Delirium

Definition Of Delirium

Delirium is sudden severe confusion and rapid changes in brain function that occur with physical or mental illness.

Symptoms Of Delirium

Delirium involves a quick change between mental states (for example, from lethargy to agitation and back to lethargy).

Symptoms include:

• Changes in alertness (usually more alert in the morning, less alert at night)
• Changes in feeling (sensation) and perception
• Changes in level of consciousness or awareness
• Changes in movement (for example, may be inactive or slow moving)
• Changes in sleep patterns, drowsiness
• Confusion (disorientation) about time or place
• Decrease in short-term memory and recall
o Unable to remember events since delirium began (anterograde amnesia)
o Unable to remember past events (retrograde amnesia)
• Disrupted or wandering attention
o Inability to think or behave with purpose
o Problems concentrating
• Disorganized thinking
o Speech that doesn\’t make sense (incoherent)
o Inability to stop speech patterns or behaviors
• Emotional or personality changes
o Anger
o Anxiety
o Apathy
o Depression
o Euphoria
o Irritability
• Movements triggered by changes in the nervous system (psychomotor restlessness)

Prevention Of Delirium

Treating the conditions that cause delirium can reduce its risk.

Complications Of Delirium

• Loss of ability to function or care for self
• Loss of ability to interact
• Progression to stupor or coma
• Side effects of medications used to treat the disorder

Expectations (prognosis) Of Delirium

Acute conditions that cause delirium may occur with chronic disorders that cause dementia. Acute brain syndromes may be reversible by treating the cause.

Delirium often lasts only about 1 week, although it may take several weeks for mental function to return to normal levels. Full recovery is common.

Causes, Incidence, And Risk Factors Of Delirium

Delirium is most often caused by physical or mental illness and is usually temporary and reversible. Many disorders cause delirium, including conditions that deprive the brain of oxygen or other substances.

Causes include:

• Drug abuse
• Infections such as urinary tract infections or pneumonia (in people who already have brain damage from stroke or dementia)
• Poisons
• Fluid/electrolyte or acid/base disturbances

Patients with more severe brain injuries are more likely to get delirium from another illness.

Signs And Tests Of Delirium

The following tests may have abnormal results:

• An exam of the nervous system (neurologic examination)
• Psychologic studies
• Tests of feeling (sensation), thinking (cognitive function), and motor function

The following tests may also be done:
• Ammonia levels
• B12 level
• Blood chemistry (chem-20)
• Blood gas analysis
• Chest x-ray
• Cerebrospinal fluid (CSF analysis
• CPK
• Drug, alcohol levels (toxicology screen)
• Electroenceophalograph (EEG)
• Glucose test
• Head CT scan
• Head MRI scan
• Liver function tests
• Mental status test
• Serum calcium
• Serum electrolytes
• Serum magnesium
• Thyroid function tests
• Thyroid stimulating hormone level
• Urinalysis

Treatment Of Delirium

The goal of treatment is to control or reverse the cause of the symptoms. Treatment depends on the condition causing delirium. Diagnosis and care should take place in a pleasant, comfortable, non-threatening, physically safe environment. The person may need to stay in the hospital for a short time.

Stopping or changing medications that worsen confusion, or that are not necessary, may improve mental function. Medications that may worsen confusion include:

• Alcohol and illegal drugs
• Analgesics
• Anticholinergics
• Central nervous system depressants
• Cimetidine
• Lidocaine

Disorders that contribute to confusion should be treated.

These may include:

• Heart failure
• Decreased oxygen (hypoxia)
• High carbon dioxide levels (hypercapnia)
• Thyroid disorders
• Anemia
• Nutritional disorders
• Infections
• Kidney failure
• Liver failure
• Psychiatric conditions (such as depression)

Treating medical and mental disorders often greatly improves mental function.

Medications may be needed to control aggressive or agitated behaviors. These are usually started at very low doses and adjusted as needed.

Medications include:
• Dopamine blockers (haloperidol, olanzapine, risperidone, clozapine)
• Mood stabilizers (fluoxetine, imipramine, citalopram)
• Sedating medications (clonazepam or diazepam)
• Serotonin-affecting drugs (trazodone, buspirone)
• Thiamine

Some people with delirium may benefit from hearing aids, glasses, or cataract surgery.

Other treatments that may be helpful:

• Behavior modification to control unacceptable or dangerous behaviors
• Reality orientation to reduce disorientation

Calling Your Health Care Provider For Delirium

Call your health care provider if there is a rapid change in mental status.

Chronic Pain

Who Is At Risk For Chronic Pain

Factors that may increase the risk of chronic pain include:

Aging. Older adults are more likely to suffer from chronic conditions such as arthritis, diabetes, shingles, and other causes of nerve problems (neuropathy). However, chronic pain is not a normal part of growing older. Smoking. Nicotine use can increase pain and decrease the effectiveness of medicines.
Health problems. These include:
Existing health conditions, such as fibromyalgia, shingles, arthritis, depression or anxiety disorders, or having a limb amputated (phantom limb pain).
Past health problems, such as joint injuries. Also, previous surgery may cause new pain or may not work to relieve pain (such as back surgery that does not relieve pain).

Overall general health condition. You may have a weakened immune system, which can lead to frequent infections or illness.
Conditions that are difficult to treat, such as nerve pain from shingles (postherpetic neuralgia).
Lifestyle, such as not eating healthy foods, not exercising regularly, smoking, or having a substance abuse or alcohol dependency problem.

Other factors that may increase your risk for developing chronic pain include injury, stress, inactivity, relationship problems, or a history of physical, sexual, or emotional abuse. Daily activities that may contribute to chronic pain include repetitive motions at work or at home, such as lifting, or being in awkward positions for long periods of time.

Alternative Pain Therapies of Chronic Pain 

How the Mind Controls Pain

Science is beginning to investigate and support the role of therapies such as biofeedback and meditation in pain control. The idea that the mind has power over the body may be especially useful to chronic pain patients who often find themselves without satisfactory medical treatments.
The emotional response to pain
Pain travels along two pathways from a source, such as an injury, back to your brain. One is the sensory pathway, which transmits the physical sensation. The other is the emotional pathway, which goes from the injury to the amygdala and the anterior cingulate cortex—areas of the brain that process emotion.

“You may not be aware of it, but you’re having a negative emotional reaction to chronic pain as well as a physical reaction,” says Natalia Morone, MD, assistant professor of general internal medicine at the University of Pittsburgh School of Medicine. Mind-body treatments that involve meditation and relaxation probably affect these emotional pathways. However, Dr. Morone admits that many doctors don’t put much stock in this theory. “Anything to do with mind-body medicine around pain is going to be controversial. This is all very new.”

Research is beginning to show the connection
In a 2005 study, researchers at Stanford University in Palo Alto, Calif., used functional magnetic resonance imaging (fMRI), which measures activity in different areas of the brain, to see whether subjects could learn to control a brain region involved in pain and whether that could be a tool for altering their pain perception.

Laura Tibbitts, 34, an event planner from San Francisco who severely injured her arm, shoulder and back when she was thrown off of a horse, participated in the study.

In describing her pain, she says: “My muscles and nerves feel like a bunch of snakes that are all intertwined, but then I also get a stabbing and shooting pain. So you have that horrible, achy, uncomfortableness, but then you get these jolts of pain.”

In the study, Tibbitts was asked to increase her pain and as she did, an image of a flame on a computer monitor became stronger and more vibrant. Then she was told to decrease her pain, which caused the flame to die-down. “Sometimes I would imagine that the pain was literally being scooped out from me, taken away and carried off. Other times I used water imagery, like it was flowing through me and taking it away,” says Tibbitts. After the test, she learned that she had been able to produce a 30% to 40% reduction in her overall pain.

Giving control to pain patients

For Sean Mackey, MD, director of the pain management division at Stanford University School of Medicine and one of the study’s researchers, the research revealed a striking element of empowerment. “Patients would say, ‘A-ha! For the first time I could see the pain in my brain, and I could control it. And that was a very powerful experience,” he says.

Dr. Mackey believes pain medicine is moving away from the concept of strict mind-body separation toward a more unified—and ancient-sounding—view in which “mind and body are really one.”

The bottom line for pain patients is that they may want to pursue pain-control techniques such as biofeedback, yoga, and meditation. But they also need to be on the alert for scams and beware of claims made by therapists seeking to exploit their desperation. Before turning to one of these therapies, it’s best to thoroughly research the practitioner you choose.

What To Keep In Your Pain Diary

1. Your pain level.

Keep track of: where your pain falls on a scale of 0 to 10. If 0 is no pain at all and 10 is the worst pain you can imagine, decide where your pain falls. Mark down what number you hit during different parts of the day. This will help your doctor look for patterns that might help him or her better target your treatment. For instance, if your pain tends to spike in the evening and you take your medication in the morning, your medication may not be lasting long enough and you may need to take smaller doses more often. 2. What medication you took and its effect.

Keep track of: how much medication you are taking, when you take it, whether it provides you any relief, and if you experience any side effects. This information will give your doctor an understanding of the magnitude of your pain and help him or her decide whether you need to try a new medication or switch from over-the-counter drugs to prescription meds. Finally, your doctor can make sure that you are not combining medications that could have a bad interaction.
3. Other treatments you tried.

Keep track of: any non-drug therapies that you use to control the pain and whether they help.

Did your back feel better or worse after your yoga class? Were you headache-free on a day you visited the acupuncturist? Did taking five minutes at the end of your day to relax and release tension help you sleep with a little less pain? This kind of information will help you see what really lessens your pain and help your doctor get closer to the source of it.

4. Anything else that relieved pain or made it worse.

Keep track of: any big changes that seemed to impact your pain. Did driving for four hours to your in-laws cause your sciatica to flare? When you were in meetings all day and not at your desk, did your lower back feel better than normal? Did those two glasses of red wine precede one of your worst migraines ever? Noticing the small changes in your daily routine that have big impacts on your pain can help you make choices to keep the pain in check.

5. Moments you are grateful for.

Keep track of: pain-free moments too. Keeping a pain diary can help you and your doctor create a plan to reduce pain and make you more comfortable. But focusing too much on your pain can inadvertently worsen it. Try to set aside a specific time a few times a week, so that you don’t spend every day obsessing about it. And remember to mark down a few good moments to remind you to stay in touch with all the other parts of your life too.

 

Cervical Cancer

What Is Cervical Cancer?

Cervical cancer occurs when abnormal cells on the cervix grow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer can often be cured when it’s found early. It is usually found at a very early stage through a Pap test.

What Are The Symptoms of Cervical Cancer ?

Symptoms of acne include whiteheads, blackheads, and pimples. These can occur on the face, neck, shoulders, back, or chest.

Pimples that are large and deep are called cystic lesions. These can be painful if they get infected. They also can scar the skin.

What Causes Cervical Cancer?

Cervical cancer is caused by severe abnormal changes in the cells of the cervix. Most precancerous or cancerous cell changes occur in the cervix at the transformation zone because these cells normally undergo constant change. During this natural process of change, some cervical cells can become abnormal if you are infected with high-risk types of HPV.

Other factors that may play a role in causing cervical cancer include:

1 One study shows that your risk of cervical cell changes may also increase if you are around someone else while they smoke (secondhand smoke).2 Cervical cell changes are more likely to go away on their own in women who don’t smoke.

Having an impaired immune system, such as from having human immunodeficiency virus (HIV).

Using birth control pills for more than 5 years. This may be related to infection with HPV,

Regular Pap test screening is the single most important tool to identify cervical cell changes early before they progress to cancer.

What Increases Your Risk ?

The most common cause of cervical cancer is a persistent infection with a high-risk type of human papillomavirus (HPV). HPV infection of the cervix is a sexually transmitted disease (STD). A past HPV infection in you or your partner can cause abnormal cervical cell changes years later since the virus may remain in the body for life. HPV infection usually does not cause symptoms and often goes away without causing any problems, so you or your partner may not be aware of a current or past HPV infection.

Other risk factors that may increase your risk for cervical cancer include:
Having an impaired immune system.

For example, women with human immunodeficiency virus (HIV) seem to:

Have higher rates of HPV infection.
Be more likely to develop cervical cell changes from HPV.
Be more likely to quickly develop cervical cancer from those cell changes.
Using birth control pills for more than 5 years. This may be related to infection with HPV.
Exposure to diethylstilbestrol (DES) before birth (prenatal exposure), though this is rare.
Smoking or a history of smoking, and possibly exposure to secondhand smoke.
Pregnant women have the same risk of developing cervical cancer as nonpregnant women.

What To Think About Cervical Cancer?

Most chemotherapy will cause some side effects.

Chemotherapy may be given after surgery to try to kill any cancer cells that may remain, which is called adjuvant therapy.

Studies show that chemotherapy given at the same time as radiation treatment (chemoradiation) improves survival rates in stages IIB, IIIA, IIIB and IVA cervical cancer without significantly increasing the side effects of either treatment. Chemoradiation may also improve survival rates in stages IB and IIA for women with large tumors.6, 1 Compared with radiation alone, chemoradiation improves survival.7 It is usually used as the primary therapy or after a hysterectomy.

Cisplatin is the medicine most often used in chemoradiation for cervical cancer.

Can Cervical Cancer Be Prevented?

The Pap test is the best way to find cervical cell changes that can lead to cervical cancer. Regular Pap tests almost always show these cell changes before they turn into cancer. It is important to follow up with your doctor after any abnormal Pap test result to treat abnormal cell changes. This may help prevent cervical cancer.

A new vaccine called Gardasil protects against four types of HPV, which together cause most cases of cervical cancer and genital warts.

You get three shots over 6 months. The vaccine is recommended for girls 11 to 12 years old. It is also recommended for females 13 to 26 years old who did not get the vaccine when they were younger.

The virus that causes cervical cancer is spread through sexual contact. The best way to avoid getting a sexually transmitted disease is to not have sex. If you do have sex, practice safer sex, such as using condoms and limiting the number of sex partners you have.

Early Detection Of Cervical Cancer

As part of your routine gynecological exam, you should have a Pap test. A Pap test is used to identify abnormal cell changes of your cervix and to screen for cervical cancer. The Pap test is the most effective screening test to prevent the development of cervical cancer.

Abnormal cervical cells on a Pap test are classified according to their degree of abnormality. Treatment decisions are guided by the kind of changes seen in the cells. In North America, abnormal cells are classified using the Bethesda system (TBS). The Bethesda system or other classification systems are used in other parts of the world.

Exams And Tests Of Cervical Cancer

The Pap test is a routine screening test used to identify abnormal cell changes of the cervix and to screen for cervical cancer. Regular Pap test screening is the single most important tool in identifying and treating cervical cell changes before they progress to cervical cancer. If cervical cancer is suspected, your health professional will take a medical history and perform a physical exam, including a pelvic exam and a Pap test. Several follow-up tests may be needed for evaluation and treatment.

Tests to confirm a diagnosis of cervical cancer include:

A colposcopy and cervical biopsy, to find out whether and where cancer cells are on the surface of the cervix.
An endocervical biopsy (or curettage), to find out whether cancer cells are in the cervical canal.
A cone biopsy or loop electrosurgical excision procedure (LEEP). These tests are sometimes recommended to remove cervical tissue for examination under a microscope.
If you are pregnant, a colposcopy and cervical biopsy can be done to confirm cervical cancer.

Tests to determine the extent (stage) of cervical cancer include:
A cone biopsy or loop electrosurgical excision procedure (LEEP).

These tests are sometimes recommended to determine the spread of cancer in cervical tissue.
A cystoscopy, to look at the interior lining of the bladder and the urethra to determine whether the cancer has spread to the urinary system.
A proctoscopy, to look at the lower part of the large intestine (colon) to determine whether the cancer has metastasized.
An intravenous pyelogram, to see whether there is any blockage of a kidney.
A chest X-ray, to check for cancer cells that have spread from the cervix.

Tests to guide treatment decisions include:

A complete blood count (CBC), to check for anemia and other abnormal blood values.
A chemistry screen, to find out how the liver and kidney are working.
A computed tomography (CT) scan of the abdomen and pelvis, to determine which treatment choice is needed depending on the spread of cancer in the abdomen and pelvis.

A magnetic resonance imaging (MRI) of the abdomen and pelvis. This test can also help determine which treatment will be recommended depending on the spread of cancer in the abdomen and pelvis.
A positron emission tomography (PET). This test is sometimes used to evaluate which organs the cancer has spread to.

How Is Cervical Cancer Diagnosed?

As part of your regular pelvic exam, you should have a Pap test. During a Pap test the doctor scrapes a small sample of cells from the surface of the cervix to look for cell changes.

If a Pap test shows abnormal cell changes, your doctor may do other tests to look for precancerous or cancer cells on your cervix.

Your doctor may also do a Pap test and take a sample of tissue (biopsy) if you have symptoms of cervical cancer, such as bleeding after sex.

Home Treatment Of Cervical Cancer

During medical treatment for any stage of cervical cancer, you can use home treatment to help manage the side effects of cervical cancer or cancer treatment. Home treatment may be all that is needed to manage the following common problems. If your doctor has given you instructions or medicines to treat these symptoms, be sure to follow them. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise can help control your symptoms.

Home treatment for:

Nausea or vomiting includes watching for and treating early signs of dehydration, such as a dry mouth, sticky saliva, and reduced urine output with dark yellow urine. Older adults can quickly become dehydrated from vomiting. Nausea and vomiting caused by chemotherapy usually require medical treatment. Your doctor may also prescribe medicines to control nausea and vomiting.
Diarrhea includes resting your stomach and being alert for signs of dehydration. Check with your doctor before using any nonprescription medicines for your diarrhea.

Constipation includes making sure that you drink enough fluids and include fruits, vegetables, and fiber in your diet each day. Do not use a laxative without consulting your doctor.
Other issues that may arise include:

Sleep problems. If you find you have trouble sleeping, some tips for managing sleep problems may be helpful, such as having a regular bedtime, getting some exercise during the day, and avoiding naps.
Fatigue. If you feel as though you do not have any energy and tire easily, try some measures to manage fatigue, such as getting extra rest, eating a balanced diet, and reducing your stress.

Urinary problems, which can be caused by both cervical cancer and its treatment. It may help to eliminate caffeinated drinks from your diet and to establish a schedule of urinating every 3 to 4 hours, regardless of whether you feel the need.
Hair loss. Hair loss may be unavoidable, but using mild shampoos and avoiding damaging hair products will reduce irritation of your scalp.
Many women with cervical cancer face emotional issues as a result of their disease or its treatment.

Finding out that you have cancer and undergoing treatment is stressful. Managing stress may include expressing your feelings to others. Learning relaxation techniques may also be helpful. Relaxation techniques, such as meditation, and support groups may be helpful.

Your feelings about your body and your sexuality may change following treatment for cancer. It may help to talk openly about your feelings with your partner and to discuss your concerns with your doctor. Your doctor may be able to refer you to organizations that can offer additional support and information.

Not all forms of cancer or cancer treatment cause pain. If pain occurs, many options are available to relieve it. If your doctor has given you instructions or medicines to treat pain, be sure to follow them. Home treatment for pain such as a nonsteroidal anti-inflammatory drug (NSAID) or an alternative therapy like biofeedback may improve your physical and mental well-being. Be sure to discuss any home treatment you use for pain with your doctor.

Some women with advanced-stage disease may choose not to have treatment because the time, costs, and side effects of treatment may be greater than the benefits. Making the decision about when to stop medical treatment aimed at prolonging life and shift the focus to end-of-life care can be difficult.

Medication Choices

The most common chemotherapy medicines used for initial treatment or with radiation treatment in stage IIA, IIB, IIIA, IIIB, and IVA include:
Cisplatin.
Fluorouracil (5-FU).

For advanced stage (stage IVB) cervical cancer or recurrent cervical cancer, the most common chemotherapy medicines used are:
Mitomycin.
Paclitaxel.
Ifosfamide.
Topotecan has been approved to use with cisplatin for advanced cervical cancer. These drugs may be used when surgery or radiation cannot be done or are not likely to work. They can also be used for cervical cancer that has returned or spread to other organs.

What To Think About Surgery Of Cervical Cancer?

If surgery is part of your treatment, you also may be given radiation therapy, chemotherapy, or combination chemoradiation. These treatments may be given before or after surgery to try to destroy any cancer cells that may remain. Radiation, chemotherapy, or chemoradiation given before a surgery to help control or reduce the size of the tumor is called neoadjuvant therapy.

Using these therapies after a surgery when only microscopic areas of cancer may still be present is called adjuvant therapy.

Compared with radiation alone, chemoradiation improves survival if it is used either before or after a hysterectomy.
Side effects from surgery can include difficulty with urination or problems with bowel habits, such as constipation or diarrhea. Your ability to have or enjoy sexual intercourse may also be affected.

Surgery Choices Of Cervical Cancer

Surgery for very early stages of cervical cancer that preserves your ability to have children includes:
A cone biopsy or loop electrosurgical excision procedure (LEEP), which removes a wedge of cervical tissue that contains the cancer.
Radical trachelectomy and laparoscopy for pelvic lymph node dissection, which removes the cervix and area lymph nodes, but not the uterus. Radical trachelectomy is not commonly used.

Surgery for most stages of cervical cancer does not preserve your ability to have children. Surgeries include:
Hysterectomy with or without removal of the ovaries, to remove the cervix and related organs where recurrence would be most likely to occur.

Modified radical hysterectomy with pelvic lymph node dissection. A radical hysterectomy usually includes removal of part of the vagina, the uterus, the ovaries, and the fallopian tubes. This removes the most likely sites of cancer and may reduce the risk of recurrence.

Other Treatment Choices

In addition to conventional medical treatment for cervical cancer, you may wish to try complementary therapies, such as:
Acupuncture.
Herbs.
Biofeedback.
Meditation.
Yoga.
Guided imagery.
Vitamins and nutritional supplements.

Complementary therapies are not a substitute for the standard treatment recommended for cervical cancer. Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.

Treatment Overview

Cervical cancer detected in its early stages can be cured with treatment and close follow-up. Treatment choices for cervical cancer may include one or more of the following therapies:

Surgery to remove the cancer
Radiation therapy to treat the cancer itself or other organs affected by the cancer
Chemotherapy to help make the cancer more sensitive to radiation therapy and to treat cancer that has spread (metastasized)
Your quality of life becomes a critical issue when considering treatment options. Be sure to discuss your personal preferences with your oncologist when he or she recommends treatment.
Initial treatment
The choice of treatment and the long-term outcome (prognosis) of cervical cancer depends on the type and stage of cancer. Your age, overall health, quality of life, and desire to be able to have children must also be considered. Treatment choices for cervical cancer may be a single therapy or a combination of therapies, such as:
Cone biopsy to remove the cancer.
Simple hysterectomy to remove the uterus and cervix.
Modified radical hysterectomy and lymph node dissection to remove the cancer.
Radiation therapy, which uses high-dose X-rays or implants in the vaginal cavity to kill cancer cells.
Chemotherapy, which uses medicines to kill cancer cells.
Radical trachelectomy to remove the cervix and the pelvic lymph nodes (lymph node dissection). But the uterus is left in place. This treatment is done less often.

Chemotherapy may be given at the same time as radiation therapy (chemo radiation). Studies show that chemotherapy given at the same time as radiation treatment (chemo radiation) improves survival rates in stages IIB, IIIA, IIIB and IVA cervical cancer without significantly increasing the side effects of either treatment. Chemo radiation may also improve survival rates in stages IB and IIA for women with large tumors. Compared with radiation alone, chemo radiation improves survival.7 It is usually used as the primary therapy or after a hysterectomy.

Microinvasive squamous cell carcinoma (stage IA1) with minimal invasion into deeper cell layers is the most treatable stage with the highest survival rates. This stage is treated with a cone biopsy or loop electrosurgical excision procedure (LEEP) or simple hysterectomy; 5-year survival rates are close to 100%.

Most treatments for cervical cancer cause side effects. Side effects may differ, depending on the type of treatment used and your age and overall health. Your doctor can talk to you about your treatment choices and the side effects associated with each treatment.
Side effects of chemotherapy may include loss of appetite, nausea, vomiting, diarrhea, mouth sores, or hair loss.
Side effects of radiation therapy may include fatigue, skin irritation, or changes in your bowel or urinary habits.
Side effects of surgery depend on the surgery used to treat the stage of your cancer.
Home treatment measures may help relieve some common side effects of cancer treatment. For more information, see the Home Treatment section of this topic.

If you have recently been diagnosed with cervical cancer, you may experience a wide variety of emotions in reaction to your diagnosis. Most women will feel some denial, anger, and grief. There is no “normal” or “right” way to react to a diagnosis of cancer. You can take steps, though, to manage your emotional reactions to learning that you have cervical cancer. Some women find that talking with family and friends is comforting, while others may need to spend time alone to understand their feelings about their disease.

If your emotions are interfering with your ability to make decisions about your health and to move forward with your life, it is important to talk with your doctor. Your cancer treatment center may offer counseling services. You may also contact your local chapter of the American Cancer Society to help you find a support group. Talking with other women who have had similar feelings after a diagnosis such as yours can help you accept and deal with your disease.
Treatment for pregnant women
Recommended treatments are the same for pregnant women as for nonpregnant women. Treatment for early stage IA cervical cancer may be delayed until after delivery if the pregnancy is in the third trimester. A vaginal delivery may be possible.

For all stages of cervical cancer, treatment will be managed by a team of doctors specializing in cancer and high-risk pregnancies. The baby does not appear to be affected by cervical cancer, but treatment for the cancer may cause problems such as an early delivery or even the loss of the baby.

10 Treatment will consider the recommendations for the specific stage of cancer, the development of the baby, and the mother’s preferences.

What to think about during initial treatment

Depending on the extent (stage) of your cancer, surgery may be combined with radiation therapy and chemotherapy. Radiation or chemotherapy given after a surgery is called adjuvant therapy.

Some women with cervical cancer may be interested in participating in research studies called clinical trials. Clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Women who do not want standard treatments or are not cured using standard treatments may want to participate in clinical trials. These are ongoing in most parts of the United States and in some other countries for all stages of cervical cancer.

Cervical cancer progresses more rapidly, has higher recurrence rates, and has a poorer prognosis in women with human immunodeficiency virus (HIV).
For more information about specific cervical cancer treatments, see the topics:
Cervical Cancer—Health Professional Information [NCI PDQ].
Cervical Cancer—Patient Information [NCI PDQ].

Ongoing treatment
After initial treatment for cervical cancer, it is important to receive follow-up care. Your emotional reactions may continue throughout the course of your treatment depending on your prognosis, the treatment methods used, and your quality-of-life decisions.

Your oncologist or gynecological oncologist will schedule regular checkups that will include:
A pelvic exam and Pap test every 3 months for the first 2 or 3 years.
After the first 2 or 3 years, a pelvic exam and Pap test every 6 months until 5 years after treatment.
Follow-up tests that may be recommended by your oncologist include an abdominal and pelvic computed tomography (CT) scan to monitor whether cancer has spread to other organs in the abdomen or pelvis.
If respiratory symptoms are present, a chest X-ray may be done to determine whether cancer has spread to the lungs.

Treatment if the condition gets worse
Cervical cancer can return after treatment. About 35% of women with cervical cancer will have persistent or recurrent disease.11 The chance that your cancer will return depends on the stage of the initial cancer: cancer found early is less likely to come back than cancer found at a later stage. If cancer returns after treatment, it is usually within 2 years of the first diagnosis.8 Your long-term outcome (prognosis) for recurrent cervical cancer depends greatly on how much the cancer has spread when the recurrence is diagnosed.

Overall, fewer than 5% of women with recurrent cancer survive 5 more years even with additional treatment.
Women who have had a radical hysterectomy and develop a recurrence that has not spread outside the pelvis have a 5-year survival rate of 30% to 40% when treated with radiation therapy. Chemotherapy may also be recommended.
Women who develop a local recurrence that has not spread outside the pelvis may be treated with an extensive surgery called pelvic exenteration, which removes all the pelvic organs and surrounding tissue to eliminate the risk of additional recurrences.
The goal of treatment of advanced-stage cervical cancer that has spread outside the pelvis is to control symptoms, reduce complications, and increase comfort (palliative care). It is not intended to cure the disease. Palliative care may include:
Radiation therapy.
Chemotherapy medicines.
Medicines for symptoms such as nausea or pain.
Complementary therapies
In addition to conventional medical treatment, you may wish to try complementary therapies, such as:
Acupuncture.
Herbs.
Biofeedback.
Meditation.
Yoga.
Visualization.
Vitamins and nutritional supplements.
Complementary therapies are not a substitute for the standard treatment recommended for cervical cancer. Before you try any of these therapies, discuss their possible benefits and side effects with your doctor. Let him or her know if you are already using any such therapies. For more information, see the topic Complementary Medicine.

End-of-life issues
Some women with advanced-stage disease that is not curable may choose not to have cancer treatment because the time, costs, and side effects of treatment may be greater than the benefits. Making the decision about when to stop cancer treatment aimed at prolonging life and shift the focus to best supportive care can be difficult.

Asthma

What Is Asthma?

Asthma causes swelling and inflammation in the airways that lead to your lungs. When asthma flares up, the airways tighten and become narrower. This keeps the air from passing through easily and makes it hard for you to breathe. These flare-ups are also called asthma attacks or exacerbations. Asthma affects people in different ways.

Some people only have asthma attacks during allergy season, or when they breathe in cold air, or when they exercise. Others have many bad attacks that send them to the doctor often. Even if you have few asthma attacks, you still need to treat your asthma. The swelling and inflammation in your airways can lead to permanent changes in your airways and harm your lungs. Many people with asthma live active, full lives. Even though asthma is a lifelong disease, treatment can control it and keep you healthy.

Asthma: How Is It Treated?

There are two parts to treating asthma. The goals are to: Control asthma over the long term. To do this, use a daily asthma treatment plan. This is a written plan that tells you which medicine to take. It also helps you track your symptoms and know how well the treatment is working. Many people take controller medicine—usually an inhaled corticosteroid—every day. Taking controller medicine every day helps to reduce the swelling of the airways and prevent attacks. Your doctor will show you how to use your inhaler correctly.

This is very important so you get the right amount of medicine to help you breathe better. Treat asthma attacks when they occur. Use an asthma action plan, which tells you what to do when you have an asthma attack. It helps you identify triggers that can cause your attacks. You use rescue medicine, such as albuterol, during an attack. If you need to use the rescue inhaler more often than usual, talk to your doctor. This is a sign that your asthma is not controlled and can cause problems. Asthma attacks can be life-threatening, but you may be able to prevent them if you follow a plan. Your doctor can teach you the skills you need to use your asthma treatment and action plans.

How Can You Prevent Asthma Attacks?

You can prevent some asthma attacks by avoiding those things that cause them. These are called triggers. A trigger can be: Irritants in the air, such as cigarette smoke or other air pollution. Don’t smoke, and try to avoid being around others when they smoke. Things you are allergic to, such as pet dander, dust mites, cockroaches, or pollen. When you can, avoid those things you are allergic to. It may also help to take certain kinds of allergy medicine. Exercise.

Ask your doctor about using an inhaler before you exercise if this is a trigger for you. Other things like dry, cold air; an infection; or some medicines, such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs). Try not to exercise outside when it is cold and dry. Talk to your doctor about vaccines to prevent some infections, and ask about what medicines you should avoid. Sometimes you don’t know what triggers an asthma attack. This is why it is important to have an asthma action plan that tells you what to do during an attack.

How Is Asthma Diagnosed?

Spirometry. Doctors use this test to diagnose and keep track of asthma. It measures how quickly you can move air in and out of your lungs and how much air you move. Peak expiratory flow (PEF). This shows how fast you can breathe out when you try your hardest. An exercise or inhalation challenge.

This test measures how quickly you can breathe after exercise or after taking a medicine. A chest X-ray, to see if another disease is causing your symptoms. Allergy tests, if your doctor thinks your symptoms may be caused by allergies. You will need routine checkups with your doctor to keep track of your asthma and decide on treatment.

What Causes Asthma?

Experts do not know exactly what causes asthma. But there are some things we do know: Asthma runs in families.

Asthma is much more common in people with allergies, though not everyone with allergies gets asthma. And not everyone with asthma has allergies. Pollution may cause asthma or make it worse.

Is This Topic For You?

This topic provides information about asthma in teens and adults.

If you are looking for information about asthma in children age 12 and younger, see the topic Asthma in Children.

Alzheimer

Signs And Symptoms of Alzheimer

1. Often forgetting what happened in the last half hour or asking the same question over an over again. Memory problems become progressively worse, eventually disturbing normal activities.

2. Confusion, faulty decision, reasoning, and lack of ability to complete simple tasks such as shopping.

3. An increasing tendency to lose things and to wander and get lost.

4. Neglect of personal hygiene and appearance.

5. Depression, agitation, paranoia and anxiety – either as direct symptoms or as reflections of the distress people feel over thinking of their inability.

6. In later stages, failure to recognize familiar places and people.

7. In advance stages, a near-total loss of memory, speech, and physical ability, and require full-time care and supervision.

What To Do Now 

1. Get examined by a doctor to check for disorders with similar symptoms. These include depression, hypoglycemia, brain tumor, drug interactions or side effects, vitamin shortages, stroke, and other conditions in which memory problems my be reversible. 2. If memory problems get worse over a period of months, see a neurologist or geriatrician for further tests. 3. Keep the home environment as soothing and organized as possibly.

In the early stages, routines and visual aids such as checklists for daily tasks can help. 4. Patiently deal with forgetfulness, cause it’s a disease, not a ill will. 5. Help the diseased one, so that he can remain active and maintain his/her family and social ties as long as possible. 6. Have the diseased one wear a medical ID bracelet that says “Memory Impaired” and shows your phone number. 7. Restrict driving. 8. Contact your doctor about ways to control symptoms like insomnia, agitated behavior, and depression.

How To Prevent It

There is currently no known way to prevent this disease.

When To Call A Doctor

1. If consistent symptoms are shown. Because the individual my not be aware of the condition, it is often up to others to help. 2. The disease can undermine resistance.

At the first sign of an infection or other illness the doctor should be called. 3. If the diseased one endangers him- or herself or others. 4. If you take care of the diseased one and feel that you are approaching a breaking point. 

Dislocation

Causes of Dislocations

Dislocations are usually caused by a sudden impact to the joint. This usually occurs following a blow, fall, or other trauma.

Definition of Dislocations

A dislocation is a separation of two bones where they meet at a joint.

(Joints are areas where two bones come together.) A dislocated bone is no longer in its normal position. A dislocation may also cause ligament or nerve damage.

Symptoms of Dislocation

A dislocated joint may be:

• Visibly out-of-place, discolored, or misshapen
• Limited in movement
• Swollen or bruised
• Intensely painful, especially if you try to use the joint or bear weight on it

Nursemaid’s elbow is a partial dislocation common in toddlers. The main symptom is refusal to use the arm. Nursemaid’s elbow can be easily treated in a doctor’s office without the following first aid steps.

Dislocation:call Immediately For Emergency Medical Assistance If

A known or suspected dislocation or broken bone
• Severe bleeding
• An area below the injured joint that is pale, cold, clammy, or blue
• Signs of infection like warmth and redness at the injured site, pus, or a fever
• A bone projecting through the skin

First Aid of Dislocation

1. Call 911 before you begin treating someone who may have a dislocation, especially if the accident causing the injury may be life-threatening.
2. If there has been a serious injury, check the person’s airway, breathing, and circulation. If necessary, begin rescue breathing, CPR, or bleeding control.
3. Do not move the person if you think that his head, back, or leg has been injured. Keep the person still. Provide reassurance.
4. If the skin is broken, take steps to prevent infection. Do not blow on the wound. Rinse the area gently to remove obvious dirt, but do not scrub or probe. Cover the area with sterile dressings before immobilizing the injury.
5. Splint or sling the injury in the position in which you found it. Do not move the joint. Be sure to immobilize the area above and below the injured joint.
6. Check the person’s blood circulation around the injury by pressing firmly on the skin in the affected area. It should blanch white, then regain color within a couple of seconds.
7. Apply ice packs to ease pain and swelling.
8. Take steps to prevent shock. Unless there is a head, leg, or back injury, lay the victim flat, elevate the feet about 12 inches, and cover the person with a coat or blanket.

Dislocation: do Not

• DO NOT move the person unless the injury has been completely immobilized.
• DO NOT move a person with an injured hip, pelvis, or upper leg unless it is absolutely necessary. If you are the only rescuer and the person must be moved, drag him or her by the clothing.
• DO NOT attempt to straighten a misshapen bone or joint or to change its position.
• DO NOT test a misshapen bone or joint for loss of function.
• DO NOT give the person anything by mouth.

Prevention of Dislocation

Preventing injuries in children:

• Teach children how to be safe and look out for themselves.
• Create a safe environment around your home.
• Pay careful attention to preventing falls by gating stairways and keeping windows closed and locked.
• Supervise children carefully. There is no substitute for close supervision, no matter how safe the environment or situation appears to be.

Preventing dislocations in adults:

• Wear protective gear when participating in contact sports.
• Avoid falls by not standing on chairs, counter tops, or other unstable objects.
• Eliminate throw rugs, especially for the elderly.

For all age groups:

• Keep a first-aid kit handy.
• Use non-skid mats on the bottom of the bathtubs and avoid bath oils.
• Use handrails on staircases.
• Remove electrical cords from floor surfaces.

Dislocation:considerations

It may be hard to tell a dislocated bone from a broken bone.

Both are emergency situations and require the same first-aid treatment. Injuries to the surrounding ligaments generally take 3 to 6 weeks to heal.

Diarrhea

Home Care

• Drink plenty of fluid to avoid becoming dehydrated. Start with sips of any fluid other than caffeinated beverages. Milk may prolong loose stools, but also provides needed fluids and nourishment. Drinking milk may be fine for mild diarrhea. For moderate and severe diarrhea, electrolyte solutions available in drugstores are usually best.
• Active cultures of beneficial bacteria (probiotics) make diarrhea less severe and shorten its duration. Probiotics can be found in yogurt with active or live cultures and in supplements.
• Foods like rice, dry toast, and bananas can sometimes help with diarrhea.

• Avoid over-the-counter anti-diarrhea medications unless specifically instructed to use one by your doctor. Certain infections can be made worse by these drugs. When you have diarrhea, your body is trying to get rid of whatever food, virus, or other bug is causing it. The medicine interferes with this process.
• Rest.

If you have a chronic form of diarrhea, like the one caused by irritable bowel syndrome, try adding bulk to your diet — to thicken the stool and regulate bowel movements. Such foods include rice, bananas, and fiber from whole-wheat grains and bran. Psyllium-containing products such as Metamucil or similar products can also add bulk to stools.

Common Causes

The most common cause of diarrhea is viral gastroenteritis, a mild viral infection that goes away on its own within a few days. This condition is often called the stomach flu. Viral gastroenteritis often occurs in mini-epidemics in schools, neighborhoods, or families.

Food poisoning and traveler’s diarrhea are two other common causes of diarrhea. They occur as a result of eating food or drinking water contaminated with bacteria or parasites.

Medications, especially antibiotics, laxatives containing magnesium, and chemotherapy for cancer treatment, can also cause diarrhea.

The following medical conditions can also lead to diarrhea:
• Malabsorption syndromes such as lactose intolerance
• Inflammatory bowel diseases (Crohn’s disease and ulcerative colitis)
• Irritable bowel syndrome (IBS)
• Celiac disease

Other less common causes of diarrhea include:

• Zollinger-Ellison syndrome
• Nerve disorders like autonomic neuropathy or diabetic neuropathy
• Carcinoid syndrome
• Gastrectomy (partial removal of the stomach)
• High dose radiation therapy

Prevention Of Diarrhea

• Wash your hands often, especially after going to the bathroom and before eating.
• Teach children to not put objects in their mouth.
• When taking antibiotics, try eating food with Lactobacillus acidophilus, a healthy bacteria. This helps replenish the good bacteria that antibiotics can kill. Yogurt with active or live cultures is a good source of this good bacteria.
• Use alcohol-based hand gel frequently.

When traveling to underdeveloped areas, follow the steps below to avoid diarrhea:
• Drink only bottled water and DO NOT use ice.
• DO NOT eat uncooked vegetables or fruit that do not have peels.
• DO NOT eat raw shellfish or undercooked meat.
• DO NOT consume dairy products.

Call Your Health Care Provider If

Call your doctor if:

• You have blood or pus in your stools or your stool is black
• You have abdominal pain that is not relieved by a bowel movement
• You have symptoms of dehydration
• You have a fever above 101°F, or your child has a fever above 100.4°F, along with diarrhea
• You have foul smelling or oily-looking stools
• You have recently traveled to a foreign country
• You have eaten with other people who also have diarrhea
• You have started on a new medication
• Your diarrhea does not get better in 5 days (2 days for an infant or child), or worsens before that
• Your child has been vomiting for more than 12 hours (in a newborn under 3 months you should call as soon as vomiting or diarrhea begins)

What To Expect At Your Health Care Provider’s Office

Your doctor will take a complete medical history and do a physical examination, paying careful attention to your abdomen.

Questions that the doctor may ask include:
• When did your diarrhea start?
• How long have you had diarrhea?
• What is the color and consistency of your stool?
• Do you have blood in your stool?
• Are you passing large amounts of mucus with your stool?
• What other symptoms do you have?
• Do you have abdominal pain or severe cramping with the diarrhea?
• Do you have fever or chills?
• Are any other family members sick?
• Have you recently traveled out of the country?
• What makes your pain worse? Stress? Specific foods?
• Have you had abdominal surgery?
• What medications do you take? Any recent changes to your medications?
• Do you drink coffee? How much?
• Do you drink alcohol? How much? How often?
• Do you smoke? How much each day?
• Are you on a special diet?

Your doctor will ask you to obtain one or more stool samples in special containers to test for signs of inflammation and infection and to identify the organism causing infection.

If there are signs of dehydration in addition to the diarrhea, your doctor may order:
• Chem-20 (to check electrolytes)
• Urine specific gravity
• BUN and creatinine. 

Considerations

Diarrhea in adults is usually mild and goes away quickly without complications. In infants and children (especially under age 3), diarrhea can cause dehydration fairly quickly.

Dengue Fever

Dengue Alert

Prevention And Personal Precaution

The best way to prevent dengue fever is to take special precautions to avoid contact with mosquitoes.

To control the growth of Dengue the environment should be cleaned up and get rid of water holding containers such as discarded tins, empty pots, broken bottles, coconut shells and similar other collections of water. Proper care must be taken so that water accumulation in unwanted places should not last for 5 days. To protect the human body from the mosquito bite we can use various materials such as spray, mat, mosquito net etc.

In addition by the use of mosquito net for the Dengue patient is helpful to prevent spreading of Dengue from a diseased a person to healthy person. As Aedes mosquito bite mainly in the morning and late evening. So it is better to use mosquito net during sleep not only at night but also in both morning and late evening to protect the human body from mosquito bite.

While there are many methods of mosquito control, experts now recommended an “Integrated approach” that is an approach which tries to combine one or more methods with a view to obtaining maximum results with minimum input and also to prevent environmental pollution with toxic chemicals and development of insecticide resistance.

Treatment

At first proper Bed rest is required. In febrile phase only paracetamol tablet may be taken to reduce the body temperature. Tepid sponging with water at room temperature is proved to be good to reduce the fever. If fever is associated with profuse and frequent vomiting then the patient should be given plenty of water as well as liquid diet (such as normal saline, fruit juice, green cocnut water, etc.) to correct the water loss from the body.

The patient should be properly observed for 48 hours after subsidence of fever for early detection of complication of Dengue syndrome.

If the following symptom such as severe abdominal pain, passage of blackish, soft, foul smelling stool, passage of blood through the vagina, vomiting of blood, bleeding from nose or gum, cold clammy skin of leg and hand present alone or in combination, then patient must be referred to hospital for proper management under evaluation. In case of infant and children. If there is convulsion or even there is a history of convulsion, then the patient must be referred to hospital for better management.

Dengue haemorrhagic fever proper fluid therapy is required both through the mouth and intravenous route to maintain the fluid and electrolyte balance of the body. In case of intravenous fluid normal saline is proved to be better than others. If platelet count in patient in blood is less than 10,000/mm3 of blood, then the platelet concentrate is required to prevent and reduce the uncontrolled, spontaneous bleeding. If the platelet concentrate is not available then the fresh blood may be given in lieu of platelet concentrate.

Clinical Features

Generally all the physical sign, symptom and alteration of all the biochemical events in the human body produced by Dengue virus are collectively called “Dengue syndrome”. For the better management purpose this Dengue syndrome is further divided into three groups. These groups are –

I) Classical Dengue fever
ii) Dengue haemorrhagic fever and
iii) Dengue Shock syndrome.

Dengue fever usually starts suddenly with a high fever, rash, severe headache, pain behind the eyes, and muscle and joint pain. The severity of the joint pain has given dengue the name “Break-bone fever.” Nausea, vomiting, and loss of appetite are common.

A rash usually appears 3 to 4 days after the start of the fever. The illness can last up to 10 days, but complete recovery can take as long as a month. Older children and adults are usually sicker than young children.

Most dengue infections result in relatively mild illness, but some can progress to dengue hemorrhagic fever. With dengue hemorrhagic fever, the blood vessels start to leak and cause bleeding from the nose, mouth, and gums. Bruising can be a sign of bleeding inside the body. Without prompt treatment, the blood vessels can collapse, causing shock (dengue shock syndrome). Dengue hemorrhagic fever is fatal in about 5 percent of cases, mostly among children and young adults.

Do’s And Don’t s

Aspirin and other NSAID drugs should not be used in Dengue to reduce the fever. Because they can cause a dangerous condition named “Ryes syndrome” in children.

They can also cause gastric irritation as well as bleeding from stomach that may complicate the Dengue fever. Any antibiotic should not be used, because the use of antibiotic may complicate the Dengue fever more. In case of Dengue shock syndrome, the use of Dopamine, corticosteroid and carbazochram for treatment are not successful.

Transmission

The disease is transmitted from one infected person to another healthy person by Aedes aegypti and Aedes albopuctus, species of Aedes genus of mosquito.

It usually breeds in artificial accumulations of water in and around human dwellings, such as water found in discarded tins, broken bottles, fire buckets, flower pots, coconut shells, earthen pots, tree holes and the like. They are most abundant during rainy seasons and bite chiefly during the day.

Diagnosis

For diagnosis of Dengue physician’s clinical suspicion is enough. But for prognostic purpose, some laboratory tests are important.

As there are no significant biochemical changes appear in Dengue on first three days, it is better to done the laboratory test after 3-5 days of the dengue fever for confirmation of diagnosis. The base line laboratory test for dengue fever is complete blood count including platelet count as well as PCV (Packed Cell Volume). In addition to above tests total leukocyte count is also important.

Definition, Alternative Names, Causes, Incidence, And Risk Factors

Definition

Dengue fever is a virus-based disease spread by mosquitoes.

See also: Dengue hemorrhagic fever

Alternative Names

O’nyong-nyong fever; Dengue-like disease; Breakbone fever

Causes, incidence, and risk factors

Dengue fever is caused by several related viruses (four different arboviruses). It is spread by the bite of mosquitoes, most commonly the mosquito Aedes aegypti, which found in tropic and subtropic regions.

This includes parts of:
• Southeast Asia
• Indonesian archipelago into northeastern Australia
• Sub-Saharan Africa
• South and Central America

Dengue fever is being seen more in world travelers. It is generally lasts a week or more. Although uncomfortable, it is not deadly. The proper diagnosis depend on whether you tell your doctor about any visits to areas of the world where dengue fever is known to occur.

Dengue fever should not be confused with Dengue hemorrhagic fever, which is a separate disease and frequently deadly.

Breast Cancer

How To Do A Breast Self-exam

It takes practice to perform a thorough breast self-examination. Ask your health professional for tips that can help you perform a breast self-examination correctly.

The best time to examine your breasts is usually one week after your menstrual period begins, when your breast tissue is least likely to be swollen or tender. If your menstrual cycle is irregular, or if you have stopped menstruating due to menopause or the removal of your uterus (hysterectomy), do your examination on a day of the month that’s easy to remember. Women who are pregnant or breast-feeding can continue to examine their breasts every month. Breast-feeding mothers can examine their breasts after a feeding or after using a breast pump so that the breasts have as little milk as possible, making the examination easier and more comfortable.

To do a breast self-examination, remove all your clothes above the waist and lie down. The examination is done while lying down so your breast tissue spreads evenly over your chest wall and is as thin as possible, making it much easier to feel all your breast tissue.

Use the pads of the three middle fingers of your left hand—not your fingertips—to check your right breast. Move your fingers slowly in small coin-sized circles.
Use three different levels of pressure to feel of all your breast tissue. Light pressure is needed to feel the tissue close to the skin surface. Medium pressure is used to feel a little deeper, and firm pressure is used to feel your tissue close to your breastbone and ribs. A firm ridge in the lower curve of each breast is normal. Use each pressure level to feel your breast tissue before moving on to the next spot.

Check your entire breast using a lengthwise strip pattern. Feel all of the tissue from the collarbone to the bra line and from the armpit to the breastbone. Start in the armpit and work down to the bottom of the bra line. Move one finger-width toward the middle and work up to the collarbone.

Repeat until you have covered the entire breast. Repeat this procedure for your left breast. See an illustration of BSE using a lengthwise strip pattern. The American Cancer Society prefers this method of breast self-examination because it is the best method for finding breast lumps.

You also can examine your breasts using a spiral pattern. Again, use three different levels of pressure to examine all your breast tissue. Avoid lifting your fingers away from the skin as you feel for lumps, unusual thicknesses, or changes of any kind. See an illustration of BSE using a spiral pattern. Most breast tissue has some lumps or thick tissue. When in doubt about a particular lump, check your other breast. If you find the same kind of lump in the same area on the other breast, both breasts are probably normal. Pay attention to any lump that feels much harder than the rest of your breast.

If you find anything that concerns you, schedule a visit with your health professional. The important thing is to learn what is normal for you and to report any changes to your health professional.
Remember that most changes you find are not breast cancer but should be checked. These changes may include:
Any new lump. It may or may not be painful to touch.
Unusual thick areas.
Sticky or bloody discharge from your nipples.
Any changes in the skin of your breasts or nipples, such as puckering or dimpling.
An unusual increase in the size of one breast.
One breast unusually lower than the other.

In addition to examining your breasts while lying down, you may also check them while in the shower. Soapy fingers slide easily across the breast and may increase your chances of detecting a change. While standing in a shower, place one arm over your head and lightly soap your breast on that side. Then, using the flat surface of your fingers—not the fingertips—gently move your hand over your breast (in the strip pattern described above), feeling carefully for any lumps or thickened areas.

What A Breast Mri Feels Like And How It Work

Magnetic resonance imaging (MRI) creates detailed images of your breast using a computer and powerful magnets. The procedure is used to follow up on worrisome symptoms or an inconclusive mammogram or ultrasound—though not always, because MRI is so expensive. MRI offers a very detailed picture of breast tissue, but it can also turn up a lot of false positives—suspicious results that prove, later, not to be cancer. High-risk women (with BRCA-1 or BRCA-2 gene mutations and/or a strong family breast cancer history) are often encouraged to get MRIs.

The procedure
MRIs are conducted with your body stretched out on a flat surface inside a metal tube. “You lie facedown and let your breasts hang through these huge holes,” recalls Kim Heier, 42, of Simi Valley, Calif. The hollows in the table contain coils for picking up the MRI’s magnetic signal. You may be given an injection of a dye that makes the mass in your breast easier to see.

Once the machine gets going, the buzzing, clicking, and thumping noises and the tight space can be nerve-wracking for some. Earplugs or headphones may be offered, and for people who are claustrophobic, taking a sedative drug beforehand might be an option.

On the other hand, some people find it appealing that there’s nothing to do but wait. “Being the mother of three children, I don’t get to sit down much, so lying in this machine for 30 minutes was kind of a relief,” recalls Heier. “[Occasionally, they] reminded me not to move and I was thinking, ‘No problem, I’m half asleep.'”

If you have cancer already
If you’ve been diagnosed with breast cancer in one breast, don’t be surprised if your doctor suggests an MRI for your other breast. A 2007 study by the American College of Radiology Imaging Network found that for women who’d been diagnosed with cancer in one breast, MRI scans picked up more than 90% of cancers in the opposite (aka contralateral) breast that had been missed by mammography and a clinical breast exam at initial diagnosis.

5 Simple Things That Could Cut Your Breast Cancer Risk

1. Limit yourself to two or three alcoholic drinks a week

Alcohol, consumed even in small amounts, is believed to increase the risk of breast cancer. Most doctors recommend cutting back on wine, beer, and hard liquor.

A recent study showed the link between drinking and breast cancer was especially strong in the 70% of tumors known as hormone-sensitive.

By Lorie Parch

2. Exercise at least three times a week (more often is even better)
And when you do exercise, work to keep your heart rate above its baseline level for a minimum of 20 continuous minutes. Long walks are nice too, but it\’s the more vigorous exercise (expect to sweat!) that really helps your heart and cuts your cancer risk.

3. Maintain your body weight, or lose weight if you\’re overweight

Research shows that being overweight or obese (especially if you\’re past menopause) increases your risk, especially if you put on the weight as an adult. And a study released in March 2008 by researchers at the University of Texas M.D. Anderson Cancer Center in Houston showed that obese and overweight women also had lower breast cancer survival rates and a greater chance of more aggressive disease than average-weight or underweight women.

4. Do a monthly breast self-exam

Be sure to get proper instruction from your doctor and have your technique reviewed regularly. You might catch a lump before a mammogram does, and it\’s a good idea to follow changes in your body.

5. Have a mammogram once a year after 40

Catching a tumor early boosts the chance of survival significantly: The five-year survival rate can be as high as 98% for the earliest stage localized disease, but hovers around 27% for distant-stage, or metastatic, disease.

What To Expect If You’re Having An Open Breast Biopsy

An open biopsy is done by a general surgeon, gynecologist, or family medicine doctor. The biopsy may be done in a surgery clinic or the hospital.

You will need to take off all or most of your clothes above the waist. You will be given a gown to use during the biopsy. The biopsy will be done while you sit or lie on an examination table. Your hands may be at your sides or raised above your head (depending on which position makes it easiest to find the lump).

An open biopsy can be done using local or general anesthesia. If local anesthesia is used, you may also be given a sedative.

If you have general anesthesia, an intravenous (IV) line will be put in your arm to give you medications. You will not be awake during the biopsy.

After the breast is numb (or you are unconscious), your doctor makes a cut through the skin and into the breast tissue to the lump. If a probe was placed using mammogram to mark the biopsy site, your doctor will take a biopsy from the area at the tip of the probe.

Stitches are used to close the skin, and a bandage is put on. You will be taken to a recovery room until you are fully awake. You can usually return to your normal activities the next day.

An open biopsy takes about 60 minutes.

What’s A Clinical Breast Exam ?

A clinical breast exam (CBE) is a hands-on examination of both breasts that every ob-gyn or family doctor should provide during a woman’s annual visit for a pelvic exam and Pap smear. The American Cancer Society recommends that women in their 20s and 30s have a CBE every three years; women 40 and older need one every year.

This can be especially useful for young women with dense breasts, says Janet Wolter, MD, a medical oncologist and the Brian Piccolo chair of Breast Cancer Research at Rush University Medical Center in Chicago, because their home breast self-exams (BSEs) are trickier to interpret.

“Older women have soft, easy-to-examine breasts. Once you’re menopausal, a lot of glandular tissue is replaced with fat and it’s easier to feel.”

Here’s what a CBE involves: Your doctor presses his or her fingers around each breast and into your armpits, checking for lumps as well as rashes, dimpling, or other abnormal skin changes. The doctor may gently squeeze each nipple to check for discharge.

No matter what your age, be sure to mention any changes you’ve noticed in your breasts to your physician during your visit, or call to discuss changes if you’re in between appointments.

Having A Breast Biopsy ?

Biopsies are the most conclusive test for telling whether you have cancer, and if so, what type. A doctor administers local or general anesthesia and then removes a sample of the suspicious lump, whether it’s a few cells, some tissue, or the entire lump. Pathologists examine the sample.

There are a few different kinds of biopsies used to help diagnose breast cancer: fine needle, core needle, stereotactic, and excisional.

Because biopsies are usually—though not always—the last step in your diagnosis, both the procedure itself and getting your results can be very stressful, but keep in mind that 80% of biopsy results come back benign.

“The whole process is nerve-racking—it’s a lot of hurry-up-and-wait and anxiety-provoking things,” says Mehra Golshan, MD, a breast surgical oncologist at the Brigham and Women’s Hospital and Dana-Farber Cancer Institute in Boston. “What happens is that something abnormal is seen and you have to hurry up and schedule a biopsy. It’s angst-provoking. Some women will need a small sedative before the procedure. Coming in with a friend or significant other usually helps a lot.” Says Kerry Apicella, 62, who had a core needle biopsy, “I can see where some people would freak out. It’s uncomfortable, and the minute they tell you not to move, of course, you feel you’ve got to move.”

Robin Hershkowitz, program director for women’s cancers at CancerCare, a national nonprofit support-services group based in New York City, suggests asking the doctor or technician to talk you through the test. “Usually it reduces your anxiety if someone says, ‘This is what will happen for a minute and a half, and then this happens.’ You can prepare for that,” she says.

3 Ways To Spot Breast Cancer

Early detection of breast cancer is key (and the closest thing to prevention we have), because a tumor is a lot easier to treat if you, your doctor, or a mammogram can catch it while it’s still small.

Screenings are for when you have no symptoms of disease but want to be sure something isn’t lurking that you haven’t spotted yet, says Peter M. Jokich, MD, director of the Rush Breast Imaging Center at Rush University Medical Center in Chicago.

Women who don’t have any breast cancer symptoms should consider committing to three kinds of routine screenings:

1. breast self-exams at home
2. clinical breast exams and, each year after you turn 40,
3. mammograms—this is the one that shouldn’t be skipped, experts say.

Other breast cancer tests—diagnostic mammograms, ultrasounds, MRIs, and biopsies—are for women with symptoms who, for example, “feel a lump, have redness on the skin of their breast, or have discharge from the nipple,” says Dr. Jokich.

What To Expect If You’re Having A Fine Needle Aspiration Breast Biopsy

A fine-needle aspiration biopsy may be done by an internist, family medicine doctor, radiologist, or a general surgeon. The biopsy may be done in your doctor’s office, a clinic, or the hospital.

You will take off your clothing above the waist. A paper or cloth gown will cover your shoulders. The biopsy will be done while you sit or lie on an examination table. Your hands may be at your sides or raised above your head (depending on which position makes it easiest to find the lump).

Your doctor will numb your skin with a shot of numbing medicine where the biopsy needle will be inserted. Once the area is numb, a needle is put through your skin into your breast tissue. Ultrasound may be used to guide the placement of the needle during the biopsy. If the lump is a cyst, the needle will take out fluid and tissue samples. If the lump is solid, a sample of tissue is taken. The biopsy sample is sent to a lab to be looked at under a microscope. You must lie still while the biopsy is done. The needle is then removed. Pressure is put on the needle site to stop any bleeding. A bandage is put on. A fine-needle aspiration biopsy takes about 5 to 15 minutes.

How To Watch For Breast Cancer Symptoms

False alarms are especially common for women with fibrocystic breasts. (RICK GOMEZ/CORBIS/VEER) Being vigilant about changes in your breasts can help you spot the symptoms of breast cancer—and spot them earlier, when the cancer is more likely to be treated successfully.

While most doctors recommend monthly breast self-exams, it’s not yet clear if the practice results in higher survival rates overall. But women do sometimes find lumps on their own.

See your doctor if you notice anything at all.

Before you panic, however, keep in mind that most breast changes and lumps don’t end up being cancer—even if you get to the point of doing a biopsy. Nearly 80% of biopsies come back benign. False alarms are especially common for women with fibrocystic changes, which can make the breasts feel thicker or lumpy, with symptoms that may change over the course of the menstrual cycle. In the meantime, your best course of action is to follow a screening regimen that includes regular mammograms, clinical breast exams, and breast self-exams. Lead writer: Lorie Parch