Archive for the ‘surgery’ Category

Advance To Every Cancer Patient

January 24, 2015

Cancer and cardiovascular disease are the most common medical causes of death in America. Tremendous advances have been in the treatment of cancer and there is often more than one treatment option for any disease. This is certainly true for prostate cancer where there are multiple treatments such as surgery, radiation, chemotherapy, and even no treatment at all but watchful waiting.

Here are my suggestions for each patient who has cancer:

1. Get a second opinion. Each patient needs to be aware of all the treatment options and to feel confident and informed about the options available. For example, a urologist who performs surgery is not likely to recommend radiation therapy when radiation therapy may be the better option for the patient. A second opinion is a chance to gain ore knowledge and insight into the accuracy of the diagnosis. Also if a pathologist looking at a biopsy or surgical specimen makes the diagnosis, I suggest that another pathologist provide a second opinion to confirm the diagnosis.

2. Find the right doctors. Nearly 20% of patients who receive a diagnosis of cancer have the disease in an advanced stage where the cancer has spread to other organs or other areas of the body. These patients with cancer that has spread, as well as all newly diagnosed patients, should get advice from physicians experienced in treating the specific type of cancer. You want to be sure that you are in the right hands.

3. Know what questions to ask. There are 10 questions compiled by the Cancer Treatment Centers of America (www.cancercenter.com/secondopinion) that would be helpful for newly diagnosed cancer patients to bring to their visit with the doctor. These are:

1 What types of diagnostic testing do you perform? An accurate diagnosis is critical because it is the basis upon which your treatment plan will be determined. For example, PET/CT scans help determine the precise location of cancer in the body to accurately plan treatment. Tumor molecular profiling identifies a tumor’s unique blueprint to choose targeted chemotherapy drugs. It’s important to have access to advanced diagnostic tests, as well as physicians who are experienced in performing them.
2 What does my diagnostic testing tell me? The information you should receive from diagnostic tests includes: where the cancer originated, the size of the tumor, the stage of cancer and whether or not it has spread to the lymph nodes or other parts of the body.
3 What treatment options are available? What do you recommend and why? Many types of cancer have a variety of treatment options available. Your doctor should be able to explain the potential benefits of each to help you understand your options, even if he or she doesn’t perform a specific treatment.
4 What happens if a treatment approach doesn’t work for me? At any point, you should feel comfortable asking your doctor about the status of your treatment. When choosing a care team, you may want to consider doctors willing to try new therapies, depending on your response. Look for professionals who will tailor treatments to your specific diagnosis, and who are willing to pursue other options if your treatment isn’t progressing as expected.
5 What are the side effects of treatment, and how often do your patients experience them? No two people will have the exact same response to cancer treatment, and side effects may vary depending on what type of treatment you choose. Ask your doctor what side effects you might experience, so that you can plan ahead and choose with all of the information you need.
6 How will you help me manage side effects? Integrative therapies can help prevent or manage side effects, so you stay strong and avoid treatment interruptions. Some therapies that can support your wellness during cancer treatment include: nutrition therapy, naturopathic medicine, mind-body medicine, acupuncture, oncology rehabilitation, spiritual support and pain management. Ask your doctor if any of these are available at your hospital, and how they can be incorporated into your treatment plan.
7 How many patients have you treated with my type and stage of cancer, and how successful have you been? Ask how much experience your doctor has treating your type and stage of cancer and whether he/she is a board-certified specialist. You may also want to ask about his/her facility’s treatment results so you can see how successful they have been in treating your cancer type.
8 Who will be involved in my care, how often will they meet and who is my main point of contact? An integrated care team including a surgical, medical, and/or radiation oncologist; dietitian; naturopathic oncology provider; clinical nurse and medical advocate (often a nurse care manager) can ensure you get support for your entire well-being during treatment. If you don’t already have a team like this in place, talk to your doctor about assembling a multidisciplinary team.
9 Where will all my treatments, appointments, tests, etc., take place? When looking for a treatment facility, consider the coordination and convenience of your treatment. Having appointments and procedures in one location can make treatment less stressful for you, and it may allow you to start treatment sooner.
10 How will you help me balance my cancer care with the demands of my normal life? Your cancer treatment should adapt to your individual needs, and family and professional obligations. Talk to your doctor about your personal needs, so that all aspects of your life are considered when choosing a treatment plan.

4. Stay strong. You will often experience significant side effects dealing with your treatment or the disease. I recommend that you consult with a nutritionist to be sure that you are receiving the right combination of calories, vitamins, and nourishment in order to be in the best physical shape to fight the disease. I also suggest a regular program of exercise that enhances your heart, lungs, and muscles to keep you in the best body-mind condition.

Bottom Line: The cancer diagnosis is often shocking and requires each patient to muster all of his\her energies to engage and fight cancer. These are a few suggestions that will help you prepared to carry the biggest fight of your life.

Prostate Cancer-Watch, Wait, and Not Whither

January 24, 2014

Prostate cancer is the most common cancer in men and the second most common cause of death in men after lung cancer.  The diagnosis is made with a PSA blood test and a digital rectal exam and if either of these are abnormal, the man is subjected to a prostate biopsy.  Then comes the big decision: does the man proceed to treatment and face the risk of urinary incontinence and\or erectile dysfunction\impotence?

In the past few years there has been a trend towards active surveillance or after receiving the diagnosis of prostate cancer, the man accepts close monitoring with repeated blood tests and possibly repeat prostate biopsies to make certain that the cancer is not progressing or escaping from the prostate and spreading to other organs or structures. 

First a comment on screening.  Men between the ages of 55 and 69 are those most likely to benefit from screening with a PSA blood test and a digital rectal examination.  A man should only be screened after a discussion with his\her physician about the benefits and harms of screening.  A new trend is not to treat every man diagnosed with prostate cancer or active surveillance.   Not every man qualifies for active surveillance. 

Men with a very low risk of cancer progression have a low-grade cancer of the prostate.  Prostate cancers are graded from 1-10 and those with a score of 6 or less may be candidates for active surveillance.  Men are in the very low risk group if only a few of the biopsies are positive for cancer and that the cancer is not felt on the digital rectal exam. 

Men who were on the active surveillance program at John Hopkins School of Medicine had a 2.8% would die of their prostate cancer compared to 1.6% of men who had a very low risk of cancer progression who had surgical removal of their prostate glands.  The researches at John Hopkins found that the average increase in life expectancy after surgical removal of the prostate gland was only 1.8 months and that the men on active surveillance would remain free of treatment for an additional 6.4 years as compared to men who had immediate treatment with surgery on their prostate glands. 

Bottom Line: Men need to have a discussion with their physicians about the benefits and risks of prostate cancer screening.  Men with a life expectancy in excess of 20 years or younger men who have low risk disease may accept the risks of treatment rather than take the chance their cancer will cause harm later.  Men with very low risk disease can take comfort that their disease can safely be managed by active surveillance. 

 

Impotence: When You Can’t Get It Up is Getting You Down

June 3, 2013

Probably nothing devastates a man more than having a failure in the bedroom. Impotence or erectile dysfunction affects nearly 33 million men in the United States. You are not alone. Help is available for nearly every man who has erectile dysfunction.
Diet
According to the Urology Channel’s “Erectile Dysfunction: Natural/Alternative Treatments,” erectile dysfunction can be treated by eating right, drinking plenty of water and avoiding sugar, dairy and caffeine. They recommend to eat whole, fresh, unrefined and unprocessed foods, including vegetables, whole grains, soy, beans, seeds, nuts, olive oil and cold-water fish such as salmon and tuna.
Taking your vitamins can also help; the Urology Channel suggests supplements such as flaxseed, and in particular vitamins C, E and the mineral zinc. These vitamins and supplements help bolster the vascular system, which is an important part of good sexual health.


Exercise
Since sexual health relies on the vascular system, a strong heart plays an important part in treating erectile dysfunction. Aerobic exercises such as power walking, running, bicycling or dancing strengthen the cardiovascular system. A stronger cardiovascular system gives stronger support to the vascular system that supports a healthy erection.
 Kegel exercises–exercises that flex the pelvic muscle– which are helpful in strengthening the ligaments that support an erection. These exercises can also increase blood flow in the pelvic area, which can aid in achieving a strong erection.



Herbs
Herbs which are used in Traditional Chinese Medicine to support healthy erectile function include ginseng, ginger and ginkgo biloba.
 Ginseng helps increase blood circulation, and is typically taken as a dried powder, often as a paste mixed with honey. Ginkgo biloba also increases blood flow in the arteries, which help support the vascular functions that enable a healthy erection.
 Another non-medical option is garlic but the treatment can be tough to take: the trick to getting the most out of garlic is to chew fresh, uncooked garlic very thoroughly. Though it is unpleasant and can be downright painful, this allows your body to absorb powerful natural nutrients through the blood vessels in the mouth. Some of the most powerful ingredients in garlic are destroyed as they travel through the digestive system, and these erectile dysfunction-fighting nutrients are only absorbed while chewing.
One out of two men over age 40 have had difficulty attaining and maintaining an erection sufficient for sexual intercourse, doctors say. And while the numbers are smaller, even some younger men may have difficulty developing an erection.
However, more than at any other time in history, erectile dysfunction is a problem with a solution. Medications and external and internal treatments have improved dramatically, allowing thousands of men to return to healthy sexual functioning. Likewise the stigma has decreased with public awareness.
Over the past 20 years, increased media attention, scores of television ads for medications like Viagra, Levitra and Cialis and starring roles in movies and television shows have moved erectile dysfunction out of the shadows and onto the list of common health concerns.
Erectile dysfunction is often caused by a lack of adequate blood flow, which can be an indicator of a potentially life-threatening health problem such as heart disease, high cholesterol, or diabetes.
Surgeries for prostate cancer, bladder and certain colorectal cancers may result in erectile dysfunction.
Regardless of age or cause, treatment options are the same, depending on the individual.

Men with heart problems and some other health conditions cannot take Viagra, Levitra, or Cialis. These drugs can be fatal for men taking nitroglycerine or any nitrates.
The next level of treatment includes injections and vacuum pumps, both of which can be effective. While the thought of injections is less than appealing to most men, the results are excellent.
If pill and external treatments are not effective, doctors say an internal prosthetic device is an option.
An implant gives the spontaneity and quality of erection that they can’t get with many of the other treatments including pills, injections or vacuum pump. Internal devices or a penile prosthesis are effective continuously on demand, which means a man and his partner can achieve a full erection on demand and within seconds that contains itself as long as they want to have sex.
While these surgeries have been performed since the 1950s improvements in surgical technique and devices are dramatic.
The 30-minute procedure is minimally invasive and usually does not require hospital admission. Men may experience some discomfort for 1-2 days after the procedure.

Men who have the prosthesis have by far the best satisfaction rate for any treatment for erection problems, up into the 99 percent range.

Bottom Line: Erectile dysfunction affections millions of American men. There are solutions both medical and surgical that can help men restore their ability to successfully engage in sexual intimacy with their partners.

Medicinal Value of Hypnosis-You Are Feeling Very Sleepy!

August 1, 2011

Hypnosis, once the stuff of parlor tricks, is being taken seriously by a growing number of medical experts. Not only can clinical hypnosis help to treat some diseases and health conditions, but it’s also being used at a growing number of hospitals in place of anesthesia. Doctors are finding that using hypnosis in combination with local anesthesia can eliminate the need for general anesthesia for some surgeries, reducing costs and speeding recovery times. And procedures normally performed with local anesthesia can be done with hypnosis and less pain medicine is required after the surgery.

Here, a brief guide:

How does hypnosis work?
It has been described as a “modified state of consciousness.” While the patient’s mind is concentrating on a pleasant place or an enjoyable experience, it doesn’t process some immediate physical sensations as painful or negative. So while surgeons are cutting into skin, for example, the patient might be thinking about being on a tropical beach with waves lapping at his feet, and wouldn’t feel any pain. Hypnosis is typically performed by a professional hypnotherapist, who uses verbal repetition and mental imagery to get the patient into a pleasurable state of focused concentration.

Where is clinical hypnosis being used?

It’s increasingly used in mainstream European hospitals and clinics, and with considerable success. France, Belgium, Germany, and the U.K. have perhaps the highest number of clinicians who practice hypnosis.

What conditions can benefit from hypnosis?

Besides minor surgery, hypnosis has been used to successfully treat anxiety, obesity, stress, nail biting, smoking addiction, chronic pain, panic attacks, and gastrointestinal disorders. Clinical hypnosis has been remarkably effective in cases of irritable bowel syndrome, with an estimated 75 to 85 percent remission rate.

Why isn’t hypnosis used more in the United States? 

Some experts say a lack of consistency with hypnosis is a concern. “It’s not used routinely because it’s not effective in everyone and it takes awhile,” says Dr. Mark Warner, president of the American Society of Anesthesiologists, as quoted by the Associated Press. Also, there’s no medical or scientific explanation on how it works. But we don’t understand acupuncture either!

Bottom Line: Hypnosis is becoming part of the medical doctors technique to perform surgery without anesthesia. Look for a greater role of hypnosis in the doctor’s office and in the operating room.

* Excerpted from The Week, http://theweek.com/article/index/217809/can-hypnosis-replace-anesthesia

Don’t Want To Die? Avoid Going to the Hospital in July

July 23, 2011

You are to have elective surgery or you need to go to the hospital for a procedure. You may want to consider deferring this decision the month of July or in early August. Why? Conventional wisdom has long held that the quality of care in hospitals plummets during the month of July. But now a new study published in the Annals of Internal Medicine on July 11 confirms that suspicion.

Most newly minted doctors, interns, residents, fellows, and nurses graduate in June and begin working in hospitals on July 1. Teaching hospitals where doctors and nurses train have little experience caring for patients, often aren’t well supervised and don’t yet know the hospital system. As a result, patients remain in the hospital longer, and risk of complications and even death are higher in early July than the rest of the year. This finding is designated the “July Effect” in medical circles.

As a group, these physicians-in-training are supervised by fully trained doctors but from day one these new doctors are writing medication orders and doing certain procedures and diagnostic tests with relatively little direct supervision, so there’s always an opportunity for something to slip through the cracks and mistakes can be made.

Because on or around July 1, fresh, inexperienced interns, residents, nurses and other new health care workers first report to work at many of the nation’s hospitals, eager to start practicing medicine — on you.

In medical circles it’s known as the “July effect.” The new study reviewed data from 39 previous studies that tracked health results in teaching hospitals — including death rates and complications from medical procedures. The best designed and largest studies, the authors found, showed mortality rates increase 4 to 12 percent in July and revealed that many patients remain in the hospital longer, spend more time in surgery and have higher hospital charges in July than in other months. After analyzing more than 62 million death certificates issued across the country from 1979 to 2006, researchers found that fatal medication errors consistently spiked in July by about 10 percent — but only in U.S. counties with many teaching hospitals — and then subsided in August to levels on par with other months. Yet there was no measurable increase in counties with facilities that don’t employ residents, such as community hospitals.

How protect yourself from the July Effect

• Bring your own health records (including a “Personal Medication Record”).
• Ask a friend, relative or other health advocate to stay with you.
• To lessen the chance of mix-ups, state your name to anyone providing you with care.
• Know the name of the doctor who is ultimately in charge of your care.
• Ask your doctor who will be doing the surgery or the procedure and consider asking him\her if they will promise to do it and have the new doctor serve as an assistant

Bottom Line: All surgery and all medical procedures have risks and complications but you can reduce these risks by avoiding a teaching hospital the month of July and early August.

This article was excerpted from “Why? New doctors and nurses report to work for the first time, eager to ‘practice’ medicine on you”
by: Sid Kirchheimer

http://www.aarp.org/health/doctors-hospitals/info-06-2010/why_you_should_avoid_the_hospital_in_july.3.html