Recurrent Breast Cancer

Friday, October 27, 2017





There's a song about pretty much everything, including kidney stones, believe it or not. So there's something there for whatever you happen to be suffering, you know?  Sinead O' Connor

KIDNEY STONES 

Are you experiencing persistent, excruciating flank (lower back) pain? This may be a warning sign of kidney stones

TESTING

Testing to verify the diagnosis includes looking for high levels of calcium or uric acid in the urine. A twenty-four hour urine collection requires drinking a lot of fluids to try and pass the stone. Imaging verification includes x-rays or CT scans.
These may show kidney stones in the urinary tract. Additional testing may include ultrasound and an intravenous pyelogram. 

TREATMENT

Small stones that don't block the kidney can be treated by your family doctor. consider. You may want to schedule a urology visit or nephrologist. 

Sometimes the stones are gradually passed through the ureters and into the bladder. Small stones usually pass in the urine with minimal discomfort. Drinking two to three quarts of water daily will flush out the urinary tract. In most cases, over the counter medicines, such as Motrin, Advil, or Naprosyn alleviate the pain. 

Stone analysis confirms the diagnosis. Uric acid stones can be treated with allopurinol to facilitate treatment. Long-term antibiotics in small doses helps treat the Struvite stones. Cystine stones more difficult to treat. drink more fluids. Consider medication that decreases cystine in the urine. Long-term use of antibiotics in small doses. 


Ultrasound may be used to pulverize the stone. This procedure lasts fourty-five to sixty minutes. Light anesthesia can facilitate the procedure. 

In rare cases, large stones that do not pass are removed by a ureteroscope with a camera and the surgery is often successful. Drinking copious amounts of water will help flush out the urinary tract.

PREVENTION 

Taking a thiazide diuretic may help prevent further stones. You can also reduce kidney stone risk by drinking water throughout the day. A diet that has fewer oxalate-rich foods, which include rhubarb, beets, okra, spinach, nuts, potatoes, chocolate, and black pepper is helpful as well. Calcium-rich foods may also reduce risk. 
                                                
To summarize, kidney stones are not life-threatening. The pain starts with lower level pain that may intensify surprisingly quickly. It hurts like heck, similar to taking your lower lip and pulling it over your head as Bill Cosby used to say (about delivering a baby). For men and women, if you have deep pain in the lower back area away from your spine, closer to your left and right sides, your next move should be a phone call should be to a urologist or a visit to the urgency care or emergency depending on the time of day and the intensity of the pain.

Source: https//www mayo clinic.org.



  





































Tuesday, October 10, 2017

Osteoarthritis (OA) is the most common form of arthritis. Over time the joint cartilage wears down. It affects the weight bearing joints, hands, knees, hips and spine. The condition can be managed. The goal of treatment is to preserve and enhance function.    

Factors that increase symptoms include older age. Women  are more likely to have the condition than men. Obesity contributes to symptoms Weight bearing joints, such as the hips, knees are especially affected.  joint trauma, such as a fall, increases risk.

Joint tenderness and stiffness are most likely during early mornings and after prolonged sitting, such as after long plane flight. 

Joint grating sensation. bone spurs, seen on x-rays, can validate the findings. X-ray imaging can validate the findings. MRI imaging may validate the findings. 

MRI imaging can facilitate the findings. 
Symptoms can be treated without surgery in most cases. Physical therapy, anti-inflammatory medicines.  Stretching, aerobics, Tai Chi, yoga improve balance, especially in a group setting. 

Cortisone injections in the joint may relieve pain. It is recommended to limit injections to no more than three to four injections over a year. Overuse of injections over time could weaken the cartilage and joint. Hyaluronic injections to the affected joint may help.

*Physical therapy improves strength and balance.  Swimming pool therapy, and walking equally effective. 

*Occupational therapy techniques such as using large grip tooth brush. Have a bench in your shower to relieve prolonged standing.

*Tai Chi and Yoga therapy combined with stretching and deep breathing. Led by a professional instructor. prevent falling or head trauma. 
*Bone re-alignment osteotomy. may be considered in special cases. this involves surgical removal a portion of leg bone. The procedure  shifts body weight away from the painful knee. 
Worn portions of the knee removed and replaced with plastic and titanium. 
*Lifestyle changes and exercise. Exercise increases endurance, strengthens muscles and improves balance. walking in pool, stationary bike.

*Don't overdo the training. If you have pain, decrease the intensity. Try a stationary bicycle. 
Consider a visit with a dietitian. 

*Aim for gradual weight loss. 
Over the counter medicines include Flexall Tablets, Aspercreme, 
Capsaicin, may relieve pain. It may be used three or four times daily. It is a component of chili peppers. Wash your hands after 
Topricin, Biofreeze Gel, Topricin, and Trivita Joint Complex. 

 *Use heat and cold to control pain. Heat relieves stiffness.
Pain creams work best when massaged into the joints. You may want to try shoe inserts for foot comfort. 

 *Gripping tools, such as opening a jar. 
*Osteopathic Manipulation and Chiopractic treatment are helpful
Acupuncture with or without current stimulation.

OTC meds for arthritis
Image result for arthritis quotes sayings
  

Friday, September 29, 2017

Recurrent Breast Cancer is a breast cancer that recurs after initial treatment. Approximately 12.4 percent of women born in the U.S. will develop breast cancer at some time during their lives.
Signs include skin inflam......mation, nipple redness, nipple discharge, painless nodules (lymph nodes) under the skin or the chest wall. Signs and symptoms include persistent and worsening pain, such as chest or bone pain.
A distant (metastatic) recurrence can migrate to the neck or collar bone: symptoms include persistent deep pain and a lump under the arm or near the collar bone (clavicle). 
Recurrent breast cancer may occur months or years after initial treatment. The cancer could recur in the same site as the original cancer. Recurrent breast cancer is not hopeless. Treatment may eliminate local, regional or distant recurrent breast cancer.
Treatments linked to a reduced risk of breast cancer recurrence include:
Women with hormone receptor positive breast cancer may reduce their risk of recurrent breast cancer by taking hormone therapy after their initial treatment. The hormone therapy may continue for at least five years.
For women with breast cancer who have increased risk of cancer recurrence, chemotherapy may decrease the chance that cancer will recur. Those who receive chemotherapy live longer.
Women who've had a breast-sparing operation to treat breast cancer and those who had a large tumor or inflammatory breast cancer have a lower chance of the cancer recurring if they're treated with radiation therapy.
Maintaining a healthy weight can decrease the risk of recurrent breast cancer. Regular exercise may reduce your risk of breast cancer recurrence.
Factors that increase the risk of a recurrence include:
Cancer in nearby lymph nodes at the time of your original diagnosis.
Women with multiple affected lymph nodes.
Women with larger tumors.
Women who don't undergo the radiation therapy.
Younger women, particularly those under age 35 at the time of their original breast cancer diagnosis.
Women with inflammatory breast cancer.
If your breast cancer wasn't responsive to hormone therapy.
How do you diagnose it?
Your doctor is likely to ask you a number of questions.
When did you first begin experooencing symptoms again?
Has the been a change in the symptoms over time?

Do these symptoms feel different from when you were first diagnosed with cancer?

How do you eel overall?
Have yunexpected weight loss? Have you lost your appetite?
If your doctor suspects you may have recurrent breast cancer based on results of a mammogram or physical exam, or because of signs and symptoms, he or she may recommend additional tests to confirm the diagnosis. Imaging tests may include a magnetic resonance imaging (MRI), computerized tomography (CT) scan, X-ray, bone scan or positron emission tomography (PET) scan. Not eveRecurrent Breast Cancer is a breast cancer that recurs after initial treatment. Approximately 12.4 percent of women born in the U.S. will develop breast cancer at some time during their lives.
 Signs include skin inflammation, nipple redness, nipple discharge, painless nodules (lymph nodes) under the skin or the chest wall. Signs and symptoms include persistent and worsening pain, such as chest or bone pain.
 A distant (metastatic) recurrence can migrate to the neck or collar bone: symptoms include persistent deep pain and a lump under the arm or near the collar bone (clavicle). 
Recurrent breast cancer may occur months or years after initial treatment. The cancer could recur in the same site as the original cancer. Recurrent breast cancer is not hopeless. Treatment may eliminate local, regional or distant recurrent breast cancer.
Treatments linked to a reduced risk of breast cancer recurrence include:

Women with hormone receptor positive breast cancer may reduce their risk of recurrent breast cancer by taking hormone therapy after their initial treatment. The hormone therapy may continue for at least five years.

For women with breast cancer who have increased risk of cancer recurrence, chemotherapy may decrease the chance that cancer will recur. Those who receive chemotherapy live longer.

Women who've had a breast-sparing operation to treat breast cancer and those who had a large tumor or inflammatory breast cancer have a lower chance of the cancer recurring if they're treated with radiation therapy.

Maintaining a healthy weight can decrease the risk of recurrent breast cancer. Regular exercise may reduce your risk of breast cancer recurrence.

Factors that increase the risk of a recurrence include:

Cancer in nearby lymph nodes at the time of your original diagnosis.
Women with multiple affected lymph nodes.

Women with larger tumors.

Women who don't undergo the radiation therapy.

Younger women, particularly those under age 35 at the time of their original breast cancer diagnosis.
 Women with inflammatory breast cancer.
 If your breast cancer wasn't responsive to hormone therapy.
 How do you diagnose it?
 Your doctor is likely to ask you a number of questions.
 When did you first begin experiencing symptoms again?
Has there been a change in the symptoms over time?
Do these symptoms feel different from when you were first diagnosed with cancer?
How do you feel overall?
Have you had any unexpected weight loss? Have you lost your appetite?

If your doctor suspects you may have recurrent breast cancer based on results of a mammogram or physical exam, or because of signs and symptoms, he or she may recommend additional tests to confirm the diagnosis. Imaging tests may include a magnetic resonance imaging (MRI), computerized tomography (CT) scan, X-ray, bone scan or positron emission tomography (PET) scan. Not every person needs every test.
Your doctor may recommend a biopsy procedure to collect suspicious cells for testing. Working in a laboratory, a pathologist examines the cells and determines the types of cells involved. A pathologist can determine if the cancer is a recurrence of cancer or a new type of cancer. Tests also show whether the cancer is sensitive to hormone treatment or targeted therapy.
 Treatment for a local recurrence may include radiation if you haven't had it before. Radiation therapy uses high-energy beams, such as X-rays, to kill cancer cells. If you didn't have radiation therapy for your first breast cancer, your doctor may recommend it. Chemotherapy and hormone therapy may also be recommended. Treatment options depend on the extent of the disease, its hormone receptor status, type of treatment you received for your first breast cancer and overall health.
 If your first cancer was treated with a lumpectomy, your doctor may recommend a mastectomy to remove all of your breast tissue. If your first breast cancer was treated with a mastectomy and the cancer comes back in the chest wall, you may have surgery to remove the new cancer along with a margin of normal tissue.
 Hormone therapy. Medications that block the growth-promoting effects of the hormones estrogen and progesterone may be recommended if your cancer is hormone receptor positive. For women whose cancer makes extra HER2 protein, the drug trastuzumab (Herceptin) can decrease the chance of the cancer recurring.
 Treatments exist for metastatic breast cancer. Options will depend on where your cancer has spread. If cancer has spread to your bones, your doctor may recommend a bone-building drug to reduce your risk of broken bones or reduce bone pain you may experience. Treatment may allow you to live longer and help relieve symptoms.
 No alternative medicine treatments exist for breast cancer. Complementary and alternative medicine therapies may help cope with side effects of treatment when combined with your doctor's care. They can also help you cope with distress. They include:

Art therapy
Dance or movement therapy
Exercise
Meditation
Music therapy
Relaxation exercises
Yoga
 Your doctor can refer you to professionals who can help you learn about and try these alternative treatments.

Keep friends and family close. Keeping your close relationships strong will help you deal with your recurrent breast cancer. Friends and family can provide the practical support you will need, such as helping take care of your house if you are in the hospital. They can serve as emotional support when you feel overwhelmed by cancer.
 The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful. Ask your doctor about support groups in the area such as the National Cancer Institute or the American Cancer Society.

Sources:  NIH Breast Cancer Institute (https://www.nih.gov/)  
Breast Cancer in American Women (https://www.cancer.gov/types/breast/risk-fact-sheet)
National Cancer Institute (https://www.cancer.gov/types/breastry person needs every test.
Your doctor may recommend a biopsy procedure to collect suspicious cells for testing. Working in a laboratory, a pathologist examines the cells and determines the types of cells involved. A pathologist can determine if the cancer is a recurrence of cancer or a new type of cancer. Tests also show whether the cancer is sensitive to hormone treatment or targeted therapy.
Treatment for a local recurrence may include radiation if you haven't had it before. Radiation therapy uses high-energy beams, such as X-rays, tokill cancer cells. If you didn't have radiation therapy for your first breast cancer, your doctor may recommend it. Chemotherapy and hormone therapy may also be recommended. Treatment options depend on the extent of the disease, its hormone receptor status, type of treatment you received for your first breast cancer and overall health.
If your first cancer was treated with a lumpectomy, your doctor may recommend a mastectomy to remove all of your breast tissue. If your first breast cancer was treated with a mastectomy and the cancer comes back in the chest wall, you may have surgery to remove the new cancer along with a margin of normal tissue.
Hormone therapy. Medications that block the growth-promoting effects of the hormones estrogen and progesterone may be recommended if your cancer is hormone receptor positive. For women whose cancer makes extra HER2 protein, the drug trastuzumab (Herceptin) can decrease the chance of the cancer recurring.
Treatments exist for metastatic breast cancer. Options will depend on where your cancer has spread. If cancer has spread to your bones, your doctor may recommend a bone-building drug to reduce your risk of broken bones or reduce bone pain you may experience. Treatment may allow you to live longer and help relieve symptoms.
No alternative medicine treatments exist for breast cancer. Complementary and alternative medicine therapies may help cope with side effects of treatment when combined with your doctor's care. They can also help you cope with distress. They include:
Art therapy
Dance or movement therapy
Exercise
Meditation
Music therapy
Relaxation exercises
Yoga
Your doctor can refer you to professionals who can help you learn about and try these alternative treatments.
Keep friends and family close. Keeping your close relationships strong will help you deal with your recurrent breast cancer. Friends and family can provide the practical support you will need, such as helping take care of your house if you are in the hospital. They can serve as emotional support when you feel overwhelmed by cancer.
The concern and understanding of a counselor, medical social worker, clergy member or cancer support group also may be helpful. Ask your doctor about support groups in the area such as the National Cancer Institute or the American Cancer Society.

Sources:

NIH Breast Cancer Institute (https://www.nih.gov/)  
Breast Cancer in American Women (https://www.cancer.gov/types/breast/risk-fact-sheet)
National Cancer Institute (https://www.cancer.gov/types/breast

Tuesday, July 11, 2017

What is a Hernia?





A. What is a hernia?

An inguinal (in the groin) hernia is a painful groin bulge. The lifetime risk of this condition is twenty-seven percent in men and three percent in women. It is one of the most common surgical procedures in the U.S.

It occurs when tissue, such as a portion of the intestine, protrudes through a weak spot in the lower abdominal muscles, causing a bulge, “hernia sac.” Symptoms include pain and bulging on the right or left groin at the pubic bone. Coughing, standing, and passing a bowel movement are painful.

Bulging is more prominent at the pubic bone. Symptoms are more prevalent with standing, coughing, passing a bowel movement and straining. Pain may radiate to the scrotum. A burning or aching sensation occurs at the bulge. Application of an ice pack could ease pain and swelling. This reduces swelling enough so that the hernia slides inward with direct pressure. Watchful waiting is reasonable if symptoms don’t progress.

B. Cause

Hernias can be the result of a pre-existing weak spot in the groin, known as the “superficial inguinal ring.” Low abdominal wall weakness at the inguinal canal can be present at early childhood. Hernias can develop as the result of straining during bowel movements, strenuous physical activity, chronic coughing, or sneezing. In men, the weak spot is the inguinal (groin) canal, where the spermatic cord enters the scrotum. In women, the canal carries a ligament that helps hold the uterus in place. Hernias may be inheritable. Some hernias have no apparent cause.

C. Surgery is recommended to repair the hernia if is painful or enlarging. Incarcerated hernia is when the patient can’t nudge the hernia bulge back in place. This would suggest a “strangulated hernia.” A strangulated hernia cuts off the blood flow to tissue that is trapped. It could progress to bowel obstruction, which is life-threatening and surgery is necessary.

There are two types of hernia surgery; open and laparoscopic repair. Open repair is done under local anesthesia and sedation. The incision is closed with stitches, staples or surgical glue.

Laparoscopy this minimally invasive procedure, which requires general anesthesia, the surgeon operates through several small incisions in the abdomen. Gas is used to inflate the abdomen to make the internal organs more visible. A small tube equipped with a tiny camera (laparoscope) is inserted into one incision. Guided by the camera, the surgeon inserts tiny instruments through other incisions to repair the hernia using synthetic mesh.

People who have laparoscopic repair might have less discomfort and scarring after surgery and a quicker return to normal activities. Laparoscopy allows the surgeon to avoid scar tissue from an earlier hernia repair, so it might be a good choice for people whose hernias recur after traditional hernia surgery. It also might be a good choice for people with hernias on both sides of the body (bilateral).

D. Prevention
·         Maintain a healthy weight. Talk to your doctor about the best exercise and diet plan for you.
·         Emphasize high-fiber foods. Fruits, vegetables and whole grains contain fiber that can help prevent constipation and straining.
·         Lift heavy objects carefully or avoid heavy lifting. If you must lift something heavy, always bend from your knees — not your waist.
·         Stop smoking. Besides its role in many serious diseases, smoking often causes a chronic cough that can lead to or aggravate an inguinal hernia.

·         Don't rely on a truss. Wearing a supportive garment designed to keep hernias in place (hernia truss) doesn't correct the problem or help prevent complications. Your doctor might recommend a hernia truss for a short time before surgery to help you feel more comfortable, but the truss isn't a replacement for surgery.

Monday, May 15, 2017

Hip Replacement

Image result for picture of older person reading a manual


Are you suffering from long term hip pain? The resulting difficulty of standing up and climbing stairs can make life miserable.  

Research reveals there are several sources of hip pain. When you are overweight there is additional stress on your joints. This can be compounded by osteonecrosis, an inadequate blood supply to the hip joint, which causes bone thinning and may ultimately collapse the bone. Dead bone tissue generates pain.  Arthritic damage is probably the most common reason to need hip replacement.  Arthritis degrades hip cartilage. The source of hip, pain in this case, is joint inflammation.

Initially, people try home exercises and physical therapy to improve balance and function. Over the counter medicines include Ben Gay, Capasaicin and Zostrix can help with pain management. More intense pain can be alleviated with prescription pain medicines. Weight reduction, over time, improves mobility. Holistic therapy may simply include a weight loss of 20 – 30 lbs.

Hip Surgery as a Solution

You might consider hip replacement when you're experiencing pain that persists despite home exercises and physical therapy. Artificial hip joints have a polished metal or ceramic ball that fits into a cup liner of hard plastic. Some prostheses use a metal cup liner, which may last longer (see illustration). If function doesn’t improve, total hip arthroplasty (touching up the bone) would be the next step. The primary goals of hip surgery are to increase mobility and function.

Post-op Recovery

Pain control is highest in the hierarchy of importance. You want to get a good night’s sleep. Sleep is restorative both physically and mentally.
The operated hip should not be flexed more than ninety degrees to prevent damage to the hardware. Once again, mobility initiates healing.

Post-operative physical therapy is crucial for improving mobility and balance. Recovery starts with simply using a wheelchair. The next step is incorporating a non-weight-bearing exercise called pool-walking. It is what it sounds like, simply walking in a pool against the water’s gentle resistance. This has a twofold effect. You increase blood flow to the hip, which speeds up healing; at the same time retraining muscles. Pool-walking also increases endorphins, hormones that give you a feel good sensation despite the pain of recovery. Gradual mobilization hastens progress and prevents blood clots.

Complications your physician will discuss with you might include post-operative infection, loosening of the prosthesis, blood clots, and infection.

Conclusion
How do you know hip surgery has taken effect? When you are progressively improving and the pain is gradually diminishing, then you are on the track to recovery. Are you exercising regularly? Go on-line to find locations in your area for a fitness program. ? Weight reduction, walking, stretching, and fitness classes are prescribed.
Older people may procrastinate. They may dread failure. Reassurance and motivation go a long way. We all want to get things done quickly. There are days you may not be able to summon up the energy for recovery; give yourself some grace to rest. Rest is an important part of recovery as well. Surround yourself with people in your life who are encouragers. A hopeful outlook and having a purpose in life will do a great deal in moving towards more pain-free mobility.



Saturday, February 4, 2017

Home Safety for Seniors


By Col. Ret Clement Hanson

Home Safety for Seniors: Old Folks at Home
During our military years, all of us have seen a few too many houses! You have been retired in Colorado for many years and want to put off another move for a long as possible.  Before you suffer a broken bone, make some minor fixes to your house which means fewer changes for you down the road. Now is the time to make life easier for the future and maybe save a painful and long recovery from a broken bone.
Older adults compose 11% of the population, but account for 23% of accidental deaths. Consider that in this population decreased reaction times, balance, hearing, and smelling abilities are decreasing even before we are aware and willing to admit it. Eyesight, depth-perception and peripheral vision are important to avoid a misstep. Increased use of prescriptions is more likely to cause dizziness and forgetfulness.
Last month, I discussed driving adjustments for older adults. This month is an article about accidents in the home, particularly falls. In the next months, I will give information about fire hazards and hazardous products commonly in the home.
Minor improvements will be mentioned first, followed by more extensive remodeling projects. Relatively easy and inexpensive fixes will be listed for the bathroom first, because that is the room where most accidents occur.
MOST ACCIDENTS OCCUR IN THE BATHROOM:
·         Install raised toilet seats.
·         Grab bars by the toilet, in the shower and tub areas.
·         Shower stool.
·         Mixer valve to avoid sudden hot and cold water.
·         Non-slip rugs
·         Lower the water heater temperature to 120 degrees to prevent burns
STAIRS PRESENT THE SECOND MOST ACCIDENT PRONE LOCATION:
·         Do not store clutter on the stairs.
·         Extra railings
·         Improve lighting
·         Mark the edges of the highest and lowest step with bright-colored tape.
OTHER AREAS OF THE HOUSE:
·         Good lighting
·         Use non-slide mats, no decorative rugs that slip.
·         Remove extension cords from traffic areas.
·         Place stools where you change shoes. Do not wear wet shoes into the house.
·         Wear good shoes with no loose shoe strings.
·         If you must use a ladder or step stool, make sure it is very sturdy. If you feel you must do these chores, do not hurry, be certain you are not tending to light-headedness due to illness, medicines, OR ALCOHOL. If your spouse says, “Don’t do it,” listen.

More Extensive Home Improvements:
·         Install new fire and carbon monoxide alarms with a ten-year life span. Then you do not have to think about getting on a ladder every time a fire alarm beeps. Have an electrician install them now, and give it no more thought for ten years!
·         Have your home security in top shape. Many possibilities to consider as technology improves. Video doorbells allow you to answer the door with your phone, whether you are home or not. Motion detector lights outside, both for your safety at night and to discourage intruders. Tell your regular visitors to call you before they come.
·         Have cellphones that you know how to operate for emergencies. Avoid having to rush to a telephone or the door when you can fall in the rush. Set up a MedAlert system.
·         Replace round door knobs with lever-type handles. Arthritic hands have a hard time with round knobs. Service dogs can open lever knobs, of course your cat can too!
·         Non-slip floor surfaces, especially where feet may be wet as in bathrooms and by outside doors.
·         Ramp at an exterior door.
·         Lifts at the stairs. Remodel to build a downstairs bedroom.
·         Make improvements that allow wheelchair or scooter access. Widen the interior doors to 36 inches wide.
·         Electric stoves instead of natural gas. This will remedy natural gas flooding and open flames.
·         Walk-in bathtub.
·         Have bathroom doors swing to outside the room instead of inside. If a person falls inside, they often block the bathroom door from opening, which makes it difficult for someone to enter the bathroom.

Keep in Mind: Any fall is a predictor of future falls. Two-thirds of folks who have fallen, will fall again within 6 months. The older the person, the more severe the falls and more likely to experience a broken bone. Many of those who fall will never return to their former functionality, and many will die from complications from falls.

Elders are often reluctant to admit to a fall for fear their activities will be curtailed. Modify your surroundings before something happens and have another pair of eyes look at your environment for hazards you have long grown used to and do not notice.