A mammogram is a special breast exam which projects the image of the inner breast tissues onto a film or a digital image. This procedure, called mammography, helps to get a clear view of the structures inside the breast. Even the very small tumors or cysts can be seen with a mammogram.

The Need for a Mammogram

A mammogram not only shows tumors, cysts and calcifications but also cancer, which cannot be found on breast self-examination. Usually, cancer can be felt by self-examination or examination by your doctor once it becomes large enough. However, a mammogram can detect the smallest cancers at a very early and and often curable stage.

Kinds of Mammograms

Screening Mammogram

A screening mammogram is done to detect cancer in women that could not be identified on breast self-examination or examination by the doctor.

Diagnostic Mammogram

A diagnostic mammogram is done to help confirm a diagnosis of cancer where a lump has already been detected on self-examination or by a doctor’s exam.

How Often Should You Have a Mammogram

Most healthy women do not need a mammogram until age 40. However, certain women are more likely to have breast cancer and should have a mammogram on a regular basis along with the breast self-examination as well as doctor’s exam. The following shows recommendations on how often you need a mammogram.

• All women should have a baseline mammogram between the ages of 35 to 40.
• After the age of 40, you should have a mammogram every year.
• Women with a family history of breast cancer or who have  been diagnosed with breast cancer, should have a mammogram earlier or more often than as mentioned above.

How to Prepare for a Mammogram

1. Cosmetics like powder, cream, oil, deodorant should not be used before the procedure as they might cause shadows and distort the image causing you to have the mammogram redone.
2. Wear two-piece clothing like pants or skirt and a shirt or that opens up the front to make undressing easier.
3. Make sure all of your previous mammogram results have been sent to the facility where you are having your current mammogram so the radiologist has them for comparison.
4. There are no diet restrictions for mammogram; products than contain caffeine should be avoided by women sensitive to caffeine as this might make the breast tender.
5. Don’t schedule a mammogram when your breasts are painful or tender. Breasts tend to be tender during the mentrual cycles (your period). Mammograms should also be avoided during the pre and post ovulatory period and premenstrual period. The best time for a mammogram is one or two weeks after your period.

The Mammogram Procedure

A mammogram is a simple, quick and easy procedure. You will be asked to remove all clothing or jewellery from your waist up. Then to stand in front of  special mammography machine. The breast is placed between two plastic “plates” and then plates then press together to flatten the breast. The flattening of the breast is done to get a clear image of the inner breast tissues. The compression of the panels on the breast can cause discomfort, but it is over quickly.

Usually two pictures are taken of each breast — craniocaudal view — where the picture is taken from above; and the mediolateral view where the picture is taken from the side. The radiologist may want more views taken if:
• your breasts are large.
• you have had breast augmentation or reduction.
• there is a breast implant.
• a previous mammogram showed an area of concern.

Risks of Having a Mammogram

Mammography is a very safe procedure. Any radiation used is a very small amount. However, it might have an effect on an unborn fetus. So,  women who are pregnant or are trying to conceive should tell their doctor and and the radiologist before having a mammogram.

Another possible risk is in women with implants. Due to the pressure of the plates pressing on the breast, the implant can be damaged. In such cases, surgery will be needed to remove the damaged implant.

Mammogram Results

• Normal — A normal mammogram means there are no malignant tissue changes seen in the breast and no breast cancer. In a normal result, mammograms are recommended every year. When a lump has been detected on self-examination, the radiologist may ask for an ultrasound to confirm the results.
• Abnormal — An abnormal mammogram shows a cyst, tumor or cancer. In an abnormal result, the radiologist may order for more tests to confirm the result. If cancer is suspected, a biopsy is recommended to confirm the cancer. After confirmation, the cancer can be treated with surgery, radiotherapy, chemotherapy and/or hormone treatment depending on the kind and aggressive nature of breast cancer found.
• Inaccurate — Though a rare case, an inaccurate mammogram may be found in women with breast implants, where the liquid of the implant or the surrounding scar tissues distort the picture. There are two types of “bad” results – false-positive and false-negative results. A false-positive mammogram shows the presence of cancer when in fact cancer is not there. In these cases a followup ultrasound, fine-needle aspiration or biopsy can be done to confirm the presence of cancer. A false-negative mammogram gives a normal result even though cancer is present. False positives happen mostly in younger women because of the density of the breast tissue, which makes it hard to interpret the mammogram.

A mammogram is an easy and safe procedure to determine breast cancer; usually done without  complications. Breast cancer detected at an early stage can be often be treated saving many lives.

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Anatomy

Thoracic Outlet Syndrome (TOS) is a condition affecting the
shoulder, arm, and hand. Nerves and blood vessels supplying the
arm and hand start at the side of the neck. Exiting from the side
of the spine, they travel between two muscles (the scalenes),
over the top of the rib cage (thorax), under the collar bone
(clavicle), through the arm pit (axilla) and down the arm to the
hand. The area where the nerves and vessels leave the neck
between the two scalene muscles and over the first rib is know as
the tos/thorox.gif”>Thoracic
Outlet.

Causes

There are probably several causes of TOS. The common
underlying cause of the syndrome is compression of the nerves and
arteries of the arm in the Thoracic Outlet. Some people
have an tos/toscx1.gif”>extra
first rib or an old fracture of the clavicle, which limits
the space for the vessels. A tos/toscx3.gif”>violent
injury, such as a car wreck while wearing a shoulder harness,
may also tear the scalene muscles. In the healing phases of this
type injury, scar tissue may form in the healing muscle, leading
to tos/sqz2.flc”>compression
of the nerves and vessels. Compression can also occur with
repetitive activities that require the arms to be held overhead
or extended forward. The more likely cause is slouching forward
and tos/slouch.flc”>dropping
the shoulders; causing tension in the muscles at side of the
neck and constricting the arteries and nerves.

Symptoms

tos/numb.flc”>Symptoms
of TOS include pain, weakness, numbness and tingling, swelling,
fatigue or coldness in the arm and hand. This syndrome can be very
difficult to diagnose. The symptoms can mimic many other
conditions, such as a herniated disk in the neck, carpal tunnel
syndrome, and even bursitis of the shoulder.

Diagnosis

Diagnosis of TOS can be difficult and frustrating. The history
and physical examination can be suggestive of TOS, but frequently
the symptoms are vague and difficult to track down. A chest xray
may show an extra cervical rib, and be helpful in the diagnosis.

tos/flash.flc”>Electrical
tests of the arm and special tests to check whether or not
the blood vessels that run with the nerve may be required to
confirm the diagnosis. Many times all of these test are negative
and the symptoms and examination must be relied on to make the
diagnosis.

Prevention/Treatments

Symptoms caused by variations in the bones and muscles may not
respond to physical therapies; however, good posture and overall
conditioning are very important in treating all causes of TOS.
Attention should be paid to the length of time the arms are used
in outstretched or overhead positions, and in heavy carrying and
lifting. Simple things like taking frequent breaks, changing
positions, stretching or using a hand truck or cart can bring
relief. More specific treatments and exercises may be prescribed
by a physician or physical therapist. Rehabilitation may begin
with a few exercises to loosen up tight muscles and joints around
the compressed nerves and blood vessels. To help restore normal
mobility, your therapist may prescribe stretching and massage for
the joints, muscles, and nerves.

Self Management

A home program of exercise is essential and must be performed
consistently to produce benefits. Postural exercises
Symptoms often respond to an exercise program addressing healthy
posture and muscle balance. Stretching and strengthening along
with awareness exercises can help achieve optimal posture.

Work management

Work hours can add up to problems. What changes can be
made to help avoid these problems?

Occupational ergonomics: A worksite specialist can
evaluate your workplace to determine safe alignment,
worksite postures, and work-related furniture.

Arm positions: Avoid holding your arms outward for
prolonged time periods.

Work heights: Avoid overhead activities,
especially if these positions bring on symptoms.

Helpful hints

Decrease tension on the shoulder straps of your seat
belt.

Use rest periods to decrease fatigue.

Women with large, pendulous breasts may benefit from a
strapless long-line bra.

Obese patients should seek advise for safe weight loss.

Symptom management

Shrug shoulders maximally and hold 30 to 60 seconds.

Lie on back with head tilted to the sore side.

Lie on back with shoulders partially shrugged.

Sleep modifications

If directed by your therapist, raise arms overhead for a
short period immediately before going to sleep.

Avoid sleeping on your stomach.

Pinning or strapping your arm to your side limits
sleeping with arms out or overhead.

Things to avoid

Heavy lifting, pulling, pushing.

Rapid breathing.

Stress.

Looking up, bending the neck back.

Elevating the arms for long periods.

Carrying bags with a strap on the sore-side shoulder.

Prevention and Long Term Management

Long term management of this problem will probably have
to rely on worksite alterations. Modifications may need
to be made in overhead activities and heavy lifting. The
primary aim, however, is to insure healthy work and
recreational postures.

Surgery

Surgery for Thoracic Outlet Syndrome is usually a last
resort. The tos/surg.flc”>surgery
is directed at removing the source of compression on the
nerves of the Brachial Plexus. If there is an extra rib
present, this is usually removed. Otherwise, surgery
consists of simply releasing the constricting elements
and scar tissue around the nerves.

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A fever is a body temperature above normal. A normal oral temperature for a resting, healthy adult is about 98.6°F (37°C). Your temperature can vary from 1 to 2 degrees throughout the day. Fever is an indication of inflammation or infection. Fever is not a disease. A fever is one way your body fights illness—your body temperature goes up to kill bacteria that cannot live at the higher temperatures. Although it may not be comfortable, a temperature of up to 102°F is generally good for you. Most healthy adults can tolerate a fever as high as 103°F to 104°F for short periods of time without having problems.

How to Take Your Temperature

Adults should take their temperature under the tongue. Taking a temperature under the armpit is not very accurate.

Mercury Thermometer

• Wash your hands with soap and warm water.
• Wash the thermometer in cold water.
• Make sure the top of the mercury is down near the bulb.
• To reset the thermometer, hold the thermometer firmly at the end opposite the mercury bulb and shake it with a downward flick of your wrist. This brings the mercury level down below the normal temperature level.
• Put the bulb end of the thermometer under your tongue and close your mouth. Keep your mouth closed while you take your temp.
• Wait 1 minute then take the thermometer out of your mouth. Hold the thermometer near light to read it; turn it slowly until you see the silver column of mercury. The number at the top of the mercury is your temperature. There is usually a mark on the thermometer showing a normal temperature at 98.6°F (37°C).
• Rinse the thermometer in cold water and clean it with alcohol before putting it away. Be sure to put it out of the reach of children because the mercury can be harmful if the thermometer is broken. What to Do if a Mercury Thermometer Breaks

Digital Thermometers

Digital thermometers can also be used but they can be expensive to buy. They are easy to read, as they have a large digital display for numbers. Before using, make sure the thermometer is clean and turned on. Remove the thermometer once it beeps. Clean it before you put it away.

How to Treat a Fever

• Increase the amount of liquids you’re drinking, especially water. Your body may try to cool itself by sweating and you should replace this loss of fluid.
• Take your temperature every two hours. Each time you take your temperature, write your temperature and the time.
• Take your temperature before the end of two hours if your other symptoms change. For example, if you start throwing up or your temperature is going up each time you take it.
• For fevers that are uncomfortable, sponge the body with lukewarm, not cold. water. Take acetaminophen, aspirin, or ibuprofen to get fever down. Do not give aspirin or products that contain aspiring to children or teens under the age of 20.
• Watch for signs of dehydration. Dehydration can happen if the fever causes you to sweat or you have other symptoms like vomiting or diarrhea. Signs of dehydration include: thirst, dry skin, dry mouth, chills, feeling tired or weak, and dark-colored urine.

When to Call Your Doctor

A fever is a symptom of a health problem and would be present along with other symptoms that mean you should call your doctor.

Fever in Newborns

Fever in newborns can be serious and should not be ignored.

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What is Gout?

Uric acid is made from the breakdown of purines (parts of tissues). This uric acid normally dissolves in the blood, goes through the kidneys and finally leaves the body in our urine. A disruption in this normal body process is a condition known as hyperuricemia. When the body fails to control the increase in uric acid, results in crystals of uric acid accumulating in joints or tissues of bones, or in both. Hyperuricemia is not dangerous, but when these crystals become hard, it causes an extremely painful condition called gout which is a form of arthritis.

Gout causes inflammatory arthritis (joint inflammation), swelling, redness, heat, stiffness in the joints and pain. A low fever of 99°F to 100°F is common. Rheumatic pain that affects tissues, joints, bones, muscles and other structures is called arthritis. Gout is responsible for about 5% of this type of arthritis. Gout is both a progressive and a chronic disease. This is because chronic gout may result in the formation of kidney stones. The deposits of hard lumps of uric acid, in the tissues and particularly in the joints, destroys the joints, reduces function of the kidney and ultimately stones in the kidneys.

Gouty arthritis is the most common inflammatory arthritis in men over the age of 40.

Gout can occur by itself, called primary gout, or along with other medical conditions, called secondary gout. Gouty arthritis is the most common inflammatory arthritis among men over the age of 40. Diagnosed after the detection of uric acid in the synovial fluid, the uric acid crystals can accumulate in the tissues around joints over many years. Chronic arthritis develops after repeated attacks of gouty arthritis. Gout can be treated even though it may be progressive.

Stages of Gout

In about 75% of people, gout begins by attacking the joints of the big toe. It eventually may involve the ankles, knees, fingers, and elbows. Attacks can last from several days to weeks. Months or years can go by between attacks with no symptoms. Attacks gradually occur more often, last longer and become more severe. Gout then progresses in four different stages:

• Asymptomatic Hyperuricemia – a stage in which there are no symptoms, but there are increased levels of uric acid. Treatment is not required.
• Acute Gouty Arthritis – this is the stage where crystals of uric acid begin to deposit in the joints causing swelling and pain. The affected area becomes warm and tender. Extreme pain attacks occur usually at night. Stressful events, alcohol or drugs, or even another illness may make the pain worse. Initial attacks get better in about 3 to 10 days, but over time attacks can be long lasting and more frequent.
• Intercritical Gout or Interval Gout – Between stages of acute gout, there are periods of normal joint function known as interval or intercritical gout. During this period, there very little, if any, pain or discomfort.
• Chronic Tophaceous Gout – this stage is acquired over a period as long as 10 years. Definitely a disabling stage, as by now, the affected joints or even the kidneys are completely damaged and beyond repair. However, patients given proper treatment in the first stages of gout can prevent this stage from happening.

Gout Causes

Though men and women can get gout, it affects men much more often. Gout affects men after puberty, but women are affected after menopause. Anyone who has undergone an organ transplant may be at the risk of developing gout at any age.

Heredity can be a cause for the occurrence of gout, but other factors are also responsible for gout. If both parents have gout, there is about a 20% chance the child will be affected as well.

Nutrition or eating habits also play a major role in gout. Unhealthy eating habits, such as eating too much junk food or alcohol—especially beer; high protein foods such as red meats, oily fish and yeast may increase the chances of gout. Very low-calorie diets can also be a factor.

Wearing shoes that don’t fit well may lead to gout.

Obesity and other nutrition factors such as starvation, dehydration or any kind of trauma are uncommon causes for gout.

Certain medicines can also cause gout. They lower the body’s ability to reduce uric acid levels in the blood. Aspirin, niacin also called nicotinic acid, cyclosporine, levodopa, are among some of the medicines that can cause gout. Certain medicines that treat tuberculosis—pyrazinamide and ethambutol—are also harmful. Diuretics used to treat heart diseases, hypertension and edema, can reduce the uric acid passed in the urine considerably, resulting in gout.

In addition to medicines, certain diseases can cause gout including lymphoma, leukemia and diseases related to hemoglobin disorders.

Gout Symptoms

Gout usually starts in the base of the big toe; acute gouty arthritis at the toe’s base is called podagra. Initial symptoms include swelling, redness, warmth, discoloration and tenderness in the affected area. The amount of the pain or tenderness cam be so bad that the mere touch of a bed sheet can be extremely painful. Gout also affects other joints such as knees, ankles, elbows, wrists, and fingers.

The first attack may go away within a few days or weeks with or without treatment. Over time, the attacks become more frequent and last longer. In addition to the local joint pain and swelling, you may also have a fever. The first attack may be in only one joint, but multiple joints may be involved as gout progresses.

The uric acid deposits, which cause the gout, may start forming the external parts of the body. The collection of urate crystals, called tophi, can be found on the elbows, ear lobes and on the back of the ankle (called Achilles ankle). The external crystals are not painful. Inside the body around the joints, these crystals collect in small liquid-filled sacs, called bursae, which lead to swelling and intense pain. Inflammation of the bursae is called bursitis. In chronic gout, these crystals can even be found in the vocal cords and spinal cord.

Kidney stones are is a major sign of the presence of gout. In rare cases, gout may cause complete kidney failure.

Insomnia, sleep loss, and loss of appetite can also be symptoms of gout.

Gout Diagnosis

Joint Aspiration

It can be difficult to diagnose gout, because the symptoms are sometimes vague and can be the same as joint infections. The most reliable test for gout is joint aspiration, called arthrocentisis. In this test, a sample of the synovial fluid of the affected area is taken with a syringe. This sample is then viewed under a microscope to check for the presence of urate crystals. If you have a medical history and symptoms of gout, you can be treated without undergoing joint aspiration.

Blood Tests

Blood tests may also be done to check cell counts, kidney function, and uric acid levels. Blood tests are not very reliable, because, during an actual gouty arthritis attack, there is an abnormal reduction in uric aid levels.

Xrays

An xray can help detect the presence of uric acid or damage to the bone due to repeated gout attacks.

Gout Treatment

The treatment of gout involves three major steps:

• stopping the immediate pain due to an inflammation
• take preventive measures for future gout attacks
• prevent the formation of more urate crystals as well as kidney stones

Successful treatment can be achieved by following a gout diet and taking gout medicines. Dietary changes include increasing fluids and reducing alcohol and beer intake.

As soon as you know you’re having an attack, get off your feet and elevate the affected joint. Stay off your feet until the most severe symptoms have gone away or gotten much better. This can help prevent another attack from happening. If the sheets cause pain on your toe, try creating a “tent” over your toe to prevent the sheets or blankets from putting pressure on your toe.

Take ibuprophen, ketoprophen or naproxen for pain relief. Do not take aspirin because aspirin can make it harder for your kidneys to get rid of the excess uric acid. If your doctor has prescribed medicine for you to take during an attack, take it exactly as prescribed. If the medicine causes nausea, vomiting, diarrhea or abdominal cramps, stop taking it and call your doctor.

You should call your doctor if you have a sudden onset of joint pain especially with pain, redness and swelling over the joint.

Gout Diet

Alcohol is a major contributor to acute gouty arthritis. Alcohol not only reduces the level of uric acid excreted from the kidneys but also causes dehydration. Both of which increase the collection of uric acid crystals in the joints. It is very important to stop or severely reduce alcohol consumption.

Seafood and organ meats—such as liver, brain, kidney, heart—are purine-rich foods. These foods should be left out of your diet. Your body converts the purine in food into uric acid. Instead, eat dairy products which do not have harmful effects in people with gout.

If you have gout, your diet should include vegetables, fruits, fruit juices, honey, garlic. Eat a lot of green leafy vegetables like cabbage. Juices from carrots, French beans, beet root, oranges and cucumbers are very effective in treating gout. Oranges, bananas, apples, grapes and cherries are good to include in your diet.

Gout Home Remedies

There are some home remedies, which help treat gout. Boiled and drained cabbage leaves can be wrapped in perforated paper and then bandaged on the affected area 3 to 4 times a day to help relieve the pain. Similarly, drinking honey and apple vinegar in equal quantities, mixed in a glass of water, can help the healing process.

In addition to diet, gout can be treated at home with home-made massage oils. Boil a mixture of rose petals and vinegar until both ingredients mix well. Cool the mixture and apply to the inflamed area to reduce pain. Soaking your foot in lukewarm water mixed with apple vinegar can also help. You can make an ointment with vinegar, black pepper and water: boil the water and vinegar, add 1 or 2 teaspoons of black pepper. Remove from he heat and let cool. Apply to the affected area.

Ice packs can also help relieve pain. Support your body weight so that the affected area does not bear weight. Using a cane or crutch may help.

Aerobic exercises are recommended can help you lose weight which can help cut down gout attacks as well as reduce the amount of weight on painful feet.

Gout Medicine

Gout medicines include pain killers, anti-inflammatory medicines to manage inflammation, and medicines to control the uric acid level.

Pain killers or relievers: Analgesics like acetaminophen (Tylenol) are used to control the pain.

Nonsteroidal Anti-Inflammatory Drugs – better known as NSAIDS: This class of medication is used to manage the inflammation caused by the uric acid crystals, but NSAIDs do not reduce the uric acid levels. The first medicines are indomethacin and naproxen, taken every day by mouth. If you are allergic to aspirin you should avoid NSAIDs. Intestinal ulcers and gastrointestinal irritation are common side effects of NSAIDs.

Corticosteroids: If you can’t take NSAIDs you doctor may prescribe corticosteroids—another kind of anti-inflammatory. Prednisone is the most common corticosteroid prescribed. Also known as adrenocorticotropic hormone (ACTH), corticosteroids are administered by mouth or as an injection into the muscle. Recovery is usually within a week. High blood pressure, changes in mood and difficulty controlling blood glucose levels are some of the side effects with short-term use of corticosteroids.

Colchicines: When NSAIDs and corticosteroids don’t work, you may be prescribed colchicine. This medicine is used to cure inflammation and prevent further attacks. When treating inflammation, the medicine is often given – once every hour until the pain is under control. Some colchicines are given once or twice a day to prevent further attacks. Side effects include vomiting, nausea and diarrhea.

In addition to these medicines, a few others which help fight gout including:

Probenecid: This uricosuric agent is not used as a treatment, but to prevent future attacks. While taking Probenecid, drink lots of fluid—this medicine works by helping the body get rid of excess uric acid through the kidneys. In rare cases it can cause the formation of kidney stones. Therefore, to avoid kidney stones, a high fluid intake is a must.

Allopurinol: A very reliable medicine used to reduced the level of uric acid in the blood. This medicine actually prevents the purines in food from being converted into uric acid. If you have kidney problems, be careful while taking this medicine as it can have severe side effects such as rash and liver damage. An extremely rare hypersensitivity may occur and can be fatal.

Febuxostat: Another very reliable and recent medicine used to lower uric acid levels in the blood. It is usually given every hour or two, until the pain is controlled. I can also be given to people with kidney problems. A side effect of this medicine is diarrhea. While you are taking this medicine, your uric acid and liver functions should be tested regularly.

Though, there are a number of medicines available to treat gout, yet it must be remembered that not all medicines can be given at the time of an acute gouty attack. At the time of inflammation, an anti-inflammatory drug must be given first and when the pain subsides only then can colchicines be given, after consultation with the doctor. This precaution should be taken since colchicines if given during the attack, increases the pain instead of reducing it.

Gout Prevention

If you have been diagnosed with gout, you may not be able to prevent it from developing but there are certain things you can do to help reduce the frequency or severity of attacks.

• Eat a healthy and balanced diet. Avoid foods that contain purines. Drink plenty of fluids every day (8-10 glasses of water) to help flush the uric acid out of your system. Eat fresh fruits and vegetables. Increase dairy products in your diet.
• Get to and keep up healthy body weight. Include regular, daily exercise.
• Reduce or eliminate the amount of alcohol you drink, especially beer. Alcohol increases the production of uric acid.
• Take all medicines exactly as prescribed. Report any problems to your doctor. Get an evaluation of new medicines you take to keep uric acid levels low as well as increase the elimination of uric acid through urine. Do not take aspirin.

Treating gouty arthritis is life-long and your lifestyle can help prevent it or at least reduce the symptoms.

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In kids and teens, BMI percentile assesses underweight, overweight, and the risk for becoming overweight. As children mature, body fatness changes as they develop. There are differences between boys and girls. For these reasons, BMI percentile for children is gender and age specific. You will find that your pediatrician will use gender specific growth charts. These charts are used for children and teens 2 – 20 years of age. The chart will show the following for BMI:

What does it mean if my child has a BMI greater than the 95th percentile?

If your child has a BMI greater than the 95th percentile, your child:

• Has a BMI higher than 95% of all children when compared to the same age and gender.
• Is considered to be overweight.
• Will most likely be overweight as an adult if lifestyle changes are not addressed
and changed.
• Is at risk for high blood pressure, cholesterol, and diabetes.

Below are specific strategies that should be a part of your child’s lifestyle:

Activity: Take Action!

• Activity goal: 60 minutes per day… but even 10 minutes of activity is healthy!
• Encourage all family members to be active every day – have fun together!
• Go for family walks, hikes, bike rides.
• Dance to your favorite music.
• Take kids to playgrounds and recreation centers.
• Park farther away from stores or malls.
• Take the stairs.
• Limit TV watching, to 1-2 hours a day.
• Limit computer and video games.

Nutrition: Eat Healthy!

• Serve fruits or vegetables at every meal (1 serving = ½-1 cup, or 1 small piece of fruit).
• Eat family meals together.
• Eat breakfast every day.
• Limit sweetened fruit drinks, sodas, fast foods, and fried foods.
• Reduce 2nd helpings and portion sizes.

Offer healthy choices…

• Chicken, turkey, fish or beans
• Snacks – low-fat popcorn, low-fat pretzels, vegetables and dip, or yogurt
• Bake, broil, boil or steam foods
• Breakfast – high fiber cereal, non-fat milk, fruit

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Whether you’re a dedicated athlete or weekend warrior your active life can lead to muscle and ligament injuries. This is a list of frequently asked questions that can help you prevent and treat sports injuries so you can get back in the game!

Q: What is a muscle strain?
A: Unlike a sprain, which is the stretching or tearing of a ligament, usually in the ankle, a strain in the stretching of a muscle or tendon. Most strains happen in the lower back and hamstring muscles in the back of the thigh.

Q: Can I avoid sports injuries?
A: It’s best to warm up your muscles with gentle exercise, like walking, for about 10-15 minutes. Keep yourself hydrated by drinking water before, during and after exercise or playing sports. It’s also important to cool down after activity.

Q: How can I stretch my upper body?
A: You can stretch your arms by extending them upward, your palms facing out and your fingers interlaced. Then slowly push your arms up and out. Hold the stretch for 20 seconds and repeat. Do side stretches by standing with your arms over your head, place the elbow of your left arm in your right hand and slowly bend toward your right side. Hold for 20 seconds. Then switch sides, holding your right arm in your left hand, and repeat stretch for 20 seconds.

Q: How can I stretch my lower body?
A:Stretch your legs by putting one foot about 2 feet in front of the other and slowly leaning forward until the knee of your front leg is directly over your ankle. Hold the stretch for 20 seconds. Repeat the stretch with your other leg. Stretch your calf by leaning against a wall with one foot in front of the other. Keep your back leg straight and your heel on the floor. Hold your stretch for 20 seconds. Repeat the stretch with your other leg.

Q: What should I not do when stretching?
A:Keep the tension on the muscle steady. Stretching shouldn’t be painful or uncomfortable. Don’t bounce when you stretch.

Q: How can I treat a muscle sprain or strain?
A: The first sign of an injury is usually pain and swelling to the injured area. For the first few days, use RICE therapy—Rest, Ice packs, Compression and Elevation.

Q: Can I take medicine to heal a muscle injury?
A:Non-prescription pain medicines, such as ibuprophen (NSAIDs) and acetominophen can reduce pain and swelling. Take these medicines according to package instructions. You can also relieve pain with ice packs. You can buy compression bandages at the pharmacy.

Q: When should I see a doctor?
A: See a doctor when you cannot walk without having a lot of pain, have numbness in an area or cannot move the injured area, you see redness or red streaks spreading out from the injured area.

More Articles About Sports Injuries

Sports injuries can include injury to knee bones, your feet and ankles, and even very serious spinal cord injuries.

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Spinal Cord Anatomy

Before you can understand a spinal cord injury, you should first learn about the anatomy—the structures and function—of the spinal cord and the spinal column including the cervical spine, thoracic spine and lumbar spine.

Spinal Cord Injury

• The spinal column—also known as the backbone—provides support for the body and protects the spinal cord. The spinal column includes vertebrae, intervertebral discs, muscles, tendons, and ligaments. The spinal column is divided into three sections—cervical, thoracic, and lumbar. Each section is named and each vertebra is numbered. There are seven cervical (C1-C7), twelve thoracic (T1-T12), five lumbar vertebrae (L1-L5), and one sacral (S1) vertebra.
• The nervous system includes the brain, spinal cord, and spinal nerves. The brain is the master control for all body functions. The spinal cord serves as the main line of communication between the brain and the body. The spinal nerves relay messages to and from the spinal cord and other parts of the body.
• There are three types of messages that travel along the spinal cord. They are sensory, motor, and reflex.
• Injury to the spinal cord results in loss of feeling and movement below the injured area. A complete injury means that there is total loss of feeling and movement below the injury. With an incomplete injury some feeling and/or movement will stay below the level of injury.
• Quadriplegia is an injury in which both the arms and legs are affected. Paraplegia is loss of function in the legs.
• There are many causes of spinal cord injury. The most common causes are accidents like automobile, diving, and falls. Other problems that cause spinal cord injury are Guillain Barre, Transverse Myelitis, tumors, and Spina Bifida.
• Spinal shock occurs immediately after a spinal cord injury. The result is a loss of reflexes, movement and feeling below the level of injury. The return of reflex activity signals the end of spinal shock..
• The reflex function of the spinal cord may remain after spinal cord injury. Depending on the level of injury, reflexes can be used for bowel and bladder emptying and for sexual functioning.
• Surgery may be needed to stabilize the spinal column and to prevent further injury to the spinal cord. For cervical injuries a wiring and fusion may be done. A halo device may be used to stabilize some types of cervical injuries. The halo is worn for 8 to 12 weeks while healing of the injured area takes place and allows the patient to be mobile. Harrington rods may be inserted for thoracic and lumbar injuries.

Spinal Cord Anatomy

To better understand a spinal cord injury,

What you should find about your spinal cord injury

• What is the level of your spinal cord injury?
• Do you have a complete or incomplete injury?
• Are you a quadriplegic or paraplegic?
• Do you have reflexes below your injury?
• Did you have surgery to your spinal column? If so, what type of surgery did you have?

Chart Showing Function After Spinal Cord Injury

Complete and Incomplete Spinal Cord Injury

• A complete spinal cord injury means there is a total blockage of signals at the point of injury. There will not be any feeling or movement below the level of injury. A complete spinal cord can change the control of all the functions of the nervous system.
• An incomplete spinal cord injury means that there is partial damage to the spinal cord. Some feeling and movement lost will depend on how much damage is done to the spinal cord. The way that the bowel and bladder empties often changes too.
• Today, as far as we know, injury to the spinal cord is permanent. Whether or not your spinal cord injury is complete or incomplete is not always known right after a spinal cord injury.

The Reflex Function

• After spinal cord injury, reflexes will remain intact above the level of injury. If the spinal cord injury is above T12 some reflexes will probably be present below the level of injury. If the spinal cord injury is below L1 you probably will not have reflexes below the injured level. It is important to know if you have reflexes below your level of
  

  injury so you will know how to care for your bowel and bladder.

Spinal Shock

• Immediately following a spinal cord injury the spinal cord goes into spinal shock. Spinal shock is a period of time when reflexes, movement, and feeling may be absent below the level of injury.
• Spinal shock may take hours, days, weeks, or months to resolve. The return of reflex activity below the level of injury is a sign that the person is coming out of spinal shock. The reason for spinal shock is not known.

Surgery to the Spinal Column

Surgery is most commonly done to stabilize the spinal column and to prevent more spinal cord damage. Damage may continue to occur if pressure remains on the cord. The type of surgery needed will depend on the type and level of injury.

Wiring And Fusion

• It is most often done on cervical injuries.
• The surgery may be done from the front or back of the neck depending on the type of injury.
• Surgery is done to the back of the neck most often.
• The bones (vertebrae) are put back into place if needed.
• The neck is positioned correctly, bone chips are removed from the hip and placed in the damaged area.
• The broken bones are wired together with the bone chips from the hip.
• A Philadelphia (hard) collar is worn for 6 to 8 weeks after surgery to add support to the repaired area until healing takes place.
• After 6 to 8 weeks x-rays are taken to make sure the bone chips have fused with the broken bones making a strong supportive backbone.

Halo

• A Halo device may be used when there is a cervical injury.
• The halo ring is attached to the bones of the head.
• The ring is then attached to a halo vest with bars, to keep the head and neck in one position while the injured area is healing.
• The halo is worn for 8 to 12 weeks.
• X-rays are taken to make sure the bones have healed together.

Harrington Rods

• Harrington rods stabilize the thoracic and lumbar areas of the spinal column.
• The rods are about 6 inches long and are made of stainless steel.
• During surgery, the rods are placed behind and on both sides of the spinal column.
• After surgery these patients will follow a limited program to avoid certain activities like pulling, twisting, and pushing up until healing has taken place. They will also wear a Jewett brace to keep from bending and twisting.
• The limited program lasts 6 to 8 weeks.
• X-rays are taken to make sure the bones are healing and the rods are in position.

Glossary for Spinal Cord Injury

Abdomen

The middle front part of the body (stomach area)

Cauda Equina

A bundle of nerves which branch off the end of the spinal cord and carry messages about bowel, bladder, and sexual function. It is located below the lumbar area of the spinal cord and looks like a horse’s tail.

Cervical

The neck area, where 8 cervical nerves carry messages for movement and feeling to the arms, the hands, the fingers and the diaphragm.

Diaphragm

The main muscle of breathing located under the rib cage.

Guillan Barre Syndrome

A rare illness that affects the spinal nerves as well as the cranial nerves which renders the nerves unable to carry messages for movement, feeling, reflexes, bowel and bladder control.

Harrington Rods

Stainless steel rods placed on the back part of the spinal column during surgery to stabilize thoracic and lumbar injuries.

Limited Program

Patients with Harrington Rods are placed on a “limited program” during which the person is not allowed to do certain activities that may put pressure on the rods, until healing has taken place.

Lumbar

Lower area of the back. The 5 lumbar nerves carry messages for movement and feeling to the legs and hips.

Motor Nerve

A nerve which carries movement messages.

Nerve

Connects the brain and spinal cord with parts of the body; carries messages for movement and feeling.

Nervous System

Includes the brain, spinal cord, and nerves. It controls almost all body functions.

Paralysis

Loss of movement and feeling.

Paraplegia

Paraplegia occurs when there is injury to the spinal cord in the thoracic, lumbar, or sacral area. This causes loss of feeling and movement in the chest, stomach area and legs.

Quadriplegia

Quadriplegia occurs when there is injury to the spinal cord in the cervical area. This causes loss of feeling and movement in the arms, chest, stomach area and legs.

Reflex

Movement of a muscle caused by a signal (pain, heat, pressure), that does not come from the brain. It goes from the muscle to the spinal cord and then back to the muscle.

Sacral (tailbone)

The lowest part of the back, includes five nerves which carry messages for movement and feeling to the legs, feet, bowel, bladder, and sexual organs.

Sensory Nerve

A nerve which carries feeling (touch, pressure, pain, temperature) messages.

Spasm

An uncontrolled muscle movement.

Spinal Column

The backbone, made up of many sections of bone (vertebrae) stacked one on top of the other. The spinal cord runs down through a canal in the middle of this column.

Spinal Cord

Carries messages about movement and feeling to and from the Brain; contains reflex centers.

Spinal Fluid

Fluid which flows around the brain and spinal cord protecting them from the injury.

Spinal Shock

A period of time when reflexes, movement and feeling are absent below the level of injury.

Tetraplegia

Paralysis affecting the arms, chest, stomach area and legs.

Thoracic

The upper and mid back area, where twelve nerves carry messages for movement and feeling to the mid body.

Vertebrae

Bones which make up the backbone.

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What Is Breast Cancer?

Breast cancer, a common cancer in women, is a disease in which cancer (malignant) cells are found in the tissues of the breast. Each breast has 15-20 sections called lobes, which have many smaller sections called lobules. The lobes and lobules are connected by thin tubes called ducts. The most common type of breast cancer is ductal cancer. It is found in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma. Lobular carcinoma is more often found in both breasts than other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer. In this disease, the breast is warm, red, and swollen.

The genes in your cells carry the hereditary information that you got from your parents. Sometimes, a test can be done to look for a gene that may be associated with a certain hereditary trait. Recently, a gene was found to be defective in 5% of breast cancer patients. Hereditary breast cancer makes up about 5%-10% of all breast cancer cases. Relatives of breast cancer patients who carry this defective gene may be more likely to develop breast or ovarian cancer. Tests are being developed to find who has the genetic defect long before any cancer appears.

You should see your doctor if you notice changes in your breast. Women older than 50 years of age should also have a special x-ray called a mammogram, which may find tumors that are too small to feel. Check with your doctor on how often you should have this xray.

If you have a lump in your breast, your doctor may need to cut out a small piece and look at it under the microscope to see if there are any cancer cells. This procedure is called a biopsy. Sometimes the biopsy is done by inserting a needle into the breast and drawing out some of the tissue. If the biopsy shows that there is cancer, it is important that certain tests (called estrogen and progesterone receptor tests) be done on the cancer cells.

Estrogen and progesterone receptor tests may tell whether hormones affect the way the cancer grows. They may also give information about the chances of the tumor coming back (recurring). The results help your doctor decide whether to use hormone therapy to stop the cancer from growing. Tissue from the tumor needs to be taken to the laboratory for estrogen and progesterone tests at the time of biopsy because it may be hard to get enough cancer cells later, although newer techniques can be used on tissue that is not fresh.

About 15%-20% of breast cancers are sometimes called carcinoma in situ (found only in the duct area). They may be either ductal carcinoma in situ (sometimes called intraductal carcinoma) or lobular carcinoma in situ. Sometimes lobular carcinoma in situ is found when a biopsy is done for another lump or when an abnormality is found on the mammogram. Even though it is referred to as a cancer, it is not actually cancer. However, patients with this condition have a 25% chance of developing breast cancer in either breast in the next 25 years.

Your chance of recovery (prognosis) and choice of treatment depend on the stage of your cancer (whether it is just in the breast or has spread to other places in the body), the type of breast cancer, certain characteristics of the cancer cells, and whether the cancer is found in your other breast. Your age, weight, menopausal status (whether you still have menstrual periods), and general health can also affect your prognosis and choice of treatment.

Once breast cancer has been found, more tests will be done to find out if the cancer has spread from the breast to other parts of the body. This is called staging. To plan treatment, your doctor needs to know the stage of your disease. The following stages are used for breast cancer.

How Breast Cancer Is Treated

There are treatments for all patients with breast cancer. Four types of treatment are used:

• Surgery (taking out the cancer in an operation)
• Radiation therapy (using high-dose x-rays to kill cancer cells)
• Chemotherapy (using drugs to kill cancer cells)
• Hormone therapy (using hormones to stop the cells from growing).
• Biological therapy (using your body’s immune system to fight cancer) and
• Bone Marrow transplantation are being tested in clinical trials.

Surgery

Most patients with breast cancer have surgery to remove the cancer from the breast. Usually, some of the lymph nodes under the arm are also taken out and looked at under a microscope to see if there are any cancer cells. Different types of surgery are used:

Surgery To Conserve The Breast:

Other Types Of Surgery:

Reconstructive Surgery:

The TRAM Flap Procedure
Identification of target and donor sites	Raising the flap and trans- posing it to the target site	Resulting reconstruction

Radiation therapy

is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).

Chemotherapy

is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth or it may be put into the body by inserting a needle into a vein or muscle. Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells outside the breast area.

If tests show that the breast cancer cells have estrogen receptors and progesterone receptors, you may be given hormone therapy. Hormone therapy is used to change the way hormones in the body help cancers grow. This may be done by using drugs that change the way hormones work or by surgery to take out organs that make hormones, such as the ovaries. Hormone therapy with tamoxifen is given for 5 years in patients with early (no lymph nodes involved). Hormone therapy with tamoxifen or estrogens can act on cells all over the body and may increase your chance of getting cancer of the uterus. You should go to your doctor for a pelvic examination every year, and you should report any vaginal bleeding other than your menstrual period to your doctor as soon as possible.

If your doctor removes all the cancer that can be seen at the time of the operation, you may be given radiation therapy, chemotherapy, or hormone therapy after surgery to try to kill any cancer cells that may be left. Therapy given after an operation when there are no cancer cells that can be seen is called adjuvant therapy.

Biological therapy

tries to get your body to fight cancer. It uses materials made by your body or made in a laboratory to boost, direct, or restore your body’s natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy. This treatment is now only being given in clinical trials.

Bone marrow transplantation

is a newer type of treatment that is being studied in clinical trials. Sometimes breast cancer becomes resistant to treatment with radiation therapy or chemotherapy. Very high doses of chemotherapy may then be used to treat the cancer. Because the high doses of chemotherapy can destroy your bone marrow, marrow is taken from your bones before treatment. The marrow is then frozen and you are given high-dose chemotherapy with or without radiation therapy to treat the cancer. The marrow you had taken out is then thawed and given to you through a needle inserted into a vein to replace the marrow that was destroyed. This type of transplant is called an autologous transplant. If the marrow you are given is taken from another person, the transplant is called an allogeneic transplant.

Peripheral blood stem cell transplant

is another type of autologous transplant. Your blood is passed through a machine that removes the stem cells (immature cells from which all blood cells develop) and then returns your blood to you. This procedure is called leukapheresis and usually takes 3 or 4 hours to complete. The stem cells are treated with drugs to kill any cancer cells and then frozen until they are transplanted to you. This procedure may be done alone or with an autologous bone marrow transplant.

A greater chance for recovery occurs if your doctor chooses a hospital that does more than five bone marrow transplantations per year.

Treatment By Stage

Treatment for breast cancer depends on the type and stage of your disease, your age and menopausal status, and your overall health.

You may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to go into a clinical trial. Not all patients are cured with standard therapy and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information. Clinical trials are going on in most parts of the country for all.

Treatment For Breast Cancer In Situ

Your treatment depends on whether you have ductal carcinoma in situ or lobular carcinoma in situ. Since it is difficult to distinguish between these two types, it may be helpful to have a second opinion by having your biopsy preparations (slides) studied by pathologists at another hospital.

If you have ductal carcinoma in situ, your treatment may be one of the following:

1. Surgery to remove the whole breast (total mastectomy).
2. Surgery to remove only the cancer (lumpectomy) followed by radiation therapy.
3. Clinical trial of surgery to remove only the cancer (lumpectomy) followed by radiation therapy with or without hormone therapy.

Rarely, some of the lymph nodes under the arm may also be removed during the above surgeries.

If you are going to have a mastectomy, you may want to think about having breast reconstruction (making a new breast mound). It may be done at the time of the mastectomy or at some future time. The breast may be made with your own (non-breast) tissue or by using implants. Different types of implants can be used. The Food and Drug Administration (FDA) has announced that breast implants filled with silicone gel may only be used in clinical trials. Saline-filled breast implants, which contain saltwater and not silicone gel, may also be used. Before you decide to get an implant, you may call the FDA (1-800-532-4440) to get more information, then discuss any questions you have with your doctor.

If you have lobular carcinoma in situ (LCIS), you have a marker for a higher risk of an invasive cancer in both breasts: about a 25% chance over 25 years. LCIS is not breast cancer, and many women with LCIS never develop breast cancer. The treatment options for LCIS are varied and quite controversial. Your treatment may be one of the following:

1. Biopsy to diagnose the LCIS followed by regular examinations and yearly mammograms to find any changes as early as possible.
2. A large clinical trial is testing hormone therapy with the drug tamoxifen to see whether it can prevent cancer from occurring. You can call the Cancer Information Service for more information (1-800-4-CANCER).
3. Surgery to remove both breasts, called total mastectomy.

Treatment For Stage I Breast Cancer

Your treatment may be one of the following:

1. Surgery to remove only the cancer and some surrounding breast tissue (lumpectomy) or to remove part of the breast (partial or segmental mastectomy); both are followed by radiation therapy. Some of the lymph nodes under the arm are also removed. This treatment provides identical long-term cure rates as those from mastectomy. Your doctor’s recommendation on which procedure to have is based on tumor size and location and its appearance on mammogram.
2. Surgery to remove the whole breast (total mastectomy) or the whole breast and the lining over the chest muscles (modified radical mastectomy). Some of the lymph nodes under the arm are also taken out.

Adjuvant therapy (given in addition to the treatments listed above):

1. Chemotherapy.
2. Hormone therapy. If you receive a drug called tamoxifen, you will probably take it for 5 years.
3. Clinical trials of adjuvant chemotherapy in certain patients.
4. Clinical trials of no adjuvant therapy for patients with a good chance of recovery (prognosis).
5. Clinical trials of treatment to keep your ovaries from working.

If you are going to have a mastectomy, you may want to think about having breast reconstruction (making a new breast mound). It may be done at the time of the mastectomy or at some future time. The breast may be made with your own (non-breast) tissue or by using implants. Different types of implants can be used. The Food and Drug Administration (FDA) has announced that breast implants filled with silicone gel may only be used in clinical trials. Saline-filled breast implants, which contain saltwater and not silicone gel, may also be used. Before you decide to get an implant, you may call the FDA (1-800-532-4440) to get more information, then discuss any questions you have with your doctor.

Treatment For Stage II Breast Cancer

Your treatment may be one of the following:

1. Surgery to remove only the cancer and some surrounding breast tissue (lumpectomy) or to remove part of the breast (partial or segmental mastectomy). Some of the lymph nodes under the arm are also removed. Radiation therapy is given following surgery. This treatment provides identical long-term cure rates as those from mastectomy. Your doctor’s recommendation on which procedure to have is based on tumor size and location and its appearance on mammogram.
2. Surgery to remove the whole breast (total mastectomy) or the whole breast and the lining over the chest muscles (modified radical mastectomy). Some of the lymph nodes under the arm are also taken out.

Adjuvant therapy (following surgery):

1. Chemotherapy with or without hormonal therapy.
2. Hormone therapy. If you receive a drug called tamoxifen and your lymph nodes are not involved, you will probably take it for 5 years
3. Clinical trial of chemotherapy before surgery (neoadjuvant therapy).
4. Clinical trials of high-dose chemotherapy with bone marrow transplantation for patients with cancer in more than three lymph nodes.

If you are going to have a mastectomy, you may want to think about having breast reconstruction (making a new breast mound). It may be done at the time of the mastectomy or at some future time. The breast may be made with your own (non-breast) tissue or by using implants. Different types of implants can be used. The Food and Drug Administration (FDA) has announced that breast implants filled with silicone gel may only be used in clinical trials. Saline-filled breast implants, which contain saltwater and not silicone gel, may also be used. Before you decide to get an implant, you may call the FDA (1-800-532-4440) to get more information, then discuss any questions you have with your doctor.

Treatment For Stage III Breast Cancer

Stage III breast cancer is further divided into stage IIIA (can be operated on) and IIIB (biopsy is usually the only surgery performed).

Stage IIIA cancer:

1. Your treatment may be one of the following surgeries: Surgery to remove the whole breast and the lining over the chest muscles (modified radical mastectomy) or the whole breast and the chest muscles (radical mastectomy). Some of the lymph nodes under the arm are also taken out.
2. Radiation therapy given after surgery.
3. Chemotherapy with or without hormone therapy given with surgery and radiation therapy.
4. Clinical trials are testing new chemotherapy with or without hormonal drugs; they are also testing chemotherapy before surgery (neoadjuvant therapy).
5. Clinical trials of high-dose chemotherapy with bone marrow or peripheral stem cell transplantation.

Stage IIIB Cancer:

Your treatment will probably be biopsy followed by radiation therapy to the breast and the lymph nodes. In some cases, a mastectomy may be done following radiation therapy.

1. Chemotherapy to shrink the tumor, followed by surgery and/or radiation therapy.
2. Hormonal therapy followed by additional therapy.
3. Clinical trials are testing new chemotherapy drugs and biological therapy, new drug combinations, and new ways of giving chemotherapy.
4. Clinical trials of high-dose chemotherapy with bone marrow or peripheral stem cell transplantation.

Treatment For Stage IV Breast Cancer

You will probably have a biopsy and then be given one or more of the following:

1. Radiation therapy or, sometimes, a mastectomy to reduce your symptoms.
2. Hormonal therapy with or without surgery to remove your ovaries.
3. Chemotherapy.
4. Clinical trials are testing new chemotherapy and hormonal drugs and new combinations of drugs and biological therapy.
5. Clinical trials of high-dose chemotherapy with bone marrow or peripheral stem cell transplantation.

Treatment For Inflammatory Breast Cancer

Your treatment will probably be a combination of chemotherapy, hormonal therapy, and radiation therapy, which may be combined with surgery to remove the breast. The treatment is usually like that for stage IIIB or IV breast cancer.

Treatment For Recurrent Breast Cancer

Breast cancer that comes back (recurs) can often be treated, but usually cannot be cured when it recurs in another part of the body. Some patients with recurrence in the breast can be cured, however. Your choice of treatment depends on hormone receptor levels, the kind of treatment you had before, the length of time from first treatment to when the cancer came back, where the cancer recurred, whether you still have menstrual periods, and other factors.

Your treatment may be one of the following:

1. Hormonal therapy with or without surgery to remove your ovaries.
2. For the small group of patients whose cancer has come back only in one place, surgery and/or radiation therapy.
3. Radiation therapy to help relieve pain due to the spread of the cancer to the bones and other places.
4. Chemotherapy.
5. A clinical trial of new chemotherapy drugs, new hormonal drugs, biological therapy, or bone marrow transplantation.

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Urinary tract infections are a serious health problem affecting millions of people each year. Infections of the urinary tract are common — only respiratory infections occur more often.

Each year, urinary tract infections (UTI’s) account for about eight million doctor visits. Women are especially prone to UTI’s. One woman in five will develop a UTI during her lifetime.

The Urinary Tract

The urinary system is made up of the kidneys, ureters, bladder, and urethra. The key players in the system are the kidneys, a pair of purplish-brown organs located below the ribs toward the middle of the back. The kidneys:

• remove liquid waste from the blood, as urine
• keep a stable balance of salts and other substances in the blood, and
• produce a hormone that aids in the formation of red blood cells.

Narrow tubes, called ureters, carry urine from the kidneys to the bladder, a triangle-shaped chamber in the lower abdomen. Urine is stored in the bladder and emptied out of the body through the urethra.

The average adult passes about a quart and a half of urine each day. The amount of urine varies, depending on the fluids and foods a person eats and drinks. The volume of urine produced at night is about half that produced in the daytime.

Causes of UTI

Normal urine is sterile. It contains fluids, salts, and waste products, but it is free of bacteria, viruses, and fungi. An infection occurs when microorganisms, usually bacteria from the digestive tract, cling to the opening of the urethra and begin to multiply. Most UTIs arise from one specific type of bacteria, Escherichia coli or E. coli, which normally lives in the colon.

In most cases, bacteria start growing in the urethra. An infection that is limited to the urethra is called urethritis. From the urethra bacteria often move to the bladder, causing a bladder infection, called cystitis. If the infection is not treated right away, bacteria then goes up the ureters and infects the kidneys, called pyelonephritis.

Microorganisms called chlamydia and strong>mycoplasma can also cause UTI’s in both men and women. However, these type infections tend to remain in the urethra and reproductive system. Unlike E. coli, chlamydia and mycoplasma can be sexually transmitted. Infections caused by chlamydia or mycoplasma require treatment of both sex partners.

The urinary system is structured in a way that helps prevent infection. The ureters and bladder normally prevent urine from backing up toward the kidneys. The flow of urine from the bladder helps wash bacteria out of the body. In men, the prostate gland produces secretions that slow bacterial growth. Immune defenses also prevent infection in both men and women. Despite your body’s safeguards, infections can still occur.

Who is at Risk for UTI

Some people are more prone to getting a UTI than others. Any abnormality of the urinary tract that obstructs the flow of urine, for example a kidney stone, sets the stage for an infection. An enlarged prostate gland can slow the flow of urine and increase the risk of UTI.

A common source of UTI is catheters, or tubes, placed in the bladder. Someone who cannot urinate, is in a coma, or is critically ill, often needs a catheter that must remain in the bladder for a long time. Some people, especially the elderly or those with nervous system disorders who lose bladder control, may need a catheter for life. Bacteria on the catheter can cause infection in the bladder.

People with diabetes have a higher risk of a UTI because of changes in their immune
system caused by their diabetes. Any disorder that suppresses the immune system raises the risk of a urinary tract infection.

UTI’s may occur in babies born with abnormalities of the urinary tract and may need to be corrected with surgery. UTI’s rarely happen in boys and young men. In women, though, the rate of UTI’s gradually increases with age. Scientists are not sure why women have more urinary infections than men. One factor may be that a woman’s urethra is shorter than a male’s. This allows bacteria quicker access to the into the bladder. Also, a woman’s urethral opening, called the meatus, is near the anus and vagina, both are sources of bacteria. Also, for many women, sexual intercourse seems to trigger an infection, although the reasons are unclear.

According to several studies, women who use a diaphragm are more likely to develop a UTI than women who use other forms of birth control. Recently, researchers found that women whose partners use a condom with spermicidal foam also tend to have growth of E. coli bacteria in the vagina.

Recurrent Urinary Tract Infections

Many women suffer from frequent UTI’s. Nearly 20 percent of women who have a UTI will
have another; thirty percent of those will have yet another. Of the last group, 80 percent will have recurrences.

Usually, each infection is caused by type of bacteria that is different from the infection before, indicating a separate infection. Even when there are several UTI’s in a row caused by e. coli, slight differences in the bacteria indicate separate, distinct infections.

Studies suggests that one factor behind recurrent UTI’s may be the ability of bacteria to attach to cells lining the urinary tract. A recent study has also shown that women with recurrent UTI’s tend to have certain blood types. Some scientists speculate that women with these blood types are more prone to UTI’s because the cells lining the vagina and urethra may allow bacteria to attach more easily. Further research will show whether this association is correct and may prove useful in identifying those women who are at high risk for UTI’s.

Urinary Tract Infections in Pregnancy

Pregnant women do not seem to be more prone to UTI’s than other women. However, when a UTI does occur, it is more likely to travel to the kidneys. According to some reports, about 2 to 4 percent of pregnant women develop a urinary infection. Scientists think that hormonal changes and shifts in the position of the urinary tract during pregnancy make it easier for bacteria to travel up the ureters to the kidneys. For this reason, many doctors recommend periodic testing of urine during pregnancy.

Symptoms of Urinary Tract Infection

Not everyone with a UTI has symptoms, but most people have some. Symptoms can include a frequent urge to urinate and a painful, burning feeling in the area of the bladder or urethra during urination. It is not unusual to feel bad all over — such as tired, shaky, or "washed out" — and to feel pain even when not urinating. Often, women feel an uncomfortable pressure above the pubic bone. Some men experience a fullness in the rectum. It is common for a person with a urinary infection to complain that, despite the urge to urinate, only a small amount of urine is passed. The urine itself may look milky or cloudy, even reddish if blood is present. A fever may mean that the infection has reached the kidneys. Other symptoms of a kidney infection include pain in the back or side just below the ribs, nausea, or vomiting.

In children, the symptoms of a urinary infection may be overlooked or attributed to another disorder. A UTI should be considered a possibility when a child or infant seems irritable, is not eating normally, has an unexplained fever that does not go away, has leaking urine or loose bowels, or is not growing properly. The child should be seen by a doctor if there are any of these symptoms; especially if there is a change in the child’s urinary pattern.

Diagnosis of Urinary Tract Infection

To find out whether or not you have a UTI, your doctor will test a sample of urine for pus and bacteria. You will be asked to give a "clean catch" urine sample.

How to do a clean catch urine specimen

Wash the genital area and collect a "midstream" sample of urine in a sterile container. Catching urine this way helps prevent bacteria from the genital area from getting into the sample.

The sample is usually sent to a laboratory. However, some doctors’ offices are able to do the testing. The urine is checked for both white and red blood cells, and bacteria. The bacteria are grown in a culture, and tested against different antibiotics to see which medicine works best to kill the bacteria.

Some microbes, like chlamydia and mycoplasma, can only be detected with special bacterial cultures. A doctor suspects one of these infections if you have the symptoms of a UTI and pus in the urine, but a standard culture fails to grow bacteria.

When an infection does not clear up with treatment and is traced to the same strain of
bacteria, the doctor will order other tests to take pictures of the urinary tract. One of these tests is an intravenous pyelogram, which is an x-ray of the bladder, kidneys, and ureters. A dye that can be seen with an x-ray is injected into a vein, and several x-rays are taken. The xray shows an outline of the urinary tract, and any small changes in the structure of the urinary tract.

If you have recurrent UTI, your doctor may recommend an ultrasound,
which is a test that shows pictures of the urinary tract using sound waves. Another useful test is cystoscopy. A cystoscope is an instrument made of a hollow tube with several lenses and a light source. A cystoscope allows the doctor to actually look inside the bladder.

Treatment Of Urinary Tract Infection

UTI’s are treated with antibacterial medicines. The type of medicine and how long the treatment lasts depends on your health history and the results of the urine tests. The sensitivity test is very useful in helping the doctor choose the most effective medicine. The medicines used most often to treat routine, uncomplicated UTI’s are trimethoprim (Trimpex), trimethoprim/sufamethoxazole (Bactrim, Septra, Cotrim), amoxicillin (Amoxil, Trimox, Wymox), nitrofurantoin (Macrodantin, Furadantin), and ampicillin.

A UTI can often be cured with 1 or 2 days of treatment if the infection is not complicated by an obstruction or nervous system disorder. Still, many doctors ask their patients to take antibiotics for a week or two to assure that the infection has been cured. Single-dose treatment is not recommended for some patients, for example, those who have waited before getting treatment and have signs of a kidney infection, patients with diabetes or structural abnormalities, or men who have prostate infections. Longer treatment may also needed by patients with infections caused by mycoplasma or chlamydia, which are usually treated with tetracycline, trimethoprim/sulfamethoxazole (TMP/SMZ), or doxycycline. A follow-up urinalysis helps to confirm that the urinary tract infection has been cured. It is important to take all of the medicine prescribed even though the symptoms may go away before the infection is completely cured.

Patients who are very sick with kidney infections may be hospitalized until they can drink fluids and take needed medicines by themselves. Kidney infections often require several weeks of antibiotic treatment.

Various medicines are available to relieve the pain of a UTI. A heating pad or a warm bath may also help. Most doctors suggest drinking plenty of water to help cleanse the urinary tract of bacteria. It is best to avoid coffee, alcohol, and spicy foods if you have a UTI. One of the best things a smoker can do for the bladder is to quit smoking. Smoking is the major known cause of bladder cancer.

Recurrent Infections in Women

About 4 out of 5 women who have a UTI get another within 18 months; many women have them more often. A woman who has frequent three or more UTIs each year should ask her doctor about one of the following treatment options:

• Low doses of an antibiotic such as TMP/SMZ or nitrofurantoin daily for 6 months or longer. If taken at bedtime, the drug remains in the bladder longer and may be more effective.
• A single dose of an antibiotic after sexual intercourse.
• A short course, 1 or 2 days, of antibiotics whenever symptoms appear.

Dipsticks that change color when there in an infection present are now available without prescription. The strips detect nitrite, which is formed when bacteria change urine to nitrate. The test can detect about 90 percent of UTI’s and may be useful for women who have recurrent infections.

Doctors suggest some added steps that women can take to avoid infection:

• Drink plenty of water every day. Some doctors suggest drinking cranberry juice, which in large amounts inhibits the growth of some bacteria by acidifying the urine. Vitamin C supplements have the same effect.
• Urinate when you feel the need
• Wipe from front to back to prevent bacteria around the anus from entering the vagina or urethra;
• Take showers instead of tub baths;
• Cleanse the genital area before sexual intercourse;
• Avoid using feminine hygiene sprays and scented douche, which may irritate the urethra.

Urinary Tract Infections During Pregnancy

A pregnant woman who develops a UTI should be treated promptly to avoid premature birth of her baby and other risks such as high blood pressure. Some antibiotics are not safe to take during pregnancy. Your doctor will consider various factors such as the drug’s effectiveness, the stage of pregnancy, the mother’s health, and potential effects on the fetus when selecting the best treatment.

Complicated Urinary Tract Infections

Curing infections that come from a urinary obstruction or nervous system disorder depends on finding and correcting the underlying problem, sometimes with surgery. If the underlying cause goes untreated, you may be at risk of kidney damage. Also, such infections tend to come from a wider range of bacteria, and sometimes from more than one type of bacteria at a time.

UTI’s are unusual in men. They usually stem from an obstruction — for example, a urinary stone or enlarged prostate — or a medical procedure that requires a catheter. The first step is to identify the infecting organism and the medicine which will kill it. Doctors often recommended longer therapy in men than in women, in part to prevent infections of the prostate gland. Prostate infections, called prostatitis, are harder to cure because antibiotics are unable to penetrate infected prostate tissue effectively. Therefore, men with prostatitis often need long-term treatment with a carefully selected antibiotic for a UTI.

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I like to read blogs, too. I also like to share when I find good blogs. So, I’ll start listing the blogs I like and hope you share with us the blogs you like. You can send your suggestions with the submit news button above or leave a comment below.

Doctor David’s Blog: Musings of a Pediatric Oncologist

Many years ago I was approached by a pediatric oncologist to write a booklet for her patients. She wanted a booklet for parents caring for terminally ill children—like how they get their clocks turned around so that night is day, and even though they are going to die shortly, they still need care for their broken arms, legs and teeth—they still deserve some quality of life. As it turns out, she never had time to help me finish the booklet so it was never done. But with that short relationship I acquired a real admiration for those who can deal with the deaths of children and give them dignity in the process. This blog we like is by a pediatric oncologist who seems to be able to do just that.

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