Medical Advice

Hernia And Hernia Surgery

2020-10-11T07:36:00.009-07:00

What is a hernia?

A hernia means something coming through. It most frequently occurs when an organ or internal tissue pokes through a hole or weakness in your abdominal muscle wall.

In many cases, people have no or very few hernia symptoms. You may notice a swelling or lump in your stomach area or groin. Often you have no hernia pain.

If your hernia causes sudden pain and especially if it can’t be pushed back in, you should seek urgent medical care. It may mean that your hernia is trapped or tightly pinched where it pokes through the muscle wall (obstruction) and in extreme cases it may cut off the blood supply to your intestines and tissues in your abdomen (strangulation).

A hernia is not usually a serious condition but it will not go away without hernia treatment known as a hernia repair.

What does the hernia surgery involve?

Hernia repair surgery is the world’s most common surgical procedure. Hernia surgery can help to relieve pain, return the hernia abdominal organs to their correct place and, strengthen the weak muscle area.

A hernia operation usually takes around an hour as a day case procedure. It can be performed by:

• Open surgery – under local or general anaesthetic, an incision usually around 2.5 to 3 inches is made to your skin near your hernia and your surgeon will push your hernia back into your abdomen. The incision is then either stitched closed or much more commonly a mesh is placed over the hole and fixed using fine stitches. The mesh acts like a scaffold and your own tissue will grow through the mesh to reinforce the weakened area without putting tension on the surrounding tissues.

• Keyhole (laparoscopic) surgery – under general anaesthetic, several smaller incisions are made to allow your surgeon to use a less invasive technique using various special instruments including a tiny telescopic camera to repair your hernia. A mesh may then be used to strengthen your abdominal wall.

If hernia surgery is recommended, your surgeon will advise on the most appropriate type of surgery based on the location and severity of your hernia.

Are there different types of hernia?

Most hernias are found in the abdomen. Areas of weakness in the abdominal wall where hernias are commonly found include the groin, upper stomach, belly button and, where you have a surgical scar.

The most frequently seen types of hernia include:

• Inguinal hernias – the most common hernia, seen more in men, causes a bulge in your groin. The inguinal hernia appears through your inguinal canal, a narrow passage that blood vessels pass through in your abdominal wall and, may reach your scrotum.

• Femoral hernias – also a bulge in your groin, relatively uncommon and seen more in women. The femoral hernia happens at the hole in your abdominal wall where the femoral artery and vein pass from the abdomen into your leg.

• Hiatus hernias - occur in your upper chest area when part of your stomach pushes up into your chest by squeezing through a gap in your diaphragm called the hiatus.

• Umbilical/periumbilical hernias – occur at the umbilicus, a natural weakness in your abdominal wall, when fatty tissue or a part of your bowel pokes through your abdomen near your naval.

• Incisional hernia – occurs through a scar from past abdominal surgery as tissue pokes through the weak healed site in your abdominal wall.

What complication can happen after the hernia surgery?

Hernia surgery is a routine procedure, but as with all surgeries there are risks of complications. These may vary depending upon the exact hernia operation you have and your health. Your surgeon will discuss these with you in detail.

Often the greatest complication risk is a reoccurrence of the hernia. Other hernia surgery side effects include: build-up of seroma or a fluid-filled sac under the surface of the skin, inability or difficulty urinating, organ or tissue damage, wound infection and, rejection of the mesh.

How soon will I recover after the hernia surgery?

Recovery time after hernia surgery is usually two to three weeks. Most patients will return to normal daily activities and go back to work within a week. You should not do any heavy lifting for at least six weeks. Your surgeon will talk to you about what you can and cannot do for your specific hernia operation.

And Also:

ABOUT YOUR HERNIA SURGERY

Hernia repair has been around for a long time. That means traditional techniques have been perfected while new options and materials have been developed. While not every technique is right for every hernia, they all have common goals: to provide the strongest repair and least chance of recurrence with the least possible discomfort and quickest recovery.

OPEN TENSION REPAIR

Until about 25 years ago, hernias were repaired one way, referred to as ‘open tension’ repair. Here’s what that means:

Open — An incision of 3" to 6" is made in the abdomen to give the surgeon access to the hernia.

Tension — The edges of healthy tissue around the hernia are pulled together and sewn with sutures.

The incision is then closed with dissolving sutures or abdominal adhesive.

This method has been tried and true for decades and may be the only way to repair a very large hernia. The incision tends to be painful and recovery can take as long as five to six weeks. The incision also leaves a scar, although it’s usually very low on the abdomen. Tension repair has a higher recurrence rate than non-tension, or mesh, repair.

THE BEST REASON TO FIX YOUR HERNIA EARLY!

Today’s hernia repair options include new techniques and materials that can make surgery less invasive, recovery faster, and recurrence less likely. And the smaller your hernia (meaning the earlier you fix it), the more options you’re likely to have.

NON-TENSION OR MESH REPAIR

Non-tension means just that. Instead of pulling the tissue around the hernia together, a piece of mesh is positioned to reinforce the area and fixed in place with sutures and/or staples.

The mesh is made of a flexible material that stays in the abdomen and encourages new tissue to grow into it.

Mesh repair has a lower incidence of recurrence than tension repair. There are also different kinds of mesh, including patches, plugs, three-dimensional, expanding, self-absorbing, and even self-gripping mesh that requires few to no sutures to keep it in place. A surgeon who specializes in hernia repair is most likely to have experience using the latest procedures. Ask which ones he or she uses, which may be best for you, and why. Sometimes the best procedure for you is the one with which your surgeon has the most experience and is most comfortable. Don’t hesitate to ask!

LAPAROSCOPIC OR CLOSED REPAIR

Many inguinal hernias can be repaired using a ‘closed’ or laparoscopic procedure — especially when they’re smaller. Laparoscopic repair entails inserting special instruments through tiny incisions in the abdomen through which the surgeon is able to visualize and perform the procedure. Laparoscopic repair uses mesh for reinforcement, so it has a lower recurrence rate. Plus, a smaller incision means less discomfort after surgery, little to no scarring, and a quicker return to normal activity. Many people return to work within a few days.

HOW IT WORKS

Your surgeon makes three or four ¼" to ½" incisions in your abdomen. One is near your navel and the others lower down.

A laparoscope, a fiber-optic tube with a tiny camera on the end, is inserted through one of the openings, allowing the surgeon to visualize the area on a TV monitor.

The surgeon performs the procedure using tiny surgical instruments inserted through the other openings while viewing it on the TV monitor. The mesh is positioned and fastened in place with sutures and/or staples.

The instruments are removed and the holes are closed with a stitch or two or with surgical tape.

ANESTHESIA

While open hernia repair may be done under general, regional (spinal), or even local anesthesia with sedation, laparoscopic hernia repair is always done under general anesthesia. If the idea of general anesthesia makes you nervous, it shouldn’t. General anesthesia is extraordinarily safe with today’s precise administration and monitoring. Your anesthesiologist is present throughout your surgery and monitors you continuously. When your procedure is finished and the anesthesia is stopped, you’ll wake up very quickly.

And if you’re concerned about side effects from general anesthesia, such as nausea and vomiting or headaches, you should know these are rare — the exception rather than the rule. Even if you’re having open repair, your surgeon may prefer to perform the surgery with general anesthesia. It may be easier and more comfortable for you, too. After all, what’s easier than going to sleep, waking up and…it’s done?

BEFORE YOUR SURGERY

A few days before surgery, your surgeon may order a pre-op exam consisting of blood tests, an EKG (electrocardiogram), and a chest X-ray to be sure your heart and lungs are in good condition. You may be instructed to stop taking some over-the-counter medications for a week to 10 days before surgery, such as aspirin or ibuprofen (Advil), which can increase bleeding. Make sure your surgeon knows all the prescription and over-the-counter medications you take, including natural or nutritional supplements. You may also be given a prescription for pain medication to take after surgery, in case you need it. Fill it before your surgery, so you don’t have to think about it after.

THE DAY OF SURGERY

You’ll arrive at the hospital the morning of your surgery; you’ll sign consent forms, change into a hospital cap and gown, have your blood pressure taken, and be started on an IV (intravenous line). The area of your hernia may need to be scrubbed and shaved to guard against infection.

The anesthesiologist will meet with you and review the type of anesthesia you and your surgeon have decided on. You’ll be given medication to relax you.

Next you’ll be taken to the operating room, your anesthesia will be administered and the next thing you know…

THAT’S IT — YOU’RE DONE.

You’ll be waking up in the recovery room with your surgery behind you. Sound easier than dealing with your hernia? It is. Now you can concentrate on your recovery and getting back to your life.

And Also:

ABDOMINAL HERNIA FACTS

Symptoms of a hernia include pain or discomfort and a localized swelling somewhere on the surface of the abdomen or in the groin area.

There are many different types of hernias.

Serious complications from a hernia result from the trapping of tissues in the hernia (incarceration), which can result in the damage or death of the tissue.

Hernia repair and the treatment of hernia complications require surgery.

Lumps and swelling in the abdominal area should be examined by a doctor.

WHAT IS AN ABDOMINAL HERNIA?

A hernia is a general term that refers to a bulge or protrusion of a body tissue or organ through the structure that normally contains it. For example, brain tissue can herniate as can discs in the spine. A common herniation in people is an abdominal herniation.

An abdominal hernia is an opening or weakness in the muscular structure of the wall of the abdomen. The peritoneum (lining of the abdominal cavity) protrudes through the opening and this defect causes a bulging of the abdominal wall. This bulging is usually more noticeable when the abdominal muscles are tightened, thereby increasing the pressure in the abdomen. Any activities that increase intra-abdominal pressure can worsen a hernia; examples of such activities are lifting, coughing, or even straining to urinate or have a bowel movement. Imagine a barrel with a hole in its side and a balloon that is blown up inside the barrel. Part of the inflated balloon would bulge out through the hole. The balloon going through the hole is like the tissues of the abdomen bulging through a hernia.

When the lining protrudes it can contain intra-abdominal contents such as the intestines and omentum (the layer of fat that covers abdominal organs). Serious complications from a hernia can result from the trapping of tissues in the hernia -- a process called incarceration. Trapped or incarcerated tissues may have their blood supply cut off, leading to damage or death of the tissue. The treatment of an incarceration usually involves surgery.

About 10% of the population will have an abdominal hernia during their lifetime. The hernias may occur in infants, children, and adults -- both in males and females. However, the majority of abdominal hernias occur in males.

WHERE ARE ABDOMINAL HERNIAS LOCATED?

The most common location for hernias is the groin (or inguinal) area. There are several reasons for this tendency. First, there is a natural anatomical weakness in the groin region which results from incomplete muscle coverage. Second, the upright position of human posture results in a greater force that pushes toward the bottom of the abdomen, thereby increasing the stress on these weaker tissues. The combination of these factors over time breaks down the support tissues, enlarging any preexisting hole, or leads to a tear, resulting in a new hole.

Several different types of hernia may occur, and frequently coexist, in the groin area. These include indirect, direct, and femoral hernias, which are defined by the location of the opening of the hernia from the abdomen to the groin. Another type of hernia, called a ventral hernia, occurs in the midline of the abdomen, usually above the navel (umbilicus). Hernias can also occur within the navel (umbilical hernia).

WHAT ARE ABDOMINAL HERNIA SYMPTOMS AND SIGNS?

Symptoms of a hernia include pain or discomfort and a localized swelling somewhere on the surface of the abdomen or in the groin area. A hernia can also be painless and only appear as a bulging. The pain may be intermittent or constant and the swelling may decrease or be absent, depending on the amount of pressure in the abdomen. Constant, intense pain at a bulge site may indicate a medical emergency and should be evaluated immediately by a doctor.

WHAT ARE THE DIFFERENT TYPES OF ABDOMINAL HERNIAS?

Epigastric, umbilical, incisional, lumbar, internal, inguinal, hiatal, and Spigelian hernias all occur at different sites of the abdomen in areas that are prone to anatomical or structural weakness. With the exception of internal hernias (within the abdomen), these hernias are commonly recognized as a lump or swelling and are often associated with pain or discomfort at the site. Internal hernias can be extremely difficult to diagnose until the intestine (bowel) has become trapped and obstructed because there is usually no external evidence of a lump.

HOW IS AN ABDOMINAL HERNIA REPAIRED AND TREATED?

A hernia repair requires surgery. There are several different procedures that can be used for fixing any specific type of hernia. In the open surgical approach, following appropriate anesthesia and sterilization of the surgical site, an incision is made over the area of the hernia and carried down carefully through the sequential tissue layers. The goal is to separate away all the normal tissue and define the margins of the hole or weakness. Once this has been achieved, the hole is then closed, usually by some combination of suture and a plastic mesh. When a repair is done by suture alone, the edges of the defect are pulled together, much like sewing a hole together in a piece of cloth. One of the possible complications of this approach is that it can put excessive strain on the surrounding tissues through which the sutures are passed. Over time, with normal bodily exertion, this strain can lead to the tearing of these stressed tissues and the formation of another hernia. The frequency of such recurrent hernias, especially in the groin region, has led to the development of many different methods of suturing the deep tissue layers in an attempt to provide better results.

In order to provide a secure repair and avoid the stress on the adjacent tissue caused by pulling the hole closed, an alternative technique was developed which bridges the hole or weakness with a piece of plastic-like mesh or screen material. The mesh is a permanent material and, when sewn to the margins of the defect, it allows the body's normal healing process to incorporate it into the local structures. Hernia repair with mesh has proved to be a very effective means of repair.

After the hernia repair is completed, the overlying tissues and skin are surgically closed, usually with absorbable sutures. More and more of hernia repairs are now being done using laparoscopic techniques.

WHAT IS LAPAROSCOPIC ABDOMINAL HERNIA REPAIR SURGERY?

A number of factors have led to the development of a new method of repair called laparoscopic hernia repair. This technique is an extension of a traditional mesh repair method that was used in patients who may have already experienced several hernia recurrences at the same site. Previously, this mesh repair approach had required a separate incision somewhat removed from the target area. However, with the progressive development of the instruments and techniques for laparoscopic surgery, the same procedure can now be done with several relatively small incisions. This allows the surgeon to enter the space behind the hernia defect and place the mesh with minimal injury to the surface of the abdomen. The advantages of this method include coverage of all the potential sites of groin hernia, which reduces the risks of recurrence while also decreasing the amount of postsurgical pain.

WHAT ABOUT THE USE OF A LASER IN ABDOMINAL HERNIA REPAIR?

This is a relatively common question. It arises because, for a time, there were some surgeons marketing "laser hernia repair." While a laser may have been used to make the incision and to separate the tissues, the laser has no application in the repair of a hernia. It is impossible to perform the necessary structural repair with a laser, which functions essentially as a cutting tool. There has been no evidence that incisions by lasers will decrease pain or decrease healing time.

WHAT KIND OF ANESTHESIA IS USED FOR ABDOMINAL HERNIA SURGERY?

Most hernia repairs can be done with a variety of anesthetic methods. With modern general anesthetic techniques and monitoring, general anesthesia is very safe. However the surgery can also be performed under local anesthesia or regional anesthetics, often using sedation medications at the same time to help relax the patient. The specific type of anesthetic for an individual patient is selected after careful evaluation of the patient's general health and individual concerns.

CAN STRENGTHENING THE MUSCLES MAKE AN ABDOMINAL HERNIA GO AWAY?

Unfortunately, exercising to improve a hernia is likely to aggravate the condition. The hernia exists because of a localized absence of muscle and supporting structure. Exercise can strengthen the surrounding muscles, thereby worsening the localized weakness and increasing the pressures inside the abdomen. The result is that more tissue can be forced through the defect and enlarge the hernia.

WHAT CAN BE DONE TO PREVENT AN ABDOMINAL HERNIA?

Most of the factors that lead to the development of hernias are beyond the control of the individual. Some of those factors are inherited and develop as the individual grows. The arrangement of the local tissues and their thickness and strength may greatly affect the relative risk of developing a hernia over a lifetime. However, that risk can be increased by failure to use good body mechanics when lifting, poor abdominal support posture, smoking and weight-control problems.

ARE ABDOMINAL HERNIAS INHERITED?

Since genetics dictate inherited features and structure, there is a significant risk of inheriting the anatomical features that may predispose to a hernia. There may also be inherited factors that result in tissue weakness, which ultimately allows the deterioration of the supporting structures and leads to the formation of a hernia. However, this does not necessarily imply that the offspring of an individual with a hernia will ultimately develop the problem. However, some infants are born with congenital defects that lead to hernia development.

DO ABDOMINAL HERNIAS USUALLY DEVELOP ON BOTH SIDES OF THE BODY?

Groin hernias are somewhat more likely to develop on both sides. This is probably because the structural elements develop symmetrically, and the stresses on the body that occur over time are similar on both sides. When a patient becomes aware of a groin swelling on one side, examination by a doctor will often identify a small hernia on the opposite side.

SHOULD ALL ABDOMINAL HERNIAS BE REPAIRED?

In general, hernias that are at risk for complications, that cause pain, or that limit activity should be repaired. If they are not repaired, there is a risk that an emergency surgical procedure may be required at a later date.

Sometimes, a hernia can be temporarily controlled by wearing a belt-like device that applies external compression, which pushes the tissues back into the abdomen and holds them there. This device is called a truss. The truss must be carefully applied on a daily basis. It should only be used for selected situations following careful evaluation by a doctor.

HOW CAN A PERSON DETERMINE IF A LUMP OR SWELLING IS AN ABDOMINAL HERNIA?

Not all lumps or swellings on the abdominal wall or in the groin are hernias. People should have such lumps or swellings examined by a doctor. Other possible causes include benign or malignant tumors or enlarged lymph nodes. These problems require entirely different types of evaluation and treatments; self-diagnosis may be incorrect and delay needed treatments.

The Heart And Heart Surgery

2020-10-10T21:23:00.007-07:00

Heart Surgery Overview

Thousands of heart surgeries are performed every day in the United States.

Thousands of heart surgeries are performed every day in the United States. Even though there is a shortage of donor organs, more than 3,400 people have heart transplants each year.

Two major advances in medicine made heart surgery possible:

The heart-lung machine, which takes over the work of the heart.

Body cooling techniques, which allow more time for surgery without causing brain damage.

What is a heart-lung machine?

The heart-lung machine is also called a cardiopulmonary bypass machine. It takes over for the heart by replacing the heart’s pumping action and by adding oxygen to the blood. This means that the heart will be still for the operation, which is necessary when the heart has to be opened (open heart surgery).

When you are connected to the heart-lung machine, it does the same job that your heart and lungs would do. The heart-lung machine carries blood from the upper-right chamber of the heart (the right atrium) to a special reservoir called an oxygenator. Inside the oxygenator, oxygen bubbles up through the blood and enters the red blood cells. This causes the blood to turn from dark (oxygen-poor) to bright red (oxygen-rich). Then, a filter removes the air bubbles from the oxygen-rich blood, and the blood travels through a plastic tube to the body’s main blood conduit (the aorta). From the aorta, the blood moves throughout the rest of the body.

The heart-lung machine can take over the work of the heart and lungs for hours. Trained technicians called perfusion technologists (blood flow specialists, also called the “pump team”) operate the heart-lung machine.

What are cooling techniques?

Cooling techniques let surgeons stop the heart for long periods without damaging the heart tissue. Cool temperatures avoid damage to the heart tissue by reducing the heart’s need for oxygen.

The heart may be cooled in 2 ways:

Blood is cooled as it passes through the heart-lung machine. In turn, this cooled blood lowers body temperature when it reaches all of the body parts.

Cold salt-water (saline) is poured over the heart.

After cooling, the heart slows and stops. Injecting a special potassium solution into the heart can speed up this process and stop the heart completely. The heart is then safe from tissue injury for 2 to 4 hours.

Who is in the operating room during surgery?

During heart surgery, a highly trained group works as a team.

The cardiovascular surgeon heads up the surgery team and performs the key parts of the surgery.

The assisting surgeons follow the direction of the cardiovascular surgeon.

The cardiovascular anesthesiologist gives you the medicines that make you sleep during the surgery (called anesthesia) and monitors the ventilator, which breathes for you during surgery.

The perfusion technologists run the heart-lung machine.

The cardiovascular nurses are specially trained to assist in heart surgery.

What kinds of heart and blood vessel surgeries are there?

Coronary Artery Bypass

This is the most common kind of heart surgery, also called coronary artery bypass graft surgery (CABG), coronary artery bypass (CAB), coronary bypass, or bypass surgery.

The surgery involves using a healthy section of blood vessel from another part of the body to bypass a part of a diseased or blocked coronary artery. This creates a new route for blood to flow, so that the heart muscle will get the oxygen-rich blood it needs to work properly.

During bypass surgery, the breastbone (sternum) is divided, the heart is stopped, and blood is sent through a heart-lung machine. Unlike other kinds of heart surgery, the chambers of the heart are not opened during bypass surgery.

The terms single bypass, double bypass, triple bypass, or quadruple bypass refer to the number of arteries that are bypassed.

Valve repair or replacement

Blood is pumped through your heart in only one direction. Heart valves play key roles in this one-way blood flow, opening and closing with each heartbeat. Pressure changes behind and in front of the valves allow them to open their flap-like “doors” (called cusps or leaflets) at just the right time, then close them tightly to prevent a backflow of blood.

Two of the most common kinds of valve problems that require surgery are

Stenosis, which means the leaflets do not open wide enough and only a small amount of blood can flow through the valve. Stenosis (narrowing) occurs when the leaflets thicken, stiffen, or fuse together. Surgery is needed to either open the valve that is there or replace it with a new one.

Regurgitation, which is also called insufficiency or incompetence, means that the valve does not close properly and blood leaks backward instead of moving in the proper forward direction.

Surgery is needed to either tighten or replace the valve.

Surgical repair of a valve involves the surgeon rebuilding the valve so that it will work properly. Valve replacement means that the valve is replaced with a biological valve (made of animal or human tissue) or a mechanical valve (made from materials such as plastic, carbon, or metal).

Arrhythmia Surgery

Any irregularity in your heart’s natural rhythm is called an arrhythmia. Arrhythmias are usually treated first with medicines. Other treatments may include

Electrical cardioversion, where the cardiologist or surgeon uses paddles to “shock” the heart back into a normal rhythm.

Catheter ablation, where the cardiologist uses a special tool to destroy (ablate) the cells that are causing the arrhythmia. This is done in the cardiac catheterization laboratory (the cath lab).

Pacing and rhythm-control devices, including pacemakers and implantable cardioverter defibrillators (ICDs). Patients can have these devices implanted while in the operating room or the cath lab.

When these treatments do not work, surgery may be needed. One type of surgery is called Maze surgery. In Maze surgery, surgeons create a “maze” of new electrical pathways to let electrical impulses travel easily through the heart. Maze surgery is used most often to treat a type of arrhythmia called atrial fibrillation. Atrial fibrillation is the most common type of arrhythmia.

Aneurysm Repair

An aneurysm is a balloon-like bulge in a blood vessel or in the wall of the heart. An aneurysm occurs when the wall of a blood vessel or the heart becomes weakened. Pressure from the blood forces it to bulge outward, forming what you might think of as a blister. An aneurysm can often be repaired before it bursts.

Surgery involves replacing the weakened section of blood vessel or heart with a patch or artificial tube (called a graft).

Aneurysms in the wall of the heart occur most often in the lower-left chamber (called the left ventricle). These aneurysms are called left ventricular aneurysms, and they may develop after a heart attack. (A heart attack can weaken the wall of the left ventricle.) If a left ventricular aneurysm leads to an irregular heartbeat or to heart failure, the surgeon may perform open heart surgery to remove the damaged part of the wall.

Transmyocardial Laser Revascularization (TMLR)

Angina is the pain you feel when a diseased vessel in your heart (called a coronary artery) can no longer deliver enough blood to a part of the heart to meet its need for oxygen. The heart’s lack of oxygen-rich blood is called ischemia. Angina usually occurs when your heart has an extra need for oxygen-rich blood, such as during exercise. Angina is nearly always caused by coronary artery disease (CAD).

Transmyocardial laser revascularization (TMLR) is a procedure that uses lasers to make channels in the heart muscle, in an attempt to allow blood to flow from a heart chamber directly into the heart muscle. If the blood flow is increased, more oxygen can reach the heart. This procedure is only done as a last resort. For example, TMLR may be done in patients who have had many coronary artery bypass operations and cannot have another bypass operation.

Carotid Endarterectomy

Carotid artery disease affects the vessels leading to the head and brain. Like the heart, the brain’s cells need a constant supply of oxygen-rich blood. This blood supply is delivered to the brain by the 2 large carotid arteries in the front of your neck and by 2 smaller vertebral arteries at the back of your neck. The right and left vertebral arteries come together at the base of the brain to form what is called the basilar artery. A stroke most often occurs when fatty plaque blocks the carotid arteries and the brain does not get enough oxygen.

Carotid endarterectomy is the most common surgical treatment for carotid artery disease. Surgeons make an incision at the location of the blockage in the neck and a tube is inserted above and below the blockage to reroute blood flow. Surgeons can then remove the fatty plaque.

A carotid endarterectomy can also be done by a technique that does not require blood flow to be rerouted. In this procedure, the surgeon stops the blood flow just long enough to peel the blockage away from the artery.

Heart Transplantation

The first heart transplants were performed in the late 1960s. But it was not until the use of anti-rejection medicines in the 1980s that the procedure became an accepted operation. Today, heart transplantation gives hope to a select group of patients who would otherwise die of heart failure.

The need for a heart transplant can be traced to one of many heart problems, each of which causes damage to the heart muscle. The two most common heart problems are idiopathic cardiomyopathy (disease of the heart muscle without a known cause) and coronary artery disease (the buildup of plaque in the arteries of the heart).

As the heart problem gets worse, the heart grows weaker and is less able to pump oxygen-rich blood to the rest of the body.

Because the heart must work harder to pump blood through the body, it tries to make up for this extra work by becoming enlarged (hypertrophied). In time, the heart works so hard to pump blood that it may simply wear out, overcome by disease and unable to meet even the smallest pumping demands.

Medicines, mechanical devices to assist the heart, and other therapies (including stem cell therapy) can sometimes help and even improve a patient’s condition. But when those treatments fail, transplantation becomes the only option.

And Also:

Cardiac Procedures and Surgeries

If you've had a heart attack, you may have already had certain procedures to help you survive your heart attack and diagnose your condition. For example, many heart attack patients have undergone thrombolysis, a procedure that involves injecting a clot-dissolving agent to restore blood flow in a coronary artery.

This procedure is administered within a few (usually three) hours of a heart attack. If this treatment isn't done immediately after a heart attack, many patients will need to undergo coronary angioplasty or coronary artery bypass graft surgery (CABG) later to improve blood supply to the heart muscle.

Cardiac Procedures and Surgeries

Angioplasty

Also known as Percutaneous Coronary Interventions [PCI], Balloon Angioplasty and Coronary Artery Balloon Dilation. View an animation of angioplasty.

What the Procedure Does

Special tubing with an attached deflated balloon is threaded up to the coronary arteries. The balloon is inflated to widen blocked areas where blood flow to the heart muscle has been reduced or cutoff. Often combined with implantation of a stent to help prop the artery open and decrease the chance of another blockage. Considered less invasive because the body is not cut open. Lasts from 30 minutes to several hours. May require an overnight hospital stay.

Reason for the Procedure

Greatly increases blood flow through the blocked artery.

Decreases chest pain (angina).

Increases ability for physical activity that has been limited by angina or ischemia.

Can also be used to open neck and brain arteries to help prevent stroke.

Angioplasty, Laser

What the Procedure Does

Similar to angioplasty except that the catheter has a laser tip that opens the blocked artery. Pulsating beams of light vaporize the plaque buildup.

Reason for the Procedure

Increases blood flow through blocked arteries.

Artificial Heart Valve Surgery

(Also known as Heart Valve Replacement Surgery)

What the Procedure Does

Replaces an abnormal or diseased heart valve with a healthy one.

Reason for the Procedure

Restores function of the heart valves.

Atherectomy

What the Procedure Does

Similar to angioplasty except that the catheter has a rotating shaver on its tip to cut away plaque from the artery.

Reason for the Procedure

Increases blood flow through the blocked artery by removing plaque buildup.

May also be used in carotid arteries (major arteries of the neck leading to the brain) to remove plaque and reduce risk for stroke.

Bypass Surgery

(Also known as CABG, pronounced "cabbage," Coronary Artery Bypass Graft done via Open-Heart Surgery)

What the Procedure Does

Treats blocked heart arteries by taking arteries or veins from other parts of your body — called grafts — and using them to reroute the blood around the clogged artery to supply blood flow to your heart muscle. View an animation of blood flow(link opens in new window). A patient may undergo one, two, three or more bypass grafts, depending on how many coronary arteries are narrowed. Requires several days in the hospital.

Reason for the Procedure

One of the most common and effective procedures to manage blockage of blood to the heart muscle.

Improves the supply of blood and oxygen to the heart.

Relieves chest pain (angina).

Reduces risk of heart attack.

Improves ability for physical activity that has been limited by angina or ischemia.

Cardiomyoplasty

What the Procedure Does

An experimental procedure in which skeletal muscles are taken from a patient's back or abdomen. Then they're wrapped around an ailing heart. This added muscle, aided by ongoing stimulation from a device similar to a pacemaker, may boost the heart's pumping motion.

Reason for the Procedure

Increases the pumping motion of the heart.

Heart Transplant

What the Procedure Does

Removes a diseased heart and replaces it with a healthy human heart when a heart is irreversibly damaged. Uses hearts from organ donation.

Reason for the Procedure

Recognized as a proven procedure to restore heart health in appropriately selected patients.

Minimally Invasive Heart Surgery

(Also known as Limited Access Coronary Artery Surgery and includes Port-Access Coronary Artery Bypass (PACAB or PortCAB) and Minimally Invasive Coronary Artery Bypass Graft (MIDCAB or minimally invasive CABG)

What the Procedure Does

An alternative to standard bypass surgery (CABG). Small incisions ("ports") are made in the chest. Chest arteries or veins from your leg are attached to the heart to "bypass" the clogged coronary artery or arteries. The instruments are passed through the ports to perform the bypasses. The surgeon views these operations on video monitors rather than directly. In PACAB, the heart is stopped and blood is pumped through an oxygenator or "heart-lung" machine. MIDCAB is used to avoid the heart-lung machine. It's done while the heart is still beating. Requires several days in the hospital.

Reason for the Procedure

Manages blockage of blood flow to the heart and improves the supply of blood and oxygen to the heart.

Relieves chest pain (angina).

Reduces risk of heart attack.

Improves ability for physical activity.

Radiofrequency Ablation

(Also known as Catheter Ablation)

What the Procedure Does

A catheter with an electrode at its tip is guided through the veins to the heart muscle with real-time, moving X-rays (fluoroscopy) displayed on a video screen. The catheter is placed at the exact site inside the heart where cells give off the electrical signals that stimulate the abnormal heart rhythm. Then a mild, painless radiofrequency energy (similar to microwave heat) is transmitted to the pathway. This destroys carefully selected heart muscle cells in a very small area (about 1/5 of an inch).

Reason for the Procedure

Preferred treatment for many types of rapid heartbeats (arrhythmias) especially supraventricular tachyarrhythmias.

Stent Placement

What the Procedure Does

A stent is a wire mesh tube used to prop open an artery during angioplasty. The stent stays in the artery permanently. View an animation of a stent(link opens in new window).

Coronary narrowings can form again within stents and are referred to as “restenosis.”

Reason for the Procedure

Holds the artery open.

Improves blood flow to the heart muscle.

Relieves chest pain (angina).

Transmyocardial Revascularization (TMR)

What the Procedure Does

An incision is made on the left breast to expose the heart. Then, a laser is used to drill a series of holes from the outside of the heart into the heart's pumping chamber. In some patients TMR is combined with bypass surgery. In those cases an incision through the breastbone is used for the bypass. Usually requires a hospital stay.

Reason for the Procedure

Used to relieve severe chest pain (angina) in very ill patients who aren't candidates for bypass surgery or angioplasty.

New Medical Discoveries

2020-10-06T18:32:00.004-07:00

Close up shot of doctor wearing virtual reality glasses

Artificial organs and a possible cancer cure aren't the future—they're the now

3D-Printed Devices and Organs

Scientists gathering around 3-D printer and watching process of model production in laboratory

The 3D printer was invented in 1983 by Chuck Hull. In 2019, however, the medical industry began to perfect 3D printers to design and create artificial organs. Implants, joints, and prosthetics can be measured and designed precisely, so they fit perfectly in your body. The printing has improved the ability to accurately design and create artificial organs, so they're more likely to be comfortable and mobile for the recipient.

Research published in the British Medical Journal studied 350 cases of 3D-printed artificial implants, the majority of which were used in oral and maxillofacial surgery (affecting the mouth, teeth, jaws and face) and 23.7% of which were used in musculoskeletal system (which provides form, support, stability, and movement to the body). These implants were found to be "clinically effective," and it was concluded that these 3D printed devices "outperformed their conventional comparators."

In one case, published in the New England Journal of Medicine, Dr. Glenn Green treated an infant with localized bronchial malacia, a breathing issue, with a three-dimensional splint created by a 3D printer. The splint immediately improved the infant's breathing. Said Dr. Green: "Beyond anything that I even dreamt about during my early training, 3D printing offers the ability to create medical devices to improve the lives of our patients."

Genetic Testing to Decrease the Opioid Epidemic

Opioid addiction is an overwhelming and dangerous problem in the U.S. According to the National Institute on Drug Abuse, more than 130 people die in the U.S. every day from opioid overdoses and 21% to 29% of patients who were prescribed opiates by their doctors abuse them. Since chronic pain is the reason for opioid prescriptions, the medical industry is focused on alternative therapies for pain relief. In 2019, the process of pharmacogenomic testing was analyzed and may be one of the strongest methods of alternative therapy to opioid prescriptions.

According to the Cleveland Clinic, "Pharmacogenomics is the study of how genetic factors relate to interindividual variability of drug response." A patient's genetics are studied and tested so the medical provider can better predict how he or she will metabolize a drug. With this information, more accurate and effective drug therapy can be prescribed for pain management. With unique and custom-tailored drug therapies for pain sufferers, the need for opioid prescriptions can decrease.

Routine pharmacogenomic testing is not endorsed by the Food and Drug Administration (FDA) and isn't widely accepted by medical providers or health insurance companies yet. However, research, additional testing, and clinical trials conducted by the National Heart, Lung, and Blood Institute this year may bring this method to the forefront to fight against the opioid crisis.

A Possible Cure for Cervical Cancer

Medical Research Scientists Examines Laboratory Mice kept in a Glass Cage. She Works in a Light Laboratory

One of the most exciting medical discoveries of 2019 was when Australian scientists used gene-editing technology to eliminate cancer from experimental mice. Over five years, these scientists injected specialized nanoparticles into mice that had tumors caused by the gene E7. This is the gene usually found in cancers caused by the human papillomavirus (HPV), which is the culprit for cervical cancer.

The scientists edited this gene by introducing additional DNA, a technique called Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR). Nigel McMillan, the lead researcher in the study, said, "This is like adding a few extra letters into a word, so the spell checker doesn't recognize it anymore."

All mice survived this treatment, and the tumors were 100% eliminated. The scientists may move on to conducting this experiment in humans next. While this treatment has a ways to go before it can be approved and proven effective, it's an exciting small step to the potential cure for cancer.

Virtual Reality for Medical Training

Today's virtual reality is so realistic, medical students and professionals can use these programs to practice performing medical procedures and surgeries or to learn more about real-life situations they may encounter in a healthcare setting.

A study published in Cyberpsychology and Behavior states that virtual reality technology is being used in the healthcare industry for:

Medical crisis training.

Temporal bone dissection.

Orthopedic surgery.

Virtual endoscopy simulator.

Arthroscopic knee surgery.

Interventional neuroradiology procedures.

Esophageal intubation training.

Laparoscopic skill practice.

Not only can virtual reality training help future medical professionals practice dealing with real-world situations, but they can also build confidence in currently practicing doctors. By sharpening their skills through virtual reality programs, medical providers can put their knowledge to the test to ensure they feel comfortable performing complicated or grueling medical procedures and surgeries.

A Visor That Detects Strokes

The volumetric impedance phase shift spectroscopy (VIPS) device

About 800,000 strokes occur each year, according to research published in Neurotherapeutics. Approximately 87% of these strokes are ischemic strokes, which are caused by blood clots blocking blood flow to the brain. About 10% of these strokes are primary hemorrhage strokes, which usually occurs when blood vessels in the brain rupture. While hemorrhage strokes aren't as common, they're more deadly. According to Harvard Medical School, 30% to 60% of people with an intracerebral hemorrhage die.

Since hemorrhage strokes cause internal bleeding inside the brain, fast diagnosis and treatment is crucial to prevent permanent brain damage or death. Medical professionals focusing on how to quickly diagnose this type of stroke created the hemorrhage scanning visor. This visor scans the brain to detect bleeding. By simply placing the hemorrhage scanning visor on a patient's head, a medical professional can easily identify if the brain is hemorrhaging and begin treatment immediately. Science Daily claims this visor has 92% accuracy and provides results within seconds, making this a promising medical discovery of 2019.

Discovery of a New HIV Strand

Focused life science professional pipetting human serum media containing HIV infected cells from petri dish to microtiter plate

The discovery of a new Human Immunodeficiency Virus (HIV) strand in 2019 sounds like a bad thing. But, to develop effective treatments for this disease, researchers must be able to identify each different strand and learn how it behaves. This is the first new strand of HIV that's been identified in 19 years, so it's
a breakthrough that can help researchers in their quest for effective treatment.

According to the Journal of Acquired Immune Deficiency Syndrome, specimen CG-0018a-01 is a rare form of HIV. Researchers are still studying how it affects the body and if it responds to the HIV treatments that are already developed. Co-author of the study, Dr. Carole McArthur, states, "This discovery reminds us that to end the HIV pandemic, we must continue to out-think this continuously changing virus and use the latest advancements in technology and resources to monitor its evolution."

RNA-Based Therapies

Laboratory research of cancer diseases, rack with RNA samples

Genetic diseases, including certain forms of cancer and neurological diseases, are currently incurable, but researchers are dedicated to finding treatments. RNA therapies work similarly to DNA based therapies and have shown promise for treating gene mutation disorders in 2019. RNA therapy interferes with genetic data at the ribonucleic acid (RNA) level to try and "fix" the gene mutation that's causing the disease.

By tweaking the nucleobase code, or the fundamental units of genetic code, scientists can adjust what the therapy affects. According to Professor Paula Hammond from MIT: "You simply change the sequence, and you're hitting another indication. If the platform works once, it multiplies."

According to UMass Medical School's RNA Therapeutics Institute, this treatment is still undergoing clinical trials but has been showing favorable outcomes. Once tested appropriately, researchers are hopeful RNA-based therapies can help to treat:

Neurodegenerative diseases.

Diabetes.

Atherosclerosis.

Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig's Disease).

Preeclampsia.

Hypercholesterolemia.

Viral infections.

Alpha-1 antitrypsin.

Huntington's disease.

Frontotemporal Lobar Degeneration (FTLD).

Telemedicine

Videoconferencing With Happy Female Doctor On Laptop

We stare at our phones to check work emails or look for the latest shopping deals. Why not use this little piece of addictive technology to improve our health? Telemedicine, also referred to as telehealth, has taken off in 2019. With the latest telemedicine services, you can see a doctor right through an app on your smartphone instead of waiting for a face-to-face appointment. In some cases, a simple email providing information on your symptoms will suffice, while some specialists may want to video chat with you before offering a diagnosis or treatment. Telemedicine is a great way for patients with chronic conditions to check in with doctors without going through the rigamarole of making an appointment and heading to the doctor's office.

According to the American Hospital Association, telemedicine will continue to grow. About 76% of U.S. hospitals offer telehealth services to their patients. Medicare provides some form of reimbursement for telemedicine sessions, and 35 states and the District of Columbia have enacted "parity" laws that require private health insurance companies to cover telehealth services. The telemedicine industry has proven its effectiveness and convenience in 2019, and growth and improvement should continue over the coming years.

An Injection to Prevent Paralysis

Radiologist analysing X-ray image with human spine in consulting room

According to the National Spinal Cord Injury Statistical Center, there are about 17,700 new spinal cord injury cases each year in the United States. Some of these cases can cause paralysis or even death. When your body experiences a trauma, it goes into overdrive, attempting to clear out damaged tissue and provide defense against infection. But sometimes your body's reaction to the injury can do more harm than good.

With a spinal cord injury, the body's reaction can cause nerve damage, numbness, or paralysis. That's why researchers from the University of Michigan focused their studies on eliminating this sometimes debilitating and permanently damaging over-reactive immune response. These scientists discovered that an injection of non-pharmaceutical nanoparticles helped to suppress the harmful immune activity that occurs after a spinal injury.

Not only is the effectiveness of this spinal injury "Epi-pen" good news for those who experience spinal cord injuries, but this treatment also shows promise for other conditions. According to Jonghyuck Park from the University of Michigan, a research fellow on this study, "Hopefully, this technology could lead to new therapeutic strategies not only for patients with spinal cord injury but for those with various inflammatory diseases."

Bluetooth-Enabled Inhalers

The Asthma and Allergy Foundation of America claims that more than 25 million Americans have asthma. This condition is easily manageable by using an asthma inhaler. But one product making waves this year can prove to be helpful for these people living with asthma. A Bluetooth-enabled smart inhaler has a small device attached to it that records the date and time of the last dose administered. This data is sent to the patient's smartphone, allowing the patient to track the frequency of inhaler use and stay on a strict treatment plan as needed. By keeping track of the frequency of use, doctors can identify if a patient is overusing an inhaler and further investigate the reasons for overuse.

According to Jon-Paul Sherlock, director of AstraZeneca's Intelligent Pharmaceutical Respiratory division, "This new technology introduces the potential to support patients, ensuring they get the best from the medicine they have been prescribed." Adding this cutting-edge technology to inhalers can change the way asthma sufferers manage their condition and can make it easier for them to stay healthy.

Arthritis, Its Causes And Treatment

2020-10-05T14:47:00.006-07:00

What are the causes and types of arthritis?

Treatment, Causes, Types, Natural remedies, Early signs

Arthritis means joint inflammation, but the term is used to describe around 200 conditions that affect joints, the tissues that surround the joint, and other connective tissue. It is a rheumatic condition.

The most common form of arthritis is osteoarthritis. Other common rheumatic conditions related to arthritis include gout, fibromyalgia, and rheumatoid arthritis (RA).

Rheumatic conditions tend to involve pain, aching, stiffness, and swelling in and around one or more joints. The symptoms can develop gradually or suddenly. Certain rheumatic conditions can also involve the immune system and various internal organs of the body.

Some forms of arthritis, such as rheumatoid arthritis and lupus (SLE), can affect multiple organs and cause widespread symptoms.

According to the Centers for Disease Control and Prevention (CDC), 54.4 million adults in the United States have received a diagnosis of some form of arthritis. Of these, 23.7 million people have their activity curtailed in some way by their condition.

Arthritis is more common among adults aged 65 years or older, but it can affect people of all ages, including children.

Facts on arthritis

Arthritis refers to around 200 rheumatic diseases and conditions that affect joints, including lupus and rheumatoid arthritis.

It can cause a range of symptoms and impair a person’s ability to perform everyday tasks.

Physical activity has a positive effect on arthritis and can improve pain, function, and mental health.

Factors in the development of arthritis include injury, abnormal metabolism, genetic makeup, infections, and immune system dysfunction.

Treatment aims to control pain, minimize joint damage, and improve or maintain quality of life. It involves medications, physical therapies, and patient education and support.

Treatment

The doctor will likely recommend a course of physical therapies to help you manage some of the symptoms of arthritis.

Treatment for arthritis aims to control pain, minimize joint damage, and improve or maintain function and quality of life.

A range of medications and lifestyle strategies can help achieve this and protect joints from further damage.

Treatment might involve:

medications

non-pharmacologic therapies

physical or occupational therapy

splints or joint assistive aids

patient education and support

weight loss

surgery, including joint replacement

Medication

Non-inflammatory types of arthritis, such as osteoarthritis, are often treated with pain-reducing medications, physical activity, weight loss if the person is overweight, and self-management education.

These treatments are also applied to inflammatory types of arthritis, such as RA, along with anti-inflammatory medications such as corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), and a relatively new class of drugs known as biologics.

Medications will depend on the type of arthritis. Commonly used drugs include:

Analgesics: these reduce pain, but have no effect on inflammation. Examples include acetaminophen (Tylenol), tramadol (Ultram) and narcotics containing oxycodone (Percocet, Oxycontin) or hydrocodone (Vicodin, Lortab). Tylenol is available to purchase online.

Non-steroidal anti-inflammatory drugs (NSAIDs): these reduce both pain and inflammation. NSAIDs include available to purchase over-the-counter or online, including ibuprofen (Advil, Motrin IB) and naproxen sodium (Aleve). Some NSAIDs are available as creams, gels or patches which can be applied to specific joints.

Counterirritants: some creams and ointments contain menthol or capsaicin, the ingredient that makes hot peppers spicy. Rubbing these on the skin over a painful joint can modulate pain signals from the joint and lessen pain. Various creams are available to purchase online.

Disease-modifying antirheumatic drugs (DMARDs): used to treat RA, DMARDs slow or stop the immune system from attacking the joints. Examples include methotrexate (Trexall) and hydroxychloroquine (Plaquenil).

Biologics: used with DMARDs, biologic response modifiers are genetically engineered drugs that target various protein molecules involved in the immune response. Examples include etanercept (Enbrel) and infliximab (Remicade).

Corticosteroids: prednisone and cortisone reduce inflammation and suppress the immune system.

Natural remedies

A healthful, balanced diet with appropriate exercise, avoiding smoking, and not drinking excess alcohol can help people with arthritis maintain their overall health.

Diet

There is no specific diet that treats arthritis, but some types of food may help reduce inflammation.

The following foods, found in a Mediterranean diet, can provide many nutrients that are good for joint health:

fish

nuts and seeds

fruits and vegetables

beans

olive oil

whole grains

Foods to avoid

There are some foods that people with arthritis may want to avoid.

Nightshade vegetables, such as tomatoes, contain a chemical called solanine that some studies have linked with arthritis pain. Research findings are mixed when it comes to these vegetables, but some people have reported a reduction in arthritis symptoms when avoiding nightshade vegetables.

Self-management

Self-management of arthritis symptoms is also important.

Key strategies include:

staying physically active

achieving and maintaining a healthy weight

getting regular check-ups with the doctor

protecting joints from unnecessary stress

Seven habits that can help a person with arthritis to manage their condition are:

Being organized: keep track of symptoms, pain levels, medications, and possible side effects for consultations with your doctor.

Managing pain and fatigue: a medication regimen can be combined with non-medical pain management. Learning to manage fatigue is key to living comfortably with arthritis.

Staying active: exercise is beneficial for managing arthritis and overall health.

Balancing activity with rest: in addition to remaining active, rest is equally important when your disease is active.

Eating a healthful diet: a balanced diet can help you achieve a healthy weight and control inflammation. Avoid refined, processed foods and pro-inflammatory animal-derived foods and choose whole plant foods that are high in antioxidants and that have anti-inflammatory properties.

Improving sleep: poor sleep can aggravate arthritis pain and fatigue. Take steps to improve sleep hygiene so you find it easier to fall asleep and stay asleep. Avoid caffeine and strenuous exercise in the evenings and restrict screen-time just before sleeping.

Caring for joints: tips for protecting joints include using the stronger, larger joints as levers when opening doors, using several joints to spread the weight of an object such as using a backpack and gripping as loosely as possible by using padded handles.

Do not sit in the same position for long periods. Take regular breaks to keep mobile.

Physical therapies

Doctors will often recommend a course of physical therapy to help patients with arthritis overcome some of the challenges and to reduce limitations on mobility.

Forms of physical therapy that may be recommended include:

Warm water therapy: exercises in a warm-water pool. The water supports weight and puts less pressure on the muscles and joints

Physical therapy: specific exercises tailored to the condition and individual needs, sometimes combined with pain-relieving treatments such as ice or hot packs and massage

Occupational therapy: practical advice on managing everyday tasks, choosing specialized aids and equipment, protecting the joints from further damage and managing fatigue

Physical activity

Research suggests that although individuals with arthritis may experience short-term increases in pain when first beginning exercise, continued physical activity can be an effective way to reduce symptoms long-term.

People with arthritis can participate in joint-friendly physical activity on their own or with friends. As many people with arthritis have another condition, such as heart disease, it is important to choose appropriate activities.

Joint-friendly physical activities that are appropriate for adults with arthritis and heart disease include:

walking

swimming

cycling

A health care professional can help you find ways to live a healthful lifestyle and have a better quality of life.

Natural therapies

A number of natural remedies have been suggested for different types of arthritis.

According to the organization Versus Arthritis, based in the United Kingdom (U.K.), some research has supported the use of devil’s claw, rosehip, and Boswellia, from the frankincense tree. Devil’s claw and Boswellia supplements can be purchased online.

There is some evidence that turmeric may help, but more studies are needed to confirm their effectiveness.

Various other herbs and spices have been recommended for RA, but again, more research is needed. They include turmeric, garlic, ginger, black pepper, and green tea.

Many of these herbs and spices are available to purchase online in supplement form, including turmeric, ginger, and garlic.

Anyone who is considering using natural remedies for any type of arthritis should speak to a doctor first.

Causes

There is no single cause of all types of arthritis. The cause or causes vary according to the type or form of arthritis.

Possible causes may include:

injury, leading to degenerative arthritis

abnormal metabolism, leading to gout and pseudogout

inheritance, such as in osteoarthritis

infections, such as in the arthritis of Lyme disease

immune system dysfunction, such as in RA and SLE

Most types of arthritis are linked to a combination of factors, but some have no obvious cause and appear to be unpredictable in their emergence.

Some people may be genetically more likely to develop certain arthritic conditions. Additional factors, such as previous injury, infection, smoking and physically demanding occupations, can interact with genes to further increase the risk of arthritis.

Diet and nutrition can play a role in managing arthritis and the risk of arthritis, although specific foods, food sensitivities or intolerances are not known to cause arthritis.

Foods that increase inflammation, particularly animal-derived foods and diets high in refined sugar, can make symptoms worse, as can eating foods that provoke an immune system response.

Gout is one type of arthritis that is closely linked to diet, as it is caused by elevated levels of uric acid which can be a result of a diet high in purines.

Diets that contain high-purine foods, such as seafood, red wine, and meats, can trigger a gout flare-up. Vegetables and other plant foods that contain high levels of purines do not appear to exacerbate gout symptoms, however.

Risk factors for arthritis

Certain risk factors have been associated with arthritis. Some of these are modifiable while others are not.

Non-modifiable arthritis risk factors:

Age: the risk of developing most types of arthritis increases with age.

Sex: most types of arthritis are more common in females, and 60 percent of all people with arthritis are female. Gout is more common in males than females.

Genetic factors: specific genes are associated with a higher risk of certain types of arthritis, such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) and ankylosing spondylitis.

Modifiable arthritis risk factors:

Overweight and obesity: excess weight can contribute to both the onset and progression of knee osteoarthritis.

Joint injuries: damage to a joint can contribute to the development of osteoarthritis in that joint.

Infection: many microbial agents can infect joints and trigger the development of various forms of arthritis.

Occupation: certain occupations that involve repetitive knee bending and squatting are associated with osteoarthritis of the knee.

Comorbidities

More than half of adults in the U.S. with arthritis report high blood pressure. High blood pressure is associated with heart disease, the most common comorbidity among adults with arthritis.

Around 1 in 5 of adults in the U.S. who have arthritis are smokers. Smoking is associated with chronic respiratory conditions, the second most common comorbidity among adults with arthritis.

Types

There are around 200 types of arthritis, or musculoskeletal conditions. These are split into seven main groups:

Inflammatory arthritis

Degenerative or mechanical arthritis

Soft tissue musculoskeletal pain

Back pain

Connective tissue disease

Infectious arthritis

Metabolic arthritis

Inflammatory arthritis

Inflammation is a normal part of the body’s healing process. The inflammation tends to occur as a defense against viruses and bacteria or as a response to injuries such as burns. However, with inflammatory arthritis, inflammation occurs in people for no apparent reason.

Inflammatory arthritis can affect several joints, damaging the surface of the joints and the underlying bone.

Inflammatory arthritis is characterized by damaging inflammation that does not occur as a normal reaction to injury or infection. This type of inflammation is unhelpful and instead causes damage in the affected joints, resulting in pain, stiffness and swelling.

Inflammatory arthritis can affect several joints, and the inflammation can damage the surface of the joints and also the underlying bone.

Examples of inflammatory arthritis include:

Rheumatoid arthritis (RA)

Reactive arthritis

Ankylosing spondylitis

Arthritis associated with colitis or psoriasis

The word “arthritis” means “joint inflammation,” but inflammation may also affect the tendons and ligaments surrounding the joint.

Degenerative or mechanical arthritis

Degenerative or mechanical arthritis refers to a group of conditions that mainly involve damage to the cartilage that covers the ends of the bones.

The main job of the smooth, slippery cartilage is to help the joints glide and move smoothly. This type of arthritis causes the cartilage to become thinner and rougher.

To compensate for the loss of cartilage and changes in joint function, the body begins to remodel the bone in an attempt to restore stability. This can cause undesirable bony growths to develop, called osteophytes. The joint can become misshapen. This condition is commonly called osteoarthritis.

Osteoarthritis can also result from previous damage to the joint such as a fracture or previous inflammation in the joint.

Soft tissue musculoskeletal pain

Soft tissue musculoskeletal pain is felt in tissues other than the joints and bones. The pain often affects a part of the body following injury or overuse, such as tennis elbow, and originates from the muscles or soft tissues supporting the joints.

Pain that is more widespread and associated with other symptoms may indicate fibromyalgia.

Back pain

Back pain can arise from the muscles, discs, nerves, ligaments, bones, or joints. Back pain may stem from problems with organs inside the body. It can also be a result of referred pain, for example, when a problem elsewhere in the body leads to pain in the back.

There may be a specific cause, such as osteoarthritis. This is often called spondylosis when it occurs in the spine. Imaging tests or a physical examination may detect this.

A “slipped” disc is another cause of back pain, as is osteoporosis, or thinning of the bones.

If a doctor cannot identify the exact cause of back pain, it is often described as “non-specific” pain.

Connective tissue disease (CTD)

Connective tissues support, bind together, or separate other body tissues and organs. They include tendons, ligaments, and cartilage.

CTD involves joint pain and inflammation. The inflammation may also occur in other tissues, including the skin, muscles, lungs, and kidneys. This can result in various symptoms besides painful joints, and it may require consultation with a number of different specialists.

Examples of CTD include:

SLE, or lupus

scleroderma, or systemic sclerosis

dermatomyositis

Infectious arthritis

A bacterium, virus, or fungus that enters a joint can sometimes cause inflammation.

Organisms that can infect joints include:

Salmonella and Shigella, spread through food poisoning or contamination

chlamydia and gonorrhea, which are sexually transmitted diseases (STDs)

hepatitis C, a blood-to-blood infection that may be spread through shared needles or transfusions

A joint infection can often be cleared with antibiotics or other antimicrobial medication. However, the arthritis can sometimes become chronic, and joint damage may be irreversible if the infection has persisted for some time.

Metabolic arthritis

Uric acid is a chemical created when the body breaks down substances called purines. Purines are found in human cells and several foods.

Most uric acid dissolves in blood and travels to the kidneys. From there, it passes out in urine. Some people have high levels of uric, acid because they either naturally produce more than they need or their body cannot clear the uric acid quickly enough.

Uric acid builds up and accumulates in some people and forms needle-like crystals in the joint, resulting in sudden spikes of extreme joint pain or a gout attack.

Gout can either come and go in episodes or become chronic if uric acid levels are not reduced.

It commonly affects a single joint or a small number of joints, such as the big toe and hands. It usually affects the extremities. One theory is that uric acid crystals form in cooler joints, away from the main warmth of the body.

Some of the more common types of arthritis are discussed below.

Rheumatoid arthritis

Rheumatoid arthritis and osteoarthritis share some characteristics, but they are different conditions.

Rheumatoid arthritis (RA) occurs when the body’s immune system attacks the tissues of the body, specifically connective tissue, leading to joint inflammation, pain, and degeneration of the joint tissue.

Cartilage is a flexible, connective tissue in joints that absorb the pressure and shock created by movement like running and walking. It also protects the joints and allows for smooth movement.

Persistent inflammation in the synovia leads to the degeneration of cartilage and bone. This can then lead to joint deformity, pain, swelling, and redness.

RA can appear at any age and is associated with fatigue and prolonged stiffness after rest.

RA causes premature mortality and disability and it can compromise quality of life. Conditions it is linked to include cardiovascular diseases, such as ischemic heart disease and stroke.

Diagnosing RA early gives a better chance of learning how to manage symptoms successfully. This can reduce the impact of the disease on quality of life.

Osteoarthritis

Osteoarthritis is caused by a reduction in the normal amount of cartilage tissue through wear and tear throughout life.

Osteoarthritis is a common degenerative joint disease that affects the cartilage, joint lining and ligaments, and underlying bone of a joint.

The breakdown of these tissues eventually leads to pain and joint stiffness.

The joints most often affected by osteoarthritis are those that get heavy use, such as hips, knees, hands, the spine, the base of the thumb, and the big toe joint.

And Also:

Arthritis, Symptoms, Causes, Diagnosis, Treatments, Diet and exercise, Outlook

What is arthritis?

Arthritis is an inflammation of the joints. It can affect one joint or multiple joints. There are more than 100 different types of arthritis, with different causes and treatment methods. Two of the most common types are osteoarthritis (OA) and rheumatoid arthritis (RA).

The symptoms of arthritis usually develop over time, but they may also appear suddenly. Arthritis is most commonly seen in adults over the age of 65, but it can also develop in children, teens, and younger adults. Arthritis is more common in women than men and in people who are overweight.

What are the symptoms of arthritis?

Joint pain, stiffness, and swelling are the most common symptoms of arthritis. Your range of motion may also decrease, and you may experience redness of the skin around the joint. Many people with arthritis notice their symptoms are worse in the morning.

In the case of RA, you may feel tired or experience a loss of appetite due to the inflammation the immune system’s activity causes. You may also become anemic — meaning your red blood cell count decreases — or have a slight fever. Severe RA can cause joint deformity if left untreated.

What causes arthritis?

Cartilage is a firm but flexible connective tissue in your joints. It protects the joints by absorbing the pressure and shock created when you move and put stress on them. A reduction in the normal amount of this cartilage tissue cause some forms of arthritis.

Normal wear and tear causes OA, one of the most common forms of arthritis. An infection or injury to the joints can exacerbate this natural breakdown of cartilage tissue. Your risk of developing OA may be higher if you have a family history of the disease.

Another common form of arthritis, RA, is an autoimmune disorder. It occurs when your body’s immune system attacks the tissues of the body. These attacks affect the synovium, a soft tissue in your joints that produces a fluid that nourishes the cartilage and lubricates the joints.

RA is a disease of the synovium that will invade and destroy a joint. It can eventually lead to the destruction of both bone and cartilage inside the joint.

The exact cause of the immune system’s attacks is unknown. But scientists have discovered genetic markers that increase your risk of developing RA fivefold.

How is arthritis diagnosed?

Seeing your primary care physician is a good first step if you’re unsure who to see for an arthritis diagnosis. They will perform a physical exam to check for fluid around the joints, warm or red joints, and limited range of motion in the joints. Your doctor can refer you to a specialist if needed.

If you’re experiencing severe symptoms, you may choose to schedule an appointment with a rheumatologist first. This may lead to a faster diagnosis and treatment.

Extracting and analyzing inflammation levels in your blood and joint fluids can help your doctor determine what kind of arthritis you have. Blood tests that check for specific types of antibodies like anti-CCP (anti-cyclic citrullinated peptide), RF (rheumatoid factor), and ANA (antinuclear antibody) are also common diagnostic tests.

Doctors commonly use imaging scans such as X-ray, MRI, and CT scans to produce an image of your bones and cartilage. This is so they can rule out other causes of your symptoms, such as bone spurs.

How is arthritis treated?

The main goal of treatment is to reduce the amount of pain you’re experiencing and prevent additional damage to the joints. You’ll learn what works best for you in terms of controlling pain. Some people find heating pads and ice packs to be soothing. Others use mobility assistance devices, like canes or walkers, to help take pressure off sore joints.

Improving your joint function is also important. Your doctor may prescribe you a combination of treatment methods to achieve the best results.

Shop heating pads for pain relief.

Medication

A number of different types of medication treat arthritis:

Analgesics, such as hydrocodone (Vicodin) or acetaminophen (Tylenol), are effective for pain management, but don’t help decrease inflammation.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and salicylates, help control pain and inflammation. Salicylates can thin the blood, so they should be used very cautiously with additional blood thinning medications.

Menthol or capsaicin creams block the transmission of pain signals from your joints.

Immunosuppressants like prednisone or cortisone help reduce inflammation.

If you have RA, your doctor may put you on corticosteroids or disease-modifying antirheumatic drugs (DMARDs), which suppress your immune system. There are also many medications to treat OA available over the counter or by prescription.

Shop capsaicin creams for pain relief.

Surgery

Surgery to replace your joint with an artificial one may be an option. This form of surgery is most commonly performed to replace hips and knees.

If your arthritis is most severe in your fingers or wrists, your doctor may perform a joint fusion. In this procedure, the ends of your bones are locked together until they heal and become one.

Physical therapy

Physical therapy involving exercises that help strengthen the muscles around the affected joint is a core component of arthritis treatment.

What lifestyle changes can help people with arthritis?

Weight loss and maintaining a healthy weight reduce the risk of developing OA and can reduce symptoms if you already have it.

Eating a healthy diet is important for weight loss. Choosing a diet with lots of antioxidants, such as fresh fruits, vegetables, and herbs, can help reduce inflammation. Other inflammation-reducing foods include fish and nuts.

Foods to minimize or avoid if you have arthritis include fried foods, processed foods, dairy products, and high intakes of meat.

Some research also suggests that gluten antibodies may be present in people with RA. A gluten-free diet may improve symptoms and disease progression. A 2015 study also recommends a gluten-free diet for all people who receive a diagnosis of undifferentiated connective tissue disease.

Regular exercise will keep your joints flexible. Swimming is often a good form of exercise for people with arthritis because it doesn’t put pressure on your joints the way running and walking do. Staying active is important, but you should also be sure to rest when you need to and avoid overexerting yourself.

At-home exercises you can try include:

the head tilt, neck rotation, and other exercises to relieve pain in your neck

finger bends and thumb bends to ease pain in your hands

leg raises, hamstring stretches, and other easy exercises for knee arthritis

What is the long-term outlook for people with arthritis?

While there’s no cure for arthritis, the right treatment can greatly reduce your symptoms.

In addition to the treatments your doctor recommends, you can make a number of lifestyle changes that may help you manage your arthritis.

Pneumonia, Its Causes And Treatment

2020-10-05T13:44:00.015-07:00

What you should know about pneumonia

Symptoms, Treatment, In children, Causes, Risk factors, Types, Prevention, Diagnosis

Pneumonia is an infection of the lungs with a range of possible causes. It can be a serious and life-threatening disease.

It normally starts with a bacterial, viral, or fungal infection.

The lungs become inflamed, and the tiny air sacs, or alveoli, inside the lungs fill up with fluid.

Pneumonia can occur in young and healthy people, but it is most dangerous for older adults, infants, people with other diseases, and those with impaired immune systems.

In the United States (U.S.), around 1 million people are treated in the hospital for pneumonia each year, and around 50,000 die from the disease.

Here are some key points about pneumonia.

Pneumonia is an infection of the lungs that can cause mild to severe illness in people of all ages.

It is the leading cause of death due to infection in children younger than 5 years of age worldwide.

Pneumonia and influenza together are ranked as the eighth leading cause of death in the U.S.

Those at high risk for pneumonia include older adults, the very young, and people with underlying health problems.

Symptoms

Pneumonia is a serious lung infection with a number of possible causes.

The first symptoms of pneumonia usually resemble those of a cold or flu. The person then develops a high fever, chills, and cough with sputum.

Common symptoms include:

cough

rusty or green phlegm, or sputum, coughed up from lungs

fever

fast breathing and shortness of breath

shaking chills

chest pain that usually worsens when taking a deep breath

known as pleuritic pain

fast heartbeat

fatigue and weakness

nausea and vomiting

diarrhea

sweating

headache

muscle pain

confusion or delirium, especially in older adults

dusky or purplish skin color, or cyanosis, from poorly oxygenated blood

Symptoms can vary depending on other underlying conditions and the type of pneumonia.

Treatment

Treatment depends on the type and severity of the pneumonia.

Bacterial types of pneumonia are usually treated with antibiotics.
Viral types of pneumonia are usually treated with rest and plenty of fluids. Antiviral medications can be used in influenza.

Fungal types of pneumonia are usually treated with antifungal medications.

Doctors commonly prescribe over-the-counter (OTC)
medications to help manage the symptoms of pneumonia. These include treatments for reducing fever, reducing aches and pains, and suppressing coughs.

In addition, it is crucial to rest and drink plenty of fluids. Staying hydrated helps to thin out thick phlegm and mucus, making it easier to cough up.

Hospitalization for pneumonia may be required if symptoms are especially bad or if an individual has a weakened immune system or other serious illnesses.

In the hospital, patients are generally treated with intravenous antibiotics and fluids. They may need a supplemental oxygen supply.

In children

In most children, the immune system can protect them from pneumonia. If a child does develop pneumonia, it is usually due to a virus.

Symptoms include:

difficulty breathing

not feeding properly

coughing

fever

irritability

dehydration

Toddlers may complain of pain in their chest, and they may vomit after coughing.

Treatment includes plenty of rest and a regular intake of fluids. The doctor may suggest over-the-counter for abdominal problems, but cough medicines will not help. Adults should not smoke around children, especially if they have pneumonia.

Causes

Bacteria and viruses are the main causes of pneumonia.
Pneumonia-causing germs can settle in the alveoli and multiply after a person breathes them in.

Pneumonia can be contagious. The bacteria and viruses that cause pneumonia are usually inhaled.

They can be passed on through coughing and sneezing, or spread onto shared objects through touch.

The body sends white blood cells to attack the infection. This is why the air sacs become inflamed. The bacteria and viruses fill the lung sacs with fluid and pus, causing pneumonia.

Risk factors

Those most at risk include people who:

are aged under 5 years or over 65 years

smoke tobacco, consume large amounts of alcohol, or both

have underlying conditions such as cystic fibrosis, chronic obstructive pulmonary disorder (COPD), asthma, or conditions that affect the kidneys, heart, or liver

have a weakened or impaired immune system, due, for example, to AIDS, HIV, or cancer

take medicines for gastroesophageal reflux disease (GERD)

have recently recovered from a cold or influenza infection
experience malnutrition

have been recently hospitalized in an intensive care unit

have been exposed to certain chemicals or pollutants

Some groups are more prone than others to pneumonia, including Native Alaskan or certain Native American ethnicities.

Types

There are different types of pneumonia, depending on their cause.

Bacterial pneumonia: The most common cause is the bacterium Streptococcus pneumoniae (S. pneumoniae), but many different bacteria can cause pneumonia

Viral pneumonia: This can result from the respiratory syncytial virus (RSV) and influenza types A and B, known as the flu
Aspiration pneumonia: This can happen when a person breathes food, liquids, or stomach contents into the lungs. This type is not contagious.

Fungal pneumonia: This can result from a condition such as valley fever, caused by the Coccidioides fungus.

Hospital-acquired pneumonia: This can occur in patients being treated for other conditions, for example, those attached to a respirator, or breathing machine.

Regardless of the cause, the signs and symptoms will be similar.

Prevention

There are two different vaccines to prevent pneumococcal disease, the most common bacterial cause of pneumonia.

These cover a wide variety of pneumococcal infections and are recommended for both children and adults, depending on their health conditions.

pneumococcal conjugate vaccine, or Prevnar

pneumococcal polysaccharide vaccine, or Pneumovax

Keeping to a vaccination schedule can help prevent infection.

Prevnar (PCV13) is normally included as part of an infant’s routine immunizations.

It is recommended for children under 2 years, adults over 65 years, and those between the ages of 2 and 64 years with certain medical conditions.

Pneumovax (PPSV23) is recommended for children and adults who are at increased risk of developing pneumococcal infections.

This includes:

adults aged 65 years or older

people with diabetes

those with chronic heart, lung, or kidney disease

people who consume large amounts of alcohol or who smoke

those without a spleen

Those aged between 2 and 64 years with certain other medical conditions may be advised to have this vaccine

The vaccine may not completely protect older adults from pneumonia, but it can significantly reduce the risk of developing pneumonia and other infections caused by S. pneumoniae), including blood and brain infections.

Along with vaccinations, physicians recommend:

regular hand washing

covering the mouth and nose when coughing or sneezing

refraining from smoking

eating healthfully

exercising 5 days a week

staying away from the sputum or cough particles of others with pneumonia

Most people recover from pneumonia in 1 to 3 weeks. Those at risk of severe symptoms should ensure they keep up their vaccinations.

Diagnosis

A doctor will ask about symptoms and medical history and will carry out a physical examination.

An X-ray can show if there is any damage to the lungs.

They may suspect pneumonia if they hear coarse breathing, wheezing, crackling, or decreased breath sounds when listening to the chest through a stethoscope.

The doctor may also check the oxygen levels in the blood with a painless monitor on the finger called a pulse oximeter.

Chest X-rays can confirm a pneumonia diagnosis and show which areas of the lungs are affected.

A CT scan of the chest may provide more detailed information.

Blood tests measure the white blood cell count.

This helps determine how severe the infection is, and whether a bacteria, virus, or fungus is the likely cause.

Blood cultures may reveal whether the microorganism from the lungs has spread into the blood stream.

An arterial blood gas (ABG) blood test may provide a more accurate reading of the body’s oxygen and carbon dioxide levels and other factors.

A sputum analysis can determine which organism is causing the pneumonia.

A bronchoscopy is sometimes used for further investigation.

A thin, flexible, and lighted tube called a bronchoscope is passed down into the lungs. This enables the doctor to examine directly the infected parts of the airways and lungs. The patient is under anesthetic.

And Also:

Pneumonia Symptoms and Diagnosis

Pneumonia is an infection that inflames your lungs' air sacs (alveoli). The air sacs may fill up with fluid or pus, causing symptoms such as a cough, fever, chills and trouble breathing.

What Are the Symptoms of Pneumonia?

Pneumonia symptoms can vary from so mild you barely notice them, to so severe that hospitalization is required. How your body responds to pneumonia depends on the type germ causing the infection, your age and your overall health.

The signs and symptoms of pneumonia may include:

Cough, which may produce greenish, yellow or even bloody mucus

Fever, sweating and shaking chills

Shortness of breath

Rapid, shallow breathing

Sharp or stabbing chest pain that gets worse when you breathe deeply or cough

Loss of appetite, low energy, and fatigue

Nausea and vomiting, especially in small children

Confusion, especially in older people

Questions about your symptoms?

Bacterial pneumonia, which is the most common form, tends to be more serious than other types of pneumonia, with symptoms that require medical care. The symptoms of bacterial pneumonia can develop gradually or suddenly. Fever may rise as high as a dangerous 105 degrees F, with profuse sweating and rapidly increased breathing and pulse rate. Lips and nailbeds may have a bluish color due to lack of oxygen in the blood. A patient's mental state may be confused or delirious.

The symptoms of viral pneumonia usually develop over a period of several days. Early symptoms are similar to influenza symptoms: fever, a dry cough, headache, muscle pain, and weakness. Within a day or two, the symptoms typically get worse, with increasing cough, shortness of breath and muscle pain. There may be a high fever and there may be blueness of the lips.

Symptoms may vary in certain populations. Newborns and infants may not show any signs of the infection. Or, they may vomit, have a fever and cough, or appear restless, sick, or tired and without energy. Older adults and people who have serious illnesses or weak immune systems may have fewer and milder symptoms. They may even have a lower than normal temperature. Older adults who have pneumonia sometimes have sudden changes in mental awareness. For individuals that already have a chronic lung disease, those symptoms may worsen.

When to call a doctor

If you think you or your child has symptoms of pneumonia, don't wait for the disease to get even worse before you seek care. Call your doctor. And see your doctor right away if you have difficulty breathing, develop a bluish color in your lips and fingertips, have chest pain, a high fever, or a cough with mucus that is severe or is getting worse.

It's especially important to get medical attention for pneumonia if you are in a high-risk group, including adults older than age 65, children age two or younger, people with an underlying health condition or weakened immune system. For some of these vulnerable individuals, pneumonia can quickly become a life-threatening condition.

How Is Pneumonia Diagnosed?

Sometimes pneumonia can be difficult to diagnose because the symptoms are so variable, and are often very similar to those seen in a cold or influenza. To diagnose pneumonia, and to try to identify the germ that is causing the illness, your doctor will ask questions about your medical history, do a physical exam, and run some tests.

Medical history

Your doctor will ask you questions about your signs and symptoms, and how and when they began. To help figure out if your infection is caused by bacteria, viruses or fungi, you may be asked some questions about possible exposures, such as:

Any recent travel

Your occupation

Contact with animals

Exposure to other sick people at home, work or school

Whether you have recently had another illness

Physical exam

Your doctor will listen to your lungs with a stethoscope. If you have pneumonia, your lungs may make crackling, bubbling, and rumbling sounds when you inhale.

Diagnostic Tests

If your doctor suspects you may have pneumonia, they will probably recommend some tests to confirm the diagnosis and learn more about your infection. These may include:

Blood tests to confirm the infection and to try to identify the germ that is causing your illness.

Chest X-ray to look for the location and extent of inflammation in your lungs.

Pulse oximetry to measure the oxygen level in your blood. Pneumonia can prevent your lungs from moving enough oxygen into your bloodstream.

Sputum test on a sample of mucus (sputum) taken after a deep cough, to look for the source of the infection.

If you are considered a high-risk patient because of your age and overall health, or if you are hospitalized, the doctors may want to do some additional tests, including:

CT scan of the chest to get a better view of the lungs and look for abscesses or other complications.

Arterial blood gas test, to measure the amount of oxygen in a blood sample taken from an artery, usually in your wrist. This is more accurate than the simpler pulse oximetry.

Pleural fluid culture, which removes a small amount of fluid from around tissues that surround the lung, to analyze and identify bacteria causing the pneumonia.

Bronchoscopy, a procedure used to look into the lungs' airways. If you are hospitalized and your treatment is not working well, doctors may want to see whether something else is affecting your airways, such as a blockage. They may also take fluid samples or a biopsy of lung tissue.

Bunion And Bunion Treatnent

2020-10-04T17:32:00.007-07:00

Facts you should know about bunions

A bunion is a bony prominence from realignment of the joint at the base of the big toes.

Bunions most commonly affect the inner foot at the base of the big toe but also can affect the outside of the foot at the base of the little toe, referred to as a bunionette or tailor's bunion.

Bunions affect both women and men, however they are more common in women.

Bunions may or may not cause symptoms.

Bunions are a progressive deformity.

Treatment of bunions can include rest, icing, alteration of footwear, foot supports (orthotics), medications, steroid injections, and/or surgery.

What are bunions?

The common bunion is a localized area of enlargement or prominence of the inner portion of the joint at the base of the big toe. The enlargement actually represents a misalignment of the big toe joint (metatarsal phalangeal joint) and, in some cases, additional bone formation. The misalignment causes the big toe to point outward and rotate (medically termed hallux abducto valgus deformity) toward the smaller toes. This deformity is progressive and will increase with time although the symptoms may or may not be present. The enlarged joint at the base of the big toe (the first metatarsophalangeal joint, or MTP joint) can become inflamed with redness, tenderness, and pain. A small fluid-filled sac (bursa) adjacent to the joint can also become inflamed (bursitis), leading to additional swelling, redness, and pain. A deeper joint pain may occur as localized arthritis develops in later stages of the deformity.

A less common bunion is located at the joint at the base of the fifth (pinky) toe. This bunion is sometimes referred to as a tailor's bunion or bunionette. The misalignment at the fifth MTP joint causes the pinky toe to point inward and create an enlargement of the joint.

Bunion Treatment

Treatment usually includes shoes with a roomy toe box (you should be able to wiggle your toes; the toe box should be wide enough to accommodate the bony prominence), padding, over-the-counter arch supports, orthotics, and taping by a physical therapist or doctor. Surgery is an option when conservative treatment fails and you have chronic pain.

What are the causes of bunions?

While the precise cause is not known, it is believed that bunions are caused by multiple factors including abnormal foot function and mechanics, such as overpronation, abnormal anatomy at first MTP joint, and genetic factors. Overpronation is a common cause of bunion in younger individuals. Abnormal biomechanics can lead to instability of the metatarsal phalangeal joint and muscle imbalance, resulting in the deformity. Abnormal anatomy at the first MTP joint can predispose an individual to develop a bunion deformity. A study has found a significant genetic heritability of bunion deformity amongst Caucasians of European descent.

Although shoe gear doesn't directly cause a bunion, it can certainly make the condition painful and swollen. Other less common causes of bunion deformities include trauma (sprains, fractures, and nerve injuries), neuromuscular disorders (polio or Charcot-Marie-Tooth disease), and limb-length discrepancies (one leg shorter than the other) where the longer leg develops the bunion. The longer limb will tend to cause the foot to overpronate.

Various arthritic conditions can cause or exacerbate bunion deformity. Gout, a painful joint condition, very commonly involves the first MTP joint, which can progress to arthritic bunion deformity. Rheumatoid arthritis often causes severe bunions to develop along with other toe deformities.

Who develops bunions?

Bunions most commonly affect women. Some studies report that bunion symptoms occur nearly 10 times more frequently in women. It has been suggested that tight-fitting shoes, especially high-heel and narrow-toed shoes, might increase the risk for bunion formation. Tight footwear certainly is a factor in precipitating the pain and swelling of bunions. Complaints of bunions are reported to be more prevalent in people who wear closed shoes than in barefoot people.

Other risk factors for the development of bunions include abnormal formation of the bones of the foot at birth (congenital) and arthritic diseases such as rheumatoid arthritis. In some cases, repetitive stresses to the foot can lead to bunion formation. Bunions are common in ballet dancers.

What are symptoms and signs of a bunion?

Bunions may or may not cause symptoms. Early symptoms may be foot pain in the involved area when walking or wearing shoes; rest and/or change to a wider shoe relieves this pain. Shoe pressure in this area can cause intermittent pain while the development of arthritis in more severe bunions can lead to chronic, constant pain. For arthritis sufferers, removing shoes or resting does not always provide relief. Besides ill-fitting shoes, unsupportive flimsy soled shoes can add stress to the bunion joint and increase pain and instability to the area.

Skin changes such as blisters and calluses may also develop as a result of repeated friction and pressure on the prominence by ill-fitting shoes or from the deformity caused by arthritis.

Bunions that cause marked pain are often associated with swelling of the soft tissues, redness, joint stiffness, and local tenderness. It is important to note that, in postpubertal men and postmenopausal women, pain at the base of the big toe can be caused by gout and gouty arthritis that is similar to the pain caused by bunions.

How do health care professionals diagnose a bunion?

A physician will consider a bunion as a possible diagnosis when noting the symptoms described above. The anatomy of the foot, including joint and foot function, is assessed during the examination. Radiographs (X-ray films) of the foot can be helpful to determine the integrity of the joints of the foot and to screen for underlying conditions, such as arthritis or gout. X-ray films are an excellent method of calculating the alignment of the toes when taken in a standing position (weight-bearing).

What is the treatment for bunions? Are there home remedies to treat bunions?

Nonsurgical treatments such as rest and wearing loose (wider) shoes or sandals (preferably with a supportive sole) can often relieve the irritating pain of bunions. Walking shoes may have some advantages, for example, over high-heeled styles that pressure the sides of the foot.

Anti-inflammatory medications, such as acetylsalicylic acid (aspirin, Ecotrin), ibuprofen (Advil, Children's Advil/Motrin, Medipren, Motrin, Nuprin, PediaCare Fever), and naproxen (Anaprox, Naprelan, Naprosyn, Aleve), can help to ease inflammation and provide pain relief. Local cold-pack application is sometimes helpful, as well.

Bunion shields or pads can reduce pressure on the bunion caused by closed shoes. A bunion splint may also help if the condition is still in its early stage with minimal deformity. Splints help to place the toe in a corrected position, while stretching tight soft tissue structures. Night splints are used while sleeping and splint booties can be worn inside a shoe. Taping and toe separators can also be used to achieve the same goal.

Stretches and manipulation of first MTP joint structures can help preserve joint mobility. This can delay onset of arthritis at the joint -- a common late-stage finding of long-term bunion deformity.

Custom orthotics are used to improve foot mechanics and address overpronation. Orthotics can prevent progression of bunion and relieve pain by improving joint function. In addition, orthotics need to be worn in stable, well-fitting, laced shoes. These shoes can positively influence joint position and reduce discomfort that is commonly encountered in ill-fitting, tight shoes.

Inflammation of the joint at the base of the big toe can often be relieved by a local injection of cortisone.

Constant pressure or friction can lead to skin breakdown and infection that may require antibiotic therapy.

When the measures above are effective in relieving symptoms, patients should avoid irritating the bunion again by optimizing footwear and foot care. Many treatments without surgery can provide pain relief. However, the only way to change the bunion structure is by performing surgery.

Is surgery required to correct a bunion?

For those whose bunions cause persisting pain despite conservative care, a surgical operation is considered for correction of the bunion. The surgical operation to cure a bunion is referred to as a bunionectomy. Surgical procedures can correct deformity and relieve pain, leading to improved foot function. These procedures typically involve removing bony growth of the bunion while realigning the big toe joint. Surgery is often, but not always, successful; failure to relieve pain can result from the big toe moving back to its previous deviated position even after surgery since bunion surgery does not always address mechanical problems. However, proper footwear and orthotics can reduce the chances of surgical failure.

Is it possible to prevent bunions?

If the diagnosis is made early on, such as in preadolescence, bunion development can be slowed and, in some cases, arrested with the proper supportive shoe gear and custom functional shoe inserts (orthotics). Physical therapy involving stretch can also be beneficial. Avoidance of certain athletic activities with improper shoe fit and toe pressure can prevent the symptoms that occur with bunions. Early examination by a podiatrist is recommended.

What is the prognosis of a bunion?

The treatments described above are very effective in treating bunion deformities, and the prognosis can be excellent. However, the correct diagnosis is essential to define any underlying associated deformities as well as the bunion severity. Also, a bunion is a progressive deformity and will get worse with time. It can cause instability to the rest of the foot and sometimes lead to arthritis in the joint at the base of the big toe. It is, therefore, advised to consult with a foot specialist to fully evaluate a bunion. Early recognition, diagnosis, and bunion care can prevent debilitating aftereffects.

And Also:

What you need to know about bunions

Causes Symptoms Pictures Diagnosis Home remedies Treatment Prevention Outlook

Bunions are a symptom of a progressive bone disorder. They appear as a bony bump at the base of the big toe joint.

The technical term for bunions is hallux valgus. They develop because of a structural problem in the bone of the foot and toes, usually the metatarsophalangeal (MTP) joint. As a result of this, the feet no longer line up properly.

Bunion usually affects the bone of the big toe, which inclines toward the second toe instead of straight ahead.

The big toe pushes against the neighboring toe. This causes the joint to stick out.

The symptoms of bunions often occur in adults, but adolescents might also experience them.

They might occur because of an inherent problem with the bones of the foot. Some people have hallus valgus but never develop symptoms. Shoes that crowd the toes can increase the risk of symptoms, but they do not cause bunions directly.

Bunions might also occur near the base of the little toe instead of the big toe. These are known as bunionettes or “tailor’s bunion.”

Causes

Bunions are bony bumps that often form at the base of the big toe.

Many medical scientists believe people inherit the bone structure that causes bunions to develop.

Other factors add to the risk of bunion growth, including.

overpronation, which means having a low arch or uneven weight-bearing in the foot and tendon that makes the toe joint unstable

hypermobility, or having a big toe bone that moves more than usual

foot injuries

types of arthritis, such as rheumatoid arthritis

conditions that affect both the nerves and muscles, such as polio

If the feet do not develop properly before birth, this can also increase the risk.

Some people suggest that high-heeled or narrow shoes promote the growth of bunions. They might aggravate already-existing bunions or cause bunions to develop in people with a genetic risk of the condition, but they do not cause bunion growth directly.

A 2014 systematic review suggests that around 2 percent of children under the age of 10 years have this condition and almost half of all adults.

Adolescent bunions are most likely to occur in girls between the ages of 10 and 15 years. This tendency usually runs in families.

A younger person with bunion is usually able to move their toe up and down. In adults, a bunion is more likely to restrict movement.

Symptoms

The classic symptom of a bunion is a bump that forms at the base of the big toe. These can also form at the base of the little toe. When this occurs, a doctor will diagnose bunionette or “tailor’s bunion”.

Other symptoms of bunions may include:

pain and soreness

numbness

a burning sensation

swelling at the joint of the affected toe

increased skin thickness at the base of the affected toe

hardened skin under the foot

redness

bump on the base of the affected toe

the presence of corns or calluses

movement restriction within the affected toe

Wearing narrow shoes and high heels or standing for a long time may worsen the symptoms.

Bunions begin as small lumps. They get worse over time, however, causing pain and making walking difficult.

Complications

Bunions can lead to other conditions, including:

bursitis, or swelling of the fluid-filled pads responsible for cushioning the bones, tendons, and muscles

hammertoe, where abnormal joint bending leads to pain and pressure

metatarsalgia, or swelling and pain in the ball of the foot

calluses

pain

difficulty walking

decreased mobility in the toes

arthritis

Avoiding shoes that cramp the feet is one way to prevent the developing of some of these complications.

Diagnosis

A diagnosis is usually possible by observing and examining the bunion.

A healthcare provider can also use physical examination and X-rays to diagnose the presence of bunions. An X-ray will indicate the severity of the bunion and help direct the next stage of treatment.

Home remedies

Treating some bunions does not require surgery. Cortisone injections might help.

Lifestyle adaptations to relieve bunions include:

Appropriately fitting footwear: Shoes that leave sufficient space inside for the toes can relieve pressure.

Foot measuring: A good shoe shop will measure your feet and advise on suitable footwear options.

Shoe inserts: Also known as orthotics, inserts relieve pressure on the toe.

Padding, taping, or splinting of the toe: This can help provide support and reduce irritation.

Avoiding activities that increase pain: These activities might include standing for a long period of time or playing contact sports.

Ice: Applying ice to the affected area can help reduce swelling.

Treatment

Two main options are available to actively treat bunion: Medications and surgery.

Medication

Medication can help with pain and swelling.

Pain-relieving medications: Ibuprofen, for example, can reduce pain and swelling. They are available over-the-counter.

Cortisone injections: These can relieve swelling, particularly in the fluid-filled pads that cushion the bones. A doctor will advise about these.

Surgery

Some people with bunions may need surgery.

When bunions require surgery, several different procedures are available.

Surgery may be suitable for people who:

experience pain and inflammation that does not improve with other treatments

have a deformity severe enough that the toe may cross over another toe

cannot bend or straighten a toe, due to stiffness

Bunion surgery very rarely occurs in younger people with bunions.

Following surgery, a full recovery can take up to 6 months. Regular visits to the doctor may be necessary.

Surgery will aim to relieve pain, realign the metatarsophalangeal (MTP) joint, and correct any deformities that are causing the problem.

Repair of the tendons and ligaments

This surgery involves shortening any weak joint tissues and lengthening the toe. Tendons and ligament repair often takes place alongside an osteotomy.

Osteotomy

This is a corrective procedure to realign the joint. Doctors use pins, screws, or plates to fix the bone.

Arthrodesis

This is a procedure to remove the swollen joint surface.

The surgeon then inserts screws, wires, or plates to hold the joint together during healing. This procedure usually helps people with severe bunions, arthritis, or those who have had unsuccessful bunion surgery.

Exostectomy

The surgeon removes the bump on the toe joint. They will often perform this surgery in combination with an osteotomy.

Exostectomy does not usually treat the underlying cause of the bunion.

Resection arthroplasty

This is a procedure to remove the damaged portion of the toe joint, providing more space between the toe bones. Surgeons reserve this procedure for:

older adults with a bunion

people who have had bunion surgery that did not resolve the problem

those with severe arthritis who cannot undergo arthrodesis

Docors do not often recommend this surgical procedure.

Prevention

Wearing well-fitting shoes with a wide toe box can help prevent the development of bunions. Avoid shoes with pointy toes and high heels.

People should also avoid wearing shoes that cause cramping, squeezing, pressing, or irritation of the toes and feet.

Outlook

The outlook of a bunion depends on the individual.

Some people have problems that continue to worsen over time, while others with the underlying deformity have no symptoms. If often occurs in both feet.

Migraine And Migraine Treatment

2020-10-04T15:15:00.012-07:00

Symptoms & causes

Diagnosis & treatment

Doctors & departments

Diagnosis

If you have migraines or a family history of migraines, a doctor trained in treating headaches (neurologist) will likely diagnose migraines based on your medical history, symptoms, and a physical and neurological examination.

If your condition is unusual, complex or suddenly becomes severe, tests to rule out other causes for your pain might include:

MRI. An MRI scan uses a powerful magnetic field and radio waves to produce detailed images of the brain and blood vessels. MRI scans help doctors diagnose tumors, strokes, bleeding in the brain, infections, and other brain and nervous system (neurological) conditions.

CT scan. A CT scan uses a series of X-rays to create detailed cross-sectional images of the brain. This helps doctors diagnose tumors, infections, brain damage, bleeding in the brain and other possible medical problems that may be causing headaches.

CT scan

Lumbar puncture (spinal tap)

Treatment

Migraine treatment is aimed at stopping symptoms and preventing future attacks.

Many medications have been designed to treat migraines.

Medications used to combat migraines fall into two broad categories:

Pain-relieving medications. Also known as acute or abortive treatment, these types of drugs are taken during migraine attacks and are designed to stop symptoms.

Preventive medications. These types of drugs are taken regularly, often daily, to reduce the severity or frequency of migraines.

Your treatment choices depend on the frequency and severity of your headaches, whether you have nausea and vomiting with your headaches, how disabling your headaches are, and other medical conditions you have.

Medications for relief

Medications used to relieve migraine pain work best when taken at the first sign of an oncoming migraine — as soon as signs and symptoms of a migraine begin. Medications that can be used to treat it include:

Pain relievers. These over-the-counter or prescription pain relievers include aspirin or ibuprofen (Advil, Motrin IB, others). When taken too long, these might cause medication-overuse headaches, and possibly ulcers and bleeding in the gastrointestinal tract.

Migraine relief medications that combine caffeine, aspirin and acetaminophen (Excedrin Migraine) may be helpful, but usually only against mild migraine pain.

Triptans. These are prescription drugs such as sumatriptan (Imitrex, Tosymra) and rizatriptan (Maxalt) are prescription drugs used for migraine because they block pain pathways in the brain. Taken as pills, shots or nasal sprays, they can relieve many symptoms of migraine. They might not be safe for those at risk of a stroke or heart attack.

Dihydroergotamines (D.H.E. 45, Migranal). Available as a nasal spray or injection, these are most effective when taken shortly after the start of migraine symptoms for migraines that tend to last longer than 24 hours. Side effects can include worsening of migraine-related vomiting and nausea.

People with coronary artery disease, high blood pressure, or kidney or liver disease should avoid dihydrogergotamines.

Lasmiditan (Reyvow). This new oral tablet is approved for the treatment of migraine with or without aura. In drug trials, lasmiditan significantly improved pain as well as nausea and sensitivity to light and sound. Lasmiditan can have a sedative effect and cause dizziness, so people taking it are advised not to drive or operate machinery for at least eight hours. Lasmiditan also shouldn't be taken with alcohol or other drugs that depress the central nervous system.

Ubrogepant (Ubrelvy). This oral calcitonin gene-related peptide receptor antagonist is approved for the treatment of acute migraine with or without aura in adults. It's the first drug of this type approved for migraine treatment. In drug trials, ubrogepant was more effective than placebo in relieving pain and other migraine symptoms such as nausea and sensitivity to light and sound two hours after taking it. Common side effects include dry mouth, nausea and excessive sleepiness. Ubrogepant should not be taken with strong CYP3A4 inhibitor drugs.

Opioid medications. People who have migraines who can't take other migraine medications, narcotic opioid medications, especially those that contain codeine, might help. Because they can be highly addictive, these are usually used only if no other treatments are effective.

Anti-nausea drugs. These can help if your migraine with aura is accompanied by nausea and vomiting. Anti-nausea drugs include chlorpromazine, metoclopramide (Reglan) or prochlorperazine (Compro). These are usually taken with pain medications.

Preventive medications

Medications can help prevent frequent migraines. Your doctor might recommend preventive medications if you have frequent, long-lasting or severe headaches that don't respond well to treatment.

Preventive medication is aimed at reducing how often you get a migraine how severe the attacks are and how long they last. Options include:

Blood pressure-lowering medications. These include beta blockers such as propranolol (Inderal, Innopran XL, others) and metoprolol tartrate (Lopressor). Calcium channel blockers such as verapamil (Tarka, Verelan) can be helpful in preventing migraines with aura.

Antidepressants. A tricyclic antidepressant (amitriptyline) can prevent migraines. Because of the side effects of amitriptyline, such as sleepiness and weight gain, other antidepressants might be prescribed instead.

Anti-seizure drugs. Valproate and topiramate (Topamax) might help you have less frequent migraines, but can cause side effects such as dizziness, weight changes, nausea and more.

Botox injections. Injections of onabotulinumtoxinA (Botox) about every 12 weeks help prevent migraines in some adults.

Calcitonin gene-related peptide (CGRP) monoclonal antibodies.

Erenumab-aooe (Aimovig), fremanezumab-vfrm (Ajovy) and galcanezumab-gnlm (Emgality) are newer drugs approved by the Food and Drug Administration to treat migraines. They're given monthly by injection. The most common side effect is a reaction at the injection site.

Migraine medications and antidepressants

Migraine treatment: Can antidepressants help?

Lifestyle and home remedies

When symptoms of migraine start, try heading to a quiet, darkened room. Close your eyes and rest or take a nap. Place a cool cloth or ice pack wrapped in a towel or cloth on your forehead or at the back of your neck.

Other practices that might soothe migraine with aura pain include:

Try relaxation techniques. Biofeedback and other forms of relaxation training teach you ways to deal with stressful situations, which might help reduce the number of migraines you have.

Develop a sleeping and eating routine. Don't sleep too much or too little. Set and follow a consistent sleep and wake schedule daily. Try to eat meals at the same time every day.

Drink plenty of fluids. Staying hydrated, particularly with water, might help.

Keep a headache diary. Continue recording in your headache diary even after you see your doctor. It will help you learn more about what triggers your migraines and what treatment is most effective.

Exercise regularly. Regular aerobic exercise reduces tension and can help prevent a migraine. If your doctor agrees, choose aerobic activity you enjoy, such as walking, swimming and cycling. Warm up slowly, however, because sudden, intense exercise can cause headaches.

Regular exercise can also help you lose weight or maintain a healthy body weight, and obesity is thought to be a factor in migraines.

Alleviating migraine pain

Alternative medicine

Nontraditional therapies might help with chronic migraine pain.

Acupuncture. Clinical trials have found that acupuncture may be helpful for headache pain. In this treatment, a practitioner inserts many thin, disposable needles into several areas of your skin at defined points.

Biofeedback. Biofeedback appears to be effective in relieving migraine pain. This relaxation technique uses special equipment to teach you how to monitor and control certain physical responses related to stress, such as muscle tension.

Cognitive behavioral therapy. Cognitive behavioral therapy may benefit some people with migraines. This type of psychotherapy teaches you how behaviors and thoughts affect how you perceive pain.

Herbs, vitamins and minerals. There is some evidence that the herbs feverfew and butterbur might prevent migraines or reduce their severity, though study results are mixed. Butterbur isn't recommended because of safety concerns.

A high dose of riboflavin (vitamin B-2) may also prevent migraines or reduce the frequency of headaches. Coenzyme Q10 supplements might decrease the frequency of migraines, but larger studies are needed.

Due to low magnesium levels in some people with migraines, magnesium supplements have been used to treat migraines, but with mixed results.

Ask your doctor if these treatments are right for you. Don't use feverfew, riboflavin or butterbur if you're pregnant or without first talking with your doctor.

Chiropractic adjustment

Preparing for your appointment

You'll probably first see a primary care provider, who might then refer you to a doctor trained in evaluating and treating headaches (neurologist).

Here's some information to help you get ready for your appointment.

What you can do

Keep track of your symptoms. Keep a headache diary by writing a description of each incident of visual disturbances or unusual sensations, including when they occurred, how long they lasted and what triggered them. A headache diary can help your doctor diagnose your condition.

Write down key personal information, including major stresses or recent life changes.

Make a list of all medications, vitamins or supplements you take, including doses. It's particularly important to list all medications you've used to treat your headaches.

Write down questions to ask your doctor.

Take a family member or friend along, if possible, to help you remember the information you receive.

For migraines, questions to ask your doctor include:

What is likely triggering my migraines?

Are there other possible causes for my migraine symptoms?

What tests do I need?

Are my migraines likely temporary or chronic?

What is the best course of action?

What are the alternatives to the primary approach that you're suggesting?

What changes to my lifestyle or diet do you suggest I make?

I have these other health conditions. How can I best manage them together?

Are there printed materials you can give me? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, including:

How often do your headaches occur?

How severe are your symptoms?

What, if anything, seems to improve your symptoms?

What, if anything, appears to worsen your symptoms?

Does anyone else in your family have migraines?

And Also:

Migraines: Simple steps to head off the pain

Migraines cause pain as real as the pain of injuries — with one difference: Healthy habits and simple nonmedical remedies sometimes stop migraines before they start.

Medication is a proven way to both treat and prevent migraines. But medication is only part of the story. It's also important to take good care of yourself and understand how to cope with migraine pain when it strikes.

The same lifestyle choices that promote overall good health can also reduce the frequency and severity of your migraines.

Combining medication with behavioral measures and lifestyle can often be the most effective way to handle migraines.

Find a calm environment

At the first sign of a migraine, take a break and step away from whatever you're doing if possible.

Turn off the lights. Migraines often increase sensitivity to light and sound. Relax in a dark, quiet room. Sleep if you can.

Try temperature therapy. Apply hot or cold compresses to your head or neck. Ice packs have a numbing effect, which may dull the sensation of pain. Hot packs and heating pads can relax tense muscles. Warm showers or baths may have a similar effect.

Drink a caffeinated beverage. In small amounts, caffeine alone can relieve migraine pain in the early stages or enhance the pain-reducing effects of acetaminophen (Tylenol, others) and aspirin.

Be careful, however. Drinking too much caffeine too often can lead to withdrawal headaches later on. And having caffeine too late in the day may interfere with your sleep, which can also affect migraines.

Sleep well

Migraines may keep you from falling asleep or wake you up at night. Likewise, migraines are often triggered by a poor night's sleep.

Here are some tips to encourage sound sleep.

Establish regular sleep hours. Wake up and go to bed at the same time every day — even on weekends. If you nap during the day, keep it short. Naps longer than 20 to 30 minutes may interfere with nighttime sleep.

Unwind at the end of the day. Anything that helps you relax can promote better sleep: listen to soothing music, soak in a warm bath or read a favorite book.

But watch what you eat and drink before bedtime. Intense exercise, heavy meals, caffeine, nicotine and alcohol can interfere with sleep.

Minimize distractions. Save your bedroom for sleep and intimacy. Don't watch television or take work materials to bed. Close your bedroom door. Use a fan to muffle distracting noises.

Don't try so hard to sleep. The harder you try to sleep, the more awake you'll feel. If you can't fall asleep, read or do another quiet activity until you become drowsy.

Check your medications. Medications that contain caffeine or other stimulants — including some medications to treat migraines — may interfere with sleep.

Eat wisely

Your eating habits can influence your migraines. Consider the basics:

Be consistent. Eat at about the same time every day.

Don't skip meals. Fasting increases the risk of migraines.

Keep a food journal. Keeping track of the foods you eat and when you experience migraines can help identify potential food triggers.

Avoid foods that trigger migraines. If you suspect that a certain food — such as aged cheese, chocolate, caffeine or alcohol — is triggering your migraines, eliminate it from your diet to see what happens.

Exercise regularly

During physical activity, your body releases certain chemicals that block pain signals to your brain. These chemicals also help alleviate anxiety and depression — and these two conditions can make migraines worse.

Obesity also increases the risk of chronic headaches. Maintaining a healthy weight through exercise and diet can provide additional benefits in managing migraines.

If your doctor agrees, choose any exercise you enjoy. Walking, swimming and cycling are often good choices. Just remember to ease into exercise gradually, as very vigorous exercise may trigger migraines.

Manage stress

Stress and migraines often go hand in hand. You can't avoid daily stress, but you can keep it under control to help manage your migraines:

Simplify your life. Don't look for ways to squeeze more activities or chores into the day. Instead, find a way to leave some things out.

Manage your time wisely. Update your to-do list every day — both at work and at home. Delegate what you can, and divide large projects into manageable chunks.

Take a break. If you feel overwhelmed, a few slow stretches or a quick walk may renew your energy for the task at hand.

Adjust your attitude. Stay positive. If you find yourself thinking, "This can't be done," switch gears. Think instead, "This will be tough. But I can make it work."

Enjoy yourself. Find time to do something you enjoy for at least 15 minutes every day. It could be playing a game, having coffee with a friend or pursuing a hobby. Doing something you enjoy is a natural way to combat stress.

Relax. Deep breathing from your diaphragm can help you relax. Focus on inhaling and exhaling slowly and deeply for at least 10 minutes every day. It may also help to consciously relax your muscles, one group at a time. When you're done, sit quietly for a minute or two.

Keep a migraine diary

A diary may help you determine what triggers your migraines. Note when your migraines start, what you were doing at the time, how long they last and what, if anything, provides relief.

Until recently, avoiding migraine triggers was considered the best advice. But new research suggests this may actually increase sensitivity to potential triggers.

A more useful approach may be to gradually expose yourself to triggers, and learn to cope with these headache triggers by using behavioral management techniques. These may include identifying and challenging negative thoughts, relaxation training, and stress reduction. More research is needed to understand if and how this approach is more effective in managing migraines.

Strive for balance

Living with migraines is a daily challenge. But making healthy lifestyle choices can help. Ask your friends and loved ones for support.

If you're feeling anxious or depressed, consider joining a support group or seeking counseling. Believe in your ability to take control of the pain.

Lung Cancer Treatment

2020-10-03T20:45:00.006-07:00

Lung Cancer - Non-Small Cell: Types of Treatment

The types of treatments that are the standard of care for NSCLC are discussed here. "Standard of care" means the best treatments known. When making treatment plan decisions, you are encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

There are 5 main ways to treat NSCLC:

Surgery

Radiation therapy

Chemotherapy

Targeted therapy

Immunotherapy

Descriptions of these common types of treatments used for NSCLC are listed below, followed by an outline of the common treatment plans by stage. Your care plan also includes treatment for symptoms and side effects, an important part of cancer care.

Treatment options and recommendations depend on several factors, including the type and stage of cancer, possible side effects, and the patient’s preferences and overall health. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called "shared decision making." Shared decision making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision making is particularly important for NSCLC because there are different treatment options.

Surgery

The goal of surgery is to completely remove the lung tumor and the nearby lymph nodes in the chest. The tumor must be removed with a surrounding border or margin of healthy lung tissue. A “negative margin” means that when the pathologist examined the lung or a piece of lung that was removed by the surgeon, no cancer was found in the healthy tissue surrounding the tumor. A surgical oncologist is a doctor who specializes in treating cancer using surgery. A thoracic surgeon is specially trained to perform lung cancer surgery.

The following types of surgery may be used for NSCLC:

Lobectomy. The lungs have 5 lobes, 3 in the right lung and 2 in the left lung. A lobectomy is the removal of an entire lobe of the lung. It is currently thought to be the most effective type of surgery, even when the lung tumor is very small.

A wedge resection. If the surgeon cannot remove an entire lobe of the lung, the surgeon can remove the tumor, surrounded by a margin of healthy lung.

Segmentectomy. This is another way to remove the cancer when an entire lobe of the lung cannot be removed. In a segmentectomy, the surgeon removes the portion of the lung where the cancer developed.

Pneumonectomy. If the tumor is close to the center of the chest, the surgeon may have to remove the entire lung.

The time it takes to recover from lung surgery depends on how much of the lung is removed and the health of the patient before surgery. Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have.

Additional treatments can be given before and after your surgery to help lower the risk of recurrence.

Neoadjuvant therapy, also known as induction therapy, is a therapy given before your surgery. In addition to treating the primary tumor and lowering your risk of recurrence, this type of therapy is also used to help reduce the extent of surgery.

More commonly, you will receive adjuvant therapy. Adjuvant therapy is treatment that is given after surgery. It is intended to get rid of any lung cancer cells that may still be in the body after surgery. This helps lower the risk of recurrence, though there is always some risk that the cancer will come back.

These types of adjuvant therapy used for NSCLC include radiation therapy and systemic therapies, such as chemotherapy, targeted therapy, and immunotherapy. Each therapy is described below.

Radiation therapy

Radiation therapy is the use of high energy x-rays or other particles to destroy cancer cells. If you need radiation therapy, you will see a specialist called a radiation oncologist. A radiation oncologist is the doctor who specializes in giving radiation therapy to treat cancer. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time. This can vary from just a few days of treatment to several weeks.

Like surgery, radiation therapy cannot be used to treat widespread cancer. Radiation therapy only destroys cancer cells directly in the path of the radiation beam. It also damages the healthy cells in its path. For this reason, it cannot be used to treat large areas of the body.

Sometimes, CT scans are used to plan out exactly where to direct the radiation beam to lower the risk of damaging healthy parts of the body. This is called intensity modulated radiation therapy (IMRT) or stereotactic body radiation therapy (SBRT). It is not an option for all patients, but it may be used for early-stage disease and small tumors when surgery is not an option.

Some people with Stage I NSCLC or people who cannot have surgery may be treated with radiation therapy as an alternative treatment to surgery.

Side effects of radiation therapy

People with lung cancer who receive radiation therapy often experience fatigue and loss of appetite. If radiation therapy is given to the neck or center of the chest, side effects can include a sore throat and difficulty swallowing. Patients may also notice skin irritation, similar to sunburn, where the radiation therapy was directed. Most side effects go away soon after treatment is finished.

If the radiation therapy irritates or inflames the lung, patients may develop a cough, fever, or shortness of breath months and sometimes years after the radiation therapy ends. About 15% of patients develop this condition, called radiation pneumonitis. If it is mild, radiation pneumonitis does not need treatment and goes away on its own. If it is severe, a patient may need treatment for radiation pneumonitis with steroid medications, such as prednisone.

Radiation therapy may also cause permanent scarring of the lung tissue near where the original tumor was located. The scarring does not usually cause symptoms. However, severe scarring can cause a permanent cough and shortness of breath. For this reason, radiation oncologists carefully plan the treatments using CT scans of the chest to lessen the amount of healthy lung tissue exposed to radiation.

Therapies using medication

Systemic therapy is the use of medication to destroy cancer cells. This type of medication is given through the bloodstream to reach cancer cells throughout the body. Systemic therapies are generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

The types of systemic therapies used for NSCLC include:

Chemotherapy

Targeted therapy

Immunotherapy

Each of these types of therapies are discussed below in more detail. A person may receive 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.

The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. It has been shown to improve both the length and quality of life for people with lung cancer of all stages.

A chemotherapy regimen, or schedule, usually consists of a specific number of cycles given over a set period of time. The type of lung cancer you have, such as adenocarcinoma or squamous cell carcinoma, affects which drugs are recommended for chemotherapy.

Common drugs used to treat lung cancer include either 2 or 3 drugs given together or 1 drug given by itself. Some common drugs include:

Carboplatin or cisplatin (both are available as generic drugs)

Docetaxel (Taxotere)

Gemcitabine (Gemzar)

Nab-paclitaxel (Abraxane)

Paclitaxel (Taxol)

Pemetrexed (Alimta)

Vinorelbine (Navelbine)

Chemotherapy may also damage healthy cells in the body, including blood cells, skin cells, and nerve cells. The side effects of chemotherapy depend on the person and the dose used, but they can include fatigue, low numbers of blood cells, risk of infection, mouth sores, nausea and vomiting, loss of appetite, diarrhea, numbness and tingling in the hands and feet, and hair loss. Some lung cancer chemotherapy treatments do not cause significant hair loss.

Your medical oncologist can often prescribe drugs to help relieve many of these side effects. Hormone injections may be used to prevent white blood cell counts from becoming too low. Nausea and vomiting are also often avoidable. In many cases, side effects usually go away after treatment is finished.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.

Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in the tumor. For some lung cancers, abnormal proteins are found in unusually large amounts in the cancer cells. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them.

Targeted therapy for NSCLC includes:

Epidermal growth factor receptor (EGFR) inhibitors. Researchers have found that drugs that block EGFR may be effective for stopping or slowing the growth of lung cancer when the cancer cells have EGFR mutations. This medication is a pill that can be taken by mouth. The side effects of EGFR inhibitors often include a rash that looks like acne and diarrhea.

Osimertinib (Tagrisso) is a first treatment option for some people with NSCLC whose tumors have EGFR mutations. Osimertinib is also approved for the treatment of metastatic NSCLC with an EGFR mutation when other drugs listed above no longer work.

Erlotinib (Tarceva) has been shown to work better than chemotherapy if the lung cancer has a mutation in the EGFR gene. It is an option for patients with locally advanced and metastatic NSCLC. This medication is a pill that can be taken by mouth. The side effects of erlotinib include a rash that looks like acne, and diarrhea.

Afatinib (Gilotrif) is an initial treatment option for NSCLC. It may also be an option for patients who have already received other treatments for squamous NSCLC. It is a type of drug called a tyrosine kinase inhibitor (TKI).

Dacomitinib (Vizimpro) is approved as an initial treatment for NSCLC that has an EGFR mutation. However, it is not frequently used.

Gefitinib (Iressa) is a first generation EFGR inhibitor that is not widely used in the United States. It is more commonly used in Asia and some other parts of the world.

Anaplastic lymphoma kinase (ALK) inhibitors. ALK is a protein that is a part of the cell growth process. When present, this mutation helps cancer cells grow. ALK inhibitors help stop this process. Mutations in the ALK gene are found in about 5% of people with NSCLC. The following drugs are currently available to target this genetic change:

Alectinib (Alecensa)

Brigatinib (Alunbrig)

Cretinib (Zykadia)

Crizotinib (Xalkori)

Lorlatinib (Lorbrena)

Drugs targeting ROS1 genetic changes. Rare mutations to the ROS1 gene can cause problems with cell growth and cell differentiation, the process by which cells change from one type of cell into another. Drugs targeting changes to the ROS1 gene include:

Crizotinib (Xalkori)

Entrectinib (Rozlytrek)

Drugs targeting NTRK fusion. This type of genetic change is found in a range of cancers, including lung cancer, and causes cancer cell growth. Larotrectinib (Vitrakvi) is used to treat NTRK fusion for people with NSCLC.

Drugs targeting BRAF V600E mutations. The BRAF gene makes a protein that is involved in cell growth and can cause cancer cells to grow and spread. A BRAF V600E mutation can be targeted with a combination of dabrafenib (Tafinlar) and tremetinib (Mekinist).

Drugs targeting MET Exon 14 Skipping. MET Exon 14 Skipping is a genetic mutation found in over 3% of NSCLC. Capmatinib (Tabrecta) has been approved to target this genetic change.

Drugs targeting RET fusion. Up to 2% of all NSCLC cases are RET fusion positive. Selpercatinib (LOXO-292) is approved to treat these genetic changes involving RET, which lead to uncontrolled cell growth.

Anti-angiogenesis therapy. Anti-angiogenesis therapy is focused on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to "starve" the tumor. The following anti-angiogenic drugs may be options for lung cancer:

Bevacizumab (Avastin, Mvasi) is an anti-angiogenic drug given along with chemotherapy for lung cancer. It may also be used along with chemotherapy and the immunotherapy drug atezolizumab for metastatic NSCLC.

The risk of serious bleeding for patients taking bevacizumab is about 2%. However, it is more common for patients with squamous cell carcinoma, so bevacizumab is not recommended for patients with this type of NSCLC.

Ramucirumab (Cyramza) is approved for NSCLC along with the chemotherapy drug docetaxel.

Ramucirumab (Cyramza) is also approved in combination with the targeted therapy drug erlotinib as a first-line treatment of NSCLC for people with an EGFR mutation.

Treatment with targeted therapy for NSCLC is changing rapidly due to the pace of scientific research. New targeted therapies are being studied in clinical trials now. Talk with your doctor about additional options that may be available to you.

Side effects of targeted therapy depend on the drug(s) you've been prescribed. Talk with your doctor about possible side effects for a specific medication and how they can be managed.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

For example, the PD-1 pathway may be very important in the immune system’s ability to control cancer growth. Blocking this pathway with PD-1 and PD-L1 antibodies has stopped or slowed the growth of NSCLC for some patients. The following immunotherapy drugs block this pathway:

Atezolizumab (Tecentriq)

Durvalumab (Imfinzi)

Nivolumab (Opdivo)

Pembrolizumab (Keytruda)

Another immune pathway that may be targeted is the CTLA-4 pathway. In lung cancer, this pathway is often blocked in combination with a drug blocking the PD-1 pathway. The FDA has approved the combination of the anti-CTLA-4 antibody ipilimumab (Yervoy) and nivolumab as a first-line treatment for people with metastatic NSCLC who have levels of PD-L1 greater than or equal to 1%. This combination can also be used with chemotherapy for people with metastatic or recurrent NSCLC with no EGFR or ALK mutations.

For most people with advanced NSCLC that cannot be treated with a targeted therapy, immunotherapy or immunotherapy plus chemotherapy is often the preferred initial treatment.

Different types of immunotherapy can cause different side effects but, in general, severe side effects are less common than with chemotherapy. Common side effects include skin reactions, flu-like symptoms, diarrhea, lung inflammation causing shortness of breath, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you.

Physical, emotional, and social effects of cancer

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

The following treatments may be given to help relieve the symptoms of NSCLC:

A tumor in the chest that is bleeding or blocking the lung passages can be shrunk with radiation therapy.

During a bronchoscopy, lung passages blocked by cancer can be opened to improve breathing.

A surgeon or pulmonologist can place a stent to prop open an airway or use a laser to burn away a tumor.

Medications are used to treat cancer pain. Most hospitals and cancer centers have pain control specialists who provide pain relief, even for severe cancer pain. Many drugs used to treat cancer pain, especially morphine, can also relieve shortness of breath caused by cancer.

Medications can be used to stop a cough, open closed airways, or reduce bronchial secretions.

Prednisone or methylprednisolone (A-Methapred, Depo-Medrol, Medrol, Solu-Medrol) can reduce inflammation caused by lung cancer or radiation therapy and improve breathing.

Extra oxygen from small, portable tanks can help make up for the lung’s reduced ability to extract oxygen from the air.

Medications are available to strengthen bones, lessen bone pain, and help prevent future bone metastases.

Appetite stimulants and nutritional supplements can improve appetite and reduce weight loss.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.

Treatment by stage of NSCLC

Different treatments may be recommended for each stage of NSCLC. Your doctor will recommend a specific treatment plan for you based on the cancer's stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this page. Clinical trials may also be a treatment option for each stage.

Stage I and II NSCLC

In general, stage I and stage II NSCLC are treated with surgery. Surgeons cure many people with an operation.

Before or after surgery, a patient may also meet with a medical oncologist. Some people with a large tumor or signs that the tumor has spread to the lymph nodes may benefit from chemotherapy. Chemotherapy may be given before the surgery, called neoadjuvant chemotherapy or induction chemotherapy. Chemotherapy may also be given after surgery, called adjuvant chemotherapy, to reduce the chance that the cancer will return.

Adjuvant chemotherapy with cisplatin is not recommended for patients with stage IA NSCLC that was completely removed with surgery. Patients with stage IB cancers should talk with their doctors about whether chemotherapy is right for them after surgery. Adjuvant cisplatin-based chemotherapy is recommended for patients with stage II NSCLC that has been completely removed with surgery. Patients with stage II NSCLC should talk with their doctor about whether this treatment is right for them.

For patients with stage I or II lung cancer who cannot undergo surgery, radiation therapy, such as stereotactic ablative radiotherapy (SABR) or stereotactic body radiotherapy (SBRT), may be offered.

Stage III NSCLC

More than 30,000 people are diagnosed with stage III NSCLC every year, and there is no single best treatment for all of these patients. Treatment options depend on the size and location of the tumor and the lymph nodes that are involved. The options generally include:

Radiation therapy

Chemotherapy

Immunotherapy

Surgery

In general, people with stage III NSCLC receive 3 different types of treatment. A combination of chemotherapy and radiation therapy followed by immunotherapy is usually recommended for NSCLC that cannot be removed with surgery. Chemotherapy and radiation therapy may be given together, which is called concurrent chemoradiotherapy. Or, they may be given one after the other, called sequential chemoradiotherapy.

Surgery may be an option after initial chemotherapy or chemotherapy with radiation therapy. Sometimes, surgery may be the first treatment, particularly when cancer is found in the lymph nodes unexpectedly after a person has originally been diagnosed with stage I or stage II cancer. If this occurs, surgery is generally followed by chemotherapy and often radiation therapy.

Adjuvant cisplatin-based chemotherapy is recommended for people with stage IIIA lung cancers that have been completely removed with surgery. Patients should talk with their doctor about the best treatment options for them.

Metastatic or stage IV NSCLC

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. If this happens, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option.

Patients with stage IV NSCLC typically do not receive surgery or radiation therapy as the main treatment. Occasionally, doctors may recommend surgery or radiation therapy for a metastasis in the brain or adrenal gland if that is the only place the cancer has spread. Radiation therapy may also be used to treat a localized area that may be causing pain. People with stage IV disease have a very high risk of the cancer spreading or growing in another location. Most patients with this stage of NSCLC receive systemic therapies, such as chemotherapy, targeted therapy, or immunotherapy. Palliative care will also be important to help relieve symptoms and side effects.

Systemic therapy for metastatic or stage IV NSCLC

The goals of systemic therapies are to shrink the cancer, relieve discomfort caused by the cancer, prevent the cancer from spreading further, and lengthen a patient’s life. These treatments can occasionally make metastatic lung cancer disappear. However, doctors know from experience that the cancer will usually return. Therefore, patients with stage IV disease are never considered “cured” of their cancer no matter how well treatment works. Treatment often continues as long as it is controlling the cancer’s growth.

Systemic therapy and palliative care have been proven to improve both length and quality of life for patients with stage IV NSCLC. If the cancer worsens or causes too many severe side effects, the treatment may be stopped. Patients would continue to receive palliative care and may be offered treatment in a clinical trial.

The first drug or combination of drugs a patient takes is called “first-line” treatment, which may be followed by "second-line" and "third-line" treatment. No specific treatment or combination of treatments works for every patient. If the first-line treatment causes too many or dangerous side effects, does not appear to be working, or stops working, the doctor may recommend a change in treatment. All patients should also receive palliative care.

First-line treatment. First-line systemic therapy for NSCLC often depends on the genetic changes found in the tumor.

For patients with tumors that do not have changes in the EGFR or ALK genes, the options include:

For people with non-squamous cell carcinoma with high PD-L1 expression: Pembrolizumab alone; a combination of pembrolizumab, carboplatin, and pemetrexed; a combination of atezolizumab, carboplatin, paclitaxel, and bevacizumab; or a combination of atezolizumab, carboplatin, and nab-paclitaxel.

For people with non-squamous cell carcinoma and low PD-L1 expression: Pembrolizumab combined with carboplatin and pemetrexed; a combination of atezolizumab, carboplatin, paclitaxel, and bevacizumab; or a combination of atezolizumab, carboplatin, and nab-paclitaxel. In those who cannot receive immunotherapy, a combination of 2 chemotherapy drugs is recommended. Pembrolizumab alone may be recommended for people who cannot receive a combination of pembrolizumab with a platinum chemotherapy.

For people with non-squamous cell carcinoma and no PD-L1 expression: Pembrolizumab combined with carboplatin and pemetrexed; a combination of atezolizumab, carboplatin, paclitaxel, and bevacizumab; or a combination of atezolizumab, carboplatin, and nab-paclitaxel. In those who cannot receive immunotherapy, a combination of 2 chemotherapy drugs is recommended.

For people with squamous cell carcinoma and high PD-L1 expression: Pembrolizumab alone, a combination of nivolumab and ipilimumab, or a combination of pembrolizumab, carboplatin, and paclitaxel or nab-paclitaxel.

For people with squamous cell carcinoma and low PD-L1 expression: A combination of pembrolizumab, carboplatin, and paclitaxel or nab-paclitaxel should be recommended when it is possible. In those who cannot receive immunotherapy, a combination of 2 chemotherapy drugs is recommended. Pembrolizumab alone may be recommended for people who cannot receive chemotherapy.

For people with squamous cell carcinoma and no PD-L1 expression: A combination of pembrolizumab, carboplatin, and paclitaxel or nab-paclitaxel should be recommended when it is possible. In those who cannot receive immunotherapy, a combination of 2 chemotherapy drugs is recommended.

For patients with tumors that have genetic changes on the EGFR gene, the following targeted therapies called TKIs may be options:

Afatinib

Dacomitinib

Erlotinib

Gefitinib

Osimertinib

For patients with tumors that have a genetic change on the ALK gene, targeted therapy options are alectinib, brigatinib, ceritinib, or crizotinib.

For patients with tumors that have a genetic change on the ROS1 gene, crizotinib is an option.

Second-line treatment. Second-line treatment for NSCLC depends on the gene mutations found in the tumor and the treatments patients have already received.

For patients with tumors that do not have changes in the EGFR, ALK, or ROS1 genes, the options include:

Nivolumab, pembrolizumab, or atezolizumab if they have a high level of PD-L1, received chemotherapy for first-line treatment, and have not received immunotherapy.

Nivolumab, atezolizumab, or chemotherapy if they have a low or unknown level of PD-L1 and have already received chemotherapy.

Chemotherapy for patients who have already received immunotherapy.

Docetaxel or docetaxel plus ramucirumab for patients who had severe side effects from immunotherapy and have already received prior platinum doublet chemotherapy or cannot tolerate a combination of chemotherapy drugs.

Pemetrexed for patients with non-squamous cell carcinoma who did not receive it during first-line treatment.

For patients with tumors that have an EGFR gene mutation, the best treatment option depends on how the cancer worsened and whether the cancer developed a mutation called T790M, which makes it resistant to the TKI. Options include:

Osimertinib

Additional chemotherapy

Continued treatment with a TKI, plus surgery or radiation therapy to the areas where the cancer has spread

For patients with tumors that have an ALK gene mutation, options are:

Alectinib

Brigatinib

Ceritinib

Lorlatinib

For patients with tumors that have a ROS1 gene mutation, treatment options depend on the treatments received previously:

Crizotinib or entrectinib, if patients have not already received it

Chemotherapy, which may be given along with bevacizumab

For patients with tumors that have a BRAF mutation, options depend on whether they have already received immunotherapy:

Atezolizumab, nivolumab, or pembrolizumab for patients who have not already received any of these immunotherapies

Dabrafenib or a combination of dabrafenib and trametinib for patients who have already received immunotherapy

Third-line treatment. Third-line treatment for NSCLC is usually chemotherapy with pemetrexed or docetaxel.

In all cases, patients and their doctors should discuss any reasons why some patients may not be able to receive immunotherapy.

Radiation therapy for brain metastases

Chemotherapy is often not as effective as radiation therapy or surgery to treat NSCLC that has spread to the brain. For this reason, NSCLC that has spread to the brain is usually treated with radiation therapy, surgery, or both. This can cause side effects such as hair loss, fatigue, and redness of the scalp. With a small tumor, a type of radiation therapy called stereotactic radiosurgery can focus the radiation only on the tumor in the brain and lessen the side effects.

Newer targeted therapies, such as osimertinib and alectinib, have shown that they can work well to treat brain metastases. In addition, immunotherapy may also be an option. This may allow many patients to have a systemic therapy for brain metastases and avoid the side effects that come from chemotherapy and radiation therapy to the brain.

Palliative care

As described above, palliative care will also be important to help relieve symptoms and side effects. Radiation therapy or surgery may also be used to treat metastases that are causing pain or other symptoms. Bone metastases that weaken major bones can be treated with surgery, and the bones can be reinforced using metal implants.

For most people, a diagnosis of metastatic cancer is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return.

If the cancer returns after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence). Most often, when there is recurrence, it is stage IV disease.

When this occurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above such as surgery, chemotherapy, and radiation therapy, but they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

And Also:

Lung Cancer Treatment

Lung Cancer Pulmonary Lung and Respiratory System

Treatment for lung cancer varies according to age, type of cancer, extent of disease, tolerance to medication and patient preference.

Treatment options include a combination of surgery, radiation, chemotherapy, immunotherapy and targeted therapy.

Specific treatment for lung cancer will be determined by your doctor based on:

Age, overall health and medical history

The type of lung cancer

Extent of the disease

Your tolerance for specific medications, procedures or therapies

Expectations for the course of the disease

Your opinion or preference

Depending on its type and stage, lung cancer may be treated with surgery, chemotherapy or other medications, radiation therapy, local treatments such as laser therapy, or a combination of treatments. Combination treatment or multimodality treatment refers to having more than one type of treatment.

Treatment for lung cancer includes one or more of the following approaches.

Surgery

Surgery is part of the treatment for early-stage lung cancers. The type of surgery depends on the size and location of the tumor in the lung, the extent of the cancer, the general health of the patient and other factors. Many surgeries are done with a long incision in the side of the chest, known as a thoracotomy. Some early stage tumors may be treated with video-assisted thoracic surgery (VATS), which uses several small incisions (instead of one large one) and special long surgical tools.

Types of surgery include:

Segmental or wedge resection: Removal of only a small part of the lung

Lobectomy: Removal of an entire lobe of the lung

Pneumonectomy: Removal of an entire lung

Sleeve resection: Removal of a piece of bronchus, after which the lung is reattached to the remaining part of the bronchus

Radiation Therapy

Radiation therapy is the use of high-energy radiation to kill cancer cells and to shrink tumors. Radiation may also be used with chemotherapy to treat lung cancer. The following techniques are used to deliver radiation therapy:

External radiation (external beam therapy): A treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Because radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.

Chemotherapy

Whereas surgery and radiation treatment are focused at only one area of the body, chemotherapy goes throughout the body to search for tumor cells. Chemotherapy is given through an IV infusion, in most cases. chemotherapy works by interfering with the cancer cells’ ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual.

Chemotherapy may be given before other treatments, after other treatments or alone for lung cancer.

Targeted Therapy

Targeted therapy is like chemotherapy in that it goes throughout the body in search of tumor cells. These are drugs that target specific parts of cancer cells or nearby cells that help them grow. So far, these drugs have only been found to be useful for some non-small cell lung cancers. For example, as cancers grow, they form new blood vessels that nourish them. It is used with the standard chemotherapy regimen. Medications with other specific targets, such as crizotinib, erlotinib and cetuximab, may also be useful.

There are specific names for the order in which treatment is given. Neoadjuvant treatment refers to having radiation or chemotherapy before surgery. Having one or both of these before surgery may help shrink the tumor, as a smaller tumor is easier to take out in surgery.

Chemotherapy or radiation soon after surgery is called adjuvant treatment. The goal of adjuvant treatment is to kill any cancer cells that may be left after the surgery. Even if there is no sign of cancer cells, your doctor may suggest adjuvant treatment, as it may lower the risk that the cancer will come back or spread.

Clinical trials are being conducted on prevention and treatment options for lung cancer, including photodynamic therapy and chemoprevention.

Immunotherapy

Immunotherapy is a new cancer treatment approach that uses drugs, vaccines and other therapies to activate the immune system’s natural defenses so it can fight cancer. One type of immunotherapy drug, called “anti-PD-1” has been shown to cause significant tumor regression in a quarter of patients who receive it after a round of chemotherapy.Three immunotherapy drugs—pembrolizumab, atezolizumab and nivolumab—have been approved to treat certain non-small cell lung cancers.

Brain Cancer Treatment

2020-10-02T16:41:00.007-07:00

Brain Tumor Treatment

Brain tumors overview What are my treatment options? What happens during radiation therapy? What are possible side effects of radiation therapy? What are some of the possible risks or complications?

What kind of treatment follow-up should I expect? Are there any new developments in treating my disease?

Brain Tumors Overview

A brain tumor is a group of abnormal cells that grows in or around the brain. Tumors can directly destroy healthy brain cells. They can also indirectly damage healthy cells by crowding other parts of the brain and causing inflammation, brain swelling and pressure within the skull.

Brain tumors are either malignant or benign. A malignant tumor, also called brain cancer, grows rapidly and often invades or crowds healthy areas of the brain. Benign brain tumors do not contain cancer cells and are usually slow growing.

Brain tumors fall into two different categories: primary or metastatic. Primary brain tumors begin within the brain. A metastatic tumor is formed when cancer cells located elsewhere in the body break away and travel to the brain. For this reason, metastatic brain tumors are almost always malignant, while primary brain tumors may be benign or malignant.

Brain tumors are classified based on where the tumor is located, the type of tissue involved, whether the tumor is benign or malignant, and other factors. If a tumor is determined malignant, the tumor cells are examined under a microscope to determine how malignant they are. Based on this analysis, tumors are rated, or graded, by their level of malignancy from least to most malignant. Factors that determine the tumor grade include how fast the cells are growing, how much blood is supplying the cells, the presence of dead cells in the middle of the tumor (necrosis), if the cells are confined to a specific area, and how similar the cancerous cells are to normal cells.

The cause of primary brain tumors is unknown. Environmental and genetic factors may cause some brain tumors. Prior exposure to therapeutic irradiation as a child seems to be a contributing cause in very few patients. Symptoms of a brain tumor include headaches, nausea, vomiting, seizures, behavior changes, memory loss, and vision or hearing problems.

What are my treatment options?

A variety of therapies are used to treat brain tumors. The type of treatment recommended depends on the size and type of the tumor, its growth rate, brain location, and the general health of the patient. Treatment options include surgery, radiation therapy, chemotherapy, targeted biological agents, or a combination of these. Surgical resection (if safe) is generally the first treatment recommendation to reduce pressure in the brain rapidly.

In the past two decades, researchers have developed new techniques of delivering radiation that target the brain tumor while protecting nearby healthy tissues. These treatments include brachytherapy, intensity-modulated radiation therapy (IMRT) and radiosurgery.

Radiation therapy may be advised for tumors that are sensitive to this treatment. Conventional radiation therapy uses external beams of x-rays, gamma rays or protons aimed at the tumor to kill cancer cells and shrink brain tumors. The therapy is usually given over a period of several weeks. Whole brain radiation therapy is an option in the case of multiple tumors or tumors that cannot be easily targeted with focal treatment.

Types of radiation therapy include:

Intensity-modulated radiation therapy (IMRT): an advanced mode of high-precision radiotherapy that utilizes computer-controlled x-ray accelerators to deliver precise radiation doses to a malignant tumor or specific areas within the tumor. The radiation dose is designed to conform to the three-dimensional (3-D) shape of the tumor by modulating—or controlling—the intensity of the radiation beam to focus a higher radiation dose to the tumor while minimizing radiation exposure to healthy cells.

Stereotactic radiosurgery (SRS): a highly precise form of radiation therapy that directs narrow beams of radiation to the tumor from different angles. For this procedure, the patient may wear a rigid head frame. Computed tomography (CT) or magnetic resonance imaging (MRI) help the doctor identify the tumor's exact location and a computer helps the doctor regulate the dose of radiation. Stereotactic radiotherapy is similar physically to radiosurgery but involves fractionation (multiple treatments). This modality would be recommended for tumors within or close to critical structures in the brain that cannot tolerate a large single dose of radiation or for larger tumors.

Three-dimensional conformal radiation therapy (3D-CRT): a conventional form of radiation treatment delivery that uses a specific arrangement of x-ray beams designed to conform to the shape of the tumor to maximize tumor dose and minimize normal surrounding tissue dose. This form of treatment is tailored to the patient's specific anatomy and tumor location. CT and/or MRI scan is often required for treatment planning.

Brachytherapy: the temporary placement of radioactive source(s) within the body, usually employed to give an extra dose—or boost—of radiation to the area of the excision site or to any residual tumor.

Surgery, also called surgical resection, is often indicated for primary brain tumors. A surgeon removes some or the entire tumor without causing severe damage to surrounding tissues. Surgery may also be used to reduce pressure within the skull (called intracranial pressure) and to relieve symptoms (called palliative treatment) in cases when the tumor cannot be removed.

Chemotherapy, or anticancer medications, may be recommended. Chemotherapy, along with radiation (concurrent therapy), has become the standard of care for primary malignant brain tumors. The use of these drugs or chemicals to slow down or kill rapidly dividing cells can be used before, during, or after surgery and/or radiotherapy to help destroy tumor cells and to prevent them from returning. Chemotherapy drugs may be taken by pill or by injection and are often used in combination with radiation therapy. Drugs called radiosensitizers, which are believed to make radiation therapy more effective, may also be prescribed.

What happens during radiation therapy?

For conventional radiation therapy, your initial visit with the radiation oncologist is called a consultation. During this visit, the physician will review the history of your illness and perform a physical examination. Consultations with other members of your treatment team may also take place at this time.

After you and your physician(s) have decided on a course of treatment, you will begin the first phase—treatment planning. During this planning phase of your treatment, a radiation oncologist—a physician who specializes in radiation therapy—will simulate your radiation therapy treatment using either conventional radiographs (x-rays) or a computed tomography (CT) scan. In most cases, an MRI scan is required. These radiographic exams are used to plan the type and direction of radiation beams used to treat the cancer.

You will be asked to lie still on the treatment table during simulation, although no radiation therapy will be given at that point. An immobilization mask will usually be made at this time to hold your head in the same position. Typically, treatment begins one to two weeks after your treatment planning session. There is significant medical physics involvement in the planning and verification of the plan before it is actually delivered to the patient.

During your actual radiation therapy treatment, you will be asked to lie on the treatment table without moving. A radiation technologist will administer the treatment prescribed by the radiation oncologist. The treatment will last only a few minutes, and you may experience seeing flashes of light or smell an odor during the actual treatment. You may also hear a noise from the treatment unit. If you undergo stereotactic radiosurgery, you may wear a rigid head frame. In this procedure, a computed tomography (CT) scan or magnetic resonance imaging (MRI) will be used to help the doctor identify the tumor's exact location and a computer will regulate the dose of radiation as needed. Multiple images may be taken on the treatment machine to guarantee your alignment.

Treatment planning sessions and your first radiation therapy treatments may take up to an hour. Thereafter, treatments will usually last a few minutes and you will be in and out of the radiation department in 30 to 45 minutes for each session. Typically, treatments are given once a day, three to five days a week, for five to seven weeks. Treatments are usually not given on weekends.

What are possible side effects of radiation therapy?

The side effects of radiation therapy to the brain may not occur until two to three weeks after the start of your therapy. Many people experience hair loss, but the amount varies from person to person. Hair may grow back once therapy is finished.

The second most frequently reported side effect is a skin irritation. The skin around your ears and scalp may become dry, itchy, red or tender. It is important not to attempt to treat this side effect on your own, but rather to seek medical treatment as soon as it occurs. Fatigue is another possible side effect of radiation therapy. The best way to fight fatigue is to get on a daily exercise regimen that is tolerable and sustainable, eat a healthy diet and rely on friends and family for support. Your normal energy levels should return about six weeks after you finish your therapy. Fatigue may be worst two to three weeks after completion of a prolonged (multi-week) radiation treatment.

Edema, or swelling of the brain, is also prevalent among individuals undergoing radiation therapy to the brain. If you experience a headache or a feeling of pressure, report your symptoms to your oncologist. You may be prescribed medications to help reduce brain swelling, prevent seizures or to control pain. When chemotherapy and radiation therapy are given at the same time, patients may experience more severe side effects. Your doctor can suggest ways to ease these uncomfortable symptoms.

Other possible side effects include:

hearing problems

nausea

vomiting

loss of appetite

memory or speech problems

headaches

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What are some of the possible risks or complications?

Radiation is a powerful weapon against cancer cells, but sometimes it kills healthy brain tissue as well—a severe side effect called radiation necrosis. Necrosis (a late effect of high doses of radiation) can cause headaches, seizures, or even death in a small number of cases. This can occur six months to a few years after treatment. However, the risk of necrosis has declined in recent years with the advent of the newer, targeted radiation therapies described above and the emergence of powerful imaging, brain mapping and information technologies.

Other complications include:

neurologic deficits (this usually depends on the area of the brain being treated)

cognitive problems

seizures

headaches

return of tumor growth

In children, radiation may damage the pituitary gland and other parts of the brain. This could cause learning problems or slow growth and development. Additionally, radiation during childhood increases the risk of developing tumors later in life. Researchers are studying chemotherapy as an alternative to radiation therapy in children with brain tumors.

What kind of treatment follow-up should I expect?

Regular follow-up treatment is extremely important after treatment for a brain tumor. Besides regular physical and neurological exams and blood tests, you may need periodic magnetic resonance imaging (MRI), MR spectroscopy, perfusion or diffusion MRI, and/or computed tomography (CT). Positron emission tomography (PET) scans are rarely used in patients with brain tumors, although they may be used to monitor extracranial (outside of the brain) disease. Your physician may also recommend home care, occupational or vocational therapy, pain management, physical therapy and participation in support groups.

This follow-up care will help your physician to:

spot any sign that the tumor is returning

monitor the health of your brain

identify and treat the side effects of chemotherapy or radiation therapy

detect the presence of other types of cancer at the earliest possible stage

Are there any new developments in treating my disease?

Over the past decade, improvements in fractionated and stereotactic radiotherapy are bringing new hope to patients with brain tumors, both in terms of survival and quality of life. A number of experimental drugs and therapies are also showing promise in clinical trials, including:

Angiogenesis inhibitors are drugs that interfere with the growth of blood vessels in the tumor, thus "starving" the tumor of the nutrients and oxygen it needs to grow. Treatment with these drugs is also called anti-angiogenetic therapy.

Immunotherapy is an experimental treatment that promotes the immune response against particular tumor antigens (tumor substances/molecules that trigger the immune system). There are many different types of immunotherapy of which a number are now approved for use while many are still being delivered in the controlled setting of a clinical trial.

New classes of biological agents targeted against various aspects of tumor cell signaling or metabolism.

Enhanced drug delivery methods (e.g. convection-enhanced delivery) are being evaluated in clinical trials.

Emerging re-irradiation (repeated administration of radiotherapy) treatment protocols for recurrent brain tumors are now available (e.g., re-irradiation with bevacizumab for glioblastoma).

Radiofrequency tumor treating fields (TTF) have recently been approved for the treatment of one type of brain tumor – glioblastoma. The fields are administered to the patient through electrodes that are placed on the patient's scalp. The fields are powered by a radiofrequency generator and batteries that are contained in a backpack. While this treatment may be of value, it does require a commitment to wearing a treatment apparatus which may be a significant lifestyle modification.

And Also:

Brain Tumor Treatment

If you are diagnosed with a brain tumor, your doctor will discuss the best options to treat it. This depends on several factors, including the location and type of the cancer and your general health.

Your treatment for a brain tumor will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Surgery

Surgery usually is the first treatment for brain tumors. Even when complete removal is not possible surgery may be able to:

Help reduce the tumor’s size

Relieve symptoms

Help doctors decide what other treatments are needed

The most common surgery for brain tumors is craniotomy, which involves opening the skull. Some brain tumors can be removed with little or no damage to the brain. However, many grow in areas that make them difficult or impossible to remove without destroying important parts of the brain.

When a brain tumor is in a challenging location, our neurosurgeons can use this innovative open MRI system that allows them to view the tumor during surgery. This helps them remove as much of the tumor as possible without damaging other parts of the brain.

Radiation Therapy

Radiation therapy may be able to stop or slow the growth of brain tumors that cannot be removed with surgery. It may be used:

With chemotherapy to help the radiation work better or lessen effect on normal parts of the brain

With targeted therapies to destroy remaining cancer cells

New radiation therapy techniques and remarkable skill allow doctors to target brain tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells.

Treatment methods, include:

Gamma Knife radiosurgery, which is not really surgery. It delivers a pinpoint dose of radiation from hundreds of angles.

Focused radiation therapy, which is aimed directly at the tumor and immediately surrounding area

Whole-brain radiation therapy, which may be needed if you have two or more brain tumors in different locations

Intensity-modulated radiotherapy (IMRT), which shapes the radiation beam to the shape of the brain tumor and lessens exposure to the rest of the brain

Proton therapy delivers high radiation doses directly to the brain tumor site, with no damage to nearby healthy tissue. It may be used to treat tumors in very sensitive areas, including in the skull base and along the spine.

Laser Interstitial Thermal Therapy

Laser interstitial thermal therapy (LITT) is performed by implanting a laser catheter into the tumor and heating it to temperatures high enough to kill the tumor.

The treatment is minimally invasive, often requiring little more than a 2-millimeter incision in the scalp, and takes just a few minutes to perform. Most patients can go home the day after treatment and can quickly return to normal activities.

LITT is currently being used to treat patients with primary and metastatic brain tumors, but can also help patients who do not respond to stereotactic radiosurgery or have radiation necrosis (tissue death caused by radiation treatment).

Chemotherapy

MD Anderson offers the most up-to-date and advanced chemotherapy options for brain tumors. These drugs may be taken orally or by injection. They may be given alone or with other treatments.

Chemotherapy often is not as effective for brain cancer as some other types of cancer. This is because of the blood-brain barrier, small blood vessels in the brain and spinal cord that protect the brain from harmful substances. They also may act as a shield against chemotherapy drugs.

Targeted Therapies

These new drugs target the specific gene changes that cause cancer.

Achilles Tendon Repair Surgery

2020-09-30T15:52:00.010-07:00

What is Achilles tendon repair surgery?

Achilles tendon repair surgery is a type of surgery to fix a damaged Achilles tendon.

The Achilles tendon is a strong, fibrous cord in the lower leg. It connects the muscles of your calf to your heel. It’s the largest tendon in your body. It helps you walk, run, and jump.

In some cases, the Achilles tendon can tear, or rupture. This is usually due to a sudden, strong force. It can happen during tough physical activity. It can happen if you suddenly move faster or pivot on your foot. Having a foot that turns outward too much can increase your risk of a torn tendon. A ruptured Achilles tendon can cause pain and swelling near your heel. You may not be able to bend your foot downward.

The Achilles tendon can also degenerate. This is also known as tendinitis or tendinopathy. This might cause symptoms like pain and stiffness along your Achilles tendon and on the back of your heel. This is most often through overuse and repeated stress to the tendon. It can result from repeated stress on your tendon, especially if you have recently been more active. Having short calf muscles can increase your risk of tendinopathy.

During the surgery, an incision is made in the back of the calf. If the tendon is ruptured, the surgeon will stitch the tendon back together. If the tendon is degenerated, the surgeon may remove the damaged part of the tendon and repair the rest of the tendon with stitches. If there is severe damage to a lot of the tendon, the surgeon might replace part or all of your Achilles tendon. This is done with a tendon taken from another place in your foot.

In some cases, the Achilles tendon repair surgery can be done as a minimally invasive procedure. This is done with several small incisions instead of one large one. It may use a special scope with a tiny camera and a light to help do the repair.

Why might I need Achilles tendon repair surgery?

You might need Achilles tendon surgery if you tore your tendon. Surgery is advised for many cases of a ruptured Achilles tendon. But in some cases, your healthcare provider may advise other treatments first. These may include pain medicine, or a temporary cast to prevent your leg from moving. And your healthcare provider may not advise surgery if you have certain medical conditions. These include diabetes and neuropathy in your legs.

Or you may need Achilles tendon repair surgery if you have tendinopathy. But in most cases, other treatments can be used to treat tendinopathy. These include resting your foot, using ice and pain medicines, and using a brace or other device to stop your foot from moving. Physical therapy can also help. If you still have symptoms after several months, your healthcare provider might advise surgery.

Depending on the type of problem you have, Achilles tendon surgery might work for you. Talk with your healthcare provider about the risks and benefits of your choices.

What are the risks of Achilles tendon repair surgery?

Every surgery has risks. Risks of Achilles tendon repair include:

Excess bleeding

Nerve damage

Infection

Blood clot

Wound healing problems

Calf weakness

Complications from anesthesia

Continued pain in your foot and ankle

Your own risks may vary according to your age, the shape of your foot and leg muscles and tendons, your general health, and the type of surgery done. Talk to your healthcare provider about any concerns you have. He or she can tell you the risks that most apply to you.

How do I prepare for Achilles tendon repair surgery?

Talk with your healthcare provider how to prepare for your surgery. Tell your healthcare provider about all the medicines you take. This includes over-the-counter medicines such as aspirin. You may need to stop taking some medicines ahead of time, such as blood thinners. If you smoke, you’ll need to stop before your surgery. Smoking can delay healing. Talk with your healthcare provider if you need help to stop smoking.

Before your surgery, you may need imaging tests. These may include ultrasound, X-rays, or magnetic resonance imaging (MRI).

Do not eat or drink after midnight the night before your surgery. Tell your healthcare provider about any recent changes in your health, such as a fever.

You may need to plan some changes at home to help you recover. This is because you won’t be able to walk on your foot normally for a while. Plan to have someone drive you home from the hospital.

What happens during Achilles tendon repair surgery?

Achilles tendon surgery can be done with several methods. The surgery is done by an orthopedic surgeon and a team of specialized healthcare providers. Ask your healthcare provider about the details of your surgery. The surgery may take a couple of hours. During your surgery:

You may have spinal anesthesia. This is so you won’t feel anything from your waist down. You’ll also likely be given sedation. This will help you sleep through the surgery.

A healthcare provider will watch your vital signs, like your heart rate and blood pressure, during the surgery.

The surgeon will make an incision through the skin and muscle of your calf. If you have minimally invasive surgery, the surgeon will make a smaller incision. He or she may then use a tiny camera with a light to help do the surgery.

Your surgeon will make an incision through the sheath that surrounds the tendon. He or she will remove parts of your damaged tendon, or repair the rip in the tendon.

Your surgeon may remove another tendon from your foot. This is then used to replace part or all of the Achilles tendon.

Your surgeon will make any other repairs that are needed.

The healthcare provider will close the layers of skin and muscle around your calf with sutures.

What happens after Achilles tendon repair surgery?

A healthcare provider will watch you for a few hours after your surgery. When you wake up, you will likely have your ankle in a splint. This is to keep it from moving. Achilles tendon surgery is often an outpatient procedure. This means you can go home the same day.

You will have some pain after your surgery, especially in the first few days. Pain medicines will help relieve your pain. Keep your leg elevated as often as possible. This can help reduce swelling and pain. Make sure to tell your healthcare provider right away if you have a high fever or pain in your ankle or calf that gets worse. After your surgery, you will likely need to use crutches. This is so you can keep your weight off your leg.

About 10 days after your surgery, you’ll need to return to your healthcare provider to have your stitches removed. Your healthcare provider might replace your splint with a cast at this time. If so, follow all instructions about keeping your cast dry. Or, your healthcare provider may give you a special removable boot instead of a cast.

Your healthcare provider will give you instructions about when you can put weight on your leg. He or she will tell you how to strengthen your ankle and leg muscles as you recover. You may need to do physical therapy to help with your recovery.

Make sure to follow all your healthcare provider’s instructions about medicines, wound care, and exercises. This will help make sure the surgery is a success for you.

Next steps

Before you agree to the test or the procedure make sure you know:

The name of the test or procedure

The reason you are having the test or procedure

What results to expect and what they mean

The risks and benefits of the test or procedure

What the possible side effects or complications are

When and where you are to have the test or procedure

Who will do the test or procedure and what that person’s qualifications are

What would happen if you did not have the test or procedure

Any alternative tests or procedures to think about

When and how will you get the results

Who to call after the test or procedure if you have questions or problems

How much will you have to pay for the test or procedure

And Also:

Achilles Tendon Repair

Description

The Achilles Tendon connects the calf muscles to the calcaneus (heel bone) and is one of the important tendons in the human body. The main action of the achilles tendon is foot plantar flexion. Common pathologies include: tendinopathy, tear or rupture. Examples of mechanisms of injury for rupture includes: falling from a height, forceful plantar flexion of the ankle (as in jumping with an extended knee), or using the foot to break a fall if you stumble. Clinically they present with a palpable gap on palpation, increased passive dorsiflexion, lack of heel raise and a positive Thompson Test. Achilles tendon rupture is either managed conservatively with a cast or surgically with an achilles tendon repair.

Conservative vs Surgical Intervention

There is much debate in the literature about treatment for achilles tendon rupture with the two options comprising of a conservative or surgical approach. Many studies have shown that the re-rupture rates are higher in cases of non-operative management. More recently studies have demonstrated equivalent or improved rates of re-rupture compare with surgical intervention. However, many people continue to be treated with surgical repair and physiotherapists will continue to see them for post-operative rehabilitation in their clinics.

Pre-op

Prior to surgery general oedema reduction interventions should be utilised (Rest, Ice, Compression, Elevation). The surgery will ideally occur within one week of the rupture.

Surgery Description

Many techniques exist for this surgery, including transverse, medial and longitudinal incisions. The ankle is placed in neutral position and the severed ends of the tendon are sutured together. The surgeon will then take the ankle through complete range of motion to look at the integrity of the repair. A cast is often applied, with the surgical technique determining how long the cast stays on. Many surgeons are now focusing on early weight bearing and passive motion to improve tendon healing. A new minimally-invasive technique involves utilisation of the peroneus brevis via two para-midline incisions. The technique reportedly preserves skin integrity over the site most prone to breakdown in a vertical incision, open reconstruction. Another study recommended percutaneous repair in the recreational athlete and in patients concerned with cosmesis, and open repair for all high-caliber athletes who cannot afford any chance of rerupture."

Post-Op

Early mobilisation following achilles tendon repair has been reported to be beneficial in terms of postoperative recovery and improved tendon vascularity. Despite the increasing supported for accelerated rehabilitation regimes, there is still no consensus regarding the most preferable protocol.

Clinic protocols:

There's three phases of post-surgical rehabilitation following achilles tendon repair.

Phase I

Phase I typically lasts three weeks.

Goals of this phase are as follows:

Control oedema and protect the repair site

Minimise scar adhesion and detrimental effects of immobilisation

Progress to full weight bearing as tolerated/indicated

Pain 5/10 or less, strength 4/5 all lower extremity muscles except plantar flexors

Phase I interventions include:

Modalities for pain and oedema

Stretching of large lower extremity muscle groups, gastrocnemius/soleus added at week 3

AROM: plantar and dorsiflexion 3x5; 3 times daily; add inversion and eversion at week 2

Foot/ankle isometrics at week 2; band exercises week 3

Proprioceptive training for lower extremities; Gait training

Upper extremity cardiovascular exercise

Joint mobilisation and soft tissue work, as indicated

Phase II

Phase II typically lasts from post op week 4-6.

Goals for this phase are as follows:

Normalized gait pattern

Full ankle ROM

5/5 lower extremity strength

Return to full ADL ability

Pain reported to be <2/10

Proprioceptive reactions equal to non-surgical side

Phase II interventions include:

Ankle flexibility at various knee angles

Progressive closed kinetic chain lower extremity strengthening

Cardiovascular progression

Proprioceptive training on variety of surfaces

Manual resisted exercises and joint mobilization, as indicated

Phase III

Phase III typically lasts from post op week 6-15.

Goals for this phase are as follows:

Initiate running program

Improve balance and coordination

Increase velocity of activity

Return to sport

Phase III interventions include:

Progressive ankle and lower extremity strengthening

Agility exercises

Double heel raise/lower progressing to single leg heel raise at various speeds

Anterior Cruciate Ligament ACL Reconstruction Surgery

2020-09-30T00:33:00.014-07:00

Anterior Cruciate Ligament ACL Reconstruction

Overview

ACL reconstruction is surgery to replace a torn anterior cruciate (KROO-she-ate) ligament (ACL) — a major ligament in your knee. ACL injuries most commonly occur during sports that involve sudden stops and changes in direction — such as basketball, soccer, football, downhill skiing and gymnastics.

In ACL reconstruction, the torn ligament is removed and replaced with a piece of tendon from another part of your knee or from a deceased donor. This surgery is an outpatient procedure that's performed through small incisions around your knee joint.

ACL reconstruction is performed by a doctor who specializes in surgical procedures of the bones and joints (orthopedic surgeon).

Anterior cruciate ligament

Ligaments are strong bands of tissue that connect one bone to another. The ACL — one of two ligaments that crosses the middle of the knee — connects your thighbone (femur) to your shinbone (tibia) and helps stabilize your knee joint.

Why it's done

Most ACL injuries happen during sports and fitness activities that can put stress on the knee:

Suddenly slowing down and changing direction (cutting)

Pivoting with your foot firmly planted

Landing from a jump incorrectly

Stopping suddenly

Receiving a direct blow to the knee

A course of physical therapy may successfully treat an ACL injury for individuals who are relatively inactive, engage in moderate exercise and recreational activities, or play sports that put less stress on the knees.

ACL reconstruction is generally recommended if:

You're an athlete and want to continue in your sport, especially if the sport involves jumping, cutting or pivoting

More than one ligament or the meniscus in your knee is injured

The injury is causing your knee to buckle during everyday activities

You're young (though other factors, such as activity level and knee instability, are more important than age)

Risks

ACL reconstruction is a surgical procedure. And, as with any surgery, bleeding and infection at the surgical site are potential risks. Other risks associated with ACL reconstruction include:

Knee pain or stiffness

Poor healing of the graft

Graft failure after returning to sport

How you prepare

Before your surgery, you'll likely undergo several weeks of physical therapy. The goal before surgery is to reduce pain and swelling, restore your knee's full range of motion, and strengthen muscles. People who go into surgery with a stiff, swollen knee may not regain full range of motion after surgery.

ACL reconstruction is an outpatient procedure, so you'll be able to go home the same day. Arrange for someone to drive you home.

Food and medications

Tell your surgeon about any medications or dietary supplements you take. If you regularly take aspirin or other blood-thinning medications, your doctor may ask you to stop taking these types of drugs for at least a week before surgery to reduce your risk of bleeding.

Follow your doctor's instructions about when to stop eating, drinking and taking any other medication the night before your surgery.

What you can expect

General anesthesia is typically used during ACL reconstruction, so you'll be comfortable during the procedure. ACL reconstruction is usually done through small incisions — one to hold a thin, tube-like video camera (arthroscope) and others to allow surgical instruments access to the joint space.

During the procedure

Your surgeon will remove your damaged ligament, and then replace it with a segment of tendon. This replacement tissue is called a graft and it comes from another part of your knee or a tendon from a deceased donor.

Your surgeon will drill sockets or tunnels into your thighbone and shinbone to accurately position the graft, which is then secured to your bones with screws or other fixation devices. The graft will serve as scaffolding on which new ligament tissue can grow.

After the procedure

Once you recover from the anesthesia, you can go home later that same day. Before you go home, you'll practice walking with crutches, and your surgeon may ask you to wear a knee brace or splint to help protect the graft.

Your doctor will give you specific instructions on how to control swelling and pain after surgery. In general, it's important to keep your leg elevated, apply ice to your knee and rest as much as possible.

Medications to help with pain relief include over-the-counter drugs such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve). Your doctor might prescribe stronger medications, such as meloxicam (Mobic, Vivlodex, others) and gabapentin (Neurontin). If opioids are prescribed, they should be taken only for breakthrough pain as they have many side effects and a significant risk of addiction.

Follow your surgeon's advice on when to ice your knee, how long to use crutches and when it's safe to bear weight on your knee. You'll also be instructed when you can shower or bathe, when you should change dressings on the wound, and how to manage post-surgery care.

Progressive physical therapy after ACL surgery helps to strengthen the muscles around your knee and improve flexibility. A physical therapist will teach you how to do exercises that you will perform either with continued supervision or at home. Following the rehabilitation plan is important for proper healing and achieving the best possible outcomes.

Results

Successful ACL reconstruction paired with focused rehabilitation can usually restore stability and function to your knee. Within the first few weeks after surgery, you should strive to regain a range of motion equal to that of your opposite knee. Recovery generally takes about nine months.

It may take eight to 12 months or more before athletes can return to their sports.

And Also:

ACL Surgery

A torn ACL (anterior cruciate ligament) is a painful and potentially debilitating condition. ACL tears are very common.

Each year in the United States, between 100,000 to 200,000 people tear their ACL. The ACL cannot heal on its own. Once torn, it will stay torn unless surgery is performed.

For some patients – mainly older people and others whose lifestyles do not include running or other rigorous excercise – conservative, nonsurgical treatments may allow them to successfully return to their normal routines.

However, anyone who has torn their ACL and returns to unrestricted activity without an intact ACL will likely experience some knee instability. Most people with active lifestyles, especially those who participate in competitive sports or other rigorous athletic activities, will need surgery to return to their prior level of activity and avoid future injury.

Without an intact ACL, a person is also much more likely to tear their meniscus. The meniscus is a pad of cartilage that cushions the bones that meet at the knee joint. There are two menisci on each knee: the medial meniscus on the inside of the knee and the lateral meniscus on the outside. A torn meniscus will cause knee pain and, sometimes swelling. More importantly, however, a damaged meniscus increases a patient's risk of developing osteoarthritis of the knee later in life.

Most people with active lifestyles, especially those who engage in competitive sports, will need ACL surgery in order to reduce the risk of future injury.

What does ACL surgery do?

In most cases, it is not possible to surgically repair or reattach a torn ACL. Most often, ACL surgery involves a complete rebuilding of the ACL. This procedure, called ACL reconstruction, is the current standard of care for surgically treating tears of the ACL.

The surgeons at the HSS Sports Medicine Institute have drafted guidelines for people who are considering ACL treatment.

How does ACL surgery work?

In ACL reconstruction surgery, a new ACL is made from a graft of replacement tissue from one of two sources:

a portion of the patient's own hamstring, quadriceps or patellar tendon

an allograft (tissue from a human organ donor)

The type of graft used for each patient is determined on a case-by-case basis.

ACL reconstruction surgery is performed using minimally invasive arthroscopic techniques, in which a combination of fiber optics, small incisions and small instruments are used. A somewhat larger incision is needed, however, to obtain the tissue graft. ACL reconstruction is an outpatient (ambulatory) procedure, in which patients can go home on the same day as their surgery.

At HSS, most patients who undergo ACL reconstruction are given an epidural nerve block during their surgery, rather than being placed fully unconscious under general anesthesia. This epidural is the same type of regional anesthesia many women receive during childbirth.

ACL reconstruction surgery steps

Reconstruction of the ACL follows a number of basic steps, although they may vary slightly from case to case:

The orthopedic surgeon makes small incisions around the knee joint, creating portals of entry for the arthroscope and surgical instruments.

The arthroscope is inserted into the knee and delivers saline solution to expand the space around the joint. This makes room for surgical tools, including the arthroscopic camera, which sends video to a monitor so that the surgeon can see inside the knee joint.

The surgeon then evaluates structures that surround the torn ACL, including the left and right meniscus and the articular cartilage. If either of these soft tissues have any lesions, the surgeon repairs them.

Next the graft will be harvested (unless a donor allograft is used). A section of tendon from another part of the patient's body is cut to create a graft, which is then attached at each end to plugs of bone taken from the patella and tibia. These plugs help to anchor the graft that will become the new ACL.

The surgeon inserts the new ACL into the femur and tibia using a flexible guide wire.

Screws are used to secure the plugs of bone. Over time, these plugs will be incorporated into the surrounding bone.

The surgical instruments are removed to complete the procedure.

How soon should you get ACL surgery?

ACL reconstruction is generally scheduled for between three and six weeks after the injury occurs. This allows inflammation in the area to subside. If surgery is performed too early, patients may develop a profound scarring response called arthrofibrosis.

Orthopedic surgeons gauge the appropriate timing of surgery based on:

whether there are other injuries present that need to be treated first

the physical appearance of the knee

the patient’s level of pain

the patient's range of motion and quality of muscle control when flexing (bending) or extending (straightening) the leg

What is the recovery time for ACL surgery?

It usually takes six to nine months for a patient to return to participating in sports after an ACL reconstruction, depending on the level of competition and the type of activity.

Patients are able to walk with crutches and a leg brace on the day of surgery. Very soon after surgery, the patient enters a rehabilitation program to restore strength, stability and range of motion to the knee. The rehabilitation process is composed of a progression of exercises:

Strengthening and range-of-motion exercises are started early in the recovery period.

Running exercises begin at about four months.

Pivoting exercises are started at around five months.

Return to playing competitive sports can begin as early as six months.

The degree of pain associated with ACL recovery varies and can be addressed successfully with medication. Recovery time also varies from patient to patient. The determination of when a patient has fully recovered is based on the restoration of muscle strength, range of motion and proprioception of the knee joint.

Arthroscopic surgical techniques have made recovery times quicker and easier, compared to when ACL construction was conducted through open surgery. But to achieve a successful outcome, it is critical to have the rehabilitation period carefully supervised by an appropriate physical therapist and to have follow-up appointments with the surgeon.

Cancer And Chemotherapy

2020-09-29T22:51:00.021-07:00

Understanding Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells. It usually works by keeping the cancer cells from growing, dividing, and making more cells. Because cancer cells usually grow and divide faster than normal cells, chemotherapy has more of an effect on cancer cells. However, the drugs used for chemotherapy are powerful, and they can still cause damage to healthy cells. This damage causes the side effects that are linked with chemotherapy.

Different types of chemotherapy

Treatment with these powerful drugs is called standard chemotherapy, traditional chemotherapy, or cytotoxic chemotherapy.

How does chemotherapy treat cancer?

Doctors use chemotherapy in different ways at different times.

These include:

Before surgery or radiation therapy to shrink tumors. This is called neoadjuvant chemotherapy.

After surgery or radiation therapy to destroy any remaining cancer cells. This is called adjuvant chemotherapy.

As the only treatment. For example, to treat cancers of the blood or lymphatic system, such as leukemia and lymphoma.

For cancer that comes back after treatment, called recurrent cancer.

For cancer that has spread to other parts of the body, called metastatic cancer.

The goals of chemotherapy

The goals of chemotherapy depend on the type of cancer and how far it has spread. Sometimes, the goal of treatment is to get rid of all the cancer and keep it from coming back. If this is not possible, you might receive chemotherapy to delay or slow cancer growth.

Delaying or slowing cancer growth with chemotherapy also helps manage symptoms caused by the cancer. Chemotherapy given with the goal of delaying cancer growth is sometimes called palliative chemotherapy.

Your chemotherapy plan

There are many drugs available to treat cancer. A doctor who specializes in treating cancer with medication, called a medical oncologist, will prescribe your chemotherapy. You may receive a combination of drugs, because this sometimes works better than only 1 drug.

The drugs, dose, and treatment schedule depend on many factors.

These include:

The type of cancer

The tumor size, its location, and if or where it has spread. This is called the stage of cancer.

Your age and general health

How well you can cope with certain side effects

Any other medical conditions you have

Previous cancer treatments

Where is chemotherapy given?

Your health care team may give you chemotherapy at the clinic, doctor's office, or hospital. Some types of chemotherapy are given by mouth, and these can be taken at home.

How long does chemotherapy take?

Chemotherapy is often given for a specific time, such as 6 months or a year. Or you might receive chemotherapy for as long as it works.

Side effects from many drugs are too severe to give treatment every day. Doctors usually give these drugs with breaks, so you have time to rest and recover before the next treatment. This lets your healthy cells heal.

For example, you might get a dose of chemotherapy on the first day and then have 3 weeks of recovery time before repeating the treatment. Each 3-week period is called a treatment cycle. Several cycles make up a course of chemotherapy. A course usually lasts 3 months or more.

Some cancers are treated with less recovery time between cycles. This is called a dose-dense schedule. It can make chemotherapy more effective against some cancers. But it also increases the risk of side effects. Talk with your health care team about the best schedule for you.

How is chemotherapy given?

Chemotherapy may be given in several different ways, which are discussed below.

Intravenous (IV) chemotherapy. Many drugs require injection directly into a vein.

This is called intravenous or IV chemotherapy. Treatment takes a few minutes to a few hours.

Some IV drugs work better if you get them over a few days or weeks. You take them through a small pump you wear or carry.

This is called continuous infusion chemotherapy.

Oral chemotherapy. You can take some drugs by mouth. They can be in a pill, capsule, or liquid. This means that you may be able to pick up your medication at the pharmacy and take it at home. Oral treatments for cancer are now more common. Some of these drugs are given daily, and others are given less often. For example, a drug may be given daily for 4 weeks followed by a 2-week break.

Injected chemotherapy. This is when you receive chemotherapy as a shot. The shot may be given in a muscle or injected under the skin. You may receive these shots in the arm, leg, or abdomen. Abdomen is the medical word for your belly.

Chemotherapy into an artery. An artery is a blood vessel that carries blood from your heart to another part of your body. Sometimes chemotherapy is injected into an artery that goes directly to the cancer. This is called intra-arterial or IA chemotherapy.

Chemotherapy into the peritoneum or abdomen. For some cancers, medication might be placed directly in your abdomen. This type of treatment works for cancers involving the peritoneum. The peritoneum covers the surface of the inside of the abdomen and surrounds the intestines, liver, and stomach. Ovarian cancer is one type of cancer that frequently spreads to the peritoneum.

Topical chemotherapy. You can take some types of chemotherapy in a cream you put on your skin. You get your medication at the pharmacy and take it at home.

And Also:

Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to kill cancer

How Chemotherapy Works against Cancer

Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. Chemotherapy is used to:

Treat cancer

Chemotherapy can be used to cure cancer, lessen the chance it will return, or stop or slow its growth.

Ease cancer symptoms

Chemotherapy can be used to shrink tumors that are causing pain and other problems.

Who Receives Chemotherapy

Chemotherapy is used to treat many types of cancer. For some people, chemotherapy may be the only treatment you receive. But most often, you will have chemotherapy and other cancer treatments. The types of treatment that you need depends on the type of cancer you have, if it has spread and where, and if you have other health problems.

How Chemotherapy Is Used with Other Cancer Treatments

When used with other treatments, chemotherapy can:

Make a tumor smaller before surgery or radiation therapy. This is called neoadjuvant chemotherapy.

Destroy cancer cells that may remain after treatment with surgery or radiation therapy. This is called adjuvant chemotherapy.

Help other treatments work better.

Kill cancer cells that have returned or spread to other parts of your body.

Chemotherapy Can Cause Side Effects

Chemotherapy not only kills fast-growing cancer cells, but also kills or slows the growth of healthy cells that grow and divide quickly. Examples are cells that line your mouth and intestines and those that cause your hair to grow. Damage to healthy cells may cause side effects, such as mouth sores, nausea, and hair loss. Side effects often get better or go away after you have finished chemotherapy.

The most common side effect is fatigue, which is feeling exhausted and worn out. You can prepare for fatigue by:

Asking someone to drive you to and from chemotherapy

Planning time to rest on the day of and day after chemotherapy

Asking for help with meals and childcare on the day of and at least one day after chemotherapy

There are many ways you can help manage chemotherapy side effects.

How Much Chemotherapy Costs

The cost of chemotherapy depends on:

The types and doses of chemotherapy used

How long and how often chemotherapy is given

Whether you get chemotherapy at home, in a clinic or office, or during a hospital stay

The part of the country where you live

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for chemotherapy. To learn more, talk with the business office where you go for treatment.

If you need financial assistance, there are organizations that may be able to help. To find such organizations, go to the National Cancer Institute database, Organizations that Offer Support Services and search for "financial assistance." Or call toll-free 1-800-4-CANCER (1-800-422-6237) to ask for information on organizations that may help.

What to Expect When Receiving Chemotherapy

How Chemotherapy Is Given

Chemotherapy may be given in many ways. Some common ways include:

Oral

The chemotherapy comes in pills, capsules, or liquids that you swallow

Intravenous (IV)

The chemotherapy goes directly into a vein

Injection

The chemotherapy is given by a shot in a muscle in your arm, thigh, or hip, or right under the skin in the fatty part of your arm, leg, or belly

Intrathecal

The chemotherapy is injected into the space between the layers of tissue that cover the brain and spinal cord

Intraperitoneal (IP)

The chemotherapy goes directly into the peritoneal cavity, which is the area in your body that contains organs such as your intestines, stomach, and liver

Intra-arterial (IA)

The chemotherapy is injected directly into the artery that leads to the cancer

Topical

The chemotherapy comes in a cream that you rub onto your skin

Chemotherapy is often given through a thin needle that is placed in a vein on your hand or lower arm. Your nurse will put the needle in at the start of each treatment and remove it when treatment is over. IV chemotherapy may also be given through catheters or ports, sometimes with the help of a pump.

Catheter

A catheter is a thin, soft tube. A doctor or nurse places one end of the catheter in a large vein, often in your chest area. The other end of the catheter stays outside your body. Most catheters stay in place until you have finished your chemotherapy treatments. Catheters can also be used to give you other drugs and to draw blood. Be sure to watch for signs of infection around your catheter.

Port

A port is a small, round disc that is placed under your skin during minor surgery. A surgeon puts it in place before you begin your course of treatment, and it remains there until you have finished. A catheter connects the port to a large vein, most often in your chest. Your nurse can insert a needle into your port to give you chemotherapy or draw blood. This needle can be left in place for chemotherapy treatments that are given for longer than one day. Be sure to watch for signs of infection around your port.

Pump

Pumps are often attached to catheters or ports. They control how much and how fast chemotherapy goes into a catheter or port, allowing you to receive your chemotherapy outside of the hospital. Pumps can be internal or external. External pumps remain outside your body. Internal pumps are placed under your skin during surgery.

How Your Doctor Decides Which Chemotherapy Drugs to Give You

There are many different chemotherapy drugs. Which ones are included in your treatment plan depends mostly on:

The type of cancer you have and how advanced it is

Whether you have had chemotherapy before

Whether you have other health problems, such as diabetes or heart disease

Where You Go for Chemotherapy

You may receive chemotherapy during a hospital stay, at home, or as an outpatient at a doctor’s office, clinic, or hospital. Outpatient means you do not stay overnight. No matter where you go for chemotherapy, your doctor and nurse will watch for side effects and help you manage them.

How Often You Receive Chemotherapy

Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on:

Your type of cancer and how advanced it is

Whether chemotherapy is used to:

Cure your cancer

Control its growth

Ease symptoms

The type of chemotherapy you are getting

How your body responds to the chemotherapy

You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, you might receive chemotherapy every day for 1 week followed by 3 weeks with no chemotherapy. These 4 weeks make up one cycle. The rest period gives your body a chance to recover and build new healthy cells.

Missing a Chemotherapy Treatment

It is best not to skip a chemotherapy treatment. But, sometimes your doctor may change your chemotherapy schedule if you are having certain side effects. If this happens, your doctor or nurse will explain what to do and when to start treatment again.

How Chemotherapy May Affect You

Chemotherapy affects people in different ways. How you feel depends on:

The type of chemotherapy you are getting

The dose of chemotherapy you are getting

Your type of cancer

How advanced your cancer is

How healthy you are before treatment

Since everyone is different and people respond to chemotherapy in different ways, your doctor and nurses cannot know for sure how you will feel during chemotherapy.

How Will I Know If My Chemotherapy Is Working?

You will see your doctor often. During these visits, she will ask you how you feel, do a physical exam, and order medical tests and scans. Tests might include blood tests. Scans might include MRI, CT, or PET scans.

You cannot tell if chemotherapy is working based on its side effects. Some people think that severe side effects mean that chemotherapy is working well, or that no side effects mean that chemotherapy is not working. The truth is that side effects have nothing to do with how well chemotherapy is fighting your cancer.

Special Diet Needs

Chemotherapy can damage the healthy cells that line your mouth and intestines and cause eating problems. Tell your doctor or nurse if you have trouble eating while you are receiving chemotherapy. You might also find it helpful to speak with a dietitian.

Working during Chemotherapy

Many people can work during chemotherapy, as long as they match their work schedule to how they feel. Whether or not you can work may depend on what kind of job you have. If your job allows, you may want to see if you can work part-time or from home on days you do not feel well.

Many employers are required by law to change your work schedule to meet your needs during cancer treatment. Talk with your employer about ways to adjust your work during chemotherapy. You can learn more about these laws by talking with a social worker.

Arthroscopic Knee Surgery

2020-09-29T17:09:00.014-07:00

Arthroscopy (ahr-THROS-kuh-pee) is a procedure for diagnosing and treating joint problems. A surgeon inserts a narrow tube attached to a fiber-optic video camera through a small incision — about the size of a buttonhole. The view inside your joint is transmitted to a high-definition video monitor.

Arthroscopy allows the surgeon to see inside your joint without making a large incision. Surgeons can even repair some types of joint damage during arthroscopy, with pencil-thin surgical instruments inserted through additional small incisions.

Why it's done

Doctors use arthroscopy to help diagnose and treat a variety of joint conditions, most commonly those affecting the:

Knee, Shoulder, Elbow, Ankle, Hip, Wrist

Diagnostic procedures

Doctors often turn to arthroscopy if X-rays and other imaging studies have left some diagnostic questions unanswered.

Surgical procedures

Conditions treated with arthroscopy include:

Loose bone fragments, Damaged or torn cartilage, Inflamed joint linings, Torn ligaments, Scarring within joints, Arthritis, Posterior cruciate ligament injury, Swollen knee

Risks

Arthroscopy is a very safe procedure and complications are uncommon.

Problems may include:

Tissue or nerve damage. The placement and movement of the instruments within the joint can damage the joint's structures.

Infection. Any type of invasive surgery carries a risk of infection.

Blood clots. Rarely, procedures that last longer than an hour can increase the risk of blood clots developing in your legs or lungs.

How you prepare

Exact preparations depend on which of your joints the surgeon is examining or repairing. In general, you should:

Avoid certain medications. Your doctor may want you to avoid taking medications or dietary supplements that can increase your risk of bleeding.

Fast beforehand. Depending on the type of anesthesia you'll have, your doctor may want you to avoid eating solid foods eight hours before your procedure.

Arrange for a ride. You won't be allowed to drive yourself home after the procedure, so make sure someone will be available to pick you up. If you live alone, ask someone to check on you that evening or, ideally, stay with you the rest of the day.

Choose loose clothing. Wear loose, comfortable clothing — baggy gym shorts, for example, if you're having knee arthroscopy — so you can dress easily after the procedure.

What you can expect

Although the experience varies depending on why you're having the procedure and which joint is involved, some aspects of arthroscopy are fairly standard.

You'll remove your street clothes and jewelry and put on a hospital gown or shorts.

A nurse will place an intravenous catheter in your hand or forearm and inject a mild sedative.

During the procedure

The type of anesthesia used varies by procedure.

Local anesthesia. Numbing agents are injected below the skin to block sensation in a limited area, such as your knee. You'll be awake during your arthroscopy, but the most you'll feel is pressure or a sensation of movement within the joint.

Regional anesthesia. The most common form of regional anesthesia is delivered through a small needle placed between two of your spine's lumbar vertebrae. This numbs the bottom half of your body, but you remain awake.

General anesthesia. Depending on the length of the operation, it may be better for you to be unconscious during the procedure.

General anesthesia is delivered through a vein (intravenously).

You'll be placed in the best position for the procedure you're having. This may be on your back or on your side. The limb being worked on will be placed in a positioning device, and a tourniquet might be used to decrease blood loss and enhance visibility inside the joint.

Another technique to improve the view inside your joint involves filling the joint with a sterile fluid. This expands the area around the joint.

One small incision is made for the viewing device. Additional small incisions at different points around the joint allow the surgeon to insert surgical tools to grasp, cut, grind and provide suction as needed for joint repair.

Incisions will be small enough to be closed with one or two stitches, or with narrow strips of sterile adhesive tape.

After the procedure

Arthroscopic surgery usually doesn't take long. For example, arthroscopy of the knee takes about an hour. After that, you'll be taken to a separate room to recover for a few hours before going home.

Your aftercare may include:

Medications. Your doctor may prescribe medication to relieve pain and inflammation.

R.I.C.E. At home, may find it helpful to rest, ice, compress and elevate the joint for several days to reduce swelling and pain.

Protection. You might need to use temporary splints — slings or crutches for comfort and protection.

Exercises. Your doctor might prescribe physical therapy and rehabilitation to help strengthen your muscles and improve the function of your joint.

Call your surgeon if you develop:

A fever, Pain not helped by medication, Drainage from your incision, Redness or swelling, New numbness or tingling

Results

In general, you should be able to resume desk work and light activity in a few days. You'll likely be able to drive again in one to three weeks, and engage in more strenuous activity a few weeks after that.

However, not everyone's recovery is the same. Your situation might dictate a longer recovery period and rehabilitation.

Your surgeon will review the findings of the arthroscopy with you as soon as possible and may send a written report. Your surgeon will continue to monitor your progress in follow-up visits and address problems.

And Also:

Reasons for Arthroscopic Knee Surgery

Arthroscopic knee surgery may be a treatment option for certain types of knee pain. Arthroscopic surgery is a procedure that involves inserting a small camera inside the joint. Through other small incisions, instruments can be inserted to repair or remove damaged structures. Arthroscopic knee surgery is often called "scoping the knee" or knee arthroscopy.

Many different surgical procedures that are commonly performed arthroscopically were once performed through the larger incisions. The advantage of arthroscopy he is being able to perform those surgical procedures without damaging normal structures around the joint. By being less invasive, the hope is there will be less pain and a faster recovery.

However, arthroscopic surgery is still a major surgical procedure, involves risks, and requires appropriate postoperative rehabilitation. It is important that you understand the nature of any surgical procedure being considered, the risks involved, and the postoperative recovery that will be necessary to achieve a successful result.

Reasons to Perform Arthroscopic Knee Surgery

Not all causes of knee pain can be effectively treated with an arthroscopic procedure. Some of the reasons to perform an arthroscopic knee surgery include:

1: Torn Cartilage/Meniscus Surgery: Meniscectomy is the official name of the surgery that involves the removal of a portion of the meniscus cartilage from the knee joint. The meniscus is a shock-absorbing wedge of cartilage that sits between the bone ends to provide cushioning and support. Smaller meniscus tears can usually be trimmed to relieve the symptoms of a torn meniscus.

Meniscus Repair: A meniscus repair is a surgical procedure done to repair the damaged meniscus. The meniscus repair can restore the normal anatomy of the knee and has a better long-term prognosis when successful. However, the meniscus repair is a more significant surgery. The recovery is longer, and, because of limited blood supply to the meniscus, repair of the meniscus is not always possible.

ACL Reconstruction: The anterior cruciate ligament, or ACL, is one of four major knee ligaments. The ACL is critical to knee stability, and people who injure their ACL often complain of their knee giving out from under them. Therefore, many patients who sustain an ACL tear opt to have surgical treatment of this injury. A majority of the ACL surgery is performed arthroscopically.

Plica Excision: A plica is a remnant of tissue left over from fetal development. In early development, your knee was divided into separate compartments. The dividers of the compartments are gradually lost over time, but some remnant remains. When this remnant tissue is more prominent, it is called a plica. When the plica is irritated, it is called plica syndrome. A plica resection is performed to remove this irritated tissue.

2: Lateral Release: The kneecap moves up and down the end of the thigh bone in a groove of cartilage. The kneecap can be pulled to the outside of this groove, or may even dislocate from the groove, causing pain with bending of the knee joint. A lateral release is performed to loosen the ligaments that pull the kneecap toward the outside of the groove.

3: Microfracture: Microfracture is a treatment used to stimulate the body to grow new cartilage in an area of damaged cartilage.

4: In a microfracture procedure, the firm outer layer of bone is penetrated, to expose the inner layers of bone where marrow cells exist. These cells can then access the damaged area and fill in the gap of cartilage.

Autologous Chondrocyte Implantation: In this procedure, arthroscopic surgery is used to identify areas of cartilage damage and harvest cartilage cells.

5: The person's own cells are then grown in the lab and reimplanted in the joint in a separate procedure, which is an open surgery rather than arthroscopic surgery.

Cartilage Transfer/OATS: Cartilage transfer involves moving cartilage from healthy parts of the joint to damaged areas. Small plugs of cartilage are removed, with a portion of underlying bone, and transferred to the area of damage. The plugs are taken from areas of the joint where the cartilage surface is not needed.

Performing Arthroscopic Knee Surgery

Knee arthroscopy can be done under general, regional, or local anesthesia. After adequate anesthesia, your surgeon will create 'portals' to gain access to the knee joint. The portals are placed in specific locations to minimize the potential for injury to surrounding nerves, blood vessels, and tendons. Through one portal, a camera is placed into the joint, and through others, small instruments can be used to address the problem. Patients who have arthroscopic knee surgery under a regional or local anesthesia can often watch their surgery on a monitor to see what is causing their problem.

The length of the knee arthroscopy procedure varies depending on what your doctor needs to accomplish. After surgery, your knee will be wrapped in a soft bandage. Depending on the type of surgery performed, your doctor may or may not allow you to place weight on the affected leg.

Most patients will work with a physical therapist to regain motion and strength of the joint. The length of rehabilitation will also vary depending on what procedure is performed at the time of surgery.

Complications

Complications of arthroscopic knee surgery include infection, swelling, and blood clots in the leg.

Complications are unusual after knee arthroscopy, and while they are cause for concern, knee arthroscopy is considered a low-risk surgical procedure.

A Final Word

Arthroscopic knee surgery is among the most common surgical procedures performed by an orthopedist. A variety of surgical procedures can be performed arthroscopically, utilizing small incisions and minimizing soft tissue damage. Not every surgical procedure can be performed through the small incisions, and there are some procedures that may be better performed through direct visualization rather than through a scope. That said, arthroscopy has tremendous benefits for many types of knee surgery, and can help people return to athletic and daily activities much sooner than they used to be able to.

Cancer And Radiation Treatment

2020-09-29T10:46:00.011-07:00

What to know about radiation therapy?

What is it?

Side effects

Radiation and other treatments

Types

What to expect

Uses

Outlook

Radiation therapy is a treatment for cancer and, less commonly, thyroid disease, blood disorders, and noncancerous growths.

A doctor may recommend radiation for cancer at different stages. In the early stages, radiation therapy can help reduce the size of a tumor before surgery or kill remaining cancer cells afterward. In the later stages, it may help relieve pain as part of palliative care.

One form of radiation treatment involves using a machine that produces a beam of radiation. The beam targets a specific area of the body. Another type involves putting a radioactive substance inside the body, either permanently or temporarily.

In this article, we focus mainly on radiation therapy as a cancer treatment.

What is radiation therapy?

Technicians administer external beam radiation therapy using a linear accelerator.

Radiation therapy uses waves of energy, such as light or heat, to treat cancers and other tumors and conditions. The form of radiation used in cancer therapy is a high-energy type known as ionizing radiation.

Scientists still do not know exactly how radiation works as a treatment for cancer.

They do know, however, that it breaks up the DNA of cancer cells in a way that disrupts their growth and division. In this way, radiation can kill cancer cells, preventing or slowing the spread of the disease.

Sometimes a doctor prescribes radiation therapy alone, but usually, they recommend it in combination with other treatments, such as chemotherapy, surgery, or both.

Side effects

Radiation can affect healthy cells as well as cancerous ones. When this happens, a person experiences side effects.

Specific side effects depend on factors such as:

the area receiving treatment

the person’s overall health

the type and doses of radiation

Short term side effects

Short term side effects radiation therapy include fatigue, skin changes, and nausea.

Short term side effects vary, depending on the part of the body receiving radiation.

They can include:

fatigue

hair loss

diarrhea

skin changes

nausea and vomiting

A 2018 study published in BMJ Open recommends screening for anxiety and depression in people undergoing radiation therapy and offering counseling services to those who may benefit from them.

Long term side effects

Long term side effects also depend on the treatment site.

They include:

heart or lung problems, if radiation affects the chest

thyroid problems, leading to hormonal changes, if radiation affects the neck area

lymphedema, which involves lymph fluid building up and causing pain

hormonal changes, including a possibility of early menopause, from radiation in the pelvic area

There is a slight chance that high doses of radiation in certain areas can increase the risk of another form of cancer developing. A doctor will provide more specific information and help with weighing the risks and benefits.

Not everyone who has radiation therapy experiences long term side effects. The risk depends on the doses, the area of treatment, and other individual factors.

Radiation therapy and other treatments

Radiation therapy is one of several cancer treatments. A doctor may prescribe these separately or in combination.

As well as radiation, a person may have:

surgery

chemotherapy

hormone therapy

targeted therapy

The treatment plan will depend on the type of cancer, among other factors.

When a person receives radiation therapy and chemotherapy at the same time, the doctor may call this “chemoradiation.” It can lead to severe adverse effects.

When cancer is at an early stage, a person may have radiation therapy before surgery, to reduce the size of a tumor. Or, they may have it after surgery to help remove any remaining cancerous cells.

Radiation is only effective in targeted areas. It is less effective when cancer has spread to distant parts of the body.

Types

There are two forms of radiation therapy.

External beam radiation therapy

This is the most common type. It involves an external machine emitting a beam of radiation that targets the treatment area.

Different forms are available, depending on the need. High-energy beams, for example, can target cancer that is deeper within the body.

Internal radiation therapy

There are different types of internal radiation therapy. Both involve implanting or introducing a radioactive substance into the body.

Brachytherapy involves inserting a radioactive implant in or close to the cancerous tissue. The implant may be temporary or permanent. Another type of internal radiation therapy involves drinking or receiving an injection of radioactive liquid.

The goal is to limit the extent to which healthy tissue around the cancer is exposed to the radiation. Doctors may recommend this treatment for prostate or ovarian cancer, for example.

A doctor may recommend undergoing both main types of radiation therapy. The decision will depend on:

the type of cancer

the size of the tumor

the tumor’s location, including the types of tissue nearby

the person’s age and overall health

other treatments

Scientists continue to explore ways of improving radiation techniques to achieve more effective outcomes with the least possible risk.

What to expect

The doctor will discuss radiation therapy and other options and help weigh the pros and cons. Before treatment starts, they will determine the right type and dosage of radiation.

A person receiving external beam radiation may undergo a CT or MRI scan before treatment. This is to pinpoint the exact location and size of the tumor. A doctor may make a permanent but small mark on the skin to ensure that the radiation therapist will target the beam correctly.

A person may need to wear a plaster cast or use a headrest or another device to ensure that they stay still during treatment. The first session may be a simulation, in which the team runs through the procedure.

Many people have five sessions per week for 3–9 weeks, but this depends on specific factors. Each session lasts for around 15 minutes. Radiation therapy is painless, but there will be damage to surrounding tissue. This is why the treatment occurs on only 5 days per week. The 2-day break allows for some healing.

A person who has internal radiation therapy may require an anesthetic before the doctor can implant the radioactive substance. Overall, several sessions and some time in the hospital may be necessary.

The details of the process depend on the type of radiation therapy and the type and location of the cancer.

Aftercare

After receiving external treatment, a person can go home and continue with their daily routine.

However, they may experience:

tiredness

sensitivity around the treatment site

emotional distress

To help manage these effects, it is important to:

get plenty of rest

eat healthfully

talk to friends and family about any side effects

follow instructions, which may involve skin care, from the treatment team

avoid spending time in the sun, due to a risk of photosensitivity

Also, monitor for adverse effects and tell the doctor if they occur. The doctor may recommend additional treatments aimed at relieving these.

People may need to speak to their employers about adjusting work schedules or taking medical leave.

Uses

A doctor may recommend radiation therapy to kill cancerous cells.

Radiation therapy can help shrink tumors and kill cancerous cells in the early stages.

This kind of treatment, in combination with other appropriate therapies, can cause cancer to go into remission. In many cases, it does not come back again.

Radiation therapy can also help treat symptoms when cancer has spread widely. At this point, the radiation is part of palliative care, which aims to relieve a person’s symptoms and improve their quality of life. It may also extend a person’s life, in some cases.

Palliative radiation treatment usually involves lower doses and fewer treatment sessions than curative treatment.

In some people with bone cancer, for example, palliative radiation treatment can help stop painful tumors from developing.

Other ways that palliative radiation treatment can help include:

relieving pressure or a blockage by reducing tumor size

treating symptoms of brain cancer, such as headaches, nausea, and dizziness

reducing symptoms of lung cancer, such as chest pain and breathlessness

controlling ulcerating tumors, bleeding, and infections

In people with head and neck cancers, an obstruction in the superior vena cava can affect the return of blood to the heart. Radiation therapy can help relieve this.

Outlook

Some people feel anxiety and concern about radiation therapy. It has various uses in treating cancer, and it can help achieve complete remission, in some cases.

The National Cancer Institute (NCI) points out that radiation can be costly.

People with health insurance should speak with their provider about coverage. Also, some organizations provide financial support and other help to people who need treatment. The NCI provide a list of options.

Discuss any concerns with the doctor and ask as many questions as possible. Knowing what to expect can help.

Will my hair grow back after radiation therapy?

Radiation therapy only causes hair loss at the site receiving the therapy. Hair loss may be temporary or permanent, depending on the site and the doses. Higher doses of radiation may be more likely to result in permanent hair loss.

And Also:

What Can One Expect During Treatment

It is normal to feel worried or overwhelmed when you learn that you will need radiation therapy. However, learning more about this type of cancer treatment may help you feel more prepared and comfortable. The information in this article can help you prepare for your first treatment.

Who is on my radiation therapy team?

A highly trained medical team will work together to provide you with the best possible care. This team may include the following health care professionals:

Radiation oncologist. This type of doctor specializes in giving radiation therapy to treat cancer. A radiation oncologist oversees radiation therapy treatments. They work closely with other team members to develop the treatment plan.

Radiation oncology nurse. This nurse specializes in caring for people receiving radiation therapy. A radiation oncology nurse plays many roles, including:

Answering questions about treatments

Monitoring your health during treatment

Helping you manage side effects of treatment

Medical radiation physicist. This professional helps design treatment plans. They are experts at using radiation equipment.

Dosimetrist. The dosimetrist helps your radiation oncologist calculate the right dose of radiation.

Radiation therapist or radiation therapy technologist. This professional operates the treatment machines and gives people their scheduled treatments.

Other health care professionals. Additional team members may help care for physical, emotional, and social needs during radiation therapy. These professionals include:

Social workers

Nutritionists or dietitians

Rehabilitation therapists, such as physical therapists or speech therapists

Dentists

What happens before radiation therapy treatment?

Each treatment plan is created to meet a patient's individual needs, but there are some general steps. You can expect these steps before beginning treatment:

Meeting with your radiation oncologist. The doctor will review your medical records, perform a physical exam, and recommend tests. You will also learn about the potential risks and benefits of radiation therapy. This is a great time to ask any questions or share concerns you may have.

Giving permission for radiation therapy. If you choose to receive radiation therapy, your health care team will ask you to sign an "informed consent" form. Signing the document means:

Your team gave you information about your treatment options.

You choose to have radiation therapy.

You give permission for the health care professionals to deliver the treatment.

You understand the treatment is not guaranteed to give the intended results.

Simulating and planning treatment. Your first radiation therapy session is a simulation. This means it is a practice run without giving radiation therapy. Your team will use imaging scans to identify the tumor location. These may include:

A computed tomography (CT) scan

Magnetic resonance imaging (MRI)

An x-ray

Depending on the area being treated, you may receive a small mark on your skin. This will help your team aim the radiation beam at the tumor.

You may also be fitted for an immobilization device. This could include using:

Tape, Foam sponges, Headrests, Molds, Plaster casts

These items help you stay in the same position throughout treatment.

For radiation therapy to the head or neck, you may receive a thermoplastic mask. This is a mesh mask that is molded to your face and secured to the table. It gently holds your head in place.

It is important for your body to be in the same position for each treatment. Your radiation oncology team cares about your comfort. Talk with the team to find a comfortable position that you can be in every time you come in for radiation therapy. Tell them if you experience anxiety lying still in an immobilization device. Your doctor can prescribe medication to help you relax.

After the simulation at your first session, your radiation therapy team will review your information and design a treatment plan. Computer software helps the team develop the plan.

What happens during radiation therapy treatment?

What happens during your radiation therapy treatment depends on the kind of radiation therapy you receive.

External-beam radiation therapy

External-beam radiation therapy delivers radiation from a machine outside the body. It is the most common radiation therapy treatment for cancer.

Each session is quick, lasting about 15 minutes. Radiation does not hurt, sting, or burn when it enters the body. You will hear clicking or buzzing throughout the treatment and there may be a smell from the machine. Typically, people have treatment sessions 5 times per week, Monday through Friday. This schedule usually continues for 3 to 9 weeks, depending on your personal treatment plan.

This type of radiation therapy targets only the tumor. But it will affect some healthy tissue surrounding the tumor. While most people feel no pain when each treatment is being delivered, effects of treatment slowly build up over time and may include discomfort, skin changes, or other side effects, depending on where in the body treatment is being delivered. The 2-day break in treatment each week allows your body some time to repair this damage. Some of the effects may not go away until the treatment period is completed. Let the health care professionals if you are experiencing side effects. Read more about the side effects of radiation therapy.

Internal radiation therapy

Internal radiation therapy is also called brachytherapy. This includes both temporary and permanent placement of radioactive sources at the site of the tumor.

Typically, you will have repeated treatments across a number of days and weeks. These treatments may require a brief hospital stay. You may need anesthesia to block the awareness of pain while the radioactive sources are placed in the body. Most people feel little to no discomfort during this treatment. But some may experience weakness or nausea from the anesthesia.

You will need to take precautions to protect others from radiation exposure. Your radiation therapy team will provide these instructions. The need for such precautions ends when:

The permanent implant loses it radioactivity

The temporary implant is removed

Weekly reports

During your treatment, your radiation oncologist will check how well it is working. Typically, this will happen at least once a week. If needed, they may adjust your treatment plan.

Personal care

Many people experience fatigue, sensitive skin at the site of radiation exposure, and emotional distress during radiation therapy. It is important to rest and take care of yourself during radiation therapy. Consider these ways to care of yourself:

Plan for extra rest.

Eat a balanced diet.

Drink liquids regularly.

Treat affected skin with lotion approved by your health care team.

Protect your affected skin from sunlight.

Seek emotional support.

Learn more about coping during treatment. And, be sure to talk with your health care team about how you are feeling throughout your treatment period.

What happens after radiation therapy treatment ends?

Once treatment ends, you will have follow-up appointments with the radiation oncologist. It's important to continue your follow-up care, which includes:

Checking on your recovery

Watching for treatment side effects, which may not happen right away

As your body heals, you will need fewer follow-up visits. Ask your doctor for a written record of your treatment. This is a helpful resource as you manage your long-term health care.

Questions to ask the health care team

Who is creating my radiation therapy treatment plan? How often will the plan be reviewed?

Which health care professionals will I see at every treatment session?

Can you describe what my first session, or simulation, will be like?

Will I need any tests or scans before treatment begins?

Will my skin be marked as part of treatment planning?

Who can I talk with if I'm feeling anxious or upset about having this treatment?

How long will each treatment session take? How often will I have radiation therapy?

Can I bring someone with me to each session?

Are there special services for patients receiving radiation therapy, such as certain parking spaces or parking rates?

Who should I talk with about any side effects I experience?

Which lotions do you recommend for skin-related side effects? When should I apply it?

How else can I take care of myself during the treatment period?

Will special precautions be needed to protect my family and others from radiation exposure during my treatment period?

What will my follow-up care schedule be?

Joint Replacement Surgeries

2020-09-28T16:14:00.010-07:00

The Different Types of Joint Replacement Surgeries

Joint Replacement Surgeries

The skeletal structure of the human body is made up of many different types of joints, the point where two bones meet. The knee joint is called a “hinge,” as it can bend and straighten. The hip and shoulder joints are “ball-and-socket” where the rounded end of one fits into the hollow of another bone, allowing for a rotation movement.

Normal joints have “articular cartilage,” and are coated with synovial fluid which allows them to move smoothly. When this cartilage erodes or is damaged due to disease, trauma, or age, or the fluid is reduced, joints become stiff and painful. This condition with symptoms such as pain and stiffness, is called arthritis.

Your doctor will first suggest non-surgical treatments to reduce pain and help you move better, often with the use of walking aids, exercise, or medications. If these do not work, the joint may be too compromised to be resolved with any other treatment, and surgery becomes necessary.

In joint replacement, abnormal bone and lining structures are surgically removed and replaced with new parts constructed of metal, plastic or carbon-coated implants. These new parts restore mobility to the joints, and are usually painless.

Benefits of Joint Replacement

· Reduce pain

· Restore motion

· Improve look and alignment

· Improve overall function

Joint Replacements

The most common joint surgeries are performed on hips and knees. However, replacement surgery can be and is conducted on other joints as well:

Hip Replacement

Hip replacement can be total or hemi (half). A total hip replacement addresses both the acetabulum and the femoral head. Hemiarthroplasty only replaces the femoral head.

Knee Replacement

The knee is the largest and most complex joint connecting major limbs and bearing the total weight of the body. It is susceptible to multiple injuries and ailments. Knee surgery options depend on the portion that needs to be treated – from a torn ACL, to partial or total knee replacement, to microfracture surgery.

Shoulder Replacement

Shoulder joint replacements include the deltopectoral approach to save the deltoid. And the transdeltoid approach, at the glenoid. Reverse Total Shoulder Replacement is an option in severe cases.

Elbow Replacement

The elbow bones are replaced with an artificial joint made from implants that attach to the bones in the arm. A metal and plastic hinge joins the implants together.

Wrist Joint Replacement (Wrist Arthroplasty)

In wrist joint replacement surgery, the damaged parts of the wrist bones are removed and replaced with artificial components.

Ankle Replacement

Total Ankle Arthroplasty (TAA) is a surgical procedure used by orthopedic foot and ankle specialist surgeons to treat ankles affected by severe arthritis.

Finger Replacement

A finger joint (PIP) and knuckle joint (MP) replacement involves removal of the damaged joint and replacement with an artificial implant. This replicates normal joint function. The specific goals are to relieve pain, restore joint stability and mobility.

Total Joint Replacement

TJR is an orthopedic procedure in which an arthritic or dysfunctional joint surface, usually in hip or knee, is replaced with a prosthesis. Joint replacement is an option when severe pain or dysfunction fails to respond to less-invasive therapies.

Joint Replacement Surgical Options

Arthroscopy

This technique involves repairing tears in soft tissue around the knee, hip, shoulder, and other joints. Damaged cartilage is repaired, and broken cartilage pieces are removed.

Replacement arthroplasty

An arthritic joint surface is replaced with an orthopedic prosthesis.

Joint Resurfacing

For knee joints, this is unicompartmental or partial knee replacement. Implants are inserted in only one of the three knee compartments: the medial (inside), lateral (outside) or patellofemoral (front) compartment. In hip joint resurfacing, a metal cup replaces the hip socket while the damaged hip ball is reshaped and topped with a metal prosthesis.

Osteotomy

A bone is cut and removed, or a piece is added near a damaged joint. In the knee, an osteotomy shifts weight from an arthritic area to a healthy area. In the hip it is used to correct misalignment, or hip dysplasia.

Synovectomy

Inflammatory arthritis affects the lining of the joints – the synovium – and damages surrounding cartilage and joints. In this procedure the affected synovium is removed.

Arthrodesis or Fusion

Hardware such as pins, plates, or rods are used to fuse two or more bones in the affected joint to create a continuous joint. As the bones grow together, they stabilize the joint and hold it in place.

Total Joint Replacement (TJR) or Total Joint Arthroplasty

The damaged joint is replaced with an implant constructed of plastic, metal, ceramic, or carbon-coated components. The implant functions like the original joint.

Minimally Invasive TJR

As in TJR, this technique also replaces damaged joints, but with smaller incisions. Less cutting and reattachment of muscle is involved.

Joint Revision

The life of an implant is between 15-20 years. Those who get them at a young age may eventually need a second replacement, known as a revision.

The relatively long-term efficacy of a joint replacement procedure provides an improved quality of life. Pain free movement, increased joint strength, easier handling of daily activities, and independence become possible.

Cataract Surgery

2020-09-27T14:54:00.010-07:00

Considering cataract surgery? What you should know

The operation to replace a clouded lens is low-risk, fast, and effective, but requires some decision making.

Cataract surgery—which involves removing the eye's clouded lens and replacing it with a clear synthetic version—once required several days in the hospital and a long recovery period. Today it is performed under local anesthesia on an outpatient basis, and people are back to their normal lives within days. The success rate is high, and the rate of vision-threatening complications is relatively low. For people with cataracts, the decision whether to have surgery may be easy to make. However, two additional decisions might be more difficult: when to have surgery and what type of lens implant to get, says Dr. Laura Fine, an ophthalmologist at Harvard-affiliated Massachusetts General Hospital.

Why you may need cataract surgery

To a great extent, cataracts are a normal consequence of aging. Cataract formation is usually a gradual process that plays out over years. The lenses of our eyes become less transparent, less resilient, and often thicker. By age 80, half of us will have cataracts.

Cataracts can creep up on you. It may be hard to tease out the effects of a developing cataract from other age-related vision changes. In the early stages you may become more nearsighted, a problem that can be corrected with glasses. As the cataract progresses, your night vision may worsen, and colors may appear duller.

Any vision changes warrant an eye exam. However, because cataract-associated changes can be subtle, it's better not to wait until your sight is noticeably affected. Comprehensive eye exams, which can detect not just cataracts but also glaucoma and other eye conditions, are recommended every two years for adults ages 40 through 64 and annually for everyone 65 or older.

The doctor will test the sharpness of your vision by having you identify a series of symbols or letters on a chart. He or she may also dilate your pupils with drops to examine the interior of the eye. Using a slit lamp—to illuminate a small area inside the eye at a time—the doctor can see any cataract and assess how extensive the clouded areas are. Additional examinations and tests help rule out other eye disorders, such as glaucoma or retinal degeneration.

When do you need a lens replacement?

Removing and replacing the clouded lens is the only effective cure for a cataract. For most people, the question is when to undergo the procedure. "There's no rush to have cataract surgery. It isn't a life-threatening situation," Dr. Fine says. That decision is usually based on how much the cataract is interfering with your vision and daily life. You may want to delay cataract surgery until you feel that you need better vision. But you might not want to wait until you can't see stair steps clearly or fail a driving test. If you have another eye condition, such as age-related macular degeneration, your doctor may recommend cataract surgery sooner because the cataracts make it difficult to examine and manage the other problem.

If your doctor determines that you have cataracts in both eyes, he or she may recommend operating first on the eye with the denser cataract. If surgery is successful and your vision improves substantially, you may elect to forgo surgery on your other eye. However, most people get significant benefits from having the second eye operation, including better depth perception and improvements in their ability to drive and to read. People usually have the second surgery once the first eye has healed and their vision is stable. If you are extremely far-sighted or nearsighted and need cataract surgery in both eyes, you may want to have the second surgery within a month or so of the first surgery to avoid problems with double vision and depth perception due to the difference in vision from eye to eye.

What's involved in cataract surgery

Experience and technology have fine-tuned the procedure to replace the eye's lens so that it takes only about 15 minutes to perform. The approach used most often is phacoemulsification—informally known as phaco. It offers good long-term results, and 97% to 98% of all cases done by an experienced surgeon are successful and free of complications.

The recovery period

You'll spend about an hour in the recovery room as the anesthesia wears off. The doctor may place a bandage or clear shield over your eye. You'll need to have someone help you get home.

Once at home, your primary goal will be to keep your eye from getting infected. You'll need to use eye drops several times a day and to keep water out of your eye. You can go about your daily routine as long as you avoid heavy lifting or activities like jogging that can jar the new lens.

It's also fine to read and watch TV by the day after surgery. The first thing you're likely to notice is how vivid colors seem and how much more detail you can see.

Your surgeon will probably ask you to return for a check-up the day after surgery, a week later, and a few weeks after that.

Making the lens choice

"The primary goal is to improve your vision and function," Dr. Fine says. There are several things to consider when you're choosing a lens, especially these points:

What's most important to you. For most people, the monofocal implant is a good choice, Dr. Fine says. It provides the best contrast vision, so it's good for driving and most other activities. It's also a good choice for people who have cataract surgery when they are relatively young, because contrast vision is likely to diminish with age. However, many people who have monofocal lens implants still need glasses for reading or distance. Multifocal lenses may be a good choice if you do lots of close work, don't want to use glasses, and accept less visual clarity as a trade-off.

Cost. Insurance typically covers monofocal lenses, but you can expect to pay about $1,500 for each toric lens and about $3,000 apiece for other specialized lenses.

The surgeon's experience. Because specialty lenses are newer and relatively few people choose them, many surgeons have limited experience placing them. If you're considering one, find out how many such implants your surgeon has performed.

Commonly used replacement lenses

As the number of cataract surgeries has grown, so have the options for lenses. The most widely used include the following:

Fixed-focus monofocal lenses.

These lenses can help you see at a distance, but you'll need reading glasses to see up close. Alternatively, some people who get fixed-focus monofocal lenses have one eye fitted with a lens that provides near vision and the other eye with a lens that provides far vision. This com-bination is called monovision. If you are considering this option, your eye surgeon may recommend that you try out monovision with contact lenses before your cataract surgery to see how well you can adjust to the combination. Monovision is usually not an ideal option for people who require crisp, detailed vision.

Accommodating monofocal lenses

A newer option, accommodating monofocal lenses, can shift from near to far vision in response to movements of the ciliary muscles in your eye, similar to the natural lens in a younger eye. These lenses offer excellent distance and middle vision, but they aren't as reliable for near vision. Eye exercises can help you get used to them, but about half of people who receive them still end up needing reading glasses.

Toric lenses

These specialized monofocal lenses are designed for people with astigmatism. Toric lenses offer focused vision at a single distance and correct your astigmatism, so you might not need distance glasses after surgery.

Multifocal lenses

Like the bifocal or progressive lenses used in glasses, multifocal lenses have different areas designed for distance, intermediate, and near vision. The brain and eye figure out which part of the lens to use. The main drawback of multifocal lenses is they can distort bright light, creating more glare and halos at night.

Types Of Surgery

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Bariatric Surgery:

Breast Surgery:

Breast augmentation surgery

Breast reduction surgery

Colon and Rectal Surgery:

Anal cancer

Anal condyloma

Anal Fissure

Anal Fistula

Anal incontinence

Anal sphincter repair

Anorectal disease:

Colon cancer

Diverticular disease

Hemorrhoids

Hereditary colon and rectal cancer

Inflammatory bowel disease (IBS)

Polyps

Rectal cancer

Rectal prolapse

Endocrine Surgery:

Thyroid surgery

Minimally invasive parathryoidectomy

Laparoscopic adrenalectomy

General Surgery:

Surgery can be an effective treatment option for a wide range of diseases and disorders. Whether you are facing a complex, innovative surgical procedure or a technique that has been used successfully thousands of times, rest assured that when appropriate, minimally invasive surgical techniques are used. This form of surgery can limit hospital stays, post-operative pain and recovery time, and often use smaller incisions that result in less scarring.

Gynecological Surgery:

If you have a gynecological condition that requires a surgical procedure, you can count on a experienced, compassionate team of gynecologists, surgeons, gynecologic oncologists, urogynecologists, interventional radiologists, anesthesiologists, and nurse specialists for the highest, most advanced level of medical care.

Endometrial Ablation

Gynecologic Cancer Surgery

Interventional Radiology

Tubal Ligation

UAE

Hand Surgery:

For certain hand injuries and conditions, a better result can be achieved with arthroscopic surgery.

Arthroscopic surgery is a minimally invasive procedure that allows surgeons to diagnose and treat hand injuries or disorders, such as carpal tunnel syndrome, without making large incisions. For the patient, this means less pain and faster recovery times.

Head and Neck Surgery:

Early identification and treatment of oral, head and neck disorders means a higher rate of positive outcomes. Be encouraged to see an ear, nose and throat (ENT or otolaryngology) specialist if you are experience problematic symptoms such as unusual lumps or sudden, unexplained pain. In many cases, and with early detection of problems, doctors will use minimally invasive techniques that will result in reduced pain and faster recoveries.

Nasal and sinus disorders, upper airway obstruction

Throat, voice and swallowing problems, including gastroesophageal reflux therapy and tonsillectomies

Diseases of the nerves in the ears, oral cavity, esophagus, head and face

Benign and malignant tumors of the head and neck

Facial deformities, including congenital (at birth) problems and issues resulting from accidents or disease

Structural problems related to hearing loss or impairment

Hernia Surgery:

Neurosurgery:

Specializing in surgery on the brain and other parts of the nervous system.

Brain tumors

Complicated cerebral aneurisms requiring skull-based approaches

Microdiscectomies

Minimally invasive spine surgeries

Thermal procedures

Orthopedic Surgery:

Achilles Tear Surgery

Arthroscopic Surgery

Meniscus Repair Surgery

Open-Knee Surgery

Shoulder Surgery

Spinal Surgery

Ophthalmological Surgery:

Ophthalmologists are experienced surgeons who use the most modern technologies, including laser surgery, to perform operations that correct problems and promote faster recovery, while minimizing the amount of pain experienced by the patient. The majority of procedures can be done on an outpatient basis and do not require an overnight stay at the hospital.

Outpatient Surgery:

Outpatient surgery, also called same day surgery or ambulatory surgery, is performed for a wide range of routine or minor conditions that do not require an overnight stay in the hospital. Some patients may be admitted to the hospital after certain types of outpatient surgery such as bariatric surgery, joint replacement, or other elective surgery.

Arthroscopy

Breast Biopsy

Burn Excision/Debridement

Cataract Surgery

Caesarean Section

Circumcision

Dental Restoration

Gastric Bypass

Head and Neck Surgery

Hysterectomy (Abdominal or Vaginal)

Knee/Hip Replacement

Laparoscopy

Liver Resection

Lung Resection

Major Abdominal Procedure

Major Vascular Surgery

Mastectomy (Radical)

Mediport Insertion or Removal

Prostate Surgery

Removal of Hardware (Plates and Screws)

Sinus Endoscopy

Tonsillectomy

Tubal Ligation

Vasectomy

Ventral Hernia

Pediatric Surgery:

Pediatric surgeons perform inpatient and outpatient surgeries, as well as pre-surgical testing and patient consultations to determine the need for an operation.

Plastic and Reconstructive Surgery:

Plastic and reconstructive surgeons are certified in Plastic Surgery as well as General Surgery, that can treat a wide variety of complicated cases. They are leaders in this specialty and are dedicated to delivering the best outcome possible for every patient.

Post-weight loss surgery abdominoplasty

Soft tissue injuries and fractures of the face

Reconstruction of burned skin

Repair of complex wounds

Removal of skin cancer lesions

Soft tissue injuries of the hand and forearm

Open and closed fractures of the hand and wrist

Carpal tunnel surgery

Breast reduction

Breast Cancer Reconstruction

Robotic Surgery:

A wide range of surgical procedure are offered that takes surgery beyond the limits of the human hand. This includes but not limited to: cholecystectomy (gallbladder removal), hysterectomies, myomectomies, hiatal and hernia repairs, removal of one or both adrenal glands, GERD related diagnoses (Reflux), and esophageal stricture.

Enhanced 3D, high-definition vision of operative field, with up to 10x magnification

New optimal dual console, which allows a second surgeon to provide assistance

Ability to mimic the surgeon’s hand movements with enhanced dexterity

Potential patient benefits

Less pain

Lower risk of infection

Lower risk of scarring

Shorter recovery time

Decreased blood loss

Eligible Procedures

Urological Surgery

Gynecological Surgery

Thoracic Surgery

Breast Surgery

Colorectal Surgery

Gallbladder removal (cholecystectomy)

Hysterectomies

Myomectomies

Hiatal and hernia repairs

GERD related diagnoses (reflux)

Adrenal gland removal

Esophageal stricture

Thoracic Surgery:

In addition to traditional open surgical techniques, surgeons often pursue minimally invasive surgical options when appropriate.

These new techniques often involve less blood loss and scarring, faster healing of tissue, faster overall recovery times, less pain, and positive patient outcomes.

Lung Airway Surgery

Pleural Tumors Surgery

Pulmonary Lobectomy and Other Lung Cancer Surgery

Trauma Surgery:

This provides immediate response by a highly specialized, in-house team of trauma professionals 24 hours per day, every day of the year.

Trauma is a time-sensitive condition, needing speed, efficiency and experience to deal with the most intense demands of a critically injured patient.

Urologic Surgery:

Surgical treatment for men with prostate, testicular or other urologic conditions. In many cases, including the most complicated medical conditions, treatment can be provided using minimally invasive surgical techniques that reduce recovery times, promote faster healing and lead to positive patient outcomes.

Prostate cancer, testicular cancer, kidney cancer and bladder cancer screening and surgery

Minimally invasive surgical treatment for benign prostate enlargement, including state-of-the-art laser methodologies

Treatment of kidney stones and kidney cancer

Bladder procedures for bleeding, incontinence, infection and cancers

Lithotripsy for bladder stones

Vascular Surgery:

Experienced vascular surgeons provide a full range of surgical treatment options for patients with vascular disease and disorders.

Whether your surgery is part of emergency treatment or an elective procedure, rest assured that state-of-the-art technology, advanced imaging techniques, and skills of trained surgeons will all be deployed to help correct your medical problems and allow you to return to your regular activities.

Angioplasty and stents

Aneurysm repair

Carotid endarterectomy

Lower extremity/limb salvage

Thrombolytic therapy

Minimally Invasive Surgery:

Minimally invasive surgery (MIS) has become the standard of care for many procedures and has become widely accepted in nearly all specialties, often replacing traditional open surgery.