radiation therapy for prostate cancer

There are 2 types of radiation therapy. In one type, called external beam radiation therapy, radiation is given from a machine like an x-ray machine. In another type, radioactive pellets (called "seeds") are injected into the prostate gland. This is sometimes called seed therapy or brachytherapy (say: "break-ee-ther-uh-pee"). Both types work about the same in curing prostate cancer.

The machine therapy is usually given 5 days a week over 7 weeks, which you might find time-consuming. However, you don't need any anesthesia. The side effects are milder than the side effects that can come with seed therapy. However, seed therapy can be done with just one hospital visit. For seed therapy, you have to have anesthesia for a few minutes, but you should be able to go home right after the treatment. In seed therapy, higher doses of radiation can be put right on the cancer. You may feel more discomfort after this treatment.

About one half of patients become impotent within 2 years of having radiation therapy. Many men feel very tired at the end of the treatment period. About 15% to 30% of men who have radiation therapy have urinary burning, urinary bleeding, frequent urination, rectal bleeding, rectal discomfort or diarrhea during or shortly after the treatment. Serious complications are rare. However, a degree of uncertainty goes along with radiation treatment. Since the prostate gland and the lymph nodes are not taken out, your doctor can't tell the exact size of the tumor. The cancer could come back many years after radiation treatment.

At 10 years after treatment, cure rates are about the same for radiation therapy and radical prostatectomy. There are no surgical risks for men who have radiation therapy. There's no risk of bleeding. You don't have to stay in the hospital. You'll recover faster. Daily activities can usually go on during the treatment. Incontinence is extremely rare afterward. However, surgery may give you a better chance of cure over the long term.

source: http://familydoctor.org/online/famdocen/home/common/cancer/treatment/264.html

radical prostatectomy and its pros and cons

What is radical prostatectomy?
Radical prostatectomy is a surgery to remove the whole prostate gland and the nearby lymph nodes. Most men who have this surgery are under general anesthesia (puts you into a sleep-like state). After the prostate gland is taken out, a catheter (a narrow rubber tube) is put through the penis into the bladder to carry urine out of the body until the area heals.
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What are the risks and benefits of radical prostatectomy?
If you're in good health, the short-term risks of this surgery are low. The hospital stay is usually 2 to 3 days, with the catheter left in place for 2 to 3 weeks. You're usually able to go back to work in about 1 month. You shouldn't have severe pain with this surgery. Most men regain bladder control a few weeks to several months after the surgery.

The main advantage of surgery is that it offers the most certain treatment. That is, if all of the cancer is removed during surgery, you are probably cured. Also, the surgery provides your doctor with accurate information about how advanced your cancer is, since the nearby lymph nodes are taken out along with the tumor.

Surgery does have risks and complications. You could lose a lot of blood during this surgery. Before the surgery, you might want to save about 2 units of your own blood in case you need a transfusion. The main risks of this surgery are incontinence (lack of bladder control) and impotence (loss of the ability to get or keep an erection long enough to have sex). Fortunately, only a very low percentage of men have severe incontinence after radical prostatectomy. Up to 35% of men have a little accidental leakage of urine during heavy lifting, coughing or laughing.

The chance of impotence decreases if the surgeon is able to avoid cutting the nerves. This may not be possible if the tumor is large. Your age and degree of sexual function before the surgery are also important factors. If you're under 50 years old when you have this surgery, you're likely to regain sexual function. If you're older than 70, you're more likely to lose sexual function. Remember, even if the nerves are cut, feeling in your penis and orgasm remain normal. Only the ability to get a rigid penis for sexual intercourse is lost. However, there are medicines and devices that can help make the penis rigid.

source: http://familydoctor.org/online/famdocen/home/common/cancer/treatment/264.html

prostate cancer treatment options

The treatment options for prostate cancer depend in part on whether the tumor has spread. For tumors that are still inside the prostate, radiation therapy (using x-rays that kill the cancer cells) and a surgery called radical prostatectomy are common treatment options. "Watchful waiting" is also a treatment option. In this approach, no treatment is given until the tumor gets bigger. Watchful waiting may be the best choice for an older man who has a higher risk of dying from something other than his prostate cancer.

Generally, tumors that have grown beyond the edge of the prostate can't be cured with either radiation or surgery. They can be treated with hormones that slow the cancer's growth.

source: http://familydoctor.org/online/famdocen/home/common/cancer/treatment/264.html

calmning night time acid reflux

Tips for Calming Nighttime Acid Reflux
Heartburn and other gastroesophageal reflux disease (GERD) symptoms experienced during the night commonly cause sleep disturbances, including arousal from sleep, increased wakefulness and overall poor sleep quality.

Here are several tips to help reduce nighttime acid reflux so you can sleep better:

1. Sleep with your head and shoulders elevated
2. Wear loose-fitting clothes
3. Wait 2 to 3 hours after eating to go to sleep
4. Avoid foods that trigger heartburn

source: http://www.acg.gi.org/

incisionless operations for acid reflux

Surgeons at the Ohio State University Medical Center have performed the first incisionless operations in the United States using a device recently approved by the Food and Drug Administration to stop gastroesophageal reflux disease.
Ohio State's Medical Center is one of the nation's leaders in incisionless surgery, a new procedure that leaves no outside scarring; results in minimal, if any, post-operative pain; reduces patients' recovery time significantly; and is expected to be one of the next major medical advancements.

Surgeons at Ohio State have treated the first two patients, using the device known as EsophyX. The mechanism, new in the United States, has been proven safe and effective in patients treated throughout Europe for gastroesophageal reflux disease (GERD), also known as heartburn.

"The medical device offers a treatment for patients who suffer from an advanced degree of GERD and, until now, would have been candidates for surgery," said Dr. Scott Melvin, division director, general and gastrointestinal surgery, and director, Center for Minimally Invasive Surgery at the OSU Medical Center.

Heartburn is a condition in which acid refluxes from the stomach into the esophagus. The burning sensation felt in the chest can last for countless hours, resulting from inflammation, bleeding or ulcers in the esophagus. GERD is known to be associated with an increased risk of cancer of the esophagus.

Almost 30 million Americans are diagnosed with chronic reflux disease that requires medication for relief of symptoms. It is estimated that millions of dollars are spent on over-the-counter and prescription medications for treatment of the condition.

The incisionless surgery allows reconstruction of the one-way valve at the top of the stomach, when the valve is defective. The new tubular device is introduced to the body totally through the mouth, and is then advanced down the esophagus into the stomach. During the procedure, the operation is viewed through a small fiberoptic camera located within the tubular surgical tools. Patients are normally in the hospital overnight and, after the procedure, are symptom free.

"Throughout medical history, we have gone from a very painful surgery, to a better tolerated surgery and, now, to a potentially pain-free incisionless procedure. In addition, the new procedure allows a treatment option for many patients when reflux is not severe enough to require surgery," noted Melvin.

"We are far from incisionless technology's adoption for widespread use with other diseases, but there is a lot of discussion among surgeons about these new techniques," said Melvin. "Our use of this type of technology will continue to allow us to treat many diseases with minimal pain from surgery."

source: http://medicalcenter.osu.edu/
http://www.news-medical.net/?id=31636

night time acid reflux

According to results of a survey presented at the 72nd Annual Scientific Meeting of the American College of Gastroenterology, nighttime acid reflux, along with some of the less typical manifestations or symptoms of gastroesophageal reflux disease (GERD), is associated with significant sleep impairment.
In a recent national survey, researchers assessed the prevalence of sleep impairment among people with GERD and people without GERD based on response to an Internet survey of a general population of U.S. adults. Using a validated GERD screening tool, 701 respondents were identified with GERD and the remaining were controls. Bonnie Dean, MPH, PhD, of Cerner LifeSciences, Ronnie Fass, MD of the University of Arizona and their research team found that sleep impairment was more common among people with GERD (41.9 percent) than those without GERD (19.4 percent). Researchers found that 49.5 percent of respondents with nighttime GERD reported sleeping poorly often or most of the time, compared to 36.7 percent of people with daytime GERD.

Using the survey, researchers also assessed sleep impairment among patients experiencing frequent nighttime atypical manifestations of GERD. In this case, Dr. Dean and her colleagues evaluated the subgroup of respondents with GERD, as identified using the validated GERD screener. They found that atypical manifestations or symptoms of GERD (i.e. coughing, sore throat, snoring, wheezing, choking, and chest pain) were common among those with acid reflux. Of GERD patients, 74 percent had at least one nighttime atypical manifestation. For almost every daytime and nighttime atypical manifestation assessed, more than 20 percent of GERD patients reported their occurrence as frequent (more than 2 days or nights per week). Researchers also found that sleep impairment was more common among GERD patients with atypical manifestations compared to GERD patients with only typical or classic symptoms such as heartburn and acid regurgitation. For eight of the nine nighttime atypical manifestations
assessed, the proportion of GERD cases reporting sleep impairment was significantly higher for GERD cases with the atypical manifestation compared with GERD cases without the atypical manifestation.

"Awareness of nighttime reflux, atypical manifestations, and associated sleep complaints should allow more complete evaluation and treatment of GERD patients," said Dr. Dean about this project.

source: http://www.acg.gi.org/

heartburn drugs and pregnancy

The Do's and Don'ts of Using Heartburn Drugs during Pregnancy
Pregnant women with mild reflux usually do well with simple lifestyle changes. If lifestyle and dietary changes are not enough, you should consult your doctor before taking any medication to relieve heartburn symptoms.

According to ACG President Amy E. Foxx-Orenstein, DO, FACG, "Heartburn medications to treat acid reflux during pregnancy should be balanced to alleviate the mother's symptoms of heartburn, while protecting the developing fetus."

Based on a review of published scientific clinical studies (in animals and humans) on the safety of heartburn medications during pregnancy, researchers conclude there are certain drugs that are considered safe for use in pregnancy and those which should be avoided.

Antacids are one of the most common over-the-counter medications to treat heartburn. As with any drug, antacids should be used cautiously during pregnancy.

Antacids

Antacids containing aluminum, calcium, or magnesium are considered safe and effective in treating the heartburn of pregnancy.
Magnesium-containing antacids should be avoided during the last trimester of pregnancy because it could interfere with uterine contractions during labor.
Avoid antacids containing sodium bicarbonate. Sodium bicarbonate could cause metabolic alkalosis and increase the potential of fluid overload in both the fetus and mother.
Histamine-type II (H-2) Receptor Antagonists
While limited data exists in humans on the safety of histamine-type II (H-2) receptor antagonists, ranitidine (Zantac?) is the only H-2 antagonist, which has been studied specifically during pregnancy.

In a double-blind, placebo controlled, triple crossover study, ranitidine (Zantac?) taken once or twice daily in pregnant heartburn patients not responding to antacids and lifestyle modification, was found to be more effective than placebo in reducing the symptoms of heartburn and acid regurgitation. No adverse effects on the fetus were reported. (Larson JD, et al., "Double-blind placebo-controlled study of ranitidine for gastroesophageal reflux symptoms during pregnancy." Obstet Gynecol 1997; 90:83-7.)

A study on the safety of cimetidine (Tagamet?) and ranitidine (Zantac?) suggests that pregnant women taking these drugs from the first trimester through their entire pregnancy have delivered normal babies. (Richter JE., "Gastroesophageal reflux disease during pregnancy. Gastroenterol Clin N Am 2003; 32:235-61.)

Proton Pump Inhibitors
Proton pump inhibitors should be reserved for pregnant patients with more severe heartburn symptoms and those not responding to antacids and lifestyle and dietary changes. Lansoprazole (Prevacid?) is the preferred PPI because of case reports of safety in pregnant women. Limited data exists about human safety during pregnancy with the newer PPIs.

source: http://www.news-medical.net/?id=33331

heartburn and pregnancy

Heartburn symptoms are one of the most commonly reported complaints among pregnant women.Heartburn usually starts during the first trimester and tends to worsen during the second and third trimesters.

Studies have shown elevated levels of the hormone progesterone accompanied by increased intra-abdominal pressures from the enlarging uterus, may lower esophageal sphincter (LES) pressure in pregnant women contributing to heartburn symptoms, according to research highlighted in the newly updated "Pregnancy in Gastrointestinal Disorders" monograph by the American College of Gastroenterology (ACG).

From the monograph, physician experts from ACG have compiled important health tips on managing heartburn symptoms, and importantly, identifying which heartburn medications are safe for use in pregnant women and those, which should be avoided.

Strategies to Ease Heartburn Symptoms during Pregnancy According to the ACG, pregnant women can treat and relieve their heartburn symptoms through lifestyle and dietary changes. The following tips can help reduce heartburn discomfort:

Avoid eating late at night or before retiring to bed. Common heartburn triggers include greasy or spicy food, chocolate, peppermint, tomato sauces, caffeine, carbonated drinks, and citrus fruits. Wear loose-fitting clothes. Clothes that fit tightly around your waist put pressure on your abdomen and the lower esophageal sphincter. Eat smaller meals. Overfilling the stomach can result in acid reflux and heartburn. Don't lie down after eating. Wait at least 3 hours after eating before going to bed. When you lie down, it's easier for stomach contents (including acid) to back up into the esophagus, particularly when you go to bed with a full stomach. Raise the head of the bed 4 to 6 inches. This can help reduce acid reflux by decreasing the amount of gastric contents that reach the lower esophagus. Avoid tobacco and alcohol. Abstinence from alcohol and smoking can help reduce reflux symptoms and avoid fetal exposure to potentially harmful substances.

source: http://www.news-medical.net/?id=33331