Thursday, May 30, 2013

Sex After a Heart Attack: Is It OK?

You've had a heart attack, and suddenly your outlook on sex is very different. You used to relish intimacy and pleasure with your partner. But now it seems like a scary proposition. Could sex trigger another heart attack? Will your sex life ever be the same? Portland cardiologist James Beckerman, MD, answers the most common questions about how sex and heart health are connected.

Q. What worries heart patients when it comes to sex?

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A. After a heart attack, some men and women fear that any type of sexual activity will provoke another one. People feel that if they've had a heart attack, it's not a good idea to stress their bodies with sexual activity. But fewer than 1% of heart attacks come from having sex. It makes sense to think of sex as a form of exercise: If your doctor clears you for physical activity, you're also likely safe for sex.

Q. Do you find patients are embarrassed to ask a doctor about sexual concerns?

A. Yes, and I think doctors are too. But sexual issues are important to discuss. Doctors have to read their patients well. You have to get a sense of their comfort level with you and how willing they are to talk about personal issues. I think when the doctor does bring it up, it shows it's OK to talk about sex. Sometimes the patient is surprised -- or even relieved -- that the doctor raises the subject because it means they don't have to.

Q. Do cardiac rehabilitation programs address sex?

A. They may do that indirectly. When heart patients worry about sexual function, a lot of their concerns are related to confidence and fear. After a heart attack, they feel that if they try to go for a run, they'll drop dead. Cardiac rehab, through structure and supervised exercise programs, teaches people that it's OK for them to exercise, OK for them to exert themselves and get back in the game. I think once they have that confidence, they can go out and use it, whether it's on the treadmill or in the bedroom.

Q. What are some of the warning signs to stop sex right away?

A. Similar to any type of exercise, if you begin to feel symptoms such as chest pain, abnormal shortness of breath, fatigue, dizziness, or palpitations, it definitely makes sense to slow down what you're doing, whether you're a man or a woman. If you're pretty certain it's angina, which is temporary pain or pressure in the chest when the heart doesn't get enough oxygen, it might help to take your nitroglycerin.

The exception to that advice is for men who use medication for erectile dysfunction -- it's dangerous to take nitroglycerin, too. Your blood pressure can fall to dangerously low levels, and there's an increased risk of heart attack and even death. If you're on an erectile dysfunction drug and have heart-related symptoms during sex, call your doctor.

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Thursday, May 23, 2013

Amputation – Surgical Removal Of A Body Part

Amputation is the surgical removal of all or part of a limb or extremity such as an arm, leg, foot, hand, toe, or finger.

Reasons for Amputation

There are many reasons an amputation may be necessary. The most common is poor circulation because of damage or narrowing of the arteries called peripheral arterial disease. Without adequate blood flow, the body's cells cannot get oxygen and nutrients they need from the bloodstream. As a result, the affected tissue begins to die and infection may set in.

Other causes for amputation may include:

·         Severe injury (from a vehicle accident or serious burn, for example)

·         Cancerous tumor in the bone or muscle of the limb

·         Serious infection that does not get better with antibiotics or other treatment

·         Thickening of nerve tissue, called a neuroma

·         Frostbite

The Amputation Procedure

An amputation usually requires a hospital stay of five to 14 days or more, depending on the surgery and complications. The procedure itself may vary, depending on the limb or extremity being amputated and the patient's general health.

Amputation may be done under general anesthesia (meaning the patient is asleep) or with spinal anesthesia, which numbs the body from the waist down.

When performing an amputation, the surgeon removes all damaged tissue while leaving as much healthy tissue as possible.

A doctor may use several methods to determine where to cut and how much tissue to remove. These include:

·         Checking for a pulse close to where the surgeon is planning to cut

·         Comparing skin temperatures of the affected limb with those of a healthy limb

·         Looking for areas of reddened skin

·         Checking to see if the skin near the site where the surgeon is planning to cut is still sensitive to touch

During the procedure itself, the surgeon will:

·         Remove the diseased tissue and any crushed bone

·         Smooth uneven areas of bone

·         Seal off blood vessels and nerves

·         Cut and shape muscles so that the stump, or end of the limb, will be able to have an artificial limb (prosthesis) attached to it

The surgeon may choose to close the wound right away by sewing the skin flaps (called a closed amputation). Or the surgeon may leave the site open for several days in case there's a need to remove additional tissue.

The surgical team then places a sterile dressing on the wound and may place a stocking over the stump to hold drainage tubes or bandages. The doctor may place the limb in traction, in which a device holds it in position, or may use a splint.

Recovery From Amputation

Recovery from amputation depends on the type of procedure and anesthesia used.

In the hospital, the staff changes the dressings on the wound or teaches the patient to change them. The doctor monitors wound healing and any conditions that might interfere with healing, such as diabetes or hardening of the arteries. The doctor prescribes medications to ease pain and help prevent infection.

If the patient has problems with phantom pain (a sense of pain in the amputated limb) or grief over the lost limb, the doctor will prescribe medication and/or counseling, as necessary.

Physical therapy, beginning with gentle, stretching exercises, often begins soon after surgery. Practice with the artificial limb may begin as soon as 10 to 14 days after surgery.

Ideally, the wound should fully heal in about four to eight weeks. But the physical and emotional adjustment to losing a limb can be a long process. Long-term recovery and rehabilitation will include:

·         Exercises to improve muscle strength and control

·         Activities to help restore the ability to carry out daily activities and promote independence

·         Use of artificial limbs and assistive devices

·         Emotional support, including counseling, to help with grief over the loss of the limb and adjustment to the new bodyimage

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Wednesday, May 22, 2013

Pulmonary Embolism (PE) - Blood Clotting

A pulmonary embolism (PE) is a blood clot in the lung. The clot usually forms in smaller vessels in the leg, pelvis, arms, or heart, but occasionally the clot can be large. When a clot forms in the large veins of the legs or arms, it is referred to as a deep venous thrombosis (DVT). The pulmonary embolism occurs when part or all of the DVT breaks away and travels through the blood in the veins and lodges in the lungs.

The clot travels through the vessels of the lung continuing to reach smaller vessels until it becomes wedged in a vessel that is too small to allow it to continue further. The clot blocks all or some of the blood from traveling to that section of the lung. These blockages result in areas in the lung were the disruption of blood flow does no allow the carbon dioxide waste to be delivered to the air sacs for removal (ventilation). Similarly, since blood is blocked to certain portions of the lung, oxygen cannot be extracted from these same air sacs (perfusion). The process of matching the lungs ventilation with the blood flow through the lungs is disrupted, resulting in ventilation-perfusion inequalities. In other words, areas in the lung are ventilated (get air) but get no blood to exchange the waste product carbon dioxide with oxygen.

If the pulmonary embolism is large, it may be capable of such a large mismatch, the patient cannot get enough oxygen into the blood and can be become acutely short of breath. In some instances, clots are so large that blood flow is blocked from the right side of the heart entering the lungs. This can result in instantaneous death. In other patients, the mismatch is not so profound, but still causes symptoms, especially when oxygen demand increases (for example, during exercise). Pulmonary infarction (death of lung tissue due to arterial blockage) is unusual because of collateral circulation

Pulmonary Embolism Causes

Several risk factors can make a person more likely to develop a blood clot that can eventually break loose and travel to the lung. Virchow's triad explains the reasons why clots form. This triad includes 1) immobilization (which reduces flow), 2) damaged vessel wall (which forms a location for clot to start, and 3) Hypercoagulable state (which makes it easier for blood to clot.

*       Immobilization: A stroke, broken bone, or spinal cord injury can result in confinement to bed so that clot formation can occur in either the arms or legs.

*       Travel: Prolonged travel, such as sitting in an airplane or a long car trip, allows the blood to sit in the legs and increases the risk of clot formation.

*       Recent surgery (includes hypercoagulable state due to surgical damage and the body trying to repair itself. It is also often associated with immobility and sometimes vessel damage depending on the surgery)

*       Trauma or injury (especially to the legs)

*       Obesity

*       Heart disease (such as an irregular heartbeat)

*       Burns

*       Previous history of blood clot in the legs (DVTs) or pulmonary embolism

Conditions that increase clotting of the blood

*       Pregnancy

*       Cancer

*       Estrogen therapy and oral contraceptives

*       Certain protein and enzyme deficiencies

Pulmonary Embolism Symptoms

Not all pulmonary embolisms exhibit the same signs and symptoms. But certain symptoms may indicate that a pulmonary embolism has occurred.

The following signs and symptoms may occur (in the order they are typically seen):

*       Chest pain: Pain is very sharp and stabbing in nature, has a sudden onset, and is worse when taking a deep breath (referred to as pleuritic chest pain).

*       Shortness of breath, especially with exertion

*       Anxiety or apprehension

*       Cough: Usually, this cough is dry, but it may be associated with blood.

*       Sweating

*       Passing out

Doctors may suspect a blood clot if any of these symptoms occur in someone who has or recently had a swollen or painful arm or leg or who has any of the risk factors listed previously.

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Tuesday, May 21, 2013

Breast Cancer

Breast cancer affects one in eight women during their lives. Breast cancer, also called breast carcinoma, kills more women in the world than any cancer except lung cancer. Breast occurs in both men and women, although male breast cancer is rare. Less than 1% of all cases of breast cancer occur in men.

Types of breast cancer
Cancer is a disease in which abnormal cells in the body grow out of control. There are different kinds of breast cancer that are determined by which cells in the breast turn into cancer. Breast cancer forms in tissues of the breast, usually in the ducts (the tubes that carry milk to the nipple) and the lobules (the glands that make milk). Common kinds of breast cancer include:

1. Ductal carcinoma - The most common kind of breast cancer which begins in the milk or breast ducts cells.
  • Ductal carcinoma in situ (DCIS) - Abnormal cancer cells are only in the lining of the milk ducts, and have not spread to other tissues in the breast.
  • Invasive ductal carcinoma - Abnormal cancer cells break through the ducts and spread into other parts of the breast tissue or spread to other parts of the body.
2. Lobular carcinoma - Cancer cells begin in the lobes, or lobules, of the breast.

  • Lobular carcinoma in situ (LCIS) - Cancer cells are found only in the breast lobules and does not spread to other tissues very often.
  • Invasive lobular carcinoma. - Cancer cells spread from the lobules to the breast tissues that are close by and can also spread to other parts of the body.

Risk factors
No one knows why some women get breast cancer, but there are a number of risk factors that women are either born with or can control by making lifestyle choices. Risks for developing breast cancer include:

  • Age - the chance of getting breast cancer rises as a woman gets older
  • Alcohol consumption
  • Dense breasts
  • Genes - women of family members diagnosed with breast cancer or ovarian cancer may wish to be tested for the presence of two genes (BRCA1 and BRCA2) that greatly increase the chances of breast cancer.
  • Menstruation - women who begin their menstrual period before the age of 12 or who go through menopause after the age of 55.
  • Not having children or having your first child after age 35
  • Obesity or being overweight
  • Use of birth control pills
  • Use of Hormone replacement therapy

Symptoms of breast cancer
Different people have different warning signs for breast cancer. Some people do not have any signs or symptoms at all and may only find out they have breast cancer after a routine mammogram. The most common symptoms of breast cancer include a lump in the breast, a change in size or shape of the breast or discharge from a nipple. The major warning signs of breast cancer are:

1. A change in how the breast or nipple looks
  • A change in the size or shape of the breast
  • A nipple turned inward into the breast
  • The skin of the breast, areola, or nipple may be scaly, red, or swollen; irritation or dimpling of breast skin ; ridges or pitting on the skin so that it looks like the skin of an orange.

2. A change in how the breast or nipple feels
  • A lump or thickening in or near the breast
  • A lump in the underarm area
  • Nipple tenderness or pain in the nipple area
  • Pain in any area of the breast

3. Nipple discharge or fluid
  • Any discharge other than milk
  • Blood from the nipple

Breast cancer treatment
Staging breast cancer

If breast cancer is diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body. This process is called staging. The stage assigned to breast cancer is based on the size of the tumor and whether the cancer has spread. Staging may involve x-rays and lab tests to identify whether the cancer has spread and, if so, to what parts of your body. Sometimes the stage often is not known until after a surgery. The type and stage of breast cancer tells doctors what kind of treatment will be needed.

The chance of recovery and treatment options for breast cancer will also depend on the following:

  • Age, general health and menstrual status
  • Beast cancer stage
  • Breast cancer type
  • Estrogen-receptor and progesterone-receptor levels in the tumor tissue
  • Human epidermal growth factor type 2 receptors (HER2/neu) levels
  • How fast the tumor is growing.
  • New cancer diagnosis or recurrence

Common treatments
Breast cancer treatment is more likely to work well when cancer is found early. Breast cancer is treated in several ways and a treatment program will depend on both the kind of breast cancer diagnosed and how far it has spread. People diagnosed with breast cancer often receive more than one kind of treatment. Main treatment modalities include:

Biological therapy - This treatment works with your body's immune system to help it fight cancer or to control side effects from other cancer treatments.

Chemotherapy - Special medicines or drugs that shrink or kill the cancer. The drugs can be pills you take or medicines given through an intravenous (IV) tube, or, sometimes, both.

Clinical trials - Clinical trials are research studies that help find new treatment options. The National Institutes of Health (NIH) provides a database of clinical trials for breast cancer.

Complementary or alternative medicine - Meditation, yoga, and dietary supplements like vitamins and herbs may help lessen the side effects of the cancer treatments or of the cancer symptoms.

Hormonal therapy - Hormonal treatment is used to block cancer cells from getting the hormones they need to grow.

Radiation - High-energy rays (similar to X-rays) that kill the cancer cells. The rays are aimed at the part of the body where the cancer is located.

Surgery - An operation where doctors cut out and remove cancer tissue

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