Archive for September, 2009

September is Ovarian Cancer Awareness Month. The subject of ovarian cancer was brought home to me this year when my 37-year-old niece was diagnosed with it.

She was much younger than the average person with ovarian cancer, and she had a type of tumor called clear-cell carcinoma, which is one of the most rare but still potentially deadly forms.

Fortunately, her symptoms prompted a timely discovery and successful treatment. She now has an excellent prognosis for a full recovery.

Her story has encouraged me to write this article about ovarian cancer in the hope that any woman who reads this will understand the symptoms and risks of this disease.

Each year in the United States, more than 22,000 women are diagnosed with ovarian cancer. It has been referred to as the “silent killer” because it usually isn’t found until it has spread to other areas of the body. Only about 20 percent of ovarian cancers are found before they spread beyond the ovaries.

Early detection is of utmost importance — survival is greatest if the cancer is found early. Women who are diagnosed in the earliest stages have a favorable survival rate, which is very encouraging.

Here are some common risk factors:

  • Family history of ovarian cancer, especially in a mother or sister
  • Family history of breast or colon cancer, or a previous diagnosis of either of these cancers
  • Never having had children
  • Being older than 50
  • Having taken certain fertility drugs
  • Obesity
  • Certain inherited breast cancer genes, although not common, have a high association with ovarian cancer
  • And the most common symptoms:

  • Abdominal fullness, pressure, bloating or swelling
  • Frequent urination
  • Discomfort or pain in the pelvic area
  • Persistent indigestion, nausea or gas
  • An unexplained change in bowel habits, especially constipation
  • Unexplained sudden weight gain or loss

Knowing what my niece went through, I can’t emphasize enough the importance of seeing your doctor if you have bloating, pressure or swelling of your abdomen or pelvis that lasts more than a few weeks. Her quick diagnosis saved her life.

If you’ve seen your doctor for these symptoms and have received a diagnosis other than ovarian cancer and your symptoms don’t improve from the recommended treatment, see your doctor again or get a second opinion.

Make sure that a pelvic exam is performed as well as an ultrasound if you and your doctor suspect it might be ovarian cancer.

Again, an early diagnosis of ovarian cancer will increase your odds of survival. You must not wait more than a few weeks to see your doctor if you have any of the above symptoms, and even more so if you also have any of the known risk factors.

Expect your doctor to consider the possibility of ovarian cancer and to perform or order the appropriate tests.

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In my two prior swine flu columns, I advised everyone to be prepared for the flu season by getting vaccinated when the vaccine is available. I also talked about being prepared to stay at home for the duration of one’s flu symptoms.

Now I would like to give advice according to the Centers for Disease Control and Prevention for medical treatment of swine flu.

There are two antiviral drugs available for treatment, Tamiflu (an oral medication) and Relenza (an inhaled medication). Antiviral treatment is recommended for the following groups of patients who display the typical symptoms of H1N1 infection, or swine flu, including fever, cough, aches, sore throat and occasionally vomiting and diarrhea:

  • All hospitalized patients with swine flu
  • Children younger than 5 years old, and especially those younger than 2
  • Adults 65 years or older
  • Pregnant women — treatment is thought to be safe and extremely important in this high-risk group
  • Those with chronic conditions, such as diabetes, asthma, heart-related conditions, cancer, and diseases of the liver, kidney or bloodIn addition to the above recommendations for antiviral treatment, anyone who shows the following symptoms needs urgent medical attention:
  • Difficult or rapid breathing
  • Altered consciousness
  • Persistent vomiting.
  • A return of flu-like symptoms, including fever and a worse cough, after a period of improvement
  • In children, not taking enough liquids, difficulty awakening or extreme irritability.

If an epidemic of swine flu does not materialize this year, there will be adequate treatment facilities available at doctor’s offices, clinics and hospitals to care for those who become ill. But if a truly major epidemic occurs, receiving adequate treatment may prove difficult.

In this scenario, health care facilities may be overwhelmed with sick patients. Medical personnel, including doctors, nurses and technicians, may be in short supply because of being too sick themselves to provide care.

We at the Palo Alto Foundation Medical Group Santa Cruz, like other local medical organizations, are making plans to deal with a worst-case scenario. In such a case, patients arriving at a facility for medical care might be screened and treated outdoors in their cars or in tents. Some clinic buildings might be designated to care for only swine flu patients. More care might be provided over the phone or by e-mail.

We are all exploring novel ideas to deal with a surge of sick patients, while at the same time remaining hopeful that such a situation will not occur.

If we find ourselves with an epidemic, it will be very important for everyone to rely on the media for up-to-date information on what could be a fluid and rapidly changing situation.

In conclusion, I repeat what I said in the beginning of this series regarding swine flu: We must be prepared, not scared.

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Health officials are concerned about the possibility of a surge in swine flu cases appearing soon after students return to school this fall.

The symptoms of H1N1 infection, called swine flu, include fever, cough, sore throat, body aches, headache and, sometimes, vomiting and diarrhea.

To help prevent an epidemic of this illness, we must all do our part. If you become sick with these symptoms, you will probably be ill for at least one week. You should stay at home and avoid close contact with others as much as possible.

Avoid most of your usual activities, such as school, work, shopping, social events and public gatherings. Do not resume any of these activities until at least 24 hours after your fever is gone. This period of isolation is of utmost importance to help prevent the spread of swine flu.

Schools will send sick students home. When an ill child is identified, there may be isolation rooms where students will wait until they can be picked up and taken home.

At all times during your illness, you need to cover your cough or sneeze with a tissue and wash your hands frequently with soap and water for 15 to 20 seconds, or use one of the many available alcohol-based hand sanitizers.

Avoid face-to-face contact with others by keeping a distance of at least 3 or 4 feet between you. If you have to leave home to seek medical care or for some other necessity, wear a mask.

In case of a severe swine flu epidemic, many of us may need to be confined to our homes for a period of time. I recommended having the following supplies on hand to get through a period of home confinement:

  • A one- to two-week supply of food and water.
  • Medication for treating fever, aches and pains, such as Tylenol (acetaminophen) or Advil (ibuprofen).
  • Cough medication, such as Robitussin DM, Vicks 44 or honey/menthol lozenges.
  • Throat lozenges, such as Sucrets Complete (with dyclonine and menthol).
  • Electrolyte drinks, such as Gatorade or Powerade.
  • Alcohol-based hand sanitizer, such as Purell.
  • Surgical masks, obtainable from most pharmacies.
  • In the event of a major swine flu epidemic, being able to see a doctor and receiving treatment may be difficult. That is why I recommend the above list of supplies and home remedies.

    No one knows how the swine flu season will unfold. I hope it will be no worse than any other flu year. But we have to be prepared, just in case.

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I want to spend the next few weeks trying to bring you up to date on the most current information concerning swine flu, which is now being referred to by the experts as the H1N1 virus.

Influenza is almost unheard of during the summer months, but we are experiencing quite a few cases in every state of the United States, as well as in most countries throughout the world.

Santa Cruz County has seen proven cases of influenza this summer caused by H1N1. Most cases have been relatively mild. It seems that H1N1 is so far no worse than the regular flu that occurs each winter season. That’s the good news.

The bad news is that I believe, as do many experts in the field, that we could possibly see a worldwide epidemic — a pandemic — of H1N1 beginning this fall. The worst-case scenario could rival the flu pandemic of 1918, during which 650,000 Americans died and there were 50,000,000 deaths around the world.

But we must also realize that 36,000 people die in the U.S. each year during a typical flu season.

I repeat, a pandemic occurring this year as we had in 1918 is only a theoretical possibility. This year’s flu season could be no worse, or even less dangerous, than usual.

Leading scientists agree that influenza viruses are very unpredictable. Therefore, there is no way to predict which of the various scenarios we will see this year. It could be serious or not. Time will tell, but I believe it is better to be prepared.

One method of preparation is through widespread vaccination programs. Most people will need one shot for the regular seasonal flu and another one (possibly two) shots for swine flu. The regular seasonal flu vaccine may be available as early as September, and it is recommended that people get this vaccine as soon as possible. The swine flu vaccine, which is on a crash development program, may be available as soon as October.

Unfortunately, both vaccines cannot be combined into one shot. They may, however, be given as two separate shots on the same day.

Because quantities of vaccines may initially be limited, some form of prioritizing will be necessary. The Center for Disease Control and Prevention has made the following recommendations as to who should be immunized.

Regular seasonal influenza:

• Health care providers

• People age 65 and older

• Pregnant women

• Those with chronic health or immune diseases

H1N1 swine influenza:

• Health care providers

• Pregnant women

• People who live with or care for children younger than 6 months of age

• People between the ages of 6 months and 24 years

• Those with chronic health or immune disorders

Once the demand for vaccine for the above priority groups has been met, and if there is still sufficient vaccine available, then all people who remain may be vaccinated.

One bit of good news regarding swine flu is that people age 65 and older seem to have a greater immunity to it than to the normal flu.

Subsequent columns will deal with what treatment may be available if an outbreak begins, how to prepare yourself and your home for a severe flu epidemic, and how medical providers and hospitals would likely cope with a flu pandemic.

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