BRCA- The Breast Cancer Susceptibility Genes

December 8, 2009 by  
Filed under Education

What are Genes?

Genes, which are in each of our body cells, help guide the growth and development of our bodies. We are all born with two copies of each gene – one we inherit from our mother and the other one from our father. When functioning normally, certain genes actually help to prevent .

What are the “ susceptibility genes”?

In rare cases, a family carries genes that have been altered or changed and do not work as well. This may lead to a much higher chance, or susceptibility, for getting breast or ovarian cancer. These genes are called the breast cancer susceptibility genes (BRCA).Men in some of these families may have a chance of getting breast cancer too. You can inherit these changed genes from either your mother???s or father???s side of the family. So far, only two breast cancer susceptibility genes, BRCA1and BRCA2, have been found. As research continues, new BRCA genes may be found in the future. While these changed genes result in an increased chance of getting breast or ovarian cancer, they do not cause cancer. Not everyone who inherits changed BRCA genes will develop breast or ovarian cancer.

If I have a family history of breast or ovarian cancer, does it mean that I may have changed BRCA genes?

Not necessarily. Most breast or ovarian cancer that occurs within families is not due to having inherited changed BRCA genes, but is instead caused by other factors. In fact, less than 10% of breast cancer is thought to be due by these changed BRCA genes.

How do I know if I might carry changed BRCA genes?

Answer “yes” or “no” to the questions below. You may have a higher chance of carrying changed BRCA genes if you answer “yes” to one or more of the following:

  • You have a close relative with a positive test for changed BRCA genes.
  • You have had both breast and ovarian cancer.
  • You have breast or ovarian cancer, and
  • You have one or more close relatives with breast cancer (especially before age 50) and/or ovarian cancer.
  • You have a strong family history of breast cancer (especially before age 50) and/or ovarian cancer in many relatives across two or more generations.
  • You had breast cancer before you were 30.
  • You are of Ashkenazi (Central or Eastern European) Jewish heritage and
  • You have had either breast cancer before you were 40, or ovarian cancer.
  • You have had breast cancer that appeared in both breasts or in many places in the same breast.

After answering “yes” to one of the preceding questions, I know I have a higher chance of carrying changed BRCA genes. What should I do?

First, talk with your provider about your concerns. After confirming your risk by looking at your family history and your personal health history, your provider may refer you toa genetic counselor. Genetic counseling is the first step in determining if changed BRCA genes are in your family, and the chance that you may have inherited these genes. During counseling, the genetic counselor will review your medical records, your health history, and your family history of cancer.

Is there a test to find out if I have changed BRCA genes?

If it seems like there may be an inherited susceptibility to cancer in your family, a blood test for the BRCA genes may be available. However, the test is not for everyone, but rather it is sometimes useful for individuals thought to be at high risk. The genetic counselor will go over the pros and cons of testing with you. With this information, you can decide, with your genetic counselor, whether this test is right for you.

If I don???t have a higher chance of carrying changed BRCA genes (I did not answer “yes” to any of the questions), should I go to genetic counseling and consider testing?

Not at this time. The only genetic test available is for women who are at very high risk. If your family history of breast cancer doesn???t fall into the high-risk pattern but continues to bother you, talk with your practitioner.

What can I do to take care of myself?

Since all women are at risk for breast cancer, screening to find breast cancer early when it is most treatable and curable is a very important step you can take for yourself.

There are 3 important screening steps you can take to find breast cancer in the early stages:

  1. Monthly breast self-exam
  2. Breast exams (done by your practitioner) in the medical office
  3. Regular mammograms. Mammography is strongly recommended for all women who are between the ages of 50-74. If you are age 40-49, talk with your health care practitioner about the age to begin having regular mammograms.

A healthy, low fat diet, regular exercise, drinking alcohol in moderation, and not smoking are other very important ways of taking care of yourself that may reduce your chances of getting breast cancer.

Testing for Breast Cancer Susceptibility Genes

The decision about taking this blood test is a very personal one and can have complex and sometimes unexpected emotional effects. An important part of genetic counseling is to help you explore what testing might mean for you and your family. Here are some simple answers to common questions and concerns. The genetic counselor will discuss the pros and cons in more detail. Results of the test will remain confidential.

What are some of the benefits of BRCA testing?

Some people who get a negative test result are relieved. Some who test positive use the results to help plan their medical care or to make personal decisions about their lives. Although we are not certain, it is likely that starting to have mammograms and breast exams at a younger age and having them more often is generally recommended and may help find breast cancer early.

Although these are drastic measures, some women who test positive for BRCA decide to have surgery to remove their breasts or ovaries to prevent cancer. At this time, we do not know how effective these surgeries will be to prevent breast or ovarian cancer.

What are some of the drawbacks to BRCA testing?

Having a negative test may give some women a false sense of security, so they may not come in for regular mammograms and breast exams like they should. Testing positive can create stress in a woman???s life, especially if she has no clear plan of action to take.

What does it mean if the BRCA test is positive?

A positive BRCA test means that the person???s chance of getting breast cancer in her lifetime may be as high as 85%, but this means that there is still at least a 15% chance that she won???t get it. It also means that their risk of getting ovarian cancer goes up but is not as high as for breast cancer. We do not know yet why some people with changed genes get cancer, and others do not.

If I decide to have BRCA testing, how will I be told my test result?

Because it is a very complex test, it may take several months to get your test result back. Once the result is available, your genetic counselor will meet with you to talk about the results and to help you decide what to do next.

Tags: cancer, Oncology, ovarian cancer, Surgery, Genetic testing, surgeries

What is Breast Cancer

December 8, 2009 by  
Filed under Education

Breast , 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 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 approximately 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 determine 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 x-ray.

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 or not you still have menstrual periods), and general health can also affect your prognosis and choice of treatment.

Stages Of Breast Cancer

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.

Breast Cancer In SituAbout 15%-20% of breast cancers are very early cancers. They are sometimes called carcinoma in situ (found only in the duct area). There are two types of breast cancer in situ. One type is ductal carcinoma in situ (also known as intraductal carcinoma); the other type is lobular carcinoma in situ. Lobular carcinoma in situ is not cancer, but for the purpose of classifying the disease, it is called breast cancer in situ, carcinoma in situ, or stage 0 breast cancer. Sometimes lobular carcinoma in situ is found when a biopsy is done for another lump or abnormality found on the mammogram. Patients with this condition have a 25% chance of developing breast cancer in either breast in the next 25 years.

Stage IThe cancer is no larger than 2 centimeters (about 1 inch) and has not spread outside the breast.

Stage IIAny of the following may be true:

The cancer is no larger than 2 centimeters but has spread to the lymph nodes under the arm (the axillary lymph nodes).

The cancer is between 2 and 5 centimeters (from 1 to 2 inches). The cancer may or may not have spread to the lymph nodes under the arm.

The cancer is larger than 5 centimeters (larger than 2 inches) but has not spread to the lymph nodes under the arm.

Stage III

Stage III is divided into stages IIIA and IIIB.

Stage IIIA is defined by either of the following:

The cancer is smaller than 5 centimeters and has spread to the lymph nodes under the arm, and the lymph nodes are attached to each other or to other structures.

The cancer is larger than 5 centimeters and has spread to the lymph nodes under the arm.

Stage IIIB is defined by either of the following:

The cancer has spread to tissues near the breast (skin or chest wall, including the ribs and the muscles in the chest).

The cancer has spread to lymph nodes inside the chest wall along the breast bone.

Stage IVThe cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain. Or, tumor has spread locally to the skin and lymph nodes inside the neck, near the collarbone.

Inflammatory breast cancerInflammatory breast cancer is a special class of breast cancer that is rare. The breast looks as if it is inflamed because of its red appearance and warmth. The skin may show signs of ridges and wheals or it may have a pitted appearance. Inflammatory breast cancer tends to spread quickly.

RecurrentRecurrent disease means that the cancer has come back (recurred) after it has been treated. It may come back in the breast, in the soft tissues of the chest (the chest wall), or in another part of the body.

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.

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:Lumpectomy (sometimes called excisional biopsy or wide excision) is the removal of the lump in the breast and some of the tissue around it. It is usually followed by radiation therapy to the part of the breast that remains. Most doctors also take out some of the lymph nodes under the arm.

Partial or segmental mastectomy is the removal of the cancer as well as some of the breast tissue around the tumor and the lining over the chest muscles below the tumor. Usually some of the lymph nodes under the arm are taken out. In most cases, radiation therapy follows.

Other Types Of Surgery:

Total or simple mastectomy is the removal of the whole breast. Sometimes lymph nodes under the arm are also taken out.

Modified radical mastectomy is the removal of the breast, some of the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles. This is the most common operation for breast cancer.

Radical mastectomy (also called the Halsted radical mastectomy) is the removal of the breast, chest muscles, and all of the lymph nodes under the arm. For many years, this was the operation most used, but it is used now only when the tumor has spread to the chest muscles.

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 stages of breast cancer (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 currently 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 stages of breast cancer. If you want more information, call the Cancer Information Service at 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.

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 rather than silicone gel, may also be used. Before you decide to get an implant, you may call the FDA (1-800-532-4440) to obtain additional 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 rather than silicone gel, may also be used. Before you decide to get an implant, you may call the FDA (1-800-532-4440) to obtain additional 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 rather than silicone gel, may also be used. Before you decide to get an implant, you may call the FDA (1-800-532-4440) to obtain additional 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, in some cases, 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 similar to 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.

To Learn More

You can also write to the National Cancer Institute at this address:

National Cancer Institute
Office of Cancer Communications
31 Center Drive, MSC 2580
Bethesda, MD 20892-2580

Tags: Recurrent disease, lobular carcinoma, ductal carcinoma in situ, Radiation, leukapheresis, Biological therapy, cancers

Open Heart Surgery – A final note – when to call your doctor

December 8, 2009 by  
Filed under Education

After you get home you may feel a little nervous and worried about being on your own. Well, don’t sit and worry if you think something is not right about your health or healing. If you have any of the following signs of a or infection call your doctor, cardiologist or . Keep their numbers handy. If the signs tell you it’s an emergency and you are not able to reach your doctors, call 911 immediately.

Your stitches or staples will be removed within 10 to 14 days after . You should check your incision every day. Call you doctor if you have signs of infection listed below.

Warning signs of infection

  • red, hot and swollen incisions(s)
  • smelling discharge coming from an incision
  • a temperature over 100 degrees for a few days
  • chest congestion, coughing, and problems with breathing at rest

Warning signs of a heart attack

  • intense, steady pressure or burning pain in the center of your chest
  • pain that starts in the center of the chest and goes to a shoulder and arm (usually the left) or both shoulders and arms, back, neck and jaw
  • prolonged pain in the upper abdomen
  • nausea, vomiting, profuse sweating
  • shortness of breath, looking pale
  • dizziness, light-headedness or fainting
  • frequent angina attacks like you may have had before surgery
  • a sense of anxiety or doom

Warning signs of an emergency

  • your are bleeding a lot of bright red blood or you see blood clots
  • you have a sharp pain that does not go away with your pain medicine
  • your incision(s) opens
  • if you had leg surgery, your leg turns blue or you lose feeling in your leg
  • your fever goes up fast or is over 101 degrees
  • you have allergic reactions to medicines you are taking
Tags: incision, Myocardial infarction, surgeon, ER, Aging-associated diseases, heart surgery, cardiologist, heart attack, Surgery

Open Heart Surgery – On the road to recovery

December 8, 2009 by  
Filed under Education

Each patient’s recovery rate is different, especially after a coronary artery bypass surgery. How quickly you recover will depend in part on your physical health before surgery and how complex and extensive your heart surgery was. The first step in recovery is when you can breathe deeply and cough to clear your lungs. When you can do this, your breathing tube will be removed and replaced with an oxygen mask. This could happen as soon as the day after your surgery. Your doctor will then have you moved from the ICU to another area of the hospital. Your care will continue as follows:

  • you will continue to have electrocardiograms to record your heart rhythm
  • you will wear an oxygen mask as needed
  • you will continue to have blood tests
  • your fluid intake and output will be monitored
  • the nurses will help you with turning in bed, coughing and deep breathing exercises
  • you will start with ice chips and sips of fluid, then solid food

Taking part in your recovery

As you become more active, you will become more involved in your own recovery – even while you are still in the hospital. Here are some activities you can do:

  • eat right – healthy food helps you heal
  • keep your lungs free of fluid, which can lead to pneumonia, by practicing your deep breathing and coughing exercises
  • get out of bed as soon as you can so your muscles stay strong; start slowly sitting on the side of the bed, then the chair, then short walks, then longer walks
  • do the recommended leg exercises to keep your legs muscles strong
  • wear elastic or support stockings if your doctor ordered them
  • use a chair with a firm back when sitting with pillows on the chair arms; raise your feet to the same height if your legs or feet swell, but don’t cross your legs (this slows blood flow)

Because of your surgery and limited movement right after, fluid can build up in your lungs. This fluid can cause pneumonia and keep you keep you in the hospital. Therefore, it is very important that you take deep breaths and cough often. You may be given an incentive spirometer to help you breathe correctly. To ease the pain when you cough, support your chest incision with a pillow or your hands.

Good days and bad days

After the first few days when you’ve come through the worst of it, your emotions may get the best of you. Don’t be surprised if you have good days and bad days. You may cry more easily, have bad dreams, not be able to concentrate or just feel afraid or down. Some of this is related to stress, lack of sleep and the effects of the anesthesia and other medicines. It’s not pleasant, but it’s normal after what you’ve been through. Don’t pretend you feel OK when you don’t. Let your family and the hospital staff know. Both you and your family may benefit a lot by talking to a rehabilitation counselor.

Better days ahead

As you near the end of your hospital stay, you will become really anxious to return home. Your mental outlook will improve and your physical recovery may even speed up once you’re home. Family, familiar surroundings and peace and quiet can help a lot.

Before you leave the hospital, you will receive instructions from your cardiac health care team about a number of things. These include :

  • how to care for your incision(s)
  • your new heart-healthy diet
  • a list of physical activities you can do during the next 6-12 weeks
  • recommended exercises
  • a list of special equipment, medicines or supplies you will need
  • the date of your first follow-up visit

Once you’re at home, pace yourself. Follow your doctor’s instructions. Be aware of how you feel during everyday activities. You will be able to tell when you can increase the amount or level of activity. When you are tired, rest. When you’re hungry, eat – but eat heart healthy foods.

Congratulations! You’re on your way. There are better days ahead!

A final note – when to call your doctor

After you get home you may feel a little nervous and worried about being on your own. Well, don’t sit and worry if you think something is not right about your health or healing. If you have any of the following signs of a or infection call your doctor, cardiologist or . Keep their numbers handy. If the signs tell you it’s an emergency and you are not able to reach your doctors, call 911 immediately.

Your stitches or staples will be removed within 10 to 14 days after surgery. You should check your incision every day. Call you doctor if you have signs of infection.

Warning signs of infection

  • red, hot and swollen incisions(s)
  • smelling discharge coming from an incision
  • a temperature over 100 degrees for a few days
  • chest congestion, coughing, and problems with breathing at rest

Warning signs of a heart attack

  • intense, steady pressure or burning pain in the center of your chest
  • pain that starts in the center of the chest and goes to a shoulder and arm (usually the left) or both shoulders and arms, back, neck and jaw
  • prolonged pain in the upper abdomen
  • nausea, vomiting, profuse sweating
  • shortness of breath, looking pale
  • dizziness, light-headedness or fainting
  • frequent angina attacks like you may have had before surgery
  • a sense of anxiety or doom

Warning signs of an emergency

  • your are bleeding a lot of bright red blood or you see blood clots
  • you have a sharp pain that does not go away with your pain medicine
  • your incision(s) opens
  • if you had leg surgery, your leg turns blue or you lose feeling in your leg
  • your fever goes up fast or is over 101 degrees
  • you have allergic reactions to medicines you are taking
Tags: Surgery, Cough CPR, heart surgery, heart attack, chest incision

Open Heart Surgery – Being admitted to the hospital for open heart surgery

December 8, 2009 by  
Filed under Education

You will usually be admitted to the hospital the day before your surgery. Simply check in at the hospital admissions desk. The hospital should have a record of your pre-admission tests and forms that you completed. Read more

Tags: open heart surgery, Cardiac surgery, General anaesthesia, Surgery, Intensive-care medicine

Open Heart Surgery – Getting Ready for open heart surgery

December 8, 2009 by  
Filed under Education

Usually, can be scheduled days or weeks in advance. It will depend upon how serious your heart condition is, your schedule and the ‘s schedule. If you have a week or two before surgery, use this time wisely. Check with your surgeon about:

  • exercise – Should you start, stop or continue exercises?
  • diet – Should you change your diet in any way?
  • weight – Would it help your recovery to lose or gain a few pounds?
  • smoking – If you smoke, can your doctor recommend a stop smoking program?
  • medicines – What medicines should you start, stop or continue taking? Remember to ask about all medicines that you take regularly or occasionally, including prescription and over-the-counter medicines.

Also, be sure to:

  • rest, relax – Take good care of your physical and mental health. Don’t overdo things. And make sure you plan some enjoyable activities to relax your mind and give your spirits a lift.
  • report health changes – Tell your doctor if you have any signs of infection, like chills, fever, coughing, runny nose, within a week of your scheduled surgery. If an infection continues, surgery may have to be rescheduled.

A special note about smoking

Not only is smoking bad for your health, but it could affect your recovery. Since most hospitals are “smoke free”, you will have to quit smoking when you go into the hospital. This means you will be going through nicotine withdrawal when your body is trying to recover from surgery. So, do yourself a big favor. Quit smoking now, and your mind and body will be able to focus on healing, not withdrawal.

Making arrangements for surgery

Whether you’re having major surgery or minor surgery, you should always have a family member or friend with you. Even when you are going for the pre-admission tests (explained later), it’s a good idea to have someone with you. He or she can listen and take notes for you – or simply hold your hand if that’s what you need! So give your family or friend plenty of notice about your upcoming tests and surgery. Also, now is a good time to make a list of any medicines you are taking and any allergies to medicines, food, etc. that you may have. Take this list with you when you go to the hospital so you don’t forget anything.

Pre-admission procedures

A few days before surgery you will need to have certain tests. Your surgeon’s office staff will tell you where to go and which tests you will need. If you have had any of these tests recently, ask your surgeon if a copy of your test results will do in place of redoing the tests. You may need:

  • a chest x-ray to see how well your lungs work
  • an electrocardiogram (ECG) and/or an echocardiogram (ECHO) that shows how your heart is working
  • blood tests that show chemistry and blood counts
  • a urine analysis

There will be paperwork to complete. You will be asked:

  • to fill out insurance forms, or provide authorization forms from your insurance company; make sure you bring your insurance card(s)
  • if you brought written orders from your doctor or lab test results
  • the name, address and telephone number of someone to contact in case of emergency

You will be told about your rights for advanced directives (your options for life support if that’s needed) and asked for a copy of your living will and health care power-of-attorney. You must sign a surgical consent form. This is a legal paper that says your surgeon has told you about your surgery and any risks you are taking. By signing this form you are saying that you agree to have the surgery and know the risks involved. Ask your doctor about any concerns you have before you sign this form.

Blood transfusion

Surgical methods today reduce much of the blood loss during surgery. However, you may need a blood transfusion. If so, your blood will be matched carefully with blood that has been carefully tested. The blood you receive can come from:

  • a blood bank – this blood supply is from the American Red Cross and is safer today than it has ever been
  • a designated donor – this can be a family member who has the same type of blood that you do
  • you (autologous blood donation) – you will donate blood at a local blood bank or hospital

Ask your surgeon which would be best for you. If you donate blood, you must do it in plenty of time for surgery. Also, be sure to eat and drink as directed if you decide to donate blood.

Tags: Hematology, Transfusion medicine, Blood, heart surgery, surgeon

Open Heart Surgery – Your visit with the heart surgeon

December 8, 2009 by  
Filed under Education

Your heart will explain the results of your tests and why surgery is being recommended. He will also explain the surgical procedure and the results you can expect. He will tell you about the risks of having or not having the surgery, the benefits of having the surgery and any options you have in place of surgery. You must consider the balance of the risks you will be taking and the benefits you will receive. Don’t be afraid of offending the surgeon or embarrassing yourself by asking questions about anything you don’t understand. Remember, the more you know, the more you will become confident about your decision. The following is a list of questions to help you get started.

Questions to ask

These are basic questions to ask your surgeon. If you think of others, write them down and bring them with you to your visit. Go over the list with your spouse and family. Ask if they have other questions they would like to have answered. Before you leave the surgeon???s office, try to get all your questions answered. Be sure you understand everything clearly. If you think of questions after you leave, write them down and call your surgeon back.

  • How will the surgery improve my condition?
  • Tell me again what will happen during the surgery?
  • Will I need blood transfusions?
  • How long will the surgery last?
  • How long will I be in the intensive care unit (ICU or CCU)?
  • How much pain should I expect and how will it be controlled?
  • What will the scar look like?
  • What are the possible complications of surgery, and how likely are they to happen?
  • Can I recover completely from this surgery? If so, how long will it take?
  • How long will I be in the hospital?
  • How long will my recovery take after I am home?
  • What will I be able to do and not do during recovery?
  • Will I need special equipment when I get home?
  • When can I return to work?
  • If I choose not to have surgery, will I get worse or remain the same?
  • Is there an alternative treatment that does not involve surgery?
  • How long do I have to decide?
  • If I decide to have the surgery, how soon should I have it?

Making your decision

Once you have the information you need to consider all your options, you may be surprised that the best decision for you is becoming pretty clear. That doesn’t mean that it’s an easy decision to make, but at least it will be one you will feel good about and will know what to expect as a result of your decision.

Tags: Nursing, surgeon, Evaluation methods, heart surgeon, open heart surgery, Surgery

Open Heart Surgery

December 8, 2009 by  
Filed under Education

A Patient and Family Guide

The thought of having can be pretty scary. You may be most afraid of what you don’t know about it. Like -

  • How should you prepare?
  • What exactly will happen during surgery?
  • How long will it take?
  • What will your recovery from surgery be like?
  • How long will it be before you fully recover?
  • Will you ever be the same again?
  • When can I return to work?
  • When can I return to sex after heart surgery?

This information will answer many questions for you and your family and hopefully put some of your fears to rest. But it can’t answer all of the questions that you might have about your own heart problem and the treatment of it. Always rely on your doctor and your healthcare team for that.

If your heart problem was discovered by your primary care doctor, he has probably referred you to a heart specialist, called a cardiologist. Following an exam and many tests, the cardiologist has recommended surgery to treat your heart problem. The cardiologist then referred you to a heart . This booklet will let you know what to expect during your visit with the surgeon. And it will explain what will take place before, during, and after your heart surgery. If you have already met with the surgeon, review the first part of this booklet to make sure you understand everything you need and want to know before making a final decision about having the surgery. Remember, peace of mind is very important to your good health. Your doctors want you to have all of the facts so you can make the decision which is best for you.

Tags: heart surgeon, Cardiac surgery, heart specialist, cardiologist, surgeon, heart surgery, Cardiac surgeon, Surgery

Seeing A Doctor For An Enlarged Prostate

December 1, 2009 by  
Filed under Education

If you have symptoms that bother you, see a doctor. He or she can find out if BPH — or another disease — is the cause. If you do have BPH, your doctor can also see if it has caused other problems. How is BPH Diagnosed?

During your visit, the doctor will most likely:

  • Give you a list of questions about your symptoms. These questions are important. Your answers will help the doctor decide if your symptoms are mild, moderate, or severe.
  • Take your medical history. Your doctor will ask you about past and current medical problems.
  • Examine your prostate gland by inserting a gloved, lubricated finger into your rectum.
  • Do a physical exam to see if other medical problems may be causing your symptoms.
  • Check your urine for blood or signs of infection (a urinalysis).
  • Test your blood to see if the prostate has affected your kidneys. Your doctor may also recommend a blood test to help detect prostate cancer.

These tests are not painful or costly. They are done to help confirm that you have BPH and to find any problems it has caused. But tests used to diagnose your condition cannot predict if BPH will cause problems later if not treated now.

Your doctor may also recommend other tests. They may help find if BPH has affected your bladder or kidneys and make sure your problems are not caused by cancer. These tests may help some patients but not everyone:

    Uroflowmetry measures how fast your urine flows and how much you pass. This test can help find how much the urine is blocked.

    Residual urine measurement shows how much urine is left in your bladder after you urinate. This test can help find out how much your bladder has been affected by BPH. The test can be done several ways. You and your doctor should talk about the method used.

    Pressure-flow studies measure the pressure in your bladder as you urinate. Some doctors feel this test is the best way to find out how much your urine is blocked. The test can help most if results of other tests are confusing or if your doctor thinks you have bladder problems. In the test, a small tube called a catheter is inserted into the penis, through the urethra, and into the bladder. The test may cause discomfort for a short time. In a few men, it may cause a urinary tract infection.

    Prostate-specific antigen (PSA) is a blood test that can help find prostate cancer. BPH does not cause cancer. But some men do have BPH and cancer at the same time.

    The PSA test is not always accurate. PSA test results can suggest cancer in BPH patients who do not have prostate cancer. The results can also sometimes suggest no cancer in men who do have cancer.

    Not all doctors agree that being tested for PSA levels lowers a patient’s chance of dying from prostate cancer. Each man with BPH is different. You and your doctor may want to discuss this test.

Your doctor may also suggest other tests such as x-rays, cystoscopy, and ultrasound. Many men do not need these tests. They are costly and not very helpful for most men with BPH. Also, cystoscopy and x-rays can cause discomfort or problems for some men. But the tests can help patients with some BPH problems or men with other problems such as blood in the urine.

    Cystoscopy lets the doctor look directly at the prostate and bladder. This test helps the doctor find the best method in men who choose invasive treatments (such as surgery). In cystoscopy, a small tube is inserted into the penis, through the urethra, and into the bladder. Some men may have discomfort during and after the test. A few may get urinary infections or blood in the urine; a few may not be able to urinate for a short time after the test.

    An x-ray called a urogram lets the doctor see blockage in the urinary tract. A dye injected into a vein makes the urine show up on the x-ray. Some men are allergic to the dye.

    Ultrasound lets the doctor see the prostate, kidneys, and bladder without a catheter or x-rays. A probe put on the skin sends sound waves (ultrasound) into the body. The echoes result in pictures of the prostate, kidneys, or bladder on a TV screen. This test is not harmful or painful. A special probe put in the rectum can give a better view of the prostate when the doctor wants to check for prostate cancer.

When Should BPH Be Treated?

BPH needs to be treated only if:

  • The symptoms are severe enough tobother you.
  • Your urinary tract is seriously affected.

An enlarged prostate alone is not reason enough to get treatment. Your prostate may not get bigger than it is now, and your symptoms may not get worse.

Ask yourself how much your symptoms really bother you:

  • Do they keep you from doing the things you enjoy, such as fishing or going to sports events?
  • Would you be a lot happier or do more if the symptoms went away?
  • Do you want treatment now?
  • Are you willing to accept some risks to try to get rid of your symptoms?
  • Do you understand the risks?

Your answers to these questions can help you choose a treatment that is right for you.

Tags: residual urine, Surgery, problems, risks, Residual urine measurement

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