Hardcore bullies are manipulators. They are masters at confusing people. But with these masters of manipulation, we must always look at the big picture!
Hardcore bullies will often try to confuse the issue when being confronted with their bullying behavior.
They will blame their victim for the incident that happened between them.
They will bring up small transgressions that the victim may have made and try to make them seem huge. For example, maybe the victim told them to “Shut Up”... The hardcore bully will make this seem like a huge insult to him or her - when in reality the hardcore bully has threatened or cursed at the victim, and the victim was just trying to defend himself or herself.
This Smoke Screen technique is one of the hardcore bullies most successful deflecting attempts because it is easy for people to get caught up in the details of the incident at hand.Hardcore bullies are experts at throwing up the smoke screen.
DON'T ALLOW YOURSELF TO BE "SMOKE SCREENED INTO BELIEVING" A HARDCORE BULLY... BECAUSE THEN YOU WILL BECOME ONE OF THEIR VICTIMS!!!!
Beware of Dr Kruschinski of Endogn and his Patient Advocates!
Friday, April 14, 2006
Dealing with Doctors When You Have Adhesion Related Disorder...
If you are suffering from adhesion-related chronic pain, you need to do whatever it takes in order to receive the kind of care you want/need from doctors. Yes, we have a controversial disorder! Yes, lots of people don't take us seriously! But that's no reason to despair! There are many books and articles that give advice on what to do when seeking the help of a doctor. They usually say things like: * Become an informed medical consumer.* Write down all of the questions you want to ask your doctor.* Make a list of all of your medications. Adhesion related disorder is poorly understood... and debated even among doctors. In fact, many of us have been treated disgracefully by them. Some doctors have gone above and beyond the call of duty to help us; but, unfortunately, there aren't enough of them!!Be sure to have a thorough physical in order to rule out other medical conditions. You don't want to push a doctor into diagnosing you as having adhesion related disorder - while leaving a serious and/or treatable condition undiagnosed.
Tips on how to deal with doctors and the medical system:
1. First, you must do your homework!! It is unfair and unjust that you should have to do this when you are ill; but you will deeply regret it if you don't. Begin by educating yourself thoroughly about your illness. You can't rely on your doctor to know about adhesion related disorder!!
2. Next, you must take your doctor visits quite seriously. It's natural for people, who are very ill, to want to go to the doctor and place all their problems in his/her hands. We all want to say: "Here, make it all better now." Unfortunately, we adhesion-sufferers often can't do this. We may be seeking the help of a doctor, who doesn't specialize in treating adhesion related disorder... a doctor, who doesn't know a whole lot about ARD.
3. No doctor can possibly keep up with all of the new medical information that's coming out!!
4. Doctors are usually overworked and under a lot of stress. The office hours in which you see him/her are not the only hours the doctor is working. Doctors see hospital patients before and after office hours. They spend hours filling out forms for patients, who are seeking disability. Doctors are awakened in the middle of the night with emergency calls.
5. Doctors are very concerned about committing malpractice... and about the good opinion of their colleagues. "First, do no harm" is drummed into doctors from the day they first enter medical school. As a result, they tend to be conservative in their judgements - and are cautious when evaluating new medical information. This can be frustrating for adhesion-sufferers... especially when all of our diagnostic tests are normal or negative for abnormal pathology. But remember, we want our doctors to be careful and conscientious, so we should be willing to cooperate with them.
6. The more work you do for the doctor, the more likely you are to get the care you need. You need to present your medical history and symptoms clearly and concisely. If and when you bring information you've printed out from the Internet about ARD, you need to include the Url (website) so doctors can see your - and their - opinions are backed up by the medical profession.
7. You can't count on doctors being completely free of pre-judgements. It is important to get past whatever preconceptions a doctor may have... and get him/her dealing with your real medical concerns.
8. If you need to seek disability, how your doctor views you and your illness can make a difference!!
9. Beware!!!! There are Doctors out there willing to profit from your pain. They will take advantage of desparate, suffering ARD patients just to make a buck!
Tips on how to deal with doctors and the medical system:
1. First, you must do your homework!! It is unfair and unjust that you should have to do this when you are ill; but you will deeply regret it if you don't. Begin by educating yourself thoroughly about your illness. You can't rely on your doctor to know about adhesion related disorder!!
2. Next, you must take your doctor visits quite seriously. It's natural for people, who are very ill, to want to go to the doctor and place all their problems in his/her hands. We all want to say: "Here, make it all better now." Unfortunately, we adhesion-sufferers often can't do this. We may be seeking the help of a doctor, who doesn't specialize in treating adhesion related disorder... a doctor, who doesn't know a whole lot about ARD.
3. No doctor can possibly keep up with all of the new medical information that's coming out!!
4. Doctors are usually overworked and under a lot of stress. The office hours in which you see him/her are not the only hours the doctor is working. Doctors see hospital patients before and after office hours. They spend hours filling out forms for patients, who are seeking disability. Doctors are awakened in the middle of the night with emergency calls.
5. Doctors are very concerned about committing malpractice... and about the good opinion of their colleagues. "First, do no harm" is drummed into doctors from the day they first enter medical school. As a result, they tend to be conservative in their judgements - and are cautious when evaluating new medical information. This can be frustrating for adhesion-sufferers... especially when all of our diagnostic tests are normal or negative for abnormal pathology. But remember, we want our doctors to be careful and conscientious, so we should be willing to cooperate with them.
6. The more work you do for the doctor, the more likely you are to get the care you need. You need to present your medical history and symptoms clearly and concisely. If and when you bring information you've printed out from the Internet about ARD, you need to include the Url (website) so doctors can see your - and their - opinions are backed up by the medical profession.
7. You can't count on doctors being completely free of pre-judgements. It is important to get past whatever preconceptions a doctor may have... and get him/her dealing with your real medical concerns.
8. If you need to seek disability, how your doctor views you and your illness can make a difference!!
9. Beware!!!! There are Doctors out there willing to profit from your pain. They will take advantage of desparate, suffering ARD patients just to make a buck!
Adhesions Can Cause Pain!!
Adhesions cause pain by binding normally separate organs and tissues together - essentially "tying them down."
The stretching and pulling of everyday movements can irritate the nerves involved. Some adhesions cause pain during intercourse (dyspareunia).
Adhesions cause inflammation.
Erythrocyte Sedimentation Rate (ESR) is a non-specific blood test that will indicate if the patient is experiencing inflammation; however, the ESR cannot indicate the location of the inflammation. Adhesional attachment sites become agitated and inflamed due to the pulling and tugging by the adhesions on the tissues of the attached organs - and this will cause inflammation. Inflammation creates pain and must be taken into consideration by the doctor when treating the ARD sufferer for pain. While pelvic pain can be an obvious symptom of adhesions, there are other serious complications that you should be aware of. Two of the more common complications of adhesions are infertility and bowel obstruction. Adhesions can and do cause disabling pain - and loss of productivity. When you meet with your doctor, be prepared to discuss your symptoms with her/him. Be prepared - become your own best doctor! Adhesion formation - involving the bowel (intestine) - is particularly common following a hysterectomy. Occasionally, these adhesions can cause the bowel to kink and prevent the passage of digested food. A bowel obstruction can occur shortly after surgery - or many years later. Symptoms of bowel obstruction may include pain, nausea, and vomiting. A bowel obstruction is a serious illness that requires immediate medical attention. Even though the overall incidence of bowel obstruction is low, you should be aware of the possibility of its occurrence.
If left untreated, a bowel obstruction can lead to serious complications - even death.
Symptoms of bowel obstruction include: * abdominal pain * nausea * vomiting * diarrhea (early) * constipation (late) * fever. Be sure to talk to your doctor if you have any of these symptoms. If you have been trying unsuccessfully to conceive, you are probably searching for the cause. It’s important to understand that there are many conditions that can cause infertility; and you should talk to your doctor to determine whether your situation requires medical attention. Adhesions that form as a result of certain types of gynecologic surgery - especially tubal surgeries and myomectomies (surgery to remove fibroids) - are a common cause of infertility.
Adhesions can form between the ovaries, fallopian tubes or pelvic walls. These adhesions can block the passage of the ovum (an egg) from the ovaries into and through the fallopian tubes. Adhesions around the fallopian tubes can also interfere with sperm transport to the ovum. The good news is that infertility due to pelvic adhesions can be successfully treated in approximately 40% to 60% of women. However, the surgical procedure, adhesiolysis, can often lead to more adhesions. The best way to reduce the chance of adhesions forming and/or reforming is for your surgeon to learn the best interventional techniques used to reduce adhesion formation. The more a surgeon practices these techniques, the more skilled they will become.
The stretching and pulling of everyday movements can irritate the nerves involved. Some adhesions cause pain during intercourse (dyspareunia).
Adhesions cause inflammation.
Erythrocyte Sedimentation Rate (ESR) is a non-specific blood test that will indicate if the patient is experiencing inflammation; however, the ESR cannot indicate the location of the inflammation. Adhesional attachment sites become agitated and inflamed due to the pulling and tugging by the adhesions on the tissues of the attached organs - and this will cause inflammation. Inflammation creates pain and must be taken into consideration by the doctor when treating the ARD sufferer for pain. While pelvic pain can be an obvious symptom of adhesions, there are other serious complications that you should be aware of. Two of the more common complications of adhesions are infertility and bowel obstruction. Adhesions can and do cause disabling pain - and loss of productivity. When you meet with your doctor, be prepared to discuss your symptoms with her/him. Be prepared - become your own best doctor! Adhesion formation - involving the bowel (intestine) - is particularly common following a hysterectomy. Occasionally, these adhesions can cause the bowel to kink and prevent the passage of digested food. A bowel obstruction can occur shortly after surgery - or many years later. Symptoms of bowel obstruction may include pain, nausea, and vomiting. A bowel obstruction is a serious illness that requires immediate medical attention. Even though the overall incidence of bowel obstruction is low, you should be aware of the possibility of its occurrence.
If left untreated, a bowel obstruction can lead to serious complications - even death.
Symptoms of bowel obstruction include: * abdominal pain * nausea * vomiting * diarrhea (early) * constipation (late) * fever. Be sure to talk to your doctor if you have any of these symptoms. If you have been trying unsuccessfully to conceive, you are probably searching for the cause. It’s important to understand that there are many conditions that can cause infertility; and you should talk to your doctor to determine whether your situation requires medical attention. Adhesions that form as a result of certain types of gynecologic surgery - especially tubal surgeries and myomectomies (surgery to remove fibroids) - are a common cause of infertility.
Adhesions can form between the ovaries, fallopian tubes or pelvic walls. These adhesions can block the passage of the ovum (an egg) from the ovaries into and through the fallopian tubes. Adhesions around the fallopian tubes can also interfere with sperm transport to the ovum. The good news is that infertility due to pelvic adhesions can be successfully treated in approximately 40% to 60% of women. However, the surgical procedure, adhesiolysis, can often lead to more adhesions. The best way to reduce the chance of adhesions forming and/or reforming is for your surgeon to learn the best interventional techniques used to reduce adhesion formation. The more a surgeon practices these techniques, the more skilled they will become.
Abdominal/Pelvic Pain Can Occur After Surgery...
Post surgical pain can present shortly following a surgery - and usually resolves over the following days and weeks as the patient recovers from that surgery. But some pain may linger for months or years following a surgical procedure. The question is, what is the source of this pain? In some cases, the answer is Adhesions! Adhesions are bands of scar tissue - intra-abdominal and/or pelvic cavity - that bind internal organs together, causing them to stick to each other. The result of these bands of scar tissue can lead to Adhesion Related Disorder (ARD).
Symptoms adhesions can cause are...
Physical disorders such as: * Chronic pain * Infertility * Bowel obstruction * Pain and difficulty having a bowel movement * Gastroesophageal reflux disease (GERD) * Urinary bladder dysfunction * Pain when walking, sitting or laying in certain positions * Loss of nutrients due to poor eating habits or loss of appetiteEmotional disorders such as:* Depression * Thoughts of suicide * HopelessnessLosses such as: * Loss of employment due to lost work days * Loss of family and social life
If you are experiencing pelvic pain, it’s important to see your doctor. Pain in the pelvic or abdominal area can be caused by a variety of conditions, some of which may be serious. Your doctor will be able to perform tests to determine the cause of your pain. Do not assume all pelvic or abdominal pain is caused by adhesions - even if you are post-adhesiolysis. One of the more common non-surgical causes of pelvic pain is endometriosis.It is important to ask for and allow diagnostic tests to rule out other sources of pathology as being the cause of your symptoms.
While some adhesions do cause pain, not all adhesions cause pain and not all pain is caused by adhesions! If all diagnostic tests are normal or negative for abnormal pathology, the one cause of pain your doctor might consider is adhesions - particularly if you have had abdominal or pelvic surgery. Adhesions are commonly associated with pelvic pain. In fact, an estimated 38 percent of women suffering from pelvic pain have adhesions. There are things your doctor can do to reduce the incidence of post-operative adhesions - and maybe even prevent them altogether.
Demand a video or DVD ofthe procedure!
Learn as much as you can about Adhesion Related Disorder - so you will be able to make informed decisions when discussing your symptoms and medical care needs with your doctor. Request all of your operative and pathology reports from Medical Records at the hospital(s), where you have had surgery - and keep a personal file of all of your medical interventions!
Symptoms adhesions can cause are...
Physical disorders such as: * Chronic pain * Infertility * Bowel obstruction * Pain and difficulty having a bowel movement * Gastroesophageal reflux disease (GERD) * Urinary bladder dysfunction * Pain when walking, sitting or laying in certain positions * Loss of nutrients due to poor eating habits or loss of appetiteEmotional disorders such as:* Depression * Thoughts of suicide * HopelessnessLosses such as: * Loss of employment due to lost work days * Loss of family and social life
If you are experiencing pelvic pain, it’s important to see your doctor. Pain in the pelvic or abdominal area can be caused by a variety of conditions, some of which may be serious. Your doctor will be able to perform tests to determine the cause of your pain. Do not assume all pelvic or abdominal pain is caused by adhesions - even if you are post-adhesiolysis. One of the more common non-surgical causes of pelvic pain is endometriosis.It is important to ask for and allow diagnostic tests to rule out other sources of pathology as being the cause of your symptoms.
While some adhesions do cause pain, not all adhesions cause pain and not all pain is caused by adhesions! If all diagnostic tests are normal or negative for abnormal pathology, the one cause of pain your doctor might consider is adhesions - particularly if you have had abdominal or pelvic surgery. Adhesions are commonly associated with pelvic pain. In fact, an estimated 38 percent of women suffering from pelvic pain have adhesions. There are things your doctor can do to reduce the incidence of post-operative adhesions - and maybe even prevent them altogether.
Demand a video or DVD ofthe procedure!
Learn as much as you can about Adhesion Related Disorder - so you will be able to make informed decisions when discussing your symptoms and medical care needs with your doctor. Request all of your operative and pathology reports from Medical Records at the hospital(s), where you have had surgery - and keep a personal file of all of your medical interventions!
Pain... Purpose of Pain... What Worsens Pain... What Blocks Pain
What Is the Purpose of Pain? Pain is your body's alarm system. It tells you that something is wrong. When part of your body is injured or hurt, nerves in that area release chemical signals. Other nerves send these signals to your brain, where they are recognized as pain. Pain often tells you that you need to do something. For example, if you touch a hot stove, pain signals from your brain make you pull your hand away. This type of pain helps protect you. Long-lasting pain, such as arthritis pain, is different. While it tells you that something is wrong, it often isn't as easy to relieve. Managing this type of pain is important, because it can disrupt your life.The Pain Cycle Along with physical changes, such as movement limitations, the emotional ups and downs of your condition can add to your pain. If you feel depressed or stressed due to limited or lost abilities, your pain seems worse. You can get caught in a cycle of pain, limited abilities, lost abilities, stress, and depression that makes everything seem harder to handle.People react differently to pain for several reasons:Physical reasons: The sensitivity of your own nervous system and the severity of your condition determine how your body reacts to pain. These factors determine whether your nerves will send or block pain signals.Emotional and social reasons: Other factors that affect how you react to pain and how much pain you feel include your fears and anxieties about pain, previous experiences with pain, energy level, and the attitude about your condition. The way people around you react to pain also may affect how you personally react to pain.Whatever the reason, many people have discovered that by learning and practicing pain management skills, it is possible to reduce pain.How Does the Body Control Pain?Pain signals are sent through a complex system of nerves in your brain and spinal cord. Your body tries to stop these signals from reaching their destination by creating chemicals that help block pain signals. These chemicals, called endorphins, are morphine-like painkilling substances that decrease the pain sensation.The body produces endorphins in response to different kinds of "controls."These include "natural" controls, such as your own thoughts and emotions. For example: imagine that a father who is driving with his children is hurt in a car accident. The father is so worried about his children that he doesn't feel the pain from his own broken arm. The concern for his children has blocked the pain signal and kept the pain from affecting him.The body also produces endorphins in response to "outside" controls, such as medicine. Morphine is one example of a powerful pain-blocking medicine. Other outside pain control methods - such as exercise, relaxation, massage, and heat and cold treatment - can stimulate the body to either release endorphins or block pain signals in other ways.The following factors can make your pain feel worse:* increased disease activity* stress* excessive physical activity* dwelling on pain* fatigue* anxiety* depressionThe following exercises and techiques can block pain signals: * positive attitude and pleasant thoughts* carefully monitored exercise* relaxation* medication* massage* distraction* pleasing sights* topical lotions* humor* heat and cold treatments If most pain can be eased, why do so many people with pain suffer needlessly?Many of us have beliefs about pain that are simply not true and prevent us from getting the relief we deserve. The truth is: Pain is not something you "just have to live with." Treatments are available to relieve or lessen most pain. If untreated, pain can make other health problems worse, slow recovery, and interfere with healing. Get help right away; and don't let anyone suggest that your pain is simply "in your head."Not all doctors know how to treat pain. Your doctor should give the same attention to your pain as to any other health problems. But many doctors have had little training in pain care. If your doctor is unable to deal with your pain effectively, ask your doctor to consult with a specialist, or consider switching doctors.Pain medications rarely cause addiction. Morphine and similar pain medications, called opioids, can be highly effective for certain conditions. Unless you have a history of substance abuse, there is little risk of addiction when these medications are properly prescribed by a doctor and taken as directed. Physical dependence - which is not to be confused with addiction - occurs in the form of withdrawal symptoms if you stop taking these medications suddenly. This usually is not a problem if you go off your medications gradually.Most side effects from opioid pain medications can be managed. Nausea, drowsiness, itching, and most other side effects, caused by morphine and similar opioid medications, usually last only a few days. Constipation from these medications can usually be managed with laxatives, adequate fluid intake, and attention to diet. Ask your doctor to suggest ways that are best for you.If you act quickly when pain starts, you can often prevent it from getting worse. Take your medications when you first begin to experience pain. If your pain does get worse, talk with your doctor. Your doctor may safely prescribe higher doses or change the prescription. Non-drug therapies such as relaxation training and others can also help give you relief.
Medical News ARDvark Blog ARD related
Lack of research 'patient risk'
Patients are suffering because not enough basic clinical research is being done, a senior doctor warns.
Scientists Suggest Alternative to Cox-2 Drugs
Stomach-safe pain relief without heart risks might be possible, research shows.
Incontinent girls may suffer overactive bladder later
NEW YORK (Reuters Health) - Women who had urinary problems as children are more likely to have overactive bladder as adults, a new study shows.
Half of young US adults lack insurance: survey
WASHINGTON (Reuters) - Half of all young adults in the United States go without health insurance, and more than 15 million Americans were uninsured for four years running, according to a government survey published this week.
Delayed surgery decreases bladder cancer survival
NEW YORK (Reuters Health) - For patients newly diagnosed with bladder cancer, delays of more than 3 months after the initial diagnosis to surgery results in decreased survival, a study shows.
Health Tip: Kick the Habit, for Good
Make a plan to quit smoking
Test Points to Aggressive Cervical Cancer
High tumor glucose uptake means poorer survival, researchers say
Many Researchers Break the Rules: Study
Pressures in and outside lab may be to blame, experts say.
MedImmune Begins Dosing Of Lupus Patients In Phase 1 Clinical Trial
The Corporate Sponsored Creation Of Disease Turns Healthy People Into Patients, Wastes Precious Resources, And Causes Iatrogenic Harm
Wall Street Journal Examines Boston Medical Center Program For Low-Income Children
A Jekyll And Hyde Of Cytokines: IL-25 Both Promotes And Limits Inflammatory Diseases
Patients are suffering because not enough basic clinical research is being done, a senior doctor warns.
Scientists Suggest Alternative to Cox-2 Drugs
Stomach-safe pain relief without heart risks might be possible, research shows.
Incontinent girls may suffer overactive bladder later
NEW YORK (Reuters Health) - Women who had urinary problems as children are more likely to have overactive bladder as adults, a new study shows.
Half of young US adults lack insurance: survey
WASHINGTON (Reuters) - Half of all young adults in the United States go without health insurance, and more than 15 million Americans were uninsured for four years running, according to a government survey published this week.
Delayed surgery decreases bladder cancer survival
NEW YORK (Reuters Health) - For patients newly diagnosed with bladder cancer, delays of more than 3 months after the initial diagnosis to surgery results in decreased survival, a study shows.
Health Tip: Kick the Habit, for Good
Make a plan to quit smoking
Test Points to Aggressive Cervical Cancer
High tumor glucose uptake means poorer survival, researchers say
Many Researchers Break the Rules: Study
Pressures in and outside lab may be to blame, experts say.
MedImmune Begins Dosing Of Lupus Patients In Phase 1 Clinical Trial
The Corporate Sponsored Creation Of Disease Turns Healthy People Into Patients, Wastes Precious Resources, And Causes Iatrogenic Harm
Wall Street Journal Examines Boston Medical Center Program For Low-Income Children
A Jekyll And Hyde Of Cytokines: IL-25 Both Promotes And Limits Inflammatory Diseases
Hemorrhoids
Hemorrhoids
Hemorrhoid surgery - series
Definition:
Hemorrhoids are painful, swollen veins in the lower portion of the rectum or anus.
Alternative Names:
Rectal lump; Piles; Lump in the rectum
Causes, incidence, and risk factors:
This condition is very common, especially during pregnancy and after childbirth. Hemorrhoids result from increased pressure in the veins of the anus. The pressure causes the veins to bulge and expand, making them painful, particularly when you are sitting.
The most common cause is straining during bowel movements. Hemorrhoids may result from constipation, sitting for long periods of time, and anal infections. In some cases they may be caused by other diseases, such as liver cirrhosis.
Internal hemorrhoids occur just inside the anus, at the beginning of the rectum. External hemorrhoids occur at the anal opening and may hang outside the anus.
Symptoms:
Symptoms of hemorrhoids include:
Anal itching
Anal ache or pain, especially while sitting
Bright red blood on toilet tissue, stool, or in the toilet bowl
Pain during bowel movements
One or more hard tender lumps near the anus
Signs and tests:
A doctor can often diagnose hemorrhoids simply by examining the rectal area. If necessary, tests that may help diagnose the problem include:
Stool guaiac (shows the presence of blood)
Sigmoidoscopy
Anoscopy
Treatment:
Over-the-counter corticosteroid creams can reduce pain and swelling. Hemorrhoid creams with lidocaine can reduce pain. Witch hazel (applied with cotton swabs) can reduce itching. Other steps for anal itching include:
Wear cotton undergarments.
Avoid toilet tissue with perfumes or colors.
Try not to scratch the area.
Sitz baths can help you to feel better. Sit in warm water for 10 to 15 minutes. Stool softeners help reduce straining and constipation.
For cases that don't respond to home treatments, a doctor may recommend surgery, like rubber band ligation or surgical hemorrhoidectomy. These procedures are generally used for patients with severe pain or bleeding who have not responded to other therapy.
Expectations (prognosis):
Most treatments are effective, but to prevent the hemorrhoids from coming back, you will need to maintain a high-fiber diet and drink plenty of fluids.
Complications:
The blood in the enlarged veins may form clots, and the tissue surrounding the hemorrhoids can die. Hemorrhoids with clots generally require surgical removal.
Severe bleeding may also occur. Iron deficiency anemia can result from prolonged loss of blood. Significant bleeding from hemorrhoids is unusual, however.
Calling your health care provider:
Call for an appointment with your health care provider if hemorrhoid symptoms do not improve with home treatment. You should also be seen if you have rectal bleeding. Your provider may want to check for other, more serious causes of the bleeding, especially if you have never bled from hemorrhoids before.
Call 911 if blood loss is significant or if you feel dizzy, lightheaded, or faint.
Prevention:
Avoid straining during bowel movements. You can help prevent hemorrhoids by preventing constipation. Drink plenty of fluids, at least eight glasses per day. Eat a high-fiber diet of fruits, vegetables, whole grains. Consider fiber supplements.
References:
Feldman M, Friedman LS, Sleisenger MH. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 7th Ed. Philadelphia, PA: Saunders; 2002.
Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th Ed. St. Louis, MO: Mosby; 2002.
Rakel P, ed.Textbook of Family Practice. 6th Ed. Philadelphia, PA: Saunders; 2002.
http://pennhealth.com/ency/article/000292.htm
Hemorrhoid surgery - series
Definition:
Hemorrhoids are painful, swollen veins in the lower portion of the rectum or anus.
Alternative Names:
Rectal lump; Piles; Lump in the rectum
Causes, incidence, and risk factors:
This condition is very common, especially during pregnancy and after childbirth. Hemorrhoids result from increased pressure in the veins of the anus. The pressure causes the veins to bulge and expand, making them painful, particularly when you are sitting.
The most common cause is straining during bowel movements. Hemorrhoids may result from constipation, sitting for long periods of time, and anal infections. In some cases they may be caused by other diseases, such as liver cirrhosis.
Internal hemorrhoids occur just inside the anus, at the beginning of the rectum. External hemorrhoids occur at the anal opening and may hang outside the anus.
Symptoms:
Symptoms of hemorrhoids include:
Anal itching
Anal ache or pain, especially while sitting
Bright red blood on toilet tissue, stool, or in the toilet bowl
Pain during bowel movements
One or more hard tender lumps near the anus
Signs and tests:
A doctor can often diagnose hemorrhoids simply by examining the rectal area. If necessary, tests that may help diagnose the problem include:
Stool guaiac (shows the presence of blood)
Sigmoidoscopy
Anoscopy
Treatment:
Over-the-counter corticosteroid creams can reduce pain and swelling. Hemorrhoid creams with lidocaine can reduce pain. Witch hazel (applied with cotton swabs) can reduce itching. Other steps for anal itching include:
Wear cotton undergarments.
Avoid toilet tissue with perfumes or colors.
Try not to scratch the area.
Sitz baths can help you to feel better. Sit in warm water for 10 to 15 minutes. Stool softeners help reduce straining and constipation.
For cases that don't respond to home treatments, a doctor may recommend surgery, like rubber band ligation or surgical hemorrhoidectomy. These procedures are generally used for patients with severe pain or bleeding who have not responded to other therapy.
Expectations (prognosis):
Most treatments are effective, but to prevent the hemorrhoids from coming back, you will need to maintain a high-fiber diet and drink plenty of fluids.
Complications:
The blood in the enlarged veins may form clots, and the tissue surrounding the hemorrhoids can die. Hemorrhoids with clots generally require surgical removal.
Severe bleeding may also occur. Iron deficiency anemia can result from prolonged loss of blood. Significant bleeding from hemorrhoids is unusual, however.
Calling your health care provider:
Call for an appointment with your health care provider if hemorrhoid symptoms do not improve with home treatment. You should also be seen if you have rectal bleeding. Your provider may want to check for other, more serious causes of the bleeding, especially if you have never bled from hemorrhoids before.
Call 911 if blood loss is significant or if you feel dizzy, lightheaded, or faint.
Prevention:
Avoid straining during bowel movements. You can help prevent hemorrhoids by preventing constipation. Drink plenty of fluids, at least eight glasses per day. Eat a high-fiber diet of fruits, vegetables, whole grains. Consider fiber supplements.
References:
Feldman M, Friedman LS, Sleisenger MH. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 7th Ed. Philadelphia, PA: Saunders; 2002.
Marx JA, Hockberger RS, Walls RM, eds. Rosen’s Emergency Medicine: Concepts and Clinical Practice. 5th Ed. St. Louis, MO: Mosby; 2002.
Rakel P, ed.Textbook of Family Practice. 6th Ed. Philadelphia, PA: Saunders; 2002.
http://pennhealth.com/ency/article/000292.htm
Vulvodynia
Irene Jackson RN, MN
Do you suffer from pain in the vulva that sometimes stops you having intercourse or inserting a tampon? If you do, you may have a type of vulvodynia.
The word vulvodynia means vulval pain. The vulva is the external parts of the female genitalia. The areas most often affected are the inner labia, the clitoris, and glands beside the urethra and on either side of the vagina.
Vulvodynia is defined as symptoms of chronic soreness of the vulva that is described as pain, burning, rawness or stinging. The sensations throb and can last for hours or days. There are at least four types of vulval pain (see chart), but the condition is often misdiagnosed or undiagnosed. Because there are often no visible changes to the vulva, some women are made to feel that they are imagining the problem.
Four kinds of Vulvodynia
Symptoms
Physical findings
History
Treatment
Cyclic vulvovaginitis
Itching, burning, redness and swelling that is worse after intercourse.
May recur at the same time of the menstrual cycle.
Vulva is hot, red and tender, and the skin may split. Often there is no vaginal discharge.
Occurs in premenopausal women, or women on hormone therapy. There is often a history of yeast infections or frequent antibiotic use.
Anti-candida cream or pills. Topical cream or oral therapy may be needed for 6 months or more.
Dysesthetic vulvodynia
Constant burning pain that is worse at night. The pain may be sharp or a deep ache. It is not related to touch.
The inner labia and area back to the anus and down the inner thighs may be affected. Detailed examination shows no abnormality.
More common in older women and women with interstitial cystitis or fibromyalgia.
Low-dose, tricyclic antidepressant, such as Amitriptyline, for several months. Prescription antihistamines.
Anticonvulsant drugs containing
Carbemazepine, (e.g.,Tegretol) may help if antidepressants aren’t effective.
Vulvar dermatoses
Chronic burning, skin disorders on the membranes of the vulva.
Inflammation, irritation and hypersensitivity. Skin eruptions including: lichen simplex, lichen sclerosis, lichen planus.
Can occur at any age.
Testosterone propionate ointment.
Topical steroids.
Biopsies to identify lesion.
Vulvar vestibulitis
Raw, burning, dry or tight skin. Symptoms caused by intercourse, touch, and insertion of tampon, tight clothes, bike-riding. Pain may be constant or only after intercourse
Inflammation of the vaginal opening (vestibule) may be present.
With severe continuous pain, vaginismus (spasm of the pelvic floor muscles) may develop.
Extremely tender to very light touch.
Can occur at any age in women who are usually sexually active until pain occurs.
Topical steroids, followed by estrogen creams if steroids aren’t effective. Surgical treatment is used in less than 20% of sufferers.
What you can do
Your family doctor may diagnose your vulval pain, but often a referral to a gynaecologist is necessary. While you are waiting for the specialist appointment or for treatment to begin working, the following tips may stop flare-ups and provide relief. Talk about your self-help plans with your doctor.
Diet
In some women, a low-oxalate diet and calcium citrate supplements help to reduce the pain. Oxalates are present in a variety of foods, from spinach to chocolate. Oxalate crystals are acid and may irritate the genital tissues. Calcium citrate reduces the acid in the urine and reduces the passage of oxalates. The low-oxalate diet cookbook A Taste of the Good Life by Bev Laumann is available in the Women’s Health Resources Library.
Clothing and toiletries
Choose cotton underwear and avoid tight clothing. Wash new panties in baking soda before wearing, and stop using fabric softeners. Switching from pantyhose to stockings or socks decreases irritation. Stop using perfumed toiletries or ones containing chemicals. Some women have found that a vaginal douche made with baking soda provides temporary relief. Use unbleached or white toilet paper. If your vulva burns after passing urine, rinse the area with clear water.
Intercourse
Use vegetable oil (such as Canola oil) or lubricants containing glycerine for lubrication. Since contraceptive creams and devices can cause irritation, reconsider your method of contraception. Talk to your doctor about the benefits of using a local anaesthetic ointment. Applying the ointment around the vaginal opening about 15 minutes before sex will increase your level of comfort, as it deadens the surface nerve endings.
General
Because increased pressure on the vulva causes pain, avoid constipation or a full bladder. Change out of wet bathing suits or clothing as soon as possible. A compress made from powdered oatmeal bath treatment can ease symptoms. Mix two tablespoons of powdered oatmeal in a litre of water and refrigerate. Soak a cotton cloth or cotton sanitary pad in the mixture, and apply over the vulva three or four times a day.
For more information and support contact The National Vulvodynia Association at PO Box 4491, Silver Spring, MD 20914-4491 or look on the Web at
www.nva.org
Do you suffer from pain in the vulva that sometimes stops you having intercourse or inserting a tampon? If you do, you may have a type of vulvodynia.
The word vulvodynia means vulval pain. The vulva is the external parts of the female genitalia. The areas most often affected are the inner labia, the clitoris, and glands beside the urethra and on either side of the vagina.
Vulvodynia is defined as symptoms of chronic soreness of the vulva that is described as pain, burning, rawness or stinging. The sensations throb and can last for hours or days. There are at least four types of vulval pain (see chart), but the condition is often misdiagnosed or undiagnosed. Because there are often no visible changes to the vulva, some women are made to feel that they are imagining the problem.
Four kinds of Vulvodynia
Symptoms
Physical findings
History
Treatment
Cyclic vulvovaginitis
Itching, burning, redness and swelling that is worse after intercourse.
May recur at the same time of the menstrual cycle.
Vulva is hot, red and tender, and the skin may split. Often there is no vaginal discharge.
Occurs in premenopausal women, or women on hormone therapy. There is often a history of yeast infections or frequent antibiotic use.
Anti-candida cream or pills. Topical cream or oral therapy may be needed for 6 months or more.
Dysesthetic vulvodynia
Constant burning pain that is worse at night. The pain may be sharp or a deep ache. It is not related to touch.
The inner labia and area back to the anus and down the inner thighs may be affected. Detailed examination shows no abnormality.
More common in older women and women with interstitial cystitis or fibromyalgia.
Low-dose, tricyclic antidepressant, such as Amitriptyline, for several months. Prescription antihistamines.
Anticonvulsant drugs containing
Carbemazepine, (e.g.,Tegretol) may help if antidepressants aren’t effective.
Vulvar dermatoses
Chronic burning, skin disorders on the membranes of the vulva.
Inflammation, irritation and hypersensitivity. Skin eruptions including: lichen simplex, lichen sclerosis, lichen planus.
Can occur at any age.
Testosterone propionate ointment.
Topical steroids.
Biopsies to identify lesion.
Vulvar vestibulitis
Raw, burning, dry or tight skin. Symptoms caused by intercourse, touch, and insertion of tampon, tight clothes, bike-riding. Pain may be constant or only after intercourse
Inflammation of the vaginal opening (vestibule) may be present.
With severe continuous pain, vaginismus (spasm of the pelvic floor muscles) may develop.
Extremely tender to very light touch.
Can occur at any age in women who are usually sexually active until pain occurs.
Topical steroids, followed by estrogen creams if steroids aren’t effective. Surgical treatment is used in less than 20% of sufferers.
What you can do
Your family doctor may diagnose your vulval pain, but often a referral to a gynaecologist is necessary. While you are waiting for the specialist appointment or for treatment to begin working, the following tips may stop flare-ups and provide relief. Talk about your self-help plans with your doctor.
Diet
In some women, a low-oxalate diet and calcium citrate supplements help to reduce the pain. Oxalates are present in a variety of foods, from spinach to chocolate. Oxalate crystals are acid and may irritate the genital tissues. Calcium citrate reduces the acid in the urine and reduces the passage of oxalates. The low-oxalate diet cookbook A Taste of the Good Life by Bev Laumann is available in the Women’s Health Resources Library.
Clothing and toiletries
Choose cotton underwear and avoid tight clothing. Wash new panties in baking soda before wearing, and stop using fabric softeners. Switching from pantyhose to stockings or socks decreases irritation. Stop using perfumed toiletries or ones containing chemicals. Some women have found that a vaginal douche made with baking soda provides temporary relief. Use unbleached or white toilet paper. If your vulva burns after passing urine, rinse the area with clear water.
Intercourse
Use vegetable oil (such as Canola oil) or lubricants containing glycerine for lubrication. Since contraceptive creams and devices can cause irritation, reconsider your method of contraception. Talk to your doctor about the benefits of using a local anaesthetic ointment. Applying the ointment around the vaginal opening about 15 minutes before sex will increase your level of comfort, as it deadens the surface nerve endings.
General
Because increased pressure on the vulva causes pain, avoid constipation or a full bladder. Change out of wet bathing suits or clothing as soon as possible. A compress made from powdered oatmeal bath treatment can ease symptoms. Mix two tablespoons of powdered oatmeal in a litre of water and refrigerate. Soak a cotton cloth or cotton sanitary pad in the mixture, and apply over the vulva three or four times a day.
For more information and support contact The National Vulvodynia Association at PO Box 4491, Silver Spring, MD 20914-4491 or look on the Web at
www.nva.org
Pneumoperitoneum versus abdominal wall lift: effects on central haemodynamics and intrathoracic pressure during laparoscopic cholecystectomy.
Full of Gas Series
Acta Anaesthesiol Scand. 2003 Aug;47(7):838-46.
Related Articles,
Links
Pneumoperitoneum versus abdominal wall lift: effects on central haemodynamics and intrathoracic pressure during laparoscopic cholecystectomy.
Andersson L, Lindberg G, Bringman S, Ramel S, Anderberg B, Odeberg-Wernerman S.
Department of Anaesthesiology and Intensive Care, Huddinge University Hospital, Stockholm, Sweden. lena.e.andersson@hs.se
BACKGROUND: It has been shown repeatedly that laparoscopic cholecystectomy using pneumoperitoneum (CO2 insufflation) may be associated with increased cardiac filling pressures and an increase in blood pressure and systemic vascular resistance. In the present study, the effects on the central circulation during abdominal wall lift (a gasless method of laparoscopic cholecystectomy) were compared with those during pneumoperitoneum. The study was also aimed at elucidating the relationships between the central filling pressures and the intrathoracic pressure.
METHODS: Twenty patients (ASA I), scheduled for laparoscopic cholecystectomy, were randomised into two groups, pneumoperitoneum or abdominal wall lift. Measurements were made by arterial and pulmonary arterial catheterization before and during pneumoperitoneum or abdominal wall lift with the patient in the horizontal position. Measurements were repeated after head-up tilting the patients as well as after 30 min head-up tilt. The intrathoracic pressure was monitored in the horizontal position before and during intervention using an intraesophageal balloon.
RESULTS: After pneumoperitoneum or abdominal wall lifting there were significant differences between the two groups regarding MAP, SVR, CVP, CI, and SV. Analogous to previous studies, in the pneumoperitoneum group CVP, PCWP, MPAP, and MAP as well as SVR were increased after CO2 insufflation (P <>
CONCLUSIONS: In healthy patients, abdominal wall lift increased cardiac index while pneumoperitoneum did not. Cardiac filling pressures and systemic vascular resistance were increased by pneumoperitoneum but unaffected by abdominal wall lift. The recorded elevated cardiac filling pressures during pneumoperitoneum may be only a reflection of the increased intra-abdominal pressure.Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 12859305 [PubMed - indexed for MEDLINE]
Acta Anaesthesiol Scand. 2003 Aug;47(7):838-46.
Related Articles,
Links
Pneumoperitoneum versus abdominal wall lift: effects on central haemodynamics and intrathoracic pressure during laparoscopic cholecystectomy.
Andersson L, Lindberg G, Bringman S, Ramel S, Anderberg B, Odeberg-Wernerman S.
Department of Anaesthesiology and Intensive Care, Huddinge University Hospital, Stockholm, Sweden. lena.e.andersson@hs.se
BACKGROUND: It has been shown repeatedly that laparoscopic cholecystectomy using pneumoperitoneum (CO2 insufflation) may be associated with increased cardiac filling pressures and an increase in blood pressure and systemic vascular resistance. In the present study, the effects on the central circulation during abdominal wall lift (a gasless method of laparoscopic cholecystectomy) were compared with those during pneumoperitoneum. The study was also aimed at elucidating the relationships between the central filling pressures and the intrathoracic pressure.
METHODS: Twenty patients (ASA I), scheduled for laparoscopic cholecystectomy, were randomised into two groups, pneumoperitoneum or abdominal wall lift. Measurements were made by arterial and pulmonary arterial catheterization before and during pneumoperitoneum or abdominal wall lift with the patient in the horizontal position. Measurements were repeated after head-up tilting the patients as well as after 30 min head-up tilt. The intrathoracic pressure was monitored in the horizontal position before and during intervention using an intraesophageal balloon.
RESULTS: After pneumoperitoneum or abdominal wall lifting there were significant differences between the two groups regarding MAP, SVR, CVP, CI, and SV. Analogous to previous studies, in the pneumoperitoneum group CVP, PCWP, MPAP, and MAP as well as SVR were increased after CO2 insufflation (P <>
CONCLUSIONS: In healthy patients, abdominal wall lift increased cardiac index while pneumoperitoneum did not. Cardiac filling pressures and systemic vascular resistance were increased by pneumoperitoneum but unaffected by abdominal wall lift. The recorded elevated cardiac filling pressures during pneumoperitoneum may be only a reflection of the increased intra-abdominal pressure.Publication Types:
Clinical Trial
Randomized Controlled Trial
PMID: 12859305 [PubMed - indexed for MEDLINE]
Science Creates a Living Bandage for Broken Hearts'Cardiac
Science Creates a Living Bandage for Broken Hearts'Cardiac patch' and other advances are on the horizon, researchers say
By E.J. MundellHealthDay Reporter
FRIDAY, Jan. 20 (HealthDay News) -- Hybrid cars are grabbing headlines, but how about "hybrid hearts"?
Merging artificially engineered products with a patient's own heart to stop or reverse cardiac damage could be the wave of the future, researchers say.
One such innovation, the "cardiac patch," is just that: A piece of living, beating cardiac tissue, grown in the lab in just a few days and applied to hearts wounded by prior heart attack or chronic disease.
"We joke that this is really 'a patch for a broken heart,'" said Gordana Vunjak-Novakovic, professor of biomedical engineering at Columbia University Medical Center in New York City, and co-director of the Tissue Engineering Resource Center at the National Institutes of Health in Bethesda, Md.
She described the new technology at a special "Hybrid Technologies" symposium held Thursday in New York City, part of the Second International Conference on Cell Therapy for Cardiovascular Diseases.
Hearts affected by heart attack or congestive heart failure develop large areas of scar tissue that is essentially non-functioning. In the most serious cases, drugs are of little help, and demand for heart transplants far outstrip the supply of donor hearts.
"So, we are trying here to make heart tissue," Vunjak-Novakovic explained. The process mimics that seen in nature, with scientists replicating the cardiac environment inside a special tissue-growing chamber called a bioreactor.
Everything has to be right: Cardiac cells must grow at a very high density but also be well-oxygenated, just as they are in the developing heart. And those cells must also be artificially electrically stimulated, since it is electric pulses that keep hearts beating.
So far, the Columbia lab has achieved real success: Vunjak-Novakovic presented video of thumbnail-sized cardiac patches rhythmically twitching just as real heart muscle does.
But the patches have not yet made their way into humans, and they may not do so for many years, Vunjak-Novakovic said.
"The real challenge is that you have to place the patch upon the heart in a way that it integrates into the heart," she said. "You don't want it to just sit there as a separate entity. It needs to connect electrically so that it syncs up with signals coming from the cells, so everything works together." Getting the patch's blood vessels to merge with those of the host heart will be another challenge, she added.
But animal trials tackling those issues are already under way, the Columbia researcher said. Someday, perhaps a decade from now, human trials might begin. And in the more distant future, the cardiac patch -- grown either from the patient or delivered "off the shelf" -- might become a routine part of cardiac care, she said.
Materials called "biopolymers" are another innovation in the cardiac-repair pipeline, according to Dr. Randall Lee, an assistant professor of medicine in the department of cardiology at the University of California, San Francisco School of Medicine.
Speaking at the meeting, he explained that these synthetic materials, with names like "alginate," "fibrin glue" and "matrigel," are injected into damaged cardiac tissue to form a kind of sticky scaffolding. In the same way that a shipwreck gives rise to a coral reef, biopolymers help gather together cells responsible for repairing and rebuilding tissue.
Biopolymers might prove especially useful for stem cell therapy, which shows great promise but has so far been disappointing when it comes to cardiovascular repair, he said.
"It may be that stem cell therapy does work -- but you're just not getting enough of the cells to stay in the area," Lee said. "You might inject 100 cells, and maybe only five stay there."
But fibrin glue, the biopolymer Lee's lab uses, comes equipped with special chemical binding sites. "These are anchors that a cell can grab on to so they stay there," he said.
In studies presented at the meeting, Lee noted that use of fibrin glue greatly increased the number of myoblasts -- progenitor heart muscle cells -- in cardiac tissue, and also boosted the formation of blood vessels. The biopolymer is gradually absorbed into tissue by about two weeks, essentially disappearing once its job is done, he said.
Lee believes second-generation biopolymers are also on the horizon, materials that will actively recruit natural, heart-healing cells and growth factors to cardiac tissue sites in need of repair.
"It's recruiting the body's own cells," he said. "That could then facilitate the whole process of regeneration."
More information
To learn more about how the heart works, head to the American Heart Association.
SOURCES: Gordana Vunjak-Novakovic, Ph.D., professor, biomedical engineering, Columbia University Medical Center, New York City, and co-director, Tissue Engineering Resource Center, National Institutes of Health, Bethesda, Md.; Randall Lee, M.D., Ph.D., assistant professor of medicine, department of cardiology, University of California, San Francisco School of Medicine; Jan. 19, 2006, presentations, Second International Conference on Cell Therapy for Cardiovascular Diseases, New York City
http://www.healthday.com/view.cfm?id=530478
By E.J. MundellHealthDay Reporter
FRIDAY, Jan. 20 (HealthDay News) -- Hybrid cars are grabbing headlines, but how about "hybrid hearts"?
Merging artificially engineered products with a patient's own heart to stop or reverse cardiac damage could be the wave of the future, researchers say.
One such innovation, the "cardiac patch," is just that: A piece of living, beating cardiac tissue, grown in the lab in just a few days and applied to hearts wounded by prior heart attack or chronic disease.
"We joke that this is really 'a patch for a broken heart,'" said Gordana Vunjak-Novakovic, professor of biomedical engineering at Columbia University Medical Center in New York City, and co-director of the Tissue Engineering Resource Center at the National Institutes of Health in Bethesda, Md.
She described the new technology at a special "Hybrid Technologies" symposium held Thursday in New York City, part of the Second International Conference on Cell Therapy for Cardiovascular Diseases.
Hearts affected by heart attack or congestive heart failure develop large areas of scar tissue that is essentially non-functioning. In the most serious cases, drugs are of little help, and demand for heart transplants far outstrip the supply of donor hearts.
"So, we are trying here to make heart tissue," Vunjak-Novakovic explained. The process mimics that seen in nature, with scientists replicating the cardiac environment inside a special tissue-growing chamber called a bioreactor.
Everything has to be right: Cardiac cells must grow at a very high density but also be well-oxygenated, just as they are in the developing heart. And those cells must also be artificially electrically stimulated, since it is electric pulses that keep hearts beating.
So far, the Columbia lab has achieved real success: Vunjak-Novakovic presented video of thumbnail-sized cardiac patches rhythmically twitching just as real heart muscle does.
But the patches have not yet made their way into humans, and they may not do so for many years, Vunjak-Novakovic said.
"The real challenge is that you have to place the patch upon the heart in a way that it integrates into the heart," she said. "You don't want it to just sit there as a separate entity. It needs to connect electrically so that it syncs up with signals coming from the cells, so everything works together." Getting the patch's blood vessels to merge with those of the host heart will be another challenge, she added.
But animal trials tackling those issues are already under way, the Columbia researcher said. Someday, perhaps a decade from now, human trials might begin. And in the more distant future, the cardiac patch -- grown either from the patient or delivered "off the shelf" -- might become a routine part of cardiac care, she said.
Materials called "biopolymers" are another innovation in the cardiac-repair pipeline, according to Dr. Randall Lee, an assistant professor of medicine in the department of cardiology at the University of California, San Francisco School of Medicine.
Speaking at the meeting, he explained that these synthetic materials, with names like "alginate," "fibrin glue" and "matrigel," are injected into damaged cardiac tissue to form a kind of sticky scaffolding. In the same way that a shipwreck gives rise to a coral reef, biopolymers help gather together cells responsible for repairing and rebuilding tissue.
Biopolymers might prove especially useful for stem cell therapy, which shows great promise but has so far been disappointing when it comes to cardiovascular repair, he said.
"It may be that stem cell therapy does work -- but you're just not getting enough of the cells to stay in the area," Lee said. "You might inject 100 cells, and maybe only five stay there."
But fibrin glue, the biopolymer Lee's lab uses, comes equipped with special chemical binding sites. "These are anchors that a cell can grab on to so they stay there," he said.
In studies presented at the meeting, Lee noted that use of fibrin glue greatly increased the number of myoblasts -- progenitor heart muscle cells -- in cardiac tissue, and also boosted the formation of blood vessels. The biopolymer is gradually absorbed into tissue by about two weeks, essentially disappearing once its job is done, he said.
Lee believes second-generation biopolymers are also on the horizon, materials that will actively recruit natural, heart-healing cells and growth factors to cardiac tissue sites in need of repair.
"It's recruiting the body's own cells," he said. "That could then facilitate the whole process of regeneration."
More information
To learn more about how the heart works, head to the American Heart Association.
SOURCES: Gordana Vunjak-Novakovic, Ph.D., professor, biomedical engineering, Columbia University Medical Center, New York City, and co-director, Tissue Engineering Resource Center, National Institutes of Health, Bethesda, Md.; Randall Lee, M.D., Ph.D., assistant professor of medicine, department of cardiology, University of California, San Francisco School of Medicine; Jan. 19, 2006, presentations, Second International Conference on Cell Therapy for Cardiovascular Diseases, New York City
http://www.healthday.com/view.cfm?id=530478
BEFORE YOU HAVE ANY SURGERY
Find Out About ARD
Before You Have Any Surgery !
Ardvark Blog
ARDchat.com
Adhesion Related Disorder
International Adhesion Society
Before You Have Any Surgery !
Ardvark Blog
ARDchat.com
Adhesion Related Disorder
International Adhesion Society
Thursday, April 13, 2006
Adhesion Related Disorder Todays News ARDvark Blog
Tas University's pharmacy software set for world distribution
The University of Tasmania hopes a piece of software developed at its School of Pharmacy will help to reduce the incorrect prescription and use of drugs around the world.
Market Place: Robust Health Insurers Suffer Infirmities in 2006
After five years of stock market gains, shares of health insurance companies have been on a slide so far this year, down 8.6 percent since the start of the year.
Massachusetts Legislation on Insurance Becomes Law
Gov. Mitt Romney signed a bill to provide nearly universal health insurance, but vetoed a provision penalizing employers who do not provide coverage.
Procedure Helps Restore Urinary Continence in Women
A bladder-supporting technique proves effective in major trial
Abnormal Pap test in teens needs cautious approach
NEW YORK (Reuters Health) - Adolescents girls with abnormal screening Pap test results should be treated less aggressively than adult women, a committee of the American College of Obstetricians and Gynecologists (ACOG) recommends in a report published this month in the college's journal, Obstetrics and Gynecology.
Colonoscopy Still Best Defense Against Colorectal Cancer
A healthy lifestyle helps, but regular screens are 'gold standard,' experts say.
Emotions Plus Brain Hormone May Strengthen Memory
Rat study might point to human memory-enhancers.
Health Tip: Prevent Food-Borne Illnesses
Store and prepare food properly
Tests Predict Long-Term Kidney Risk
Blood, urine screens can spot the dangers decades early
Epstein-Barr Virus May Be Associated With Multiple Sclerosis
Trust Between Patients And Doctors After Shipman
Environmental Toxins Disruptive To Hearing In Mammals, Yale Researchers Find
Postmenopausal Hormone Therapy Appears To Increase Risk Of Blood Clots In Veins
CQ's Carey Talks About Medical Malpractice, HSAs, FY 2007 Budget, Biodefense Spending
Boston Medical Center To Expand Healthy Residential Environment Program For Low-Income Children Nationwide
Editorials, Opinion Pieces Address Massachusetts Health Care Bill
American Indians File Lawsuit Against HHS Alleging Inadequate Care
Health Authorities, Women Need To Examine Data, Consider Risks Of Mifeprex, Editorial Says
Chronic Pain Hurts Both Workers And Employers
The University of Tasmania hopes a piece of software developed at its School of Pharmacy will help to reduce the incorrect prescription and use of drugs around the world.
Market Place: Robust Health Insurers Suffer Infirmities in 2006
After five years of stock market gains, shares of health insurance companies have been on a slide so far this year, down 8.6 percent since the start of the year.
Massachusetts Legislation on Insurance Becomes Law
Gov. Mitt Romney signed a bill to provide nearly universal health insurance, but vetoed a provision penalizing employers who do not provide coverage.
Procedure Helps Restore Urinary Continence in Women
A bladder-supporting technique proves effective in major trial
Abnormal Pap test in teens needs cautious approach
NEW YORK (Reuters Health) - Adolescents girls with abnormal screening Pap test results should be treated less aggressively than adult women, a committee of the American College of Obstetricians and Gynecologists (ACOG) recommends in a report published this month in the college's journal, Obstetrics and Gynecology.
Colonoscopy Still Best Defense Against Colorectal Cancer
A healthy lifestyle helps, but regular screens are 'gold standard,' experts say.
Emotions Plus Brain Hormone May Strengthen Memory
Rat study might point to human memory-enhancers.
Health Tip: Prevent Food-Borne Illnesses
Store and prepare food properly
Tests Predict Long-Term Kidney Risk
Blood, urine screens can spot the dangers decades early
Epstein-Barr Virus May Be Associated With Multiple Sclerosis
Trust Between Patients And Doctors After Shipman
Environmental Toxins Disruptive To Hearing In Mammals, Yale Researchers Find
Postmenopausal Hormone Therapy Appears To Increase Risk Of Blood Clots In Veins
CQ's Carey Talks About Medical Malpractice, HSAs, FY 2007 Budget, Biodefense Spending
Boston Medical Center To Expand Healthy Residential Environment Program For Low-Income Children Nationwide
Editorials, Opinion Pieces Address Massachusetts Health Care Bill
American Indians File Lawsuit Against HHS Alleging Inadequate Care
Health Authorities, Women Need To Examine Data, Consider Risks Of Mifeprex, Editorial Says
Chronic Pain Hurts Both Workers And Employers
Colostomy
(Note: This sheet is also available in an Adobe PDF version.)
Colostomy: A surgically created opening in the abdominal wall through which digested food passes.
Temporary colostomy: May be required to give a portion of the bowel a chance to rest and heal. When healing has occurred, the colostomy can be reversed and normal bowel function restored.
Permanent colostomy: May be required when a disease affects the end part of the colon or rectum.
Reasons for surgery:
Cancer, diverticulitis, imperforate anus, Hirschsprung's disease, trauma.
Care of colostomy:
A pouching system is usually worn. Pouches are odor free and different manufacturers have disposable or reusable varieties to fit one's lifestyle. Ostomy supplies are available at drug stores, medical supply stores and through the mail. Irrigation: Certain people are candidates for learning irrigation techniques that will allow for increased control over the timing of bowel movements.
Living with a colostomy: Work: With the possible exception of jobs requiring very heavy lifting, a colostomy should not interfere with work. People with colostomies are successful business people, teachers, carpenters, welders, etc. Sex and social life: Physically, the creation of a colostomy usually does not affect sexual function. If there is a problem, it is almost always related to the removal of the rectum. The colostomy itself should not interfere with normal sexual activity or pregnancy. It does not prevent one from dating, marriage or having children.
Clothing: Usually one is able to wear the same clothing as before surgery including swimwear.
Sports and activities: With a securely attached pouch one can swim, camp out, play baseball and participate in practically all types of sports. Caution is advised in heavy body contact sports. Travel is not restricted in any way. Bathing and showering may be done with or without the pouch in place.
Diet: Usually there are no dietary restrictions and foods can be enjoyed as before.
Resources available:
The physician and medical professionals are the first source of help. Specially trained nurses called Wound, Ostomy Continence Nurses (WOCN) are available for consultation in most major medical centers.
The United Ostomy Association (UOA) is a group comprised of many local chapters throughout the United States. These local groups hold meetings and provide support to prospective and existing ostomates. They sponsor educational events and have qualified visitors to make personal or telephone visits. Contact the UOA for the chapter nearest you and for other educational publications. Visit the UOA web site at www.uoa.org. It contains a great deal of information and many links to other sites, suppliers and resources.
Note: More detailed information can be found in Colostomy Guide, a publication of the United Ostomy Association. Contact UOA at 1-800-826-0826.
http://www.uoa.org/ostomy_facts_colostomy.htm
Colostomy: A surgically created opening in the abdominal wall through which digested food passes.
Temporary colostomy: May be required to give a portion of the bowel a chance to rest and heal. When healing has occurred, the colostomy can be reversed and normal bowel function restored.
Permanent colostomy: May be required when a disease affects the end part of the colon or rectum.
Reasons for surgery:
Cancer, diverticulitis, imperforate anus, Hirschsprung's disease, trauma.
Care of colostomy:
A pouching system is usually worn. Pouches are odor free and different manufacturers have disposable or reusable varieties to fit one's lifestyle. Ostomy supplies are available at drug stores, medical supply stores and through the mail. Irrigation: Certain people are candidates for learning irrigation techniques that will allow for increased control over the timing of bowel movements.
Living with a colostomy: Work: With the possible exception of jobs requiring very heavy lifting, a colostomy should not interfere with work. People with colostomies are successful business people, teachers, carpenters, welders, etc. Sex and social life: Physically, the creation of a colostomy usually does not affect sexual function. If there is a problem, it is almost always related to the removal of the rectum. The colostomy itself should not interfere with normal sexual activity or pregnancy. It does not prevent one from dating, marriage or having children.
Clothing: Usually one is able to wear the same clothing as before surgery including swimwear.
Sports and activities: With a securely attached pouch one can swim, camp out, play baseball and participate in practically all types of sports. Caution is advised in heavy body contact sports. Travel is not restricted in any way. Bathing and showering may be done with or without the pouch in place.
Diet: Usually there are no dietary restrictions and foods can be enjoyed as before.
Resources available:
The physician and medical professionals are the first source of help. Specially trained nurses called Wound, Ostomy Continence Nurses (WOCN) are available for consultation in most major medical centers.
The United Ostomy Association (UOA) is a group comprised of many local chapters throughout the United States. These local groups hold meetings and provide support to prospective and existing ostomates. They sponsor educational events and have qualified visitors to make personal or telephone visits. Contact the UOA for the chapter nearest you and for other educational publications. Visit the UOA web site at www.uoa.org. It contains a great deal of information and many links to other sites, suppliers and resources.
Note: More detailed information can be found in Colostomy Guide, a publication of the United Ostomy Association. Contact UOA at 1-800-826-0826.
http://www.uoa.org/ostomy_facts_colostomy.htm
What You Need To Know About Ovarian Cysts
More than any other organ in the body, the ovary has the capacity to form a large number and variety of cysts. In fact, the ovarian function of producing hormones and releasing eggs is directly linked to the formation of cysts. An ovarian cyst is a sac or pouch that develops in or on the ovary, often during ovulation. The contents of the cyst are usually liquid, but can also be solid or a mixture of liquid and solid materials. Although ovarian cysts are usually small (about the size of a pea or a kidney bean), they can become the size of a softball—or even larger. Large ovarian cysts are quite remarkable considering that the ovary itself is only about the size of a walnut.
Ovarian cysts are very common, and because most of them do result from changes in the normal function of the ovary, rather than from "new growths" or tumors, the vast majority are non-cancerous. Although they are most prevalent in women of childbearing age, ovarian cysts can occur in girls and women of all ages, from newborns to the elderly. You can develop a single cyst or multiple cysts.
Warning Signs of an Ovarian Cyst
Because there are many different kinds of ovarian cysts, and because their size and number may vary, they can cause a variety of symptoms. On the other hand, many cause no symptoms at all and may first be discovered during a routine gynecological exam, as your doctor examines the size and shape of your ovaries.
Pain
Abdominal pain is often the first indicator of an ovarian cyst. If the cyst is large, you may have pain, or a feeling of pressure or heaviness in the lower abdomen. Ovarian cysts can often bring on lower abdominal pain during intercourse. Another possible cause of pain is a process called "torsion," in which the stem that forms on some cysts becomes twisted, stopping the normal flow of blood and causing intense bursts of pain. If a cyst ruptures, this too can cause severe lower abdominal pain along with weakness, nausea and vomiting. Any of these pains may be severe enough to bring you to the emergency room or to your doctor, and may be the first time you learn you have a cyst.
Cysts can cause other, less daunting symptoms. For example, a cyst can press on the rectum, causing constipation, or on the bladder, creating an urge to urinate. Don't ignore these lesser symptoms. They could also be signs of a gastrointestinal disturbance or a bladder infection. Severe abdominal pain itself could also be due to appendicitis, an infection in the uterus or fallopian tubes, or an ectopic pregnancy.
Irregular Periods and Infertility
Occasionally ovarian cysts do cause irregular periods, particularly in a condition called polycystic ovaries in which the hormonal system that regulates the ovaries is disturbed, causing them to form a large number of cysts. More frequently, however, menstrual irregularities are due to other conditions, such as pregnancy, menopause, or thyroid problems.
Some women who have trouble becoming pregnant also have polycystic ovaries, but this problem is only one of many possible reasons for infertility. If you are having difficulty becoming pregnant, speak with your regular ob-gyn or with an infertility specialist. (For more information see "Overcoming Infertility: Tactics and Techniques.")
A Close Look at the Most Common Types
Once a month, your body produces what is, in effect, an ovarian cyst. It is part of ovulation, the process during which an egg ripens and is released from the ovary. The ovary contains follicles, sacs containing immature eggs and fluid. Each month during your childbearing years, the ovary produces hormones that cause a follicle to grow, and the egg within it to mature.
Once the egg is ready, the follicle ruptures and the egg is released. Thus the follicle is a fluid-filled cyst that ruptures when you ovulate. Many women experience pain or cramping when this occurs. This pain is known as mittleschmerz, the German word for "middle (mid-cycle) pain."
Once the egg is released, the follicle changes into a smaller sac called the corpus luteum, or "yellow body," named for the yellowish fatty material it contains. If the egg is not fertilized, the corpus luteum gradually disintegrates and a new follicle begins growing during the next menstrual cycle. If the egg is fertilized, the corpus luteum will remain for a few months, secreting estrogen and progesterone to support the developing embryo.
Functional Cysts
Cysts that develop as part of the natural function of the ovary are dubbed "functional cysts." There are two types, the follicle cyst and the corpus luteum cyst.
Follicle Cysts can develop in two ways: during ovulation when the follicle ruptures to release the egg, or when a developing follicle fails to rupture, leaving the follicle, or sometimes several follicles, to continue to enlarge. Follicle cysts rarely grow larger than three inches in diameter, and usually rupture or shrink after one or two menstrual cycles.
Because these cysts are usually painless, most women are unaware of them. However, when one ruptures, perhaps during sexual intercourse, you may experience intense abdominal pain that is often worsened by physical activity. The pain usually subsides after a day or two but quite often is severe enough to bring you to the emergency room. You may also experience abdominal discomfort if, in response to fertility drugs, several follicle cysts begin to grow.
Corpus Luteum Cyst. The corpus luteum that forms after ovulation is also a cyst-like structure, and it is very prone to the development of fluid or blood-filled cysts that can grow from the size of an egg to the size of a softball.
Unlike follicle cysts, corpus luteum cysts usually cause pain on only one side of the lower abdomen. If you have a corpus luteum cyst, you may be experiencing menstrual changes such as late periods or bleeding between periods. Because this set of symptoms is also associated with the dangerous condition known as tubal or ectopic pregnancy, you should be sure to go to a doctor.
Polycystic Ovaries
In some women, the ovaries tend to develop numerous follicle cysts. You may hear this condition referred to as polycystic ovarian syndrome or "disease" (PCO), Stein-Leventhal Syndrome, or sclerocystic ovarian disease.
Actually polycystic ovaries are not a "disease" at all, but the result of a hormone imbalance that causes the persistent growth of follicular cysts accompanied, usually, by failure of one follicle to mature and succeed in ovulating. The condition is fairly common, affecting between 3.5 and 7 women in 100. It generally develops during the 30s, but can begin in adolescence. Many women with polycystic ovaries have no symptoms, but the condition can cause fertility problems, due to infrequent ovulation, and can result in excess body hair and weight problems, due to hormone imbalances.
Because women with polycystic ovaries rarely or never ovulate, their menstrual periods are generally irregular, often with many months between periods. When they do have a period, it may be quite heavy, since the lining of the uterus has continued to grow during the months since their last period. While polycystic ovaries do not themselves become cancerous, excessive growth of the uterine lining, or endometrium, is thought to increase the risk of cancer of the uterus (endometrial cancer).
Endometrial Cysts
Endometrial cysts are also known as endometriomas or "chocolate cysts," because they are filled with dark blood that resembles chocolate syrup. These cysts form as the result of endometriosis, the disease in which patches of tissue from the uterine lining are found outside the uterus. In about half the cases of endometriosis, these patches appear in or on the ovaries.
With successive menstrual cycles, these misplaced pieces of endometrial tissue bleed, gradually forming endometrial cysts. Over time, the cysts grow, and some can eventually become as large as a grapefruit. Endometrial cysts can cover a large part of the ovary and prevent ovulation, resulting in infertility. Some women have no symptoms with an endometrial cyst; others have severe menstrual cramps, pain with intercourse, or pain during a bowel movement.
Although complications are infrequent, if a sizeable endometrial cyst ruptures, its contents can spill into the pelvic cavity, causing some internal bleeding. The material in the cyst may also spill onto the surface of other organs in the pelvis, such as the uterus, fallopian tubes, bladder, and intestines. This can cause the formation of scar tissue (adhesions), which in turn can cause pain and fertility problems. Other ovarian cysts, such as the follicle cyst, the simple serous cyst, and the corpus luteum cyst, may resemble a "chocolate cyst." An expert must examine the tissue under the microscope to make the diagnosis.
Cystadenomas
Unlike functional ovarian cysts, which develop from variations in the normal function of the ovaries, or endometrial cysts, which are a consequence of endometriosis, or even polycystic ovaries, which result from hormone imbalance, cystadenomas are known as neoplasms, meaning "new growths." Ovarian neoplasms are new and abnormal formations that develop from the ovarian tissue. Cystadenomas are the most common type.
Cystadenomas are classified according to the type of fluid they contain. A serous cystadenoma is filled with a thin watery fluid and is relatively large, between 2 and 6 inches in diameter. This type most frequently appears in women in their 30s and 40s, but may occur in women between the ages of 20 and 50.
A serous cystadenoma usually causes no specific symptoms, unless it grows to be so large that it results in weight gain and a large abdomen. Generally, these cysts are discovered during a routine gynecological exam. Although considered a benign growth, they do have the potential to become malignant.
A mucinous cystadenoma is filled with a sticky, thick gelatinous material and can become enormous. While most are between 6 and 12 inches in diameter, there have been rare cases of gigantic tumors measuring up to 40 inches and weighing over 100 pounds. Mucinous cystadenomas develop most often in women between the ages of 30 and 50.
Although cystadenomas are almost always benign, complications may develop. If they grow very large, they can interfere with other abdominal organs, disturbing the normal functioning of the stomach, intestines, and bowel. They may also twist, rupture, or bleed. Keep in mind, though, that if you have regular gynecological exams, your doctor would probably discover a cystadenoma long before it could grow to its potentially enormous size.
Dermoid Cysts
Dermoid cysts are also ovarian neoplasms. They are so named because they contain skin or related tissue such as hair, teeth, or bone. They are also known as benign cystic teratomas, teratoma meaning a tumor consisting of skin and hair tissue. Dermoid cysts contain this unusual type of tissue because they develop from the ovary's germ cells, the cells that normally produce the egg and contain the forerunner of all human tissues. Dermoid cysts may be present from birth, but rarely grow large enough to be noticed until adulthood.
Dermoid cysts are quite common, and although they can occur in women of any age, they most frequently affect women between the ages of 20 and 40. They generally measure between 2 and 4 inches in diameter, and usually cause no symptoms unless they become so large that they press on the intestines, bladder, or rectum. While these growths are almost always benign, there is about a 1 percent chance that a malignancy could develop. As is true of most types of cysts, the dermoid may be prone to bleeding, rupture, or twisting on its stem.
When to Seek Medical Attention
Because functional ovarian cysts usually remain quite small, often cause no symptoms, and may disappear on their own, treatment of them is not always necessary. However, since there are so many other types of ovarian cysts, you should see your doctor if you experience any of the following:
Abdominal pain or pressure that is severe or frequent
Pain with intercourse
Unusual vaginal bleeding or any vaginal bleeding after menopause
Unexplained weight gain or abdominal bloating
Irregular periods for several months or no period with a negative pregnancy test
Inability to become pregnant after 12 months of intercourse without using birth control
How Your Doctor Goes About a Diagnosis
The doctor will first ask about your symptoms, your medical history, and your family's medical history. If you are having irregular periods, it may be helpful to keep track of vaginal bleeding on a calendar and bring the information with you to your appointment.
Physical Exam and Lab Tests
Next, your doctor will give you a physical exam, including a pelvic examination. The pelvic exam involves inserting a speculum in the vagina to see the vaginal walls and cervix and to obtain a Pap smear or samples of vaginal discharge to check for possible infection. Once the speculum is removed, your doctor will do a "bimanual exam," (two fingers in the vagina, with the other hand pressing on your abdomen), during which he or she can feel the size and shape of the uterus and ovaries.
If you have an ovarian cyst, your doctor may find that your ovaries feel larger than normal, and you may have more discomfort during the bimanual exam than you normally do. In this case, the doctor may recommend additional laboratory tests to help make a diagnosis.
If you are of childbearing age, a pregnancy test is very important. If the doctor suspects you have polycystic ovaries, he or she may also want to check certain blood hormone levels that could be affected. The doctor may also draw blood for a "complete blood count" (CBC) to help identify a possible pelvic infection or to see if you have developed anemia due to excessive bleeding.
Ultrasound
Ultrasound, also called a sonogram or sonography, is one of the most frequently used methods of diagnosing ovarian cysts. This technology uses sound echoes to provide a picture of the tissues and organs inside the body. A sonogram can help determine the size of the ovaries; the number and size of any ovarian cysts; and whether a cyst is filled with solid or liquid material, or a combination of the two. Ultrasound may also show whether fluid has collected in the pelvis, which could be a sign of a recently ruptured cyst. If a pelvic ultrasound exam reveals that you have a functional ovarian cyst, there may be no need for further diagnostic procedures.
Ultrasound is a painless procedure performed in a radiology laboratory or doctor's office. For an abdominal ultrasound you will be asked to drink several glasses of water about an hour before the exam and to refrain from urinating until the exam is completed. It is important to have a full bladder because it enables the technician or radiologist to see all the pelvic organs. The technician will place the ultrasound transducer, a small hand-held device which receives and transmits the images, on your lower abdomen, move it around to get various views, and at certain points, capture these views on film for further review by a radiologist.
The most accurate pictures can be obtained by doing a transvaginal ultrasound, using a specifically designed transducer that is placed in the vagina. Because of the accuracy of the transvaginal ultrasound, some doctors skip the abdominal ultrasound and go directly to this method. The other advantage is that you do not have to have a full bladder.
If your ultrasound results show that your ovarian cyst could be composed of solid material or a combination of solid and liquid material, your doctor may recommend an x-ray (or occasionally a CAT scan or MRI). The x-ray is important because it can reveal the pieces of bone or teeth that are sometimes seen in dermoid cysts and because solid growths on the ovaries are more likely to be malignant.
Diagnostic Laparoscopy
Although the technologies of ultrasound and x-ray have helped to simplify the diagnosis of ovarian cysts, in certain cases more investigation is necessary. Sometimes your doctor will want to take a direct look at your pelvic organs in order to make a diagnosis. For example, if you have endometriosis, conventional tests and ultrasound are not very useful. Or, if your cyst is quite large, or not simply fluid-filled, or if you are over the age of 40 when the risk of cancer begins to increase, your gynecologist may wish to look directly at the cyst and the reproductive organs. This is done by performing a diagnostic laparoscopy. (See the nearby box, "What Happens during Laparoscopy.")
Treating Ovarian Cysts
Treatment depends on many factors, including the type of cyst, its size, its precise location, the type of material it contains, and your age.
Functional Ovarian Cysts: "Watch and Wait"
If you have a small functional ovarian cyst that is not causing any problems, your doctor may recommend a "watch and wait" approach. That is, you may need to return for a follow-up examination or ultrasound after one or two menstrual cycles, when there is a good chance that the cyst will have dissolved. Your doctor may suggest you avoid intercourse during this time, since it can cause a cyst to rupture. If the cyst grows, especially if it becomes larger than about 2 inches, it may need to be removed surgically.
While small functional ovarian cysts generally disappear over time, they also tend to recur with subsequent menstrual cycles. Many doctors believe that functional cysts can be controlled with the use of birth control pills, which reduce the hormones that promote growth of cysts and prevent formation of large, mature follicles that can turn into cysts. If you are already taking birth control pills for contraception, and think you may have an ovarian cyst, see your doctor because it is unlikely to be a functional cyst.
It may take a few months of using birth control pills before your cysts clear up. Your doctor can determine if the pills have been successful by repeating the pelvic exam, the ultrasound, or both. Your cysts may or may not return once you stop taking birth control pills. You can decide with your doctor how long you wish to stay on the pills.
Polycystic Ovaries: No More Surgery
Treatment for polycystic ovaries is more varied. If you have polycystic ovaries and are having problems conceiving, your doctor may recommend that you take clomiphene citrate (Clomid) to stimulate ovulation.
If you are not trying to get pregnant, and you have infrequent periods or no periods due to polycystic ovaries, the treatment is different. Your doctor may start you on the synthetic hormone called medroxyprogesterone acetate (Provera), which is similar to the natural progesterone your body would produce if you were ovulating. Provera fills in for the progesterone that would ordinarily appear after ovulation, allowing you to menstruate. This is important because even if you are not ovulating, your ovaries are still producing the estrogen that causes the uterine lining to grow. Without sufficient progesterone, the lining won't be shed during the menstrual period, and can grow too much. Although you probably feel fine and may not be eager for your periods to return, if your body is exposed only to estrogen without progesterone for long periods of time, the overgrowth of the uterine lining may increase the danger of cancer developing in the uterus.
There are several different schedules used for taking Provera tablets. Most experts agree that one good option is to take one 10-milligram tablet of Provera for 10 days each month. Taking the tablets on the first 10 days of the month makes it easy to remember. You should expect some menstrual bleeding approximately 3 to 5 days after you stop taking the tablets. Don't forget that even though you have polycystic ovaries, you may ovulate occasionally, and it is possible to become pregnant. Provera is not a contraceptive pill. In fact, it is not recommended for use during pregnancy. If you need contraception, you should continue to use your preferred method during your treatment with Provera.
Some doctors treat the symptoms of polycystic ovaries with low-dose birth control pills. When you take birth control pills your normal periods will resume, and you'll be protected against pregnancy if that is a concern. Another advantage of birth control pills over Provera is that they decrease the production of the male hormone androgen. Not only does this help control excess hair growth, sometimes a symptom of polycystic ovaries, but it also may reduce the risk of heart disease in women with polycystic ovaries. Danazol (Danocrine), a synthetic steroid that suppresses the ovaries' output of certain hormones, is another option employed by some doctors.
Because polycystic ovaries are frequently associated with high blood levels of insulin (the hormone that helps the body burn sugar), some doctors are now treating the problem with diabetes drugs that boost the body's response to insulin, thereby reducing the amount of insulin needed in the bloodstream. Drugs used for this purpose include metformin (Glucophage), pioglitazone (Actos), and rosiglitazone (Avandia). Doctors who advocate this type of drug therapy report that the hormonal imbalances associated with polycystic ovaries clear up after two or three months of treatment. After six months, they say, 90 percent of the women taking the drugs resume regular menstruation.
The original cure for polycystic ovaries was a surgical procedure called ovarian wedge resection. This involved removing at least one-third to one-half of each ovary in order to return it to normal size. In most women, this operation resulted in resumption of normal periods and normal fertility. The wedge resection is rarely done anymore thanks to the availability of drugs that induce ovulation and restore normal periods.
When Surgery Is Needed
Sometimes, however, surgical removal of a cyst is the only option. Doctors take several factors into account when deciding whether surgery is advisable. One of the most important considerations is the size of the cyst. Because there is a very slight risk of a large ovarian cyst becoming cancerous, the larger your cyst, the more likely the surgery. Although gynecologists differ on the precise "cut-off point," in most cases if a cyst is at least 2 to 2.5 inches in diameter (about the size of a tennis ball), it will be surgically removed. If your cyst is less than 2 inches, your doctor may want to track it with ultrasound examinations over a period of a few months to see whether it grows to a size that requires surgery.
Another factor doctors consider is your age. Because ovarian cysts are less likely to become cancerous in a woman in her 20s than one in her 40s, or in a woman who has passed menopause, your chance of needing surgical removal of an ovarian cyst increases with age.
The type of cyst is also an important consideration. A "simple cyst," containing only liquid material, is less likely to require surgery than a "complex cyst," containing a mixture of materials. However, if a "simple" functional cyst grows quite large or bleeds, surgery may be necessary. Once your doctor has determined the size and type of cyst you have, he or she will discuss with you the advisability of surgery. Women aged 50 years or older with complex or predominantly solid ovarian cysts should consider undergoing surgery even if the cyst is small. This is because, according to a recent study, there is a relatively high chance of these cysts becoming cancerous. The common types of cysts that almost routinely demand surgical removal are endometriomas, cystadenomas, and dermoid cysts. Surgery is also recommended occasionally for corpus luteum cysts, and for persistently enlarged follicle cysts.
Endometriomas. Because endometrial cysts are caused by endometriosis, you may wonder whether the drugs used to control endometriosis could also be effective in treating endometrial cysts. (See "Keeping Endometriosis at Bay" for more on these drugs.) And indeed, these medications may help control the growth of cysts. However, because endometrial cysts can grow quite large and are prone to rupture, perhaps causing internal bleeding, these cysts are often treated surgically.
Cystadenomas. Since cystadenomas are almost always benign, it would seem reasonable to leave them alone unless they are large or cause complications. The problem is that cystadenomas often do become enormous, causing complications simply due to their size. An additional concern is that cystadenomas are "neoplasms," or new growths of abnormal tissue, and evaluation of neoplasms can be tricky. It is difficult to determine whether a neoplasm is benign or malignant simply by looking at it. Instead, tissue from most types of neoplasms needs to be analyzed under a microscope, and the only way to get a tissue sample is through surgery.
Dermoid Cysts. Dermoid cysts are also neoplasms, and therefore candidates for surgical removal. You may know before surgery that your cyst is a dermoid because if it contains teeth as one-third to one-half of them do, your doctor may have seen them on an x-ray.
What to Expect When the Doctor Operates
Once surgery is decided upon, you'll have a meeting with your surgeon to discuss the operation and have a physical exam.
Before Surgery
Your surgeon will review the reason for your operation, the possible risks, no matter how small, and any possible aftereffects. You may find it helpful to bring a written list of questions to the meeting. Feel free to ask your surgeon to explain the operation by drawing a simple diagram of what will be removed.
Although at this point you will probably feel there are no lab tests you have not already undergone, a few basic studies may be ordered to establish that you are healthy enough for surgery:
A complete blood count (CBC), to make sure that you have no underlying infection and that your body can tolerate loss of a small amount of blood during surgery
A urinalysis to screen for infection and diseases such as diabetes or kidney problems
A blood sample to check your blood type, in the unlikely event that you need a transfusion
A recent chest x-ray or recent electrocardiogram (ECG) if you are over 40 years old
In Surgery
If you have a large cyst, your surgeon will probably remove it through an incision in your lower abdomen. The general term for any operation through the abdomen is laparotomy. If the cyst is small enough, your doctor may be able to remove it with a laparoscope, which requires only a small incision.
The type of operation you will have will depend on the size and nature of your cyst. The goal is to remove only the cyst, leaving the ovary intact. When the cyst alone is removed, the operation is called an ovarian cystectomy. The doctor may remove fluid from the cyst before taking out the cyst itself. The fluid is removed through a needle, in a process called aspiration. If a portion of the ovary is also removed, the operation is a partial oophorectomy. Occasionally, the large size of the cyst or complications such as bleeding, twisting, or rupture, may require removal of the fallopian tube with the ovary. This operation is called salpingo-oophorectomy. Surgeons make every attempt to preserve the reproductive organs, especially if you have not yet reached menopause since it's still possible to have children when only a small portion of one ovary remains. Removal of the uterus, fallopian tubes, and ovaries (total abdominal hysterectomy with bilateral salpingo-oophorectomy or TAHBSO) is very rarely used to treat the types of ovarian cysts described here, unless there is a reasonable chance that your cyst is cancerous.
After Surgery
If you have a laparotomy, you will probably be in the hospital for a few days after the surgery. During the early recovery and postoperative period, you will receive fluids and medication through your intravenous (IV) line, but you should be eating solid foods fairly quickly. You will receive medication for pain, and you can expect to be walking around the day after surgery. Your wound should heal quickly, and if your incision was closed with staples, the staples and bandage will probably be removed before you leave the hospital. If you have non-absorbable stitches, they will probably be removed 5 to 7 days after your operation.
Before you leave the hospital, you will receive a summary of the type of operation that was performed and the type of cyst that you had. You may wish to ask for a copy of the surgery report for your records. You should also receive complete instructions from your doctor or nurse regarding what to expect in the postoperative period.
You should expect to have some abdominal discomfort for a few days after you return home. You may be given a prescription for a mild pain reliever. You should call your doctor if the medication doesn't help, or if the pain does not improve after a week. You should also contact your doctor if you develop a fever of over 100 degrees, or if vaginal bleeding is heavier than a normal period.
You should expect your incision to look quite red and feel uncomfortable for a few weeks. It is normal to notice some dried blood around the incision, but call your doctor if you see pus oozing from the wound. It's fine to bathe and shower; don't worry about getting the incision wet as long as it's not oozing. The red color of the incision will gradually fade, and eventually the scar will barely be visible.
You may be able to start some non-strenuous physical activity after a week or two. Be sure not to resume intercourse or to use tampons or anything else in the vagina until you have had your postoperative checkup (usually about 2 weeks after surgery). You will probably be able to resume all your normal activities and return to work about 6 weeks after surgery.
Unless you have had both of your ovaries removed, your periods will return to normal, usually by about 4 to 8 weeks after surgery. Remember that if even a portion of one ovary remains, you can still become pregnant if you're of childbearing age. That's one of the many reasons it's important to discuss the specifics of your surgery with your doctor.
Chances are that once the ovarian cyst has been removed, it will not recur. However, the operation does not always guarantee that you'll be cyst-free in the future. As long as you have ovaries, you can have ovarian cysts. It's a good idea to continue any medical treatments your doctor has prescribed to control the cysts and, of course, to have regular gynecological exams.
Source: From the PDR® Family Guide to Women's Health and Prescription Drugs™
http://www.pdrhealth.com/content/women_health/chapters/fgwh09.shtml
Ovarian cysts are very common, and because most of them do result from changes in the normal function of the ovary, rather than from "new growths" or tumors, the vast majority are non-cancerous. Although they are most prevalent in women of childbearing age, ovarian cysts can occur in girls and women of all ages, from newborns to the elderly. You can develop a single cyst or multiple cysts.
Warning Signs of an Ovarian Cyst
Because there are many different kinds of ovarian cysts, and because their size and number may vary, they can cause a variety of symptoms. On the other hand, many cause no symptoms at all and may first be discovered during a routine gynecological exam, as your doctor examines the size and shape of your ovaries.
Pain
Abdominal pain is often the first indicator of an ovarian cyst. If the cyst is large, you may have pain, or a feeling of pressure or heaviness in the lower abdomen. Ovarian cysts can often bring on lower abdominal pain during intercourse. Another possible cause of pain is a process called "torsion," in which the stem that forms on some cysts becomes twisted, stopping the normal flow of blood and causing intense bursts of pain. If a cyst ruptures, this too can cause severe lower abdominal pain along with weakness, nausea and vomiting. Any of these pains may be severe enough to bring you to the emergency room or to your doctor, and may be the first time you learn you have a cyst.
Cysts can cause other, less daunting symptoms. For example, a cyst can press on the rectum, causing constipation, or on the bladder, creating an urge to urinate. Don't ignore these lesser symptoms. They could also be signs of a gastrointestinal disturbance or a bladder infection. Severe abdominal pain itself could also be due to appendicitis, an infection in the uterus or fallopian tubes, or an ectopic pregnancy.
Irregular Periods and Infertility
Occasionally ovarian cysts do cause irregular periods, particularly in a condition called polycystic ovaries in which the hormonal system that regulates the ovaries is disturbed, causing them to form a large number of cysts. More frequently, however, menstrual irregularities are due to other conditions, such as pregnancy, menopause, or thyroid problems.
Some women who have trouble becoming pregnant also have polycystic ovaries, but this problem is only one of many possible reasons for infertility. If you are having difficulty becoming pregnant, speak with your regular ob-gyn or with an infertility specialist. (For more information see "Overcoming Infertility: Tactics and Techniques.")
A Close Look at the Most Common Types
Once a month, your body produces what is, in effect, an ovarian cyst. It is part of ovulation, the process during which an egg ripens and is released from the ovary. The ovary contains follicles, sacs containing immature eggs and fluid. Each month during your childbearing years, the ovary produces hormones that cause a follicle to grow, and the egg within it to mature.
Once the egg is ready, the follicle ruptures and the egg is released. Thus the follicle is a fluid-filled cyst that ruptures when you ovulate. Many women experience pain or cramping when this occurs. This pain is known as mittleschmerz, the German word for "middle (mid-cycle) pain."
Once the egg is released, the follicle changes into a smaller sac called the corpus luteum, or "yellow body," named for the yellowish fatty material it contains. If the egg is not fertilized, the corpus luteum gradually disintegrates and a new follicle begins growing during the next menstrual cycle. If the egg is fertilized, the corpus luteum will remain for a few months, secreting estrogen and progesterone to support the developing embryo.
Functional Cysts
Cysts that develop as part of the natural function of the ovary are dubbed "functional cysts." There are two types, the follicle cyst and the corpus luteum cyst.
Follicle Cysts can develop in two ways: during ovulation when the follicle ruptures to release the egg, or when a developing follicle fails to rupture, leaving the follicle, or sometimes several follicles, to continue to enlarge. Follicle cysts rarely grow larger than three inches in diameter, and usually rupture or shrink after one or two menstrual cycles.
Because these cysts are usually painless, most women are unaware of them. However, when one ruptures, perhaps during sexual intercourse, you may experience intense abdominal pain that is often worsened by physical activity. The pain usually subsides after a day or two but quite often is severe enough to bring you to the emergency room. You may also experience abdominal discomfort if, in response to fertility drugs, several follicle cysts begin to grow.
Corpus Luteum Cyst. The corpus luteum that forms after ovulation is also a cyst-like structure, and it is very prone to the development of fluid or blood-filled cysts that can grow from the size of an egg to the size of a softball.
Unlike follicle cysts, corpus luteum cysts usually cause pain on only one side of the lower abdomen. If you have a corpus luteum cyst, you may be experiencing menstrual changes such as late periods or bleeding between periods. Because this set of symptoms is also associated with the dangerous condition known as tubal or ectopic pregnancy, you should be sure to go to a doctor.
Polycystic Ovaries
In some women, the ovaries tend to develop numerous follicle cysts. You may hear this condition referred to as polycystic ovarian syndrome or "disease" (PCO), Stein-Leventhal Syndrome, or sclerocystic ovarian disease.
Actually polycystic ovaries are not a "disease" at all, but the result of a hormone imbalance that causes the persistent growth of follicular cysts accompanied, usually, by failure of one follicle to mature and succeed in ovulating. The condition is fairly common, affecting between 3.5 and 7 women in 100. It generally develops during the 30s, but can begin in adolescence. Many women with polycystic ovaries have no symptoms, but the condition can cause fertility problems, due to infrequent ovulation, and can result in excess body hair and weight problems, due to hormone imbalances.
Because women with polycystic ovaries rarely or never ovulate, their menstrual periods are generally irregular, often with many months between periods. When they do have a period, it may be quite heavy, since the lining of the uterus has continued to grow during the months since their last period. While polycystic ovaries do not themselves become cancerous, excessive growth of the uterine lining, or endometrium, is thought to increase the risk of cancer of the uterus (endometrial cancer).
Endometrial Cysts
Endometrial cysts are also known as endometriomas or "chocolate cysts," because they are filled with dark blood that resembles chocolate syrup. These cysts form as the result of endometriosis, the disease in which patches of tissue from the uterine lining are found outside the uterus. In about half the cases of endometriosis, these patches appear in or on the ovaries.
With successive menstrual cycles, these misplaced pieces of endometrial tissue bleed, gradually forming endometrial cysts. Over time, the cysts grow, and some can eventually become as large as a grapefruit. Endometrial cysts can cover a large part of the ovary and prevent ovulation, resulting in infertility. Some women have no symptoms with an endometrial cyst; others have severe menstrual cramps, pain with intercourse, or pain during a bowel movement.
Although complications are infrequent, if a sizeable endometrial cyst ruptures, its contents can spill into the pelvic cavity, causing some internal bleeding. The material in the cyst may also spill onto the surface of other organs in the pelvis, such as the uterus, fallopian tubes, bladder, and intestines. This can cause the formation of scar tissue (adhesions), which in turn can cause pain and fertility problems. Other ovarian cysts, such as the follicle cyst, the simple serous cyst, and the corpus luteum cyst, may resemble a "chocolate cyst." An expert must examine the tissue under the microscope to make the diagnosis.
Cystadenomas
Unlike functional ovarian cysts, which develop from variations in the normal function of the ovaries, or endometrial cysts, which are a consequence of endometriosis, or even polycystic ovaries, which result from hormone imbalance, cystadenomas are known as neoplasms, meaning "new growths." Ovarian neoplasms are new and abnormal formations that develop from the ovarian tissue. Cystadenomas are the most common type.
Cystadenomas are classified according to the type of fluid they contain. A serous cystadenoma is filled with a thin watery fluid and is relatively large, between 2 and 6 inches in diameter. This type most frequently appears in women in their 30s and 40s, but may occur in women between the ages of 20 and 50.
A serous cystadenoma usually causes no specific symptoms, unless it grows to be so large that it results in weight gain and a large abdomen. Generally, these cysts are discovered during a routine gynecological exam. Although considered a benign growth, they do have the potential to become malignant.
A mucinous cystadenoma is filled with a sticky, thick gelatinous material and can become enormous. While most are between 6 and 12 inches in diameter, there have been rare cases of gigantic tumors measuring up to 40 inches and weighing over 100 pounds. Mucinous cystadenomas develop most often in women between the ages of 30 and 50.
Although cystadenomas are almost always benign, complications may develop. If they grow very large, they can interfere with other abdominal organs, disturbing the normal functioning of the stomach, intestines, and bowel. They may also twist, rupture, or bleed. Keep in mind, though, that if you have regular gynecological exams, your doctor would probably discover a cystadenoma long before it could grow to its potentially enormous size.
Dermoid Cysts
Dermoid cysts are also ovarian neoplasms. They are so named because they contain skin or related tissue such as hair, teeth, or bone. They are also known as benign cystic teratomas, teratoma meaning a tumor consisting of skin and hair tissue. Dermoid cysts contain this unusual type of tissue because they develop from the ovary's germ cells, the cells that normally produce the egg and contain the forerunner of all human tissues. Dermoid cysts may be present from birth, but rarely grow large enough to be noticed until adulthood.
Dermoid cysts are quite common, and although they can occur in women of any age, they most frequently affect women between the ages of 20 and 40. They generally measure between 2 and 4 inches in diameter, and usually cause no symptoms unless they become so large that they press on the intestines, bladder, or rectum. While these growths are almost always benign, there is about a 1 percent chance that a malignancy could develop. As is true of most types of cysts, the dermoid may be prone to bleeding, rupture, or twisting on its stem.
When to Seek Medical Attention
Because functional ovarian cysts usually remain quite small, often cause no symptoms, and may disappear on their own, treatment of them is not always necessary. However, since there are so many other types of ovarian cysts, you should see your doctor if you experience any of the following:
Abdominal pain or pressure that is severe or frequent
Pain with intercourse
Unusual vaginal bleeding or any vaginal bleeding after menopause
Unexplained weight gain or abdominal bloating
Irregular periods for several months or no period with a negative pregnancy test
Inability to become pregnant after 12 months of intercourse without using birth control
How Your Doctor Goes About a Diagnosis
The doctor will first ask about your symptoms, your medical history, and your family's medical history. If you are having irregular periods, it may be helpful to keep track of vaginal bleeding on a calendar and bring the information with you to your appointment.
Physical Exam and Lab Tests
Next, your doctor will give you a physical exam, including a pelvic examination. The pelvic exam involves inserting a speculum in the vagina to see the vaginal walls and cervix and to obtain a Pap smear or samples of vaginal discharge to check for possible infection. Once the speculum is removed, your doctor will do a "bimanual exam," (two fingers in the vagina, with the other hand pressing on your abdomen), during which he or she can feel the size and shape of the uterus and ovaries.
If you have an ovarian cyst, your doctor may find that your ovaries feel larger than normal, and you may have more discomfort during the bimanual exam than you normally do. In this case, the doctor may recommend additional laboratory tests to help make a diagnosis.
If you are of childbearing age, a pregnancy test is very important. If the doctor suspects you have polycystic ovaries, he or she may also want to check certain blood hormone levels that could be affected. The doctor may also draw blood for a "complete blood count" (CBC) to help identify a possible pelvic infection or to see if you have developed anemia due to excessive bleeding.
Ultrasound
Ultrasound, also called a sonogram or sonography, is one of the most frequently used methods of diagnosing ovarian cysts. This technology uses sound echoes to provide a picture of the tissues and organs inside the body. A sonogram can help determine the size of the ovaries; the number and size of any ovarian cysts; and whether a cyst is filled with solid or liquid material, or a combination of the two. Ultrasound may also show whether fluid has collected in the pelvis, which could be a sign of a recently ruptured cyst. If a pelvic ultrasound exam reveals that you have a functional ovarian cyst, there may be no need for further diagnostic procedures.
Ultrasound is a painless procedure performed in a radiology laboratory or doctor's office. For an abdominal ultrasound you will be asked to drink several glasses of water about an hour before the exam and to refrain from urinating until the exam is completed. It is important to have a full bladder because it enables the technician or radiologist to see all the pelvic organs. The technician will place the ultrasound transducer, a small hand-held device which receives and transmits the images, on your lower abdomen, move it around to get various views, and at certain points, capture these views on film for further review by a radiologist.
The most accurate pictures can be obtained by doing a transvaginal ultrasound, using a specifically designed transducer that is placed in the vagina. Because of the accuracy of the transvaginal ultrasound, some doctors skip the abdominal ultrasound and go directly to this method. The other advantage is that you do not have to have a full bladder.
If your ultrasound results show that your ovarian cyst could be composed of solid material or a combination of solid and liquid material, your doctor may recommend an x-ray (or occasionally a CAT scan or MRI). The x-ray is important because it can reveal the pieces of bone or teeth that are sometimes seen in dermoid cysts and because solid growths on the ovaries are more likely to be malignant.
Diagnostic Laparoscopy
Although the technologies of ultrasound and x-ray have helped to simplify the diagnosis of ovarian cysts, in certain cases more investigation is necessary. Sometimes your doctor will want to take a direct look at your pelvic organs in order to make a diagnosis. For example, if you have endometriosis, conventional tests and ultrasound are not very useful. Or, if your cyst is quite large, or not simply fluid-filled, or if you are over the age of 40 when the risk of cancer begins to increase, your gynecologist may wish to look directly at the cyst and the reproductive organs. This is done by performing a diagnostic laparoscopy. (See the nearby box, "What Happens during Laparoscopy.")
Treating Ovarian Cysts
Treatment depends on many factors, including the type of cyst, its size, its precise location, the type of material it contains, and your age.
Functional Ovarian Cysts: "Watch and Wait"
If you have a small functional ovarian cyst that is not causing any problems, your doctor may recommend a "watch and wait" approach. That is, you may need to return for a follow-up examination or ultrasound after one or two menstrual cycles, when there is a good chance that the cyst will have dissolved. Your doctor may suggest you avoid intercourse during this time, since it can cause a cyst to rupture. If the cyst grows, especially if it becomes larger than about 2 inches, it may need to be removed surgically.
While small functional ovarian cysts generally disappear over time, they also tend to recur with subsequent menstrual cycles. Many doctors believe that functional cysts can be controlled with the use of birth control pills, which reduce the hormones that promote growth of cysts and prevent formation of large, mature follicles that can turn into cysts. If you are already taking birth control pills for contraception, and think you may have an ovarian cyst, see your doctor because it is unlikely to be a functional cyst.
It may take a few months of using birth control pills before your cysts clear up. Your doctor can determine if the pills have been successful by repeating the pelvic exam, the ultrasound, or both. Your cysts may or may not return once you stop taking birth control pills. You can decide with your doctor how long you wish to stay on the pills.
Polycystic Ovaries: No More Surgery
Treatment for polycystic ovaries is more varied. If you have polycystic ovaries and are having problems conceiving, your doctor may recommend that you take clomiphene citrate (Clomid) to stimulate ovulation.
If you are not trying to get pregnant, and you have infrequent periods or no periods due to polycystic ovaries, the treatment is different. Your doctor may start you on the synthetic hormone called medroxyprogesterone acetate (Provera), which is similar to the natural progesterone your body would produce if you were ovulating. Provera fills in for the progesterone that would ordinarily appear after ovulation, allowing you to menstruate. This is important because even if you are not ovulating, your ovaries are still producing the estrogen that causes the uterine lining to grow. Without sufficient progesterone, the lining won't be shed during the menstrual period, and can grow too much. Although you probably feel fine and may not be eager for your periods to return, if your body is exposed only to estrogen without progesterone for long periods of time, the overgrowth of the uterine lining may increase the danger of cancer developing in the uterus.
There are several different schedules used for taking Provera tablets. Most experts agree that one good option is to take one 10-milligram tablet of Provera for 10 days each month. Taking the tablets on the first 10 days of the month makes it easy to remember. You should expect some menstrual bleeding approximately 3 to 5 days after you stop taking the tablets. Don't forget that even though you have polycystic ovaries, you may ovulate occasionally, and it is possible to become pregnant. Provera is not a contraceptive pill. In fact, it is not recommended for use during pregnancy. If you need contraception, you should continue to use your preferred method during your treatment with Provera.
Some doctors treat the symptoms of polycystic ovaries with low-dose birth control pills. When you take birth control pills your normal periods will resume, and you'll be protected against pregnancy if that is a concern. Another advantage of birth control pills over Provera is that they decrease the production of the male hormone androgen. Not only does this help control excess hair growth, sometimes a symptom of polycystic ovaries, but it also may reduce the risk of heart disease in women with polycystic ovaries. Danazol (Danocrine), a synthetic steroid that suppresses the ovaries' output of certain hormones, is another option employed by some doctors.
Because polycystic ovaries are frequently associated with high blood levels of insulin (the hormone that helps the body burn sugar), some doctors are now treating the problem with diabetes drugs that boost the body's response to insulin, thereby reducing the amount of insulin needed in the bloodstream. Drugs used for this purpose include metformin (Glucophage), pioglitazone (Actos), and rosiglitazone (Avandia). Doctors who advocate this type of drug therapy report that the hormonal imbalances associated with polycystic ovaries clear up after two or three months of treatment. After six months, they say, 90 percent of the women taking the drugs resume regular menstruation.
The original cure for polycystic ovaries was a surgical procedure called ovarian wedge resection. This involved removing at least one-third to one-half of each ovary in order to return it to normal size. In most women, this operation resulted in resumption of normal periods and normal fertility. The wedge resection is rarely done anymore thanks to the availability of drugs that induce ovulation and restore normal periods.
When Surgery Is Needed
Sometimes, however, surgical removal of a cyst is the only option. Doctors take several factors into account when deciding whether surgery is advisable. One of the most important considerations is the size of the cyst. Because there is a very slight risk of a large ovarian cyst becoming cancerous, the larger your cyst, the more likely the surgery. Although gynecologists differ on the precise "cut-off point," in most cases if a cyst is at least 2 to 2.5 inches in diameter (about the size of a tennis ball), it will be surgically removed. If your cyst is less than 2 inches, your doctor may want to track it with ultrasound examinations over a period of a few months to see whether it grows to a size that requires surgery.
Another factor doctors consider is your age. Because ovarian cysts are less likely to become cancerous in a woman in her 20s than one in her 40s, or in a woman who has passed menopause, your chance of needing surgical removal of an ovarian cyst increases with age.
The type of cyst is also an important consideration. A "simple cyst," containing only liquid material, is less likely to require surgery than a "complex cyst," containing a mixture of materials. However, if a "simple" functional cyst grows quite large or bleeds, surgery may be necessary. Once your doctor has determined the size and type of cyst you have, he or she will discuss with you the advisability of surgery. Women aged 50 years or older with complex or predominantly solid ovarian cysts should consider undergoing surgery even if the cyst is small. This is because, according to a recent study, there is a relatively high chance of these cysts becoming cancerous. The common types of cysts that almost routinely demand surgical removal are endometriomas, cystadenomas, and dermoid cysts. Surgery is also recommended occasionally for corpus luteum cysts, and for persistently enlarged follicle cysts.
Endometriomas. Because endometrial cysts are caused by endometriosis, you may wonder whether the drugs used to control endometriosis could also be effective in treating endometrial cysts. (See "Keeping Endometriosis at Bay" for more on these drugs.) And indeed, these medications may help control the growth of cysts. However, because endometrial cysts can grow quite large and are prone to rupture, perhaps causing internal bleeding, these cysts are often treated surgically.
Cystadenomas. Since cystadenomas are almost always benign, it would seem reasonable to leave them alone unless they are large or cause complications. The problem is that cystadenomas often do become enormous, causing complications simply due to their size. An additional concern is that cystadenomas are "neoplasms," or new growths of abnormal tissue, and evaluation of neoplasms can be tricky. It is difficult to determine whether a neoplasm is benign or malignant simply by looking at it. Instead, tissue from most types of neoplasms needs to be analyzed under a microscope, and the only way to get a tissue sample is through surgery.
Dermoid Cysts. Dermoid cysts are also neoplasms, and therefore candidates for surgical removal. You may know before surgery that your cyst is a dermoid because if it contains teeth as one-third to one-half of them do, your doctor may have seen them on an x-ray.
What to Expect When the Doctor Operates
Once surgery is decided upon, you'll have a meeting with your surgeon to discuss the operation and have a physical exam.
Before Surgery
Your surgeon will review the reason for your operation, the possible risks, no matter how small, and any possible aftereffects. You may find it helpful to bring a written list of questions to the meeting. Feel free to ask your surgeon to explain the operation by drawing a simple diagram of what will be removed.
Although at this point you will probably feel there are no lab tests you have not already undergone, a few basic studies may be ordered to establish that you are healthy enough for surgery:
A complete blood count (CBC), to make sure that you have no underlying infection and that your body can tolerate loss of a small amount of blood during surgery
A urinalysis to screen for infection and diseases such as diabetes or kidney problems
A blood sample to check your blood type, in the unlikely event that you need a transfusion
A recent chest x-ray or recent electrocardiogram (ECG) if you are over 40 years old
In Surgery
If you have a large cyst, your surgeon will probably remove it through an incision in your lower abdomen. The general term for any operation through the abdomen is laparotomy. If the cyst is small enough, your doctor may be able to remove it with a laparoscope, which requires only a small incision.
The type of operation you will have will depend on the size and nature of your cyst. The goal is to remove only the cyst, leaving the ovary intact. When the cyst alone is removed, the operation is called an ovarian cystectomy. The doctor may remove fluid from the cyst before taking out the cyst itself. The fluid is removed through a needle, in a process called aspiration. If a portion of the ovary is also removed, the operation is a partial oophorectomy. Occasionally, the large size of the cyst or complications such as bleeding, twisting, or rupture, may require removal of the fallopian tube with the ovary. This operation is called salpingo-oophorectomy. Surgeons make every attempt to preserve the reproductive organs, especially if you have not yet reached menopause since it's still possible to have children when only a small portion of one ovary remains. Removal of the uterus, fallopian tubes, and ovaries (total abdominal hysterectomy with bilateral salpingo-oophorectomy or TAHBSO) is very rarely used to treat the types of ovarian cysts described here, unless there is a reasonable chance that your cyst is cancerous.
After Surgery
If you have a laparotomy, you will probably be in the hospital for a few days after the surgery. During the early recovery and postoperative period, you will receive fluids and medication through your intravenous (IV) line, but you should be eating solid foods fairly quickly. You will receive medication for pain, and you can expect to be walking around the day after surgery. Your wound should heal quickly, and if your incision was closed with staples, the staples and bandage will probably be removed before you leave the hospital. If you have non-absorbable stitches, they will probably be removed 5 to 7 days after your operation.
Before you leave the hospital, you will receive a summary of the type of operation that was performed and the type of cyst that you had. You may wish to ask for a copy of the surgery report for your records. You should also receive complete instructions from your doctor or nurse regarding what to expect in the postoperative period.
You should expect to have some abdominal discomfort for a few days after you return home. You may be given a prescription for a mild pain reliever. You should call your doctor if the medication doesn't help, or if the pain does not improve after a week. You should also contact your doctor if you develop a fever of over 100 degrees, or if vaginal bleeding is heavier than a normal period.
You should expect your incision to look quite red and feel uncomfortable for a few weeks. It is normal to notice some dried blood around the incision, but call your doctor if you see pus oozing from the wound. It's fine to bathe and shower; don't worry about getting the incision wet as long as it's not oozing. The red color of the incision will gradually fade, and eventually the scar will barely be visible.
You may be able to start some non-strenuous physical activity after a week or two. Be sure not to resume intercourse or to use tampons or anything else in the vagina until you have had your postoperative checkup (usually about 2 weeks after surgery). You will probably be able to resume all your normal activities and return to work about 6 weeks after surgery.
Unless you have had both of your ovaries removed, your periods will return to normal, usually by about 4 to 8 weeks after surgery. Remember that if even a portion of one ovary remains, you can still become pregnant if you're of childbearing age. That's one of the many reasons it's important to discuss the specifics of your surgery with your doctor.
Chances are that once the ovarian cyst has been removed, it will not recur. However, the operation does not always guarantee that you'll be cyst-free in the future. As long as you have ovaries, you can have ovarian cysts. It's a good idea to continue any medical treatments your doctor has prescribed to control the cysts and, of course, to have regular gynecological exams.
Source: From the PDR® Family Guide to Women's Health and Prescription Drugs™
http://www.pdrhealth.com/content/women_health/chapters/fgwh09.shtml
High-pressure laparoscopic entry does not adversely affect cardiopulmonary function in healthy women
J Minim Invasive Gynecol. 2005 Nov-Dec;12(6):475-9.
Related Articles,
Links
High-pressure laparoscopic entry does not adversely affect cardiopulmonary function in healthy women.
Abu-Rafea B, Vilos GA, Vilos AG, Ahmad R, Hollett-Caines J, Al-Omran M.
Department of Obstetrics and Gynecology, St. Joseph's Health Care, The University of Western Ontario, London, Canada.
baburafea@gmail.com
STUDY OBJECTIVE: To determine hemodynamic and pulmonary compliance changes during laparoscopic entry using transient hyperinsufflated pneumoperitoneum.
DESIGN: Prospective observational cohort study (Canadian Task Force classification II-1). SETTING: University-affiliated teaching hospital.
SUBJECTS: From January through June 2004 one hundred healthy women underwent operative laparoscopy consecutively. Indications included chronic pelvic pain (CPP, N=66), pelvic mass (N=7), CPP and pelvic mass (N=4), primary or secondary infertility (N=23). The mean age was 34 years (range, 19-5 and the mean BMI 25.5 kg/m2 (range, 17.1-39.4).
INTERVENTIONS: With the patients under general anesthesia, muscle relaxants, and in supine position, pneumoperitoneum was established using a Veres needle. The following information was prospectively collected at different intraperitoneal insufflation pressures (IPIP): CO2 volume, heart rate, blood pressure, and pulmonary compliance. At IPIP of 30 mm Hg the primary trocar was inserted and the IPIP was immediately reduced back to the operating pressure of 15 mm Hg.
MEASUREMENTS AND MAIN RESULTS: The mean initial IPIP was 4.7 mm Hg (range, 2-9 mm Hg). The mean volume of CO2 at IPIP of 10, 15, 20, 25, and 30 mm Hg was 1.7, 3.1, 4, 4.4, and 4.7 L, respectively. There was no statistically significant change in the heart rate or pulse pressure between IPIP of 15 and 30 mm Hg. The difference in CO2 volume (1.6 L) required to achieve IPIP of 15 and 30 mm Hg was statistically significant (p<0.0001).>
CONCLUSION: The use of transient hyperinsufflated pneumoperitoneum caused minor hemodynamic alterations which were not clinically significant. The alterations in pulmonary compliance were statistically significant; however, they had no clinical significance and were tolerated well by healthy women.
PMID: 16337573 [PubMed - in process]
Related Articles,
Links
High-pressure laparoscopic entry does not adversely affect cardiopulmonary function in healthy women.
Abu-Rafea B, Vilos GA, Vilos AG, Ahmad R, Hollett-Caines J, Al-Omran M.
Department of Obstetrics and Gynecology, St. Joseph's Health Care, The University of Western Ontario, London, Canada.
baburafea@gmail.com
STUDY OBJECTIVE: To determine hemodynamic and pulmonary compliance changes during laparoscopic entry using transient hyperinsufflated pneumoperitoneum.
DESIGN: Prospective observational cohort study (Canadian Task Force classification II-1). SETTING: University-affiliated teaching hospital.
SUBJECTS: From January through June 2004 one hundred healthy women underwent operative laparoscopy consecutively. Indications included chronic pelvic pain (CPP, N=66), pelvic mass (N=7), CPP and pelvic mass (N=4), primary or secondary infertility (N=23). The mean age was 34 years (range, 19-5 and the mean BMI 25.5 kg/m2 (range, 17.1-39.4).
INTERVENTIONS: With the patients under general anesthesia, muscle relaxants, and in supine position, pneumoperitoneum was established using a Veres needle. The following information was prospectively collected at different intraperitoneal insufflation pressures (IPIP): CO2 volume, heart rate, blood pressure, and pulmonary compliance. At IPIP of 30 mm Hg the primary trocar was inserted and the IPIP was immediately reduced back to the operating pressure of 15 mm Hg.
MEASUREMENTS AND MAIN RESULTS: The mean initial IPIP was 4.7 mm Hg (range, 2-9 mm Hg). The mean volume of CO2 at IPIP of 10, 15, 20, 25, and 30 mm Hg was 1.7, 3.1, 4, 4.4, and 4.7 L, respectively. There was no statistically significant change in the heart rate or pulse pressure between IPIP of 15 and 30 mm Hg. The difference in CO2 volume (1.6 L) required to achieve IPIP of 15 and 30 mm Hg was statistically significant (p<0.0001).>
CONCLUSION: The use of transient hyperinsufflated pneumoperitoneum caused minor hemodynamic alterations which were not clinically significant. The alterations in pulmonary compliance were statistically significant; however, they had no clinical significance and were tolerated well by healthy women.
PMID: 16337573 [PubMed - in process]
Subscribe to:
Posts (Atom)