignore); symptoms, which eventually prompt a visit to a doctor. For others, an abnormality is discovered during a routine exam (i.e. colonoscopy, mammogram, an EKG). With diagnoses such as colorectal and breast cancer, patients must adapt to a new normal that includes frequent office visits, periods of hospitalization, and in some cases, suddenly facing life-altering treatments and even their mortality.

A friend and colleague bravely shared with me her early writings as she begins to process her experience of being diagnosed with breast cancer at the exact time she had hoped to start a family. With a single diagnosis, her future was forever altered. A surgeon who operates on patients with lung cancer, she found herself looking at the operating room lights from a different angle as she underwent bilateral mastectomies with reconstruction. Having always sported a thick mane of curls, her hair loss following chemotherapy is a powerful symbol of her new reality. She was anxious to return to work with a scrub cap thinly veiling her bald scalp. As she described her fears, “I am bald. I can’t hide it anymore and I am terrified of everyone’s reaction. I was and I am scared of the fact that my cancer can come back and kill me, that I may never be able to have children, that the future that I have carved so carefully for myself is so uncertain because my own body betrayed me.”

It is common for patients to feel this sense of betrayal: sometimes from their body. Sometimes from God. Patients have cried, become silent, or even angry when I have given results indicating a diagnosis of cancer. Unable to fix everything in that moment, I sit with their silence. Hand them a tissue and wait. Most patients want answers and a cure. While I generally enter these patient encounters with the goal of finding a cure and full recovery of whatever ailment may be present, there are times I am often forced to care for the patients in other ways, usually with the goal of alleviating suffering. With time, most patients process and reframe their future and transition to an active member of their treatment team.

We are all just one diagnosis away from a different reality. My interactions with patients, and now the diagnosis of a close friend and colleague compel me to consider my own reaction if faced with similar circumstances. How would I respond to a life-changing diagnosis? Above all else, I would want my physician to possess compassion–to listen, care, and remain empathetic. May I always strive to enter each patient encounter with sincerity, compassion, and gratitude for the opportunity to serve.

On Being ‘Dr. Dad’

  • hiermedia
  • June 5, 2017

I take my 10-year-old son to school as many school days as possible. We recap events from the prior day, and I give him early morning pep talks. It is a rarity, however, that I pick him up from school. During one of those rare occasions, he got into the car, smiling as he handed me a project he completed in class. It was an assignment in which he was asked to introduce his hero to his classmates. To my delight and surprise, he chose me as his hero. He explained that he looked up to me, in part, because I am a doctor.

This moment affirmed my belief that being a doctor compliments my role as a father. Being a doctor makes me a better father. Equally, being a father makes me a better doctor. While I’ve had a decade to establish a healthy relationship with my son, in clinic, I must establish a doctor-patient relationship in a relatively short amount of time. Many patients come into the clinical encounter with problems they would not share with their closest confidante. During these candid conversations, they trust I will listen and not only have solutions for their complaints but remain objective and unbiased in the process. I incorporate these same skills while instructing and nurturing my children.

One such opportunity arose after a recent track meet when my son came in 7th place during the 100-m dash run. I could see his disappointment in his performance. I could also see the embarrassment he felt. After listening to him share his feelings of being intimidated by his competition, we problem-solved and discussed ways to improve his performance for the next race. Our solutions included spending additional time after practice working on his technique. His effort paid off; he had a faster time and came in 2nd place during the following track meet. Years of listening, searching for, and offering methodical solutions to my patients subsequently have improved my problem solving as a father.

Just like my patients, my son does not follow all of my instructions. He has challenges getting homework done in a timely fashion and most definitely has challenges keeping his room clean. Guiding him through life’s challenges has taught me how to remain cool and level headed even when I am feeling anything but. Techniques that work in parenting translate to my professional responsibilities. For example, I rely on the ability to speak clearly in language the patient can understand to facilitate conversations about the medical and surgical management of various disease processes. Keeping cool and level headed in a wide range of clinical situations ranging from treating a noncompliant patient to proficiently and dexterously completing a tough surgical procedure is a necessity in my profession. Being a father of an energetic and active son has definitely equipped me for comparably challenging situations that require the same quiet resolve in my surgical practice.

Despite all the ways being a father and a doctor complement each other, it is a challenge to do them both well and give them both the time they require. I am intent to take full advantage of the time I have with each, whether in the car going to school or in the office and operating room. Time is fleeting and I recognize my son is growing older much too fast. My patients have many medical and surgical needs that continue even after the office has closed for the day. Clearly, I am not able to be present at all times for both. Nonetheless, when I am with family or with a patient, my goal is to be fully present. I know my son has a better father and my patients have a better doctor because of the experiences I have with each of them. Ultimately, I know the conversations with my son during our time in the car provides motivation, inspiration, and encouragement that will help mold him into a better version of himself that will benefit his future children and maybe, just maybe, his very own patients.

Your Top 10 Questions about Hemorrhoids Answered

  • hiermedia
  • May 2, 2017

Are you bleeding? Having pain? Any puffiness or swelling on the bottom? These could all be symptoms of hemorrhoids. But what are hemorrhoids and more importantly, how can they be prevented and treated? Here I answer your questions about this most common but dreaded malady.

  1. What is a hemorrhoid?

A hemorrhoid is an anal cushion of tissue containing blood vessels, muscle, and connective tissue. When this tissue is engorged or swollen, there is the possibility of discomfort or bleeding. Contrary to popular belief, a hemorrhoid is not a vein. Once the swelling from the hemorrhoid resolves, a skin tag may be left. There can be one or multiple tags present. Removal of the anal skin tag is not necessary unless they itch, bleed, or create difficulty maintaining proper perianal hygiene.

Anal Skin Tags

  1. What causes a hemorrhoid?

The exact cause of a hemorrhoid is unknown. Any action that increases pressure around the anus (such as straining to have a bowel movement, constipation, diarrhea, persistent heavy coughing, pregnancy, or lifting heavy objects) may lead to swelling or bleeding from the hemorrhoid.

  1. How common are hemorrhoids?

A report from the National Center for Health Statistics found that 10 million people in the US complained of troubles from hemorrhoids. Over 1 million prescriptions are written per year for medications for hemorrhoids. The peak age is 45-65 years of age, even though any age could potentially be affected.

  1. What are the symptoms of hemorrhoids?

Symptoms are dependent on the type of hemorrhoid.

The symptoms from internal hemorrhoids classically involve painless bright red bleeding that occurs during a bowel movement. Internal hemorrhoids may also prolapse or protrude outside of the anus when having bowel movements. They may reduce or go back in on their own; however, sometimes they require manual reduction (pushing them back into the anus). Pain is generally not a symptom of internal hemorrhoids, but if pain is present, it may be because of a prolapse or thrombosis of the internal hemorrhoid. A thrombosis occurs when the blood within the hemorrhoid clots and the hemorrhoid becomes very tender.


There are 4 grades of internal hemorrhoids:

Grade 1-hemorrhoids present but do not protrude

Grade 2-hemorrhoids protrude but reduce spontaneously

Grade 3-hemorrhoids protrude but require manual reduction (pushing them into the anus)

Grade 4-hemorrhoids protrude but cannot be reduced

Prolapsed internal hemorrhoids


The symptoms from external hemorrhoids involve swelling, discomfort, bleeding, and pain. They may become thrombosed. External hemorrhoids cannot be manually reduced. Struggling to “push them in” can cause more swelling and pain.

Thrombosed external hemorrhoid

  1. What can I do to prevent problems with hemorrhoids?

Drink adequate volumes of fluids each day and add bulk to the diet to eliminate straining. I recommend adding fruits, vegetables, and unprocessed wheat or oat bran to the diet. An alternative is to add psyllium seed or other fiber supplements, getting 20-35 g of fiber each day. Minimize extended periods of time on the toilet as doing so can increase strain and pressure around the anus. So that means put away the cellphone, magazines, and newspapers which may increase the amount of time spent on the toilet! Hemorrhoids may also be prevented by avoiding passing hard stools and avoiding straining with bowel movements or heavy lifting. The hemorrhoid itself may not go away. However, surgery may not be needed if there is no pain, bleeding, or swelling.

  1. So, I have a hemorrhoid. Now what?

Hydrocortisone creams may be helpful in improving symptoms of hemorrhoids.  If the over-the-counter versions do not provide relief, a stronger prescription from your doctor may be used. However, overuse of these products can make some symptoms like itching worse, which is why close follow up with the doctor is important. It is important to see an experienced physician. After a thorough examination, your doctor may conclude that symptoms reported from hemorrhoids could actually be from other anorectal diseases and conditions (i.e. anal fissures, anal abscesses, colorectal polyps, rectal prolapse).

  1. Do I need surgery for my hemorrhoids?

Not necessarily. The actual presence of the hemorrhoids or tags does not imply the need for surgery as long as symptoms are nonexistent, minimal, or tolerable. Your symptoms decide when and if surgery is needed.

  1. What are the most common procedures or surgeries for my hemorrhoids?

Internal hemorrhoids are most commonly treated with rubber band ligation, which is an in-office procedure to eliminate the symptomatic internal hemorrhoids. A ligation can also be performed in the operating room with suture. External hemorrhoids are excised in the office if a thrombosis is present (blood within the hemorrhoid clots and the hemorrhoid becomes very tender). If the external hemorrhoids are large, painful, bleeding, and not responding to medication, you may be a candidate for a surgical procedure called a hemorrhoidectomy. With this surgery, both large internal and external hemorrhoids are removed in the operating room with anesthesia.

  1. Do hemorrhoids lead to cancer?

No, they are not cancer and do not lead to cancer. However, symptoms from cancer may mimic those from hemorrhoids.

  1. So, what’s the bottom-line?

Just remember, there are a number of other potential causes of anorectal pain and bleeding. If you think you have hemorrhoids or have any of these symptoms, see a doctor. If bleeding and pain continue to be present despite treatment, definitely follow-up with your doctor to ensure you are getting the right treatment for the right problem.

A New Website: The Conversation Continues

  • hiermedia
  • February 28, 2017
At the start of medical school, I did not have preset notions about the field of medicine in which I wanted to work. I did not have specific desires to be called a “surgeon,” or an “obstetrician,” or a “pediatrician.” I did know, however, I wanted to become a physician who had the aptitude and competence to attack the pathology I had previously learned and to offer first-rate care to my patients. I also wanted a career where I could connect with people in a way that few are permitted.

Ultimately, I recognized surgery to be one of the most dynamic branches of medicine and have since devoted my professional energy toward it. I have been blessed to have a career where I have been able to educate not only my family and friends but also my colleagues and those coming behind me. I have searched for answers and continue to perfect my craft. I have studied the pathology to mend it, and have helped patients return to states of normalcy. Throughout this journey, I have been committed to become a physician dedicated to life-long learning and scholarship and a compassionate healer focused on the patient.

I have enjoyed opportunities to teach and speak to people about their health. These opportunities have ranged from impromptu 1-on-1 quick discussions in the hallways of various retail stores to larger more formal audiences at community health summits. I recently began writing on many of these topics, submitting them to national health blog sites, along with interviews and exposure in national media outlets. With the launch of this website, the discussion continues as the audience continues to grow.

Each month, I will publish a different blog along with updates of media outlets where the conversation extends. I expect this site to also address health information and messages I think are important for our community, one that reaches beyond age, race, gender, social class, or educational background. If I have learned one thing from the countless conversations I have had and questions I have been asked since I started this journey into medicine over 20 years ago, is that when it comes to health, we are all the same, with the same questions and fears about our health and the health of those we love.

Should You Poop Everyday?

  • hiermedia
  • February 16, 2017

Many patients believe that you need to have a bowel movement every day and that afterwards, a moistened wipe should be used for cleansing. Dr. Cedrek McFadden answers these questions and gives answers you can use.

Originally published by Reader’s Digest.

This Holiday Season, Pass the Family History

  • hiermedia
  • November 28, 2016

This morning, I diagnosed a 49-year-old female with stage 4 colon cancer. She will probably not be alive in 5 years. She could have possibly prevented this diagnosis if she had known her family history. Many people don’t know the health history of their family. This holiday season is a perfect time and opportunity to delve into this history and prevent more senseless deaths.

The apple really doesn’t fall too far from the tree. When it comes to genetics, neither does health. The fact remains that, while a person’s genetic makeup is not the sole determining factor of health, it does account for up to 30 percent of a person’s chance of surviving and having a long life. Genetics can contribute to longevity and health by creating changes in the genes that will either predispose for or protect against certain diseases. But are familial diseases actually discussed in families or does the code of silence prevail?

Genes can influence the presence of up to 2,000 diseases including heart disease, stroke, cancer, liver disease, alcoholism, and even depression. Many of these diseases can be prevented or even treated and controlled if caught early. For example, the risk of breast cancer in the average woman in the United States is roughly 12 percent. In those patients with abnormal BRCA1 or BRCA2 genes, that risk can rise to 80 percent. In another example, if not treated, patients with familial adenomatous polyposis, which is an inherited disorder in which a genetic mutation leads to a multitude of polyps throughout the gastrointestinal tract, have nearly a 100 percent chance of developing colorectal cancer.

Unfortunately, it is not possible to know the family history in every individual. Some children have been separated from parents either by adoption, death of the parent, or even an intentional separation of one or both parents from the life of the child. I would argue that a greater focus on preventative care, more strategic management of current diseases, and even targeted genetic testing are valuable tools in these persons.

For everyone else, it is imperative to have open and frank discussions regarding the major illness and causes of death for parents, siblings, grandparents, aunts, and uncles. I encourage patients to ask about medications, prolonged hospitalizations, major surgeries, mental health illnesses, and even drug and alcohol addictions. Get specific and ask the tough questions. Forget guilt or shame. Knowing the family history can reveal inherent health risks in a person and could lead to offering better preventive care and lifestyle changes to reduce those risks.

Other health care issues should be incorporated into the conversation. Families are often left to discuss palliative care plans for patients at times when the patient is incapacitated and unable to wholly participate in the discussion. So, what are their wishes regarding feeding tubes? Would they want to be placed on a ventilator? If their heart were to stop or if they were to have respiratory failure, do they want to be resuscitated? Most people do not consider these to be pleasant conversations, but they are certainly necessary ones to have. Knowing this vital information better equips the family to make end of life health care decisions without added frustration or unnecessarily feeling as if they were doing something wrong.

On more than one occasion, I have cared for patients and their families who failed to secure a definite end of life care plan prior to their loved one becoming critically ill. It is a painful process to watch families first accept the fact that death is imminent and in the same breath, determine when that last breath will be taken by discontinuing ventilator care. Alternatively, I have witnessed families who had those tough conversations prior to being placed in the situation of discontinuing critical care. In those cases, the decisions to execute the prearranged plans were fundamentally and seemingly made with less feelings of guilt.

This holiday season, approximately 90 percent of Americans will pass the turkey as they celebrate with family and friends. These gatherings present an opportunity to have full, uninterrupted access to family members that may otherwise not be seen throughout the year. It is practical to discuss the family medical history and even end of life issues when everyone is in the same place at the same time. By this, everyone in the family has space to express concerns and resolve conflicts regarding intended plans. Why not take advantage of this time to not only pass the turkey, but to also pass the family history around the table?

Each family should talk and delve into the health issues that matter this holiday season. Unearth the hidden medical histories of the family. Write them down. Take the collected histories to healthcare providers to incorporate into the medical record. By doing so, more family members may be around for holiday dinners for many years to come.