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Actos Bladder Cancer Headlines

By admin | Published January 27, 2012

Actos Bladder Cancer : Keep your doctor informed if you are experiencing any of the above side effects. There are drugs that can help minimize these con”ditions and make your treatment more comfortable. Luckily, these side effects tend to disappear once you are no longer receiving chemotherapy, and you will gradually feel stronger and become less vulnerable to bleeding or infections.

For invasive bladder cancer, chemotherapy is sometimes given before you have a cystectomy. Sometimes it’s given afterwards. Sometimes it’s not given at all. It depends entirely on the type of tumor you have, where it may have spread, and whether you have another medical condition that might make it difficult for you to tol”erate chemotherapy. Very advanced age can also be a factor in decid”ing whether chemotherapy is appropriate.

The choice of drugs used to treat invasive bladder cancer is similar to the choice in advanced or metastatic disease. If you have invasive transitional cell carcinoma you will probably undergo chemotherapy, as this type of cancer is responsive to either radiotherapy or surgery with chemotherapy, and many stud”ies have examined this type of cancer treatment.

If you have been diagnosed with squamous cell cancer or adeno”carcinoma, the track record for chemotherapy is not so clearly defined. Most physicians don’t recommend chemotherapy as standard treatment in conjunction with cystectomy for these types of cancer. It is, however, quite reasonable for your team to suggest that you look into a clinical trial (for example, one that is exploring the use of chemotherapy) if you have been diagnosed with squamous cell or adenocarcinoma.

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Most of the reported trials indicate that the use of single chemother”apy drugs does not have an extensive beneficial effect, but that the use of combinations of three or four chemotherapy drugs can shrink the bladder cancer in around 70 percent of cases and can also improve the cure rate and length of survival. For you as a patient, the information gleaned from these clinical trials means that if you have TCC, your doctors are likely to recom”mend treatment that includes a “cocktail” of several carefully targeted chemotherapy drugs as well as cystectomy or radiotherapy.

In some cancers, such as breast cancer, it is pretty standard practice to give several doses of chemotherapy after surgery, especially for tumors with high-risk pathological features, such as lymph-node involvement. We know of six studies that have looked at this question in bladder cancer, but the results are somewhat inconclusive as to whether chemotherapy is most effective given before or after surgery.

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When radiation is used alone or with chemotherapy there is an increased likelihood that your other organs, such as the prostate and uterus, will remain functional, as does your ability to void urine normally and have sex. The intention when chemotherapy and radio”therapy are given is usually to improve the chances of curing the cancer while preserving the bladder and avoiding the need to remove it surgically. This area is still somewhat controversial; while some physicians believe that this approach is nearly as effective as surgical removal of the bladder, others feel that cystectomy is the best treat”ment The decision depends in part upon the physical fitness of the patient as well as upon the patient’s personal preferences.

The use of radiotherapy doesn’t mean that it is without side effects. There can be scarring of the bladder tissue, and that can reduce the amount of urine your bladder can hold. The result would be an increase in the number of times you have to urinate, which can be irritating, especially at night. You also may experience an increase in bouts of cystitis.

There has been much discussion about whether the results achieved by radiotherapy are the same as those from cystectomy with, respect to achieving cure. We think that when one considers all types of bladder cancer, in the hands of a highly experienced urologist who specializes in this operation, cystectomy gives better results than radiotherapy. However, there are some patients, particularly those with other significant medical conditions, who will benefit from radiotherapy despite the possibility of a lower chance of permanent cure. In some centers, such as Massachusetts General Hospital, where the techniques of chemoradiotherapy and bladder preservation have been piloted, a urologist wall perform a cystoscopy about halfway through the planned course of radiotherapy. If the tumor is shrinking well, radiotherapy will be completed. However, if it appears that the cancer is not responding to radiotherapy, the plan wall be abandoned and replaced with a radical cystectomy.

Our use of the term or terms Actos Bladder Cancer is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Lawsuit Report

By admin | Published January 26, 2012

Actos Lawsuit : There are two broad types of cancers in the bladder: primary and metastatic. Primary bladder cancers are those that begin in the bladder itself. Metastatic cancers are those that originated in another organ and then spread to the bladder. Other tumors can get into the bladder through the bloodstream, through the lymphatic system, or by directly extending from a nearby organ, such as the prostate or the cervix.

Cancers originating in the bladder are far more common than cancers that spread to the bladder from another loca­tion. There are several types of primary tumors. Recall that transitional cell cancer accounts for at least 90% of all bladder cancers. Transitional cell tumors can be classi­fied as (1) papillary, (2) sessile, or (3) a mix of both types. Papillary tumors look like a piece of cauliflower attached to the wall by a short stalk; sessile tumors look flat and are broad-based. Almost 70% of transitional cell tumors are papillary types, which tend to have a better prognosis than sessile tumors. Less common types of bladder can­cer include squamous cell cancer, adenocarcinoma, and urachal carcinoma.

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Squamous cell carcinoma accounts for 3% to 7% of bladder cancers in the United States; however, in Egypt it accounts for 75% of the bladder cancers. There is a parasitic infection called schistosomiasis that is very common in Egypt. Infection with this parasite strongly predisposes a person to the development of squamous cell cancer. The parasite burrows into the wall of the bladder, which chronically irritates the bladder. Over many years, this chronic irritation can lead to the devel­opment of bladder cancer, most often squamous cell cancer. Other conditions that cause chronic irritation also predispose to this type of tumor. Chronic indwelling catheters, for example, can irritate the bladder and pre­dispose someone to this tumor. Squamous cell carci­noma does not tend to spread to the lymph nodes like transitional cell cancer does, although it does tend to spread aggressively directly through the bladder into neighboring structures. Because it is so locally aggres­sive and relatively resistant to chemotherapy or radia­tion, it usually has a worse prognosis than transitional cell cancers.

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Adenocarcinoma of the bladder is quite uncommon, accounting for approximately 2% of all bladder cancers in the United States. These tumors are also associated with chronic irritation. They tend to be high-grade aggressive tumors and are therefore usually associated with a worse prognosis. Urachal carcinoma is a specific type of adenocarci­noma of the bladder, but it is unique in that it does not originate in the lining of the bladder. These develop from the outer surface of the bladder, extending toward the inside of the bladder. They can then metastasize to the lymph nodes, the liver, lung, and bone.

Our use of the term or terms Actos Lawsuit is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Safyral Lawsuit News

By admin | Published January 26, 2012

Safyral Lawsuit: A dry, nonproductive cough is frequently associated with ACEI therapy and can be attributed to kinin accumulation. Patients should be urged to continue therapy, if tolerable. An alternative ACEI should be attempted prior to substitution with an ARB. A rare, but well-known, risk associated with ACEI therapy is angioedema. This life-threatening adverse reaction is most com­monly acute in onset but may occur late in therapy. Re-exposure to ACEI is not recommended, therefore alternative therapies such as hydralazine and ISDN should be considered. Angioedema has also been associated with ARBs, thus switching from an ACEI should be done with extreme caution.

Aldosterone antagonists are yet another class of agents available to target the RAAS. Sodium and water retention, hypokalemia, fibrosis, and ventricular remodeling are all consequences of excess aldosterone. The favorable effects of aldosterone antagonism in HF are due primarily to the inhibition of collagen deposition and fibrosis, therefore preventing ventricular remodeling. Spironolactone was the first aldosterone antagonist studied in the HF population. The RALES trial, which compared spironolac­tone to placebo, was halted early after a 30% relative risk reduc­tion in the primary endpoint of all-cause mortality was discovered during an interim analysis.11 Eplerenone, a selective aldosterone receptor antagonist, was studied in patients post-myocardial infarction with left ventricular dysfunction (EF < 40%).12 There was a significant reduction in mortality, risk of hospitalization due to HF, and sudden death due to cardiac causes. Unlike in the RALES trial, there were more cases of hyperkalemia and no differ­ence in gynecomastia in the eplerenone group.

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Diuretics are key ingredients in the successful management of HF patients. They are often necessary to combat the water and sodium retention elicited by angiotensin II and aldosterone. Diuretics allow for a rapid improvement in signs and symptoms of HF, such as peripheral edema, pulmonary congestion, and jugular venous pressure. These agents are often used long term to maintain symptomatic relief and improve exercise compliance. Although there have not been any clinical trials evaluating the effect of diuretics on mortality, they are indicated in all patients exhibiting signs and symptoms of volume overload.19 Diuretics should never be used alone to treat symptomatic HF. They should be used in combination with an ACEI and beta blocker to prevent further decompensation.

Diuretics, including loop and thiazide, prevent renal tubule absorption of sodium and water. Loop diuretics inhibit reabsorp­tion of sodium in the ascending limb of the Loop of Henle, while thiazide diuretics act in the distal convoluted tubule. Bumetanide, furosemide, and torsemide, all loop diuretics, increase sodium excretion by 20-25% whereas hydrochlorothiazide and metola- zone increase excretion by only 10-15%. It should also be noted that loop diuretics maintain efficacy in renal dysfunction while thiazides are less effective in patients with a creatinine clearance below 50 mL/min. Loop diuretics are, therefore, the most com­monly used diuretics in the management of HF.

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The surgical approach for left ventricular remodeling is predicated on the concept of restoring the geometry of the left ventricle to a conical shape. As shown below the left ventricle is opened in the area of dilatation or scar and direct inspection of the interior of the LV allows the surgeon to determine the beginning area of normal myocardium. This demarcation zone is used to fashion a new LV apex utilizing a constricting stitch and apical patch. The volume of the LV is determined by the patient’s preoperative LV dimensions and body surface area using a balloon template of known volume to adequately but not overly downsize the LV. Additional areas of thinning or dilatation can be plicated and the remaining LV scar is then closed to complete the repair.

Left ventricular failure secondary to myocardial cell dysfunction remains the pressing problem for the future and despite the uti­lization of surgical techniques and devices carries a significant long-term mortality. The future treatment of left ventricular fa.il- . ure may in large part reside in the new technologies surrounding the use of precursor cells growing in areas of myocardial scar or cellular dysfunction providing eventual improvement in left ven­tricular function. The use of stem cells, myoblasts, and skeletal muscle among others are currently under investigation utilizing tissue engineering by seeding cells in three-dimensional matrices of biodegradable polymers without artificial scaffolds to form new myocardial constructs. This technology of cell growth and cell implantation via vectors is well established but many questions are present and hopefully future answers will open this Pandora’s Box allowing successful treatment of end-stage heart failure.

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One of the largest series of apico-aortic conduits in elderly high risk patients has been reported by Dr John Brown in which 45 elderly patients received valved conduits for risk factors men­tioned above. The procedure as pictured below is carried through a left thoracotomy and be accomplished without cardiopulmonary’ bypass in many cases. The operative mortality was low and mid­term durability of the prostheses was good allowing the conclu­sion that high risk elderly patients with no other option could be successfully palliated.

Initially carried out for compassionate use for extremely high risk patients, clinical trials are currently under way in the US and Europe to evaluate the percutaneous or apical implantation of an expandable aortic valve prosthesis. In view of the results of per­cutaneous AVR, the optimism expressed is premature. In fact, the only published series (6 patients affected by end-stage aortic stenosis), presented by Cribier and associates, evidenced some major drawbacks, such as perivalvular leakage, which is caused by the persistence of empty space between the percutaneous and native valves owing to calcifications and which was observed in the majority of patients. Moreover, coronary’ flow obstruction provoked by the valved stent and atheroembolism of calcific debris during the positioning of the derice is possible. Grube and colleagues have recently described 1 single case of implantation of self- expandable valve prosthesis by the retrograde approach, which was deemed to facilitate coaxial positioning and to reduce the risk of perivalvular leakage, but required extracorporeal circulatory support (ECC) as a “safety measure.”

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Certainly in the setting of acute RV failure, the underlying cause needs to be addressed to the extent possible. If treatment of the underlying etiology is unsuccessful or not possible, attempts should be made to maximize right ventricular performance. According to the Frank-Starling principle, volume loading may improve RV output (even in the setting of RV contractile dysfunc­tion). Invasive monitoring (central venous or pulmonary artery catheters) is often necessary to determine the optimal filling pres­sures because excessive volume loading may be detrimental to the RV contractile function. Inotropic support using agents such as dobutamine or milrinone may improve RV contractile function, especially in the setting of high pulmonary artery pressures. In few’ cases when RV failure persists despite optimizing function using the above strategies, right ventricular assist devices are required.

Currently, MCSDs are broken down into distinct types of pumps based on their design as well as there indications for use. Current FDA-approved indications for pump use include bridge-to-recov- ery, bridge-to-transplant, and permanent lifetime therapy. The type of pumps based on design can be either paracorporeal or intracorporeal in relation to the actual location of the pump. The pumps may be either pulsatile/displacement pumps or nonpulsa­tile continuous flow pumps inclusive of the rotary impeller type or centrifugal type. The pumps may have bearings or be bearing-less as in the totally magnetically levitated pumps. The utilization of the different systems is determined most notably by the clinical situation and specifically the ultimate goals of therapy. A single institution may have an array of different pumps that are utilized in different clinical scenarios. At our institution we typically divide the pumps into two groups – those intended for acute decompen­sated support and those for more elective implant for chronic heart failure. The ultimate goal of therapy is paramount to the specific device utilized being either short-term (days to weeks) or long-term (years) support in relation to the ultimate goals of recovery, transplant, or permanent lifetime therapy.

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Total artificial heart pumps are orthotopically implanted and the native heart ventricles are excised. The first successful utiliza­tion of temporary total artificial heart was by Denton Cooley in 1969 utilizing a device developed by Liotta and DeBakey. The first permanent implant of a TAH system was done in 1982; a Jarvik-7 was implanted into Dr. Barney Clark by Dr. William DeVries at the University of Utah. Dr. Clark was supported on the Jarvik-7 for a total of 112 days. The S3>ncardia Cardiowest TAH-t system was approved as a temporary system for bridging to cardiac transplant by the FDA in 2004.Medicare approved reimbursement for the Syncardia Cardiowest TAH-t on 5/1/200S reversing its 1986 non­coverage policy for total artificial heart systems.

The goal of mechanical circulatory support is to restore normal physiologic blood flow to the body and prevent end-organ dys­function. In doing so the ventricle is unloaded thereby decreasing the myocardial workload and reducing the myocardial oxygen demand. Use of a VAD will reduce preload, myocardial wall ten­sion and oxygen consumption.15 Numerous studies have high­lighted the ability of MCSDs to adequately restore tissue perfusion and maintain as well as reverse end-organ dysfunction.

Our use of the term or terms Safyral Lawsuit: is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Lawsuit Announcement

By admin | Published January 26, 2012

Actos Lawsuit: Pain post-op is initially treated often via the epidural catheter. Intravenous medication may be given as an alternative and switched to oral pain meds once the individual is tolerating liquids. Many physicians order a PCA (patient controlled anesthesia) in which the patient pushes a button that releases pain medication via an intravenous line into the blood stream. Maximal amounts of drug administered are carefully controlled by settings on the PCA to allow safe, effective analgesia.

During the post-o you will meet regularly with an enterostomy nurse who will teach you the mechanics of caring for an ostomy and handling the ostomy appliance.period, Gradually, your pain will diminish, strength will increase, and diet will be advanced. Drains placed intraoperatively to siphon off any excess fluids from the abdomen will be removed when no longer needed. During difficult dissection, small intestines may be inadvertently opened. These injuries are usually immediately recognized and repaired without difficulty. During removal of the bladder, the rectum may be entered. Assuming the patient has had a complete bowel prep prior to surgery, the rectum is usually readily repaired.

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During removal of the pelvic lymph nodes, entry into a major vein or artery may result in significant blood loss. Smaller, inconsequential veins or branches into larger veins are usually ligated with a suture or cauterized shut. Larger veins and arteries require repair with a fine vascular suture and needle. Troublesome bleeding can also occur during removal of the bladder and from deep in the pelvis after the bladder and prostate are removed. Bleeding is stopped through suture ligation, vascular clips, or cautery.

An abscess is a pocket of pus located deep within the body. It may form from a bowel or urine leak, and generally will require drainage since antibiotics alone may not resolve it. If percutaneous drainage (drainage through the skin) is possible, the radiologist will drain the abscess. If this is not possible, the urologist will need to open the incision or make a new incision to allow the pus to be drained. A sizable abscess will generally not be cured without proper drainage. Left untreated, an abscess can result in sepsis, a life threatening bacterial infection.

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When the bowel is reconnected after removing the section for the urinary diversion, healing may not be adequate and bowel contents may leak into the abdomen. A bowel leak often will present as a failure of the bowel to return to normal function, resulting in a distended abdomen with poor bowel sounds. Distention, ileus (poor bowel function) may occur after the bowels are working well and feeding has been going on for some time. Evaluation is usually accomplished with CT Scan and oral contrast. Immediate surgical correction may be necessary. Left untreated, a bowel leak will generally lead to an abscess or possibly a fistula (a drainage tract from the bowel which may extend out through the incision or drain). The incidence of bowel leak is increased if bowel has been exposed to prior radiation, most often from radiation used to treat prostate cancer in men and uterine cancer in women.

When a piece of bowel is separated from the intestine to create the new urinary drainage system, the remaining bowel must be reanastomosed (brought back together). This may be accomplished via sewing the bowel together or through the use of staples. Sometimes the opening of the bowel connection may be obstructed secondary to swelling. If an obstruction does not clear after a reasonable time, reoperation may be required.

During a standard radical cystectomy in the male, the fine nerves which run along the base of the prostate to the penis are severed, resulting in loss of erections (impotence). If the individual having surgery still has good erections and is sexually active, these nerves can be attempted to be saved by modifying the surgery. Saving the nerves is more difficult to do, it takes more time, and is not always successful.

Our use of the term or terms Actos Lawsuit is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Asbestos Claim News

By admin | Published January 26, 2012

Asbestos Claim News – 1/25/2012: Exposure to asbestos is the link to the development of mesothelioma. People who end up with this disease usually have had some type of previous exposure to asbestos. How this works is not fully understood. It is thought that asbestos fibers are inhaled and first travel through the upper air passages, which include the throat, the trachea (windpipe), and the large bronchi (large breathing tubes of the lungs). These airways are lined with mucus, and therefore most of the fibers are cleared from these upper airways by sticking to this mucus and being coughed up or swallowed. When the fibers continue to travel and reach the small airways (the alveoli), the body’s immune system is able to sur­round, engulf, and remove the smaller fibers by a process known as phagocytosis. The large, long, thin fibers cannot be cleared as easily and may eventually reach the pleura (the lining of the lung and the chest wall), where they may irritate and injure the cells and lead to the development of calcium containing plate­like structures on the pleural lining (pleural plaques), fibrosis (scar tissue formation), or mesothelioma. These same asbestos fibers can also damage cells in the lung itself, which can lead to asbestosis (scar tissue in the lung) and/or lung cancer. Patients with these pleu­ral plaques seem to be at highest risk for developing mesothelioma.

The best way to prevent mesothelioma is to decrease one’s exposure to asbestos in the workplace, at home, and in the environment. The federal government is responsible for developing regulations that deal with asbestos exposure in the workplace. The agency that issues these regulations is known as the Occupational Safety and Health Administration (OSHA). Employ­ers are required to follow these regulations, and there­fore workers who are concerned about asbestos exposure should be discussing these concerns with their employers or union. Also, employees should be using all protective equipment provided to them by their employers and following recommended safety procedures and practices while at work. If you are exposed to asbestos in the workplace, you should be aware of the potential of bringing the fibers home on your clothes, skin, and hair. It is best to change your clothes and shower at work if at all possi­ble. If not, then it is important to do this immediately upon arriving home, which will limit the amount of exposure to others. Remove your clothes and put them in the washing machine as soon as possible.

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Malignant mesothelioma is a rare form of cancer that is found m the lining of the chest and lung (the pleura), the abdomen (the peritoneum), or the saclike space around the heart (the pericardium). Although it is rare, mesothelioma is a very serious disease that is often at an advanced stage when the diagnosis is made. In the United States an estimated 2000 to 3000 new cases of mesothelioma are diagnosed each year. Approximately three fourths of these cases start in the chest cavity and are called pleural mesothe­liomas. Another 10% to 20% begin in the abdomen and are called peritoneal mesotheliomas. Lastly, those that start in the lining around the heart are called pericardial mesotheliomas, but these are extremely rare. Mesothelioma is divided into three main types, based on what the cancer cells look like under the micro­scope. The most frequent type is epithelioid. About 50% to 70% of mesotheliomas are of this type. It usu­ally has the best prognosis or outiook of the three. The second type is called the sarcomatoid, which makes up about 7% to 20% of mesotheliomas. It has a very unpredictable pattern or nature. The last type, called mixed or biphasic, is a combination of the first two types and makes up about 20% to 35% of mesotheliomas. Although there are different types of mesothelioma, the treatment options, at this time, are essentially the same for all types.

Family members of people exposed to asbestos at work are also at an increased risk for mesothelioma. This is because these asbestos fibers are carried home on the clothes, shoes, skin, and hair of these workers and can be inhaled by others. Simian virus 40, or SV40, is a virus that has been asso­ciated with the development of malignant mesothe­lioma. This virus is found in rhesus monkeys and is now widespread among humans. The way this virus was transferred from monkeys to humans is uncertain, but it is postulated that some of the transfer occurred from 1954 to 1963 through SV40-contaminated polio vaccines administered worldwide. Those people who received the injectable form of the polio vaccine are believed to be those at greatest risk. This vaccine doesn’t folly explain the transfer of this virus, because many humans who could not have received the contaminated vaccines are now infected with the SV40 virus. One theory that has been proposed is that the SV40 virus continues to be transferred from monkeys to humans or that humans can pass the virus from person to per­son. The latter theory has been supported by data showing that SV40 can be excreted in human feces, breast milk, and semen. It is unlikely that this virus acts alone in the development of mesothelioma as most cancers have multiple risk factors associated with their development, and most mesotheliomas occur in asbestos exposed individuals. Instead, it is more likely that asbestos and SV40 may act together to develop into mesothelioma.

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Asbestos is associated with lung cancer too! Many studies have shown that the combination of smoking and exposure to asbestos is particularly haz­ardous. The risk of lung cancer is greatly increased in asbestos-exposed individuals who smoke. However, smoking in the absence of asbestos exposure has not been associated with the development of mesothe­lioma. Nevertheless, did you know that certain ciga­rette filters were constructed from asbestos fibers? Fortunately, this brand, Kents, is no longer on the market. Because of the combined effect of smoking and asbestos exposure, it is important for anyone who has ever been exposed to asbestos, or who suspects that he or she may have been exposed to the fibers, to quit smoking, or not to start. People who have been exposed to asbestos should also get regular physical exams and should seek prompt medical treatment for any respiratory illnesses.

Asbestos is a naturally occurring group of minerals that have been mined and used in different industries since the late 1800s. It is an extremely poor conductor of heat and does not conduct electricity, and therefore it has been widely used as an insulator. The flexible asbestos fibers are woven after being separated into thin threads. The fibers tend to break easily, and the dust that is formed from them breaking can float in the air and stick to clothes. The fibers can also be inhaled or swallowed and can result in serious health problems, including asbestosis, lung cancer, and mesothelioma.

There are six types of asbestos: amosite, crocidolite, anthophyllite, actinolite, tremolite, and chrysotile. The first five types are called amphibole asbestos, and they all have needlelike fibers. Chrysotile has a different texture, composition, and behavior than amphibole asbestos. Although some findings suggest that amphi­bole asbestos is more cancer causing than chrysotile, the topic remains controversial. Mesothelioma has a very long latency period (the time from the initial asbestos exposure to the development of cancer), making it doubly treacherous. This latency period can be anywhere from 25 to 40 years. The length of time it takes patients to report symptoms varies but can range from two weeks to two years, with the average being about two months. As many as 25% of patients with the disease can have symptoms for six months or more before seeking medical attention. Due to its slow onset, the disease tends to affect people between 50 and 70 years of age. It affects men three to five times more often than women and is less common in African Americans than in Caucasians. The right side of the chest is affected more than the left. The right lung is bigger than the left lung, or the right lung is of greater size and volume than the left lung.

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If you experience shortness of breath, pain in the chest or abdomen, swelling in the abdomen, or any other unusual symptom, see your doctor! The doctor will take a history from you and perform a physical exam. In listening to your chest, the doctor may not hear breath sounds clearly on one side or may hear scratchy sounds in the chest (rub). Or the doctor may notice that your abdomen is swollen. After the examination, the doctor mil link the symptoms you reported to the findings on the physical exam. The doctor will want to know whether you have had other symptoms, like fever, chills, pain, or unusual lumps on the torso. The doctor will also want to know whether your appetite is good and whether you have lost any weight. He or she may ask about asbestos exposure and cigarette use.

A patient with a large, unexplained fluid accumulation in the chest or abdomen and who has a small or moder­ate amount of thickening of the pleura should have a biopsy performed, using semi-invasive techniques (tech­niques that require only local anesthesia and that do not involve cutting into the chest or abdomen). For exam­ple, the biopsy might involve an initial thoracentesis (drainage of fluid in the chest) or paracentesis (drainage of fluid in the abdomen) and a pleural biopsy. These are relatively safe procedures that can be performed by a pulmonologist (lung physician), a radiologist, or a sur­geon. A local anesthetic (a numbing medicine such as lidocaine) is given to temporarily reduce the feeling in the area before the needle is inserted. It is important that you get the best information avail­able regarding your particular condition in order to decrease confusion, establish confidence in the treat­ment team, and have every opportunity to fight the disease and live as long as possible. In the majority of cases, your physician -will inform you whether the institution he or she is associated with has a special interest in the disease and treats more than 50 cases of mesothelioma per year. If those resources are not at your physician’s disposal, he or she should recommend a second opinion at a cancer center, which is a spe­cialized institution to which he can refer you for mesothelioma. You should not lose your primary physician or the physician who made this initial diag­nosis as your advocates.

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Oncology is a branch of medicine that deals with can­cer, and an oncologist is a specialized doctor who treats people with these cancers. Depending on your particular treatment plan and which cancer center you are referred to, you may be seen first by a medical oncologist (a specially certified physician who treats cancer and delivers chemotherapy), a thoracic surgical oncologist (a general thoracic surgeon whose practice is almost exclusively the treatment of cancers in the chest and who does not perform heart surgery), or a radiation oncol­ogist (a physician who delivers radiation). Mesothe­lioma is a very rare disease and therefore should be managed by doctors who have experience in treating it. The ideal situation is to be referred to a cancer center that deals with the disease in a multimodal way. That is, one that has a team of physicians from medicine, surgery, and radiation; nurses; and pain specialists who meet and discuss every patient in an individual­ized fashion. This group of specialists is called the multidisciplinary team. The key words here are “expe­rience” and “protocols.” You should insist on seeing individuals experienced in treating mesothelioma and who offer clinical trials (protocols) studying new ways to treat the disease.

It is important that you and your doctor communicate clearly and understand each other well. Before you visit a center or a specific doctor, see whether either has a website that you can visit. You may be pleasandy surprised that a lot of your questions about the place or physician j^ou are visiting are dealt with on this web­site. Nevertheless, how comfortable you are with your doctor will determine what questions you are able to ask and how successful your visit will be. If you don’t understand something that your doctor tells you, let him or her know this! You should be able to receive the information in a form that is understandable to you. Ask the doctor to speak in simple terms if you find the language too complex. If you have concerns about any­thing that is said, speak up and discuss these issues. Take the time to repeat back to the doctor what you heard so that he or she knows what information to reinforce and what to correct. Talk with your doctor about what your knowledge is of the disease and its treatment and any concerns and/or fears you may have.

Telling family members about a diagnosis of mesothe­lioma is a difficult thing to do. They may experience a lot of the same emotions that you do, including fear, worry, concern, anger, and sadness. These emo­tions need to be expressed, even when they are strong. The best recommendation is to communicate openly and honestly with one another. This enables you and your family to cope better with the cancer diagnosis. The entire adult family should discuss all aspects of the disease before you start treatment. This includes the type of mesothelioma, the prognosis, treatment options, goals of treatment, and side effects expected.

Our use of the term or terms Asbestos Claim is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Trans Vaginal Mesh Lawsuit Proceedings

By admin | Published January 26, 2012

Trans Vaginal Mesh Lawsuit : Any neurological lesion or condition that interrupts the cortical inhibition of detrusor contractions can result in neurogenic DO, eg multiple sclerosis or spinaL cord lesions. Urethral outflow obstruction can lead to incomplete bladder emptying, and subsequent symptoms of urgency and frequency. Treatment consists of a combination of bladder retraining and ‘bladder drill’, with anticholinergic medication to help relearn the cortical inhibition of detrusor contractions. This may be time-consuming and frustrating – correct diagnosis is necessary to ensure maximum patient compliance with this treatment.

Overflow incontinence occurs when the bladder, secondary to an injury or insult, becomes large and flaccid, and has Little or no detrusor tone or function. The condition is diagnosed when the urinary residual is more than 50% of the capacity. The bladder simply leaks as it becomes full. These injuries can occur because of injudicious and inappropriate care of the bladder after epidural anaesthesia. In the obstetric setting, lack of sensation or awareness in the mother, in combination with a busy postnatal ward, may mean that the mother does not pass urine for many hours after leaving the delivery suite. Inappropriate management, combined with a post-partum diuresis, can result in several overdistension injuries, compounding the original problem. Even a single episode of overdistension may result in permanently impaired detrusor function. The female bladder is especially sensitive to overdistension .

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Functional incontinence includes cases of UI where no organic cause can be found. Several other factors may be responsible for problems with incontinence due to interference with voiding behaviour. These include cognitive factors, such as dementia and learning difficulties, as well as physical factors, such as immobility and disability.

Symptomatic UTI is a cause of acute incontinence, especially in young women, often because of extreme frequency, urgency and pain. If symptoms persist, despite negative cultures, it is worth considering culture for fastidious organisms, such as Chlamydia trachomatis, Ureaplasma urealyticum or Mycoplasma hominis. Alternatively, empirical treatment might be considered. Atrophic urethritis and/or vaginitis in postmenopausal women are often associated with urinary tract symptoms. These conditions are due to epithelial and submucosal thinning of the urethra, with consequential irritation and loss of the mucosal seal. Incontinence associated with atrophic urethritis tends to be characterized by urgency and occasionally ‘scalding’ dysuria, and may be underreported.

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Alcohol and medications are major causes of acute incontinence in the elderly. Polypharmacy and the use of psychotropic medication compound problems with incontinence, and are most prevalent in women aged 85 years or over. The prevalence appears to be increasing . Nighttime incontinence can be exacerbated by return of peripheral oedema fluid in heart failure, peripheral venous insufficiency and hypoalbuminaemia. Other reasons for UI include cognitive impairment, such as dementia, as well as physical immobility and disability, and these may be responsible for exacerbating the impact of incontinence.

Our use of the term or terms Trans Vaginal Mesh Lawsuit is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Multaq FDA Proclamation

By admin | Published January 25, 2012

Multaq FDA : The first type of chronic hepatitis B is found in a person who carries hepatitis B, is HBsAg and HBcAb positive, but who has normal liver enzymes (AST and ALT), a normal physical exam, and is asymptomatic. Such a person is referred to as an in­active carrier of hepatitis B. HBeAg and HBV DNA are negative, and HBeAb is typically positive—indicating that this person is not infectious to others. Inactive carriers of HBV usually have minimal, if any, liver inflammation or damage. They usually live a normal life without any complications due to their liver disease. However, compared with the genera! population, these people are at a somewhat higher risk for cirrhosis and liver cancer. Therefore, regular observation—in the form of visits to the doctor approximately one to two times per year for a physical exam and blood tests—is necessary to check for early signs of disease progression.

In addition, these people are at risk for reactivation of the virus—return of HBeAg positivity. This occurs approximately 20 to 30 percent of the time. An in­dividual’s likelihood of reactivation increases if their immune system becomes suppressed. Such an occurrence may happen during treatment with immunosup­pressive drugs, such as steroids (prednisone, for example), or during a severe ill­ness, such as AIDS or cancer. Inactive carriers can also have flares of hepatitis. This may occur with or without the return of HBeAg and is noted by elevations in liver enzymes to approximately five to ten times the upper limit of normal. Repeated flares may lead to disease progression, liver scarring, and even liver failure.

Acute flares of hepatitis B should be distinguished from additional infection with hepatitis A, C, or D. Infection with an additional hepatitis virus is known as superinfection. It has been estimated that approximately 20 to 30 percent of such flares are due to superinfection with another hepatitis virus. Superinfection is as­sociated with an increased risk of liver failure.

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The probability each year that a person with chronic hepatitis B will develop cir­rhosis is about 2 percent. However, different studies have reported rates varying from 0.1 to 10 percent per year. The cumulative probability of progression to cir­rhosis over five years is approximately 15 to 20 percent. After the development of cirrhosis, the probability of developing serious complications, such as decom­pensated cirrhosis, is about 2 to 10 percent each year. The five-year survival rate after cirrhosis has developed varies from 52 to 80 percent. However, if a person has decompensated cirrhosis, the five-year survival rate decreases to between 14 and 35 percent.

More than 1 million people worldwide die each year from hepatitis B. So, why is it that some people can live a long healthy life with hepatitis B and others experience serious complications? Well, it has been demonstrated that there are many factors that influence the progression from a mild, innocuous illness to a grave outcome. These factors include advanced age, general poor health—tor ex­ample, depressed immune status such as additionally infection with HIV; the presence of advanced damage found on a liver biopsy sample; and the presence of markers of chronicity and active infectiousness, especially HBV DNA. Simi­larly, people who do not clear HBeAg (spontaneous remission) tend to have a more aggressive course than those who clear HBeAg. In fact, in some studies it has been shown that people who clear HBeAg rarely progress to cirrhosis. Fur­thermore, people who clear HBeAg. whether spontaneously or from treatment, have a decreased incidence of liver failure and an improved long-term survival rate. People who are additionally infected with the hepatitis delta virus (HDV) (see page 106) or the hepatitis C virus (see chapter 10) also have poorer prog­noses. In addition, it has been shown that the outcome of a person infected with HBV is highly dependent upon the stage at which she first obtained medical at­tention. Those people who have more advanced disease on liver biopsy samples when initially seen by a specialist have a shorter survival time. It has also been found that people with genotype C have a worse prognosis than those with other genotypes. Lastly, it has been demonstrated that people infected with HBV are more susceptible to the toxic effects of alcohol on the liver than are those with­out HBV. Therefore, it is important for people with chronic hepatitis B to avoid all intake of alcohol, as alcohol may worsen the course and accelerate the pro­gression of the disease. See chapter 17 for more information on alcohol’s effects on the liver.

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Hepatitis C is inflammation of the liver due to a virus called the hepatitis C virus (HCV). After the discovery of the hepatitis A virus in 1973 and the hepatitis B virus in 1963, the remaining hepatitis viruses were lumped into the category of non-A non-B (NANB) hepatitis. Any cases of acute or chronic hepatitis or cirrhosis with­out identifiable causes were suspected to be a result of the NANB hepatitis viruses. In 1989, a major breakthrough regarding this mysterious and intriguing disease occurred—the hepatitis C virus was identified. Now, HCV is believed to be the virus responsible for more than 90 percent of all cases of NANB hepatitis.

HCV is the most common cause of cirrhosis and liver cancer in the United States. More than 4 million Americans (approximately 2 percent of the United States population) and more than 170 million people worldwide (ap­proximately 3 percent of the world’s population) are infected with HCV. (HCV is more prevalent in Africa, the eastern Mediterranean, Southeast Asia, and the western Pacific than in the United States.) The Centers for Disease Control (CDC) estimates that only a small percentage (probably around 5 percent) of in­fected individuals are even aware that they harbor this virus in their bodies.

People between the ages of forty and fifty-nine are most likely to be diag­nosed with HCV. And it is estimated that there will be a fourfold increase in the number of adults diagnosed with HCV by the year 2015. While HCV can infect anyone with risk factors, it has been found to be more common among certain subgroups of people. For example, the prevalence of HCV among prison inmates is between 39 and 54 percent, among intravenous drug users between 70 and 90 percent, and among those attending Veterans Administration outpatient clinics between 18 and 40 percent.

While the incidence of people becoming acutely infected with HCV is de­creasing in the United States, approximately 8,000 to 12,000 deaths are attrib­uted to hepatitis C each year. Moreover, it is estimated that in the absence of appropriate therapy, this number will triple within the next two decades. In fact, chronic hepatitis C is the most common reason that a person will need to undergo a liver transplant in the United States.

Our use of the term or terms Multaq FDA is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Bladder Cancer Top News

By admin | Published January 25, 2012

Actos Bladder Cancer : You probably have already figured out that cystectomy is a surgical procedure performed under anesthesia in a hospital setting. Depending on what kind of bladder reconstruction you have, you may stay in the hospital anywhere from 5 to 14 days. The descriptions included here of medical procedures and treat­ments are of a general nature; your own experience may differ from what is discussed here. With cystectomy, an incision is made through the abdominal wall, so you can expect some mild discomfort at the incision site. The inci­sion will be covered, and you probably won’t be able to shower or get the incision wet for about a week to 10 days. You may have a drain from the incision, a flexible tube with a hollow bulb on the end that you will remove, empty, flush out, and reattach as needed. Your doc­tor will remove the drain (it’s painless) and any stitches or staples in a follow-up visit 10 days or so after your surgery.

Some possible complications include infection, bleeding, blood clots, or intestinal obstruction. You may experience some difficulties with your urinary diversion system. You’ll be asked to wait for a few weeks after surgery before you drive, and your doctors are likely to want you to refrain for several weeks from doing anything that strains the abdominal area, such as pushing and pulling a vacuum cleaner or lifting heavy objects or engaging in any other activity that might damage the scar or even pull the scar tissue apart, thereby risking the formation of a hernia. A her­nia occurs when your surgical scar pulls apart under the skin and allows a part of the underlying bowel to poke forward, creating a noticeable lump. It can interfere with the functioning of your bowel and therefore needs to be fixed, either with an external truss or sup­port, or possibly through another surgical operation.

It’s smarter just to avoid the risk in the first place by not stressing the scar soon after surgery. This is the time to take it easy and when possible allow friends or family to pamper you by helping with chores and housework. Just don’t get too used to having someone bring you the morning newspaper and a cup of coffeel Generally it’s a good idea to talk about this with your doctor and find out what you can and cannot safely do.There are some negative consequences of cystectomy that you should discuss thoroughly with your medical team. As mentioned above, there may be changes in urinary function. These will depend largely on the type of surgery and on whether an artificial bladder has been created. Sometimes while the abdominal tissues are healing after surgery there will be a period of irregular bowel function, during which you will unexpectedly have to deal with diarrhea or constipation.

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Occasionally there will be some swelling in one or both legs, due either to fluid retention or the formation of scar tissue around the lymph vessels that drain the legs. Often there will be the presence of an asymptomatic, low-grade chronic urinary tract infection that will be identified upon routine testing. This occurs because of the changed pattern of emptying the new bladder. Usually it causes no problems and doesn’t require active treatment with antibiotics. Other issues also arise. Worries about possible changes in sexual function are common, and very normal. Sexual function often does change after cystectomy That doesn’t mean you can’t have an active, playful, pleasurable sex life with your partner. It does mean that you’ll probably explore innovative strategies as you seek comfortable ways to experience fulfillment.

Men experience more extreme changes in sexual function after surgeiy than women do. Around half the men who undergo cystec­tomy experience nerve damage that leaves them impotent afterwards, a serious lifestyle change that is not only physical but emotional, requiring much thoughtful discussion between you, your partner, and your medical team both before surgery and after. If you are able to have an erection after surgery, you won’t be able to ejaculate, because ’without a prostate, your body is no longer able to produce semen. You’ll find that the physical sensation of orgasm is different from what you are accustomed to. It’s not unpleasant; just different. In general, the younger you are at the time of surgery, the more likely you will be to have erections or to regain over time the capability of having them. There are surgical procedures, such as penile inserts, that can help make sexual activity possible.

For women, a cystectomy includes the removal of the uterus and part of the vaginal wall. What does that mean for you? Well, for one thing, your vagina may be narrower as a result of the surgery. Usually it’s possible to continue to have intercourse, although sometimes there can be some pain involved. Be sure to talk to your doctor if you do experience pain as there are methods of reducing this.

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Most women diagnosed with bladder cancer already have experienced menopause. (Typically, women who receive diagnoses of bladder cancer are older.) For younger women, that may not be the case. The removal of the uterus and pos­sibly of other female organs near the Most women diagnosed bladder brings an abrupt end to the child- with bladder cancer bearing years. It may also set off typical already have experienced menopausal symptoms such as hot flash- menopause. (Typically, es or mood swings if the ovaries have women who receive been removed at surgery (removal of diagnoses of bladder ovaries is unusual). If you find yourself cancer are older.) feeling depressed or blue or uncomfort­able from hot flashes, talk to your doctor. You don’t have to feel that way; there are options available for you to consider.

As is recommended for men, talking with your partner and your medical team about the physical and emotional changes that you may experience after a cystectomy is an important part of the process, one that deserves as much consideration as the more immediate decisions about which treatment options you want to pursue. Keep in mind that cystectomy is a life-preserving weapon against invasive cancer. That doesn’t mean you can’t or shouldn’t consider the possibility of impotence or altered sexual function with your partner, or the inability to carry a child. It does offer the hope that you can celebrate many more years of healthy, loving life with your friends and family. That’s an important thing to remember at a time when life may seem to be serving you big helpings of despair.

Our use of the term or terms Actos Bladder Cancer is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Side Effects Info

By admin | Published January 25, 2012

Actos Side Effects : More information on Actos Side Effects

After the initial shock of being given a new diagnosis of cancer, a flood of emotions follow with fear and anxiety being foremost. Questions fill your mind:

How serious is it?

Can 1 be cured?

Am I going to die?

Will I suffer?

What treatments are available?

Can 1 do anything to improve my odds?

What side effects will occur from the treatments?

Will I lose time from work?

Will my insurance cover the cost?

Will I be disfigured?

Will my spouse and family be supportive?

Do 1 have a good doctor?

Bladder cancer, or any serious potentially life threatening illness is generally alien to most individuals. Suddenly, lives are changed and a new reality must be dealt with. Becoming a “patient” or worse “a cancer patient” is not only threatening, but a dreaded proposition. Cancer patients are not happy with the loss of autonomy, the invasion of privacy, the discomfort inflicted upon them and the demands on their time and quality of life. As a patient, being thrust into this altered identity, it is essential to seek out the information you need. Having a fundamental base of knowledge is a must when facing the issues and treatment decisions which lie ahead. In the following pages, together we will explore bladder cancer, a disease which is totally foreign to most of us until the diagnosis is made. I have chosen to present the information in a question and answer format, written in a conversational tone, as if I were having an extended consultation with one of my patients. The questions are typical of what individuals have asked over the years. 1 have covered the key issues and decisions the individual with bladder cancer may face. The answers are to the point and cover the essentials required to make an informed decision for most individuals. For others, a more detailed resource may be required. For helpful sources of additional information see the Appendix.

Each individual’s situation is unique. Decisions on treatment may be modified based on the patient’s preferences and values and altered by other considerations such as age and coexisting conditions. By becoming an individual knowledgeable of bladder cancer, you will be prepared to fully partner with your physician for your best possible outcome. To your companions and family members, this book will serve to answer the many questions and doubts that may arise. Having your loved ones informed and supportive is a big plus for the individual facing this new challenge.

The book is written in a logical sequence starting with finding a qualified urologist to the basics on bladder cancer, its assessment and treatment. At the end of the book, you will find chapters on complementary medicine, advance care planning, and hospice care. The book can be read in sequence or each chapter can serve as a resource covering the basics of the topic. It is my hope this book will help clarify the many issues and options individuals must face with bladder cancer. For family members, significant others and concerned friends, this resource should help improve your understanding and thus your ability to assist your loved one.

 

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Understanding bladder cancer is a tremendous first step that will assist you in your treatment. Having a qualified urologist administer the actual treatments and care for you is essential for the best possible outcome. In the following chapter, we will explore what you need to know to assure you have the right urologist.

BESIDES LEARNING ABOUT MY DISEASE, WHAT IS MY MOST IMPORTANT FIRST STEP?

Make sure you have an excellent urologist supervising your care. A urologist is a surgical specialist trained to care for conditions involving the male and female urinary tracts and the male reproductive system. The bladder is part of the urinary system, and a urologist is trained to care for problems involving it, including cancer.

IS IT IMPORTANT TO HAVE A BOARD CERTIFIED UROLOGIST?

A urologist board certified by The American Board of Urology has gone through an accredited urology training program (generally a four year program), following two years of internship and residency in surgery after four years of medical school. The urologist must be in practice after training and provide a detailed list of surgeries, including complications, over a twelve month period. The doctor will then take a two day oral and written test covering a wide spectrum of urology. If he passes, he is certified for a period of ten years. At the end of the ten year period, he must recertify to maintain his board status. Recertification entails a three month surgical and procedure log and a written test as well as reference letters from those in a position to judge the practicing urologist’s work. Any malpractice or judgments are also reviewed. Although being board certified does not guarantee you have an excellent urologist, it demonstrates that he has the fund of knowledge to practice urology competently. Even though board certification is voluntary, in today’s competitive environment more and more hospitals and insurance plans are requiring their specialists to be certified.

HOW CAN I TELL IF MY UROLOGIST IS BOARD CERTIFIED?

The urologist has worked hard to obtain board certification. The certificate from The American Board of Urology is often displayed openly in his office. If you do not see it, you can simply ask him or you can call 1-866-275-2267 or use this web site: www.certified doctor.org

SHOULD I TRY TO FIND A UROLOGIST WHO HAS BEEN IN PRACTICE FOR YEARS OR A NEWLY TRAINED ONE?

Surgery is a skill which can only be mastered with experience. The saying “practice makes perfect” definitely pertains to surgery. Although a urology training program offers the new physician years of training, his surgical skills will continue to improve with further experience. However, each individual physician has his own innate skills. Some more quickly learn and are simply better at the technical craft of surgery than others. For the most part, urologists finishing an accredited urology program have the training and skill set required to care for patients with bladder cancer.

Experience also counts. As a physician practices the art of medicine, his depth of knowledge and ability to treat grows. Ask your physician how long he has been treating patients with bladder cancer. If you require major surgery ask how many he has performed and if his complication rate matches what is expected.

Physicians by and large do improve as they practice, and all physicians are required to show that they are continuing to learn by partaking in continuing medical education, a requirement to remain licensed. Most physicians are compulsive in their medical practice and care deeply in the care they deliver. They continually strive to improve.

Some physicians may become “burned out” over the years as they continue to face the pressures of a busy medical practice. Similarly, towards the end of a surgeon’s career, technical skills may slip due to aging. New urologists are trained in the latest techniques and are familiar with recent medical literature, but may lack practical experience. In the end, recommendations from others and reputation may be your best guide to finding a qualified physician.

WHAT QUALITIES SHOULD MY UROLOGIST HAVE?

Ideally, you should have a competent, technically skilled surgeon who is also approachable and compassionate. You should be able to freely ask questions pertaining to your disease and treatment. Your physician should answer your questions forthrightly. Although some patients prefer a surgeon who will take over all aspects of care with no questions asked, most prefer in depth explanations, especially when alternatives exist and risks are involved.

Your urologist must be an individual who takes your concerns, priorities and values seriously. Your urologist should be a good communicator. It is his responsibility to keep you fully informed of your progress, make you aware immediately if things are not going well, and educate you fully in treatment alternatives. Your specific values should be incorporated into the decision process if alternatives are available. Even if your urologist makes a recommendation and you choose an alternative course (unless you are putting yourself in extreme jeopardy), he should honor your choice and continue his care of you. Becoming an educated patient will make your decision making process easier. Granted, your physician should provide you with the basics, however having time to review and digest the material will allow you to fully understand and accept your treatment regimen, providing you with peace of mind.

Beware of the physician who bombards you with statistics and studies and leaves the decision making to you. After all, you are not a physician and don’t have the practical hands on experience he does. Your physician should provide the facts and the statistics, guide you through the information, and make treatment recommendations based on your preferences.

You may find yourself emotionally distraught and overwhelmed. Having a physician on your side is invaluable. You should be able to trust your physician. Complete honesty on the part of your doctor in his care of you is a must. From the doctor’s point of view, trust is also a necessity. Physicians have an extremely difficult time dealing with individuals who do not trust them. Without trust, the physician patient relationship is extremely hindered.

Lastly, your urologist should be compassionate. Having cancer is tough enough, you shouldn’t have to deal with a rude or arrogant physician. Your urologist should be supportive at all times. He should treat you as an individual and not just as “another cancer patient.” People with bladder cancer will require long term follow up and care. Having a compassionate individual to work with will make a tremendous difference

HOW DO I FIND A GOOD BOARD CERTIFIED UROLOGIST?

A good starting point is your primary care physician. He will generally have a number of specialists to whom he generally refers his urology patients. If the primary care physician has been working with these urologists, he should have an appreciation of their skills and temperament. However, this does not mean he is referring you necessarily to the best available urologist in your area. His choices may be limited by insurance or hospital networks. An excellent source of information would be nurses who work in the operating room, recovery room or on the surgical floor where the urologist does his surgery. Asking friends or other individuals who have had experience with the urologist can also prove useful. After a little digging, you can often quickly learn what type of reputation the urologist has in the community. Generally, if an established urologist has a “good reputation” this is an indication that he has pleased many individuals with his care.

SHOULD I CHECK TO SEE HOW MANY TIMES MY UROLOGIST HAS BEEN SUED?

Given the litigious society we live in, most physicians can face at least one malpractice lawsuit during their careers. In urology, two of the most common causes of litigation would be a surgical mishap leading to a complication, or failure to diagnose cancer in a timely fashion.

Medicine is based on science, but also is an “art.” Individuals do not walk into their physicians offices with a diagnosis and treatment plan always readily apparent. Even the best intentioned, thorough physician will make mistakes. Most of these errors do not result in harm. On occasion they do, and a law suit may follow. If a physician develops a good working relationship with a patient, these bad outcomes more often than not are acknowledged and accepted without legal entanglement. Competent, busy physicians may be dealing with a higher mix of complicated patients, leading to a higher number of potential suits. Physicians who have poor “bed side manner” may find themselves dealing with more suits. If a physician has an inordinate number of suits, “red flags” should go up, as competency may be an issue.

For those individuals who wish to check out the malpractice history of their physician, you may request an inquiry from the National Practitioners Data Bank at: 1-800-767-6732 or check the web site: www.npdb-hipdb.com

Our use of the term or terms Actos Side Effects is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos and Bladder Cancer Bulletin

By admin | Published January 25, 2012

Actos and Bladder Cancer : BC is a disease of the environment and age . Populations are increasing in number, and they are growing old as well., . Since more people are living longer, more are at potential risk. Furthermore, the changing environments in developed and developing countries are causing more carcinogen concentration than can be associated to genesis of BC. Several carcinogens have been correlated to BC carcinogenesis.However, it has been proposed that other environmental factors could affect the incidence on urothelial tumors. In fact, as for many other cancers, molecular researchers try to establish genetic alterations linked to carcinogenesis that could justify genetic predisposition.

Cancer is a major public health problem. At the end of the twentieth century, more than 930,000 people died of cancer every year in 15 member countries of the European Union (EU) (Coleman et al. 2003). Using population projections, if the age-specific death rates remain constant, the absolute number of cancer deaths in 2015 will increase to 140,500 (Boyle and Ferlay 2005). BC is a worldwide health problem. In 2006 in Europe, there were an estimated 104,400 incident cases of BC

 

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diagnosed (82,800 in men and 21,600 in women) that represent a 6.6% of the total cancers in men and 2.1% in women. The estimated ratio by gender was 3.8:1, respectively. In men BC was the fourth most common cancer. Bladder cancer repre­sents a 4.1% of total deaths for cancer in men and 1.8% of total deaths in women (Ferlay et al. 2007). In the EU overall (27 countries), BC mortality rates were stable up to early 1990s, and declined, thereafter, by 16% in men and 12% in women, to reach values of 6 and 1.3/100,000, respectively, in the early years of the present decade. The only countries without declining mortality are Croatia and Poland in both sexes, Romania in men, and Denmark in women. This documented and quanti­fied reduction in BC mortality seems related to decrease in tobacco smoking, while its relationship with other risk factors remains controversial (Ferlay et al. 2008).In the United States, it is estimated that about 1.4 million new cases of cancer was diagnosed in 2008. Cancers of the prostate and breast are the most frequently diagnosed cancers in men and women, respectively, followed by lung and colorec­tal cancers in both men and in women. The fourth most common among men is the urinary BC. The 5-year relative survival rate for BC is 81% among whites and 65% among African-Americans (AAs) (taking the normal life expectancy into consider­ation) with an absolute difference of 16%. The survival rates for BC combined with certain site-specific cancer have improved significantly since the 1970s—being 74% during 1975-1977, 78% during 1984-1986, and 81% during 1996-2003.

 

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Contrary to this data, the prevalence of BC among Native Americans/Alaskan Natives (NA/AN) is generally considered to be low. Despite this low incidence, NA/AN men and women seem to be at relatively greater risk of dying from BC, once it has been diagnosed (Watson and Sidor 2008).Tobacco use is a major preventable cause of death, and especially involved in BC carcinogenesis. The year 2004 marks the anniversary of the release of the first Surgeon General’s report on Tobacco and Health, which initiated a decline in per capita cigarette consumption in the United States (Jemal et al. 2008).

In Egypt, where BC has always been related to bilharziasis, a significance decline of the relative frequency of BC was observed from 27.63% in the old series to 11.7% in the recent series. Bilharzias association dropped from 82.4% to 55.3% and there was a significant increase of transitional cell carcinoma from 16% to 65%, while squamous cell carcinoma was less frequent—from 76% to 28%. Intimately related to this, there was an increase in the median age of patients from 47 to 60 years. The decline in the frequency of BC is related to a decline in bilhar- zias egg positivity in the specimen, and this suggests a better control of the endemic disease in rural population. This trend of less association with bilharzias has changed the clinical and pathological characteristics of BC diagnosed, with signifi­cant predominance of transitional cell carcinoma and an increase in the age of patients, a pattern more similar to that in western series (Gouda et al. 2007).

The incidence and mortality rates associated with BC vary by country, ethnicity, gender, and age. For indeterminate causes, the AAs have only half the risk of white European Americans, but overall, the survival seems to be worse among the primer group. The higher incidence in European Americans is limited to superficial tumors, both groups having a similar risk of invasive tumor (Kirkali et al. 2005).

 

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