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If you just found out you need cancer treatment, there are ways to prepare yourself. Being ready will help you overcome the uncertainty and anxiety that so often goes along with starting treatment.
No matter what, remember who’s in charge: you! Too many people don’t realize that they — not their doctors — are in charge of their own health.
Here are five things you should do to help with your treatment:
1. Ask your doctor what the best and worst case scenarios are.
Whether you’re facing chemotherapy, radiation or surgery, you need to know what to expect. Many people go into cancer treatment without knowing the possibilities. Then if a worst-case scenario happens, it catches them off guard. The most important way a physician can help you prepare for treatment is to clearly set expectations of the possible good — and bad — outcomes.
2. Educate yourself.
I don’t discourage patients from looking online for information about their upcoming treatment. There are a lot of good resources there that will help you prepare:
ChemoCare.com can help you understand how chemotherapy works and what you can expect from this treatment.
Look for sites that are specific to your type of cancer. For those with kidney cancer, for instance, the Kidney Cancer Association can educate and prepare you for nephrectomy, which is the most common first step for treatment of kidney cancer.
Provide all of your physicians with documentation about your conditions. Don’t assume they have everything. Think of it as you would a financial adviser — you’re paying him or her as the expert in how to handle your investments, but the money is yours and you’re the boss.
4. Follow up.
Don’t assume that a test result is normal just because you didn’t hear anything about it.
5. Reach out for support.
Use online information only as a starting point. None of the information you find online is a substitute for a face-to-face discussion with a physician. Smart patients gather their information then bring it into my office and say, “What do you think?”
There are plenty of off-line resources and other options as well:
You mean cholesterol can actually be good for you? The answer is yes, when it’s high-density lipoprotein (HDL). That’s one of two types of cholesterol you’ll find on your lipid panel test results. The other is low-density lipoprotein (LDL).
“Think of HDL as the good, or ‘helpful,’ cholesterol, and of LDL as the ‘lousy,’ or ‘less desirable’ cholesterol,” says cardiovascular medicine specialist Heba Wassif, MD, MPH.
Why is HDL helpful?
LDL causes plaque build-up, and, over time, can lead to heart attack and stroke. HDL works in your bloodstream like a scavenger or cleaner. It removes the bad LDL cholesterol from the blood, taking it to your liver to be excreted.
It’s critical to keep your LDL low — ideally, under 100. (Your doctor may want to keep it even lower if you’ve had a cardiac event.) You also want to keep your HDL high — ideally, 50 milligrams per deciliter of blood or higher. (The normal range is 40 to 59 milligrams per deciliter.)
When HDL levels dip below 40 milligrams per deciliter, your risk of heart disease rises.
What can you do to keep HDL high?
“Although medications can increase HDL cholesterol, research has shown that they do not necessarily alter your risk of heart disease,” says Dr. Wassif. “So we focus on LDL cholesterol reduction and recommend lifestyle changes.” The American College of Cardiology and American Heart Association recommend:
A healthy, well-balanced diet. Eat a Mediterranean-style diet rich in vegetables, fruits, nuts, whole grains, and lean vegetable or animal protein and fish. (Limit trans fats, processed meats, refined carbs and sweetened beverages.)
Maintain a healthy weight, or lose excess pounds if needed. Besides improving your diet and exercise habits, a comprehensive plan may include lifestyle counseling for stress, sleep hygiene and other individual challenges you face.
Don’t smoke. If you smoke, individual or social support groups are recommended while trying to quit to increase your chances of success.
Manage your blood sugar. If you have type 2 diabetes, a healthy diet and exercise are crucial, along with any medications your doctor may recommend.
Aim for a blood pressure of < 130/80 mm Hg. Get the proper amount of good-quality sleep, follow a low-sodium diet and meet the recommended exercise guidelines.
Start by taking these small steps to change your lifestyle. They’ll help you boost your HDL, making it easier for your “bloodstream’s cleaner” to do its job.
“Abnormal” is a scary word — and getting an “abnormal” Pap test result can stop you in your tracks. Then you see the even scarier-looking words: “low-grade squamous intraepithelial lesion (LSIL).” You wonder, “What exactly is going on down there??”
Take a deep breath, and stop imagining worst-case scenarios. These test results may be nothing out of the ordinary, according to gynecologic oncologist Mariam AlHilli, MD.
Low-grade squamous intraepithelial lesion (LSIL): little cause for concern
The tissue that covers your cervix is made up of squamous
cells. Those cells are collected during a Pap smear and examined under a
microscope. LSIL is a way of categorizing mildly abnormal cervical cells.
“A Pap smear is a screening test, “says Dr. AlHilli. “It
gives us the big picture about what’s going on with your cervix. It does NOT
indicate that cancer is present. But it may tell us there is enough evidence to
justify taking another look at those cells.”
LSIL falls on the lower end of the abnormality spectrum,
which means there is less cause for concern. The overall risk of cancer in
patients with LSIL is less than one percent.
HPV and age are factors in what the LSIL result means for you
Here’s where you can let out that breath you’ve been
holding. Dr. AlHilli explains:
You probably won’t need treatment: A low-grade
abnormality such as LSIL suggests that if we biopsied the cervix, there would
only be a few abnormal cells. They would likely go away without treatment.
It’s not permanent: The cell change that
shows up as LSIL is usually reversible.
You don’t have a higher cancer risk: An
LSIL result doesn’t increase the risk that you’ll end up with a precancerous
condition or cancer.
Your age and whether the human papillomavirus
(HPV) is present are factors in deciding what to do with that pesky LSIL test
Current guidelines recommend women start Pap tests at age 21, even though women younger than age 25 have a low risk of having precancerous cells. Screening young women is important since they tend to be more sexually active, which exposes them to HPV.
How are LSIL and HPV connected? All cervical cell abnormalities are caused by HPV, which is common in young women because HPV is sexually transmitted. The good news is that the body sees HPV as an intruder and tries to fight it off.
If your immune system effectively kicks HPV to the curb, an LSIL result can be here one year, gone the next. Good riddance, HPV.
So what happens after the LSIL finding?
Any abnormal Pap result requires immediate follow up with your
gynecologist. If you’re between ages 21 and 24, your doctor will likely
recommend a repeat Pap smear in one year to see if your immune system
effectively fought off the HPV.
“If you’re over age 25 and test positive for HPV, we’ll likely use a minor procedure to get a magnified view of your cervix,” says Dr. AlHilli. “If needed, we may collect a small sample of cervical cells for biopsy.”
These tests help your doctor see if there are any precancerous cells. Then your doctor determines if you need additional treatments, such as a procedure to remove the abnormal tissue.
Cervical cancer is preventable, even after an LSIL Pap result
“We can prevent cervical cancer,” says Dr. AlHilli. “The HPV vaccination has been proven effective at preventing the HPV infections that cause cancer. All women up to age 26 should get the vaccine. And new recommendations will make it possible for women up to age 45 to be vaccinated.”
You can take these steps to decrease the likelihood of HPV
Bolster the immune system with a multivitamin
(talk to your doctor to find out which one is best for you)
Practice safe sexual intercourse
And remember, LSIL or not, you should schedule a pelvic exam at least every other year and a Pap smear every three to five years. So get out your calendar and see if it’s time to visit your friendly neighborhood gynecologist.
Here’s a unique and delicious way to spice up those oh-so-healthy edamame (soy beans) for your next gathering or dinner party. They’re great for all ages, and they’re a terrific source of protein if you’re trying to eat less meat.
Earplugs aren’t exactly glamorous — but neither is saying, “WHAT?”
every few minutes when you can’t understand your friend’s jokes over the
restaurant’s background noise.
About 36 million people in the U.S. have hearing loss. A third of them ended up there because of ear damage caused by loud sounds. While noise-induced hearing loss is common, it’s also preventable, says Sharon Sandridge, PhD, Director of Clinical Services in Audiology.
She shares her tips for keeping your ears in good listening
What’s a safe decibel level?
People often don’t think about noise-induced hearing loss, since the damage can occur years before you find yourself struggling to keep up with the conversation.
“Loud sounds are harmful, and the damage they cause
accumulates over time,” Dr. Sandridge explains. “By the time you have hearing
loss show up on a hearing test, the damage is pretty significant.”
Your ears can handle a volume of about 85 decibels (roughly the volume of city traffic) for up to eight hours a day. As sounds get louder, safe listening times drop off quickly. At high volume, your smartphone headphones are around 105 dB (or more). At that level, you can safely listen for maybe four or five minutes per day.
You’d be surprised how many everyday activities and events
fall on the too-loud side of the line. Some common culprits include:
Motorized tools like lawnmowers, snow blowers and weed whackers
Motorsports (including snowmobiles, jet skis and motorcycles)
What’s the best way to protect yourself from the onslaught
of sounds? Ear protection falls in two main categories.
Earmuffs cover the entire ear like a pair of old-school
headphones. They’re not exactly discrete (or stylish), but they are effective.
earmuffs have electronics to amplify ambient sounds like conversations and
block loud, potentially dangerous noise. They’re great if you’re a sport
shooter or work in a loud environment like a manufacturing plant.
earmuffs muffle the sound with no electronic bells or whistles. To be
effective, they have to form a tight seal around your ear, Dr. Sandridge says.
That means you can’t slap them on over a pair of earbuds. (If you want to
listen to music while you mow the lawn, look for earmuffs with an audio-input
“Earplugs are a mixed bag,” Dr. Sandridge says.
are cheap and easy, but they often don’t fit very well. Lots of people give up
on earplugs because the foam variety can be uncomfortable and make everything unpleasantly
muffled, she says.
earplugs are Dr. Sandridge’s ear protection of choice. They slip into the
ear canal so are less obvious than earmuffs. Plus, they lower the sound
intensity while still allowing sounds like speech and music to filter through
clearly. “It’s like turning down the volume instead of dulling the sounds,” she
For all earplugs, fit is key. “When you insert them, you should hear a ‘shooosh’ as the sound suddenly dies down,” she says. “You might need to experiment to find ones that fit well. If they don’t fit properly, you might as well not use them at all as they provide little to no protection.”
So go ahead and start an earplugs trend. Your future self
will be glad to hear it.
The Medical Intensive Care Unit, or what people commonly
call the ICU, can be just that – intense.
The focus of the ICU is to stabilize, diagnose and allow a patient to recover. Many patients in the ICU have other diseases in addition to the severe illness that made them so sick, says critical care physician Eduardo Mireles-Cabodevila, MD. These patients require round-the-clock care and multiple teams to care for them.
In these situations, feeling can run high for both patients
and families. Here are three questions to ask doctors and caregivers to stay
1. How and how often can I get updates about my loved one’s condition?
Asking this question will help you set expectations. As a general
rule, the ICU team will contact you when things change drastically or when they
need to inform you on events, Dr. Mireles-Cabodevila says – for example, if
your loved one needs a procedure.
Most ICUs also have a time of the day when the patient and family are informed on the patient’s progress. Many intensive care units allow and/or encourage the family to be present during the team rounds. Although medical language can sound foreign or complicated, don’t be shy to ask the team to explain.
Some ICUs allow you to request phone calls by the bedside
nurse at the beginning and end of his or her shift, to keep you updated of any
needs. This is helpful when you are unable to be at the bedside and just want
to be sure that things are OK.
Remember, you can always ask to speak to the attending
physician by asking the nurse or one of the other team members. The afternoon
hours are the best time of the day for physicians to speak with you.
2. Who is part of my loved one’s medical team?
This is a very important question. The ICU team is truly a
team. You want to know who is directing the care team, and which team members
are able to provide a complete statement of the plan of care.
You can expect close to 10 professions to be involved in helping
your loved one recover. This means that you will see a lot of people come into
the room, all of whom have specific roles and responsibilities.
Many times, a consultant may also come into the room to
discuss parts of the care. This is a common source of confusion for families, Dr.
Mireles-Cabodevila says, as they hear many opinions. When this happens, ask to
talk to your team.
It is also important to know that the number of physicians available at night is less than during the day. Although the physician at night is capable of caring for your loved one, it is best to leave deep conversations to the day team.
The ICU team is made up of the following:
Attending (staff) physician —This doctor specializes in pulmonary or critical care medicine and oversees all of your loved one’s care.
Fellow —This doctor has graduated from medical school and is now receiving additional training in pulmonary medicine and/or critical care. He or she will likely help the attending physician with procedures and care management.
Resident — This caregiver is a licensed medical doctor who is continuing training in internal medicine. He or she works closely with the attending physician and fellow.
Intern — In this case, an intern is still a licensed medical doctor, but he or she is in the first year of training after medical school. An intern may be involved in performing some tests and daily exams.
Consultant — A physician who specializes in an area of medicine or surgery. The consultant provides focused recommendations on specific problems.
Advanced practice provider (APP) – A healthcare professional, nurse practitioner or physician assistant who participates in all aspects of care and collaborates with physicians to implement a plan of care.
Registered nurse (RN) – An RN provides you and your loved ones with information about medicines, tests and procedures. The RN will be the most available to you since he or she is assigned to no more than one other patient in the ICU, and it is typically the patient in the next room. The same number of nurses are available at night as during the day.
Respiratory therapist (RT) — The RT monitors a patient’s breathing and cares for those on mechanical ventilators (e.g. breathing machines). The RTs care for several patients (6 to 10) at the same time.
Pharmacist — A pharmacist is available every day for the physicians and nurses to monitor the drugs your loved one is receiving and to answer questions from them.
Case manager/social worker — Case managers and social workers are available to provide individual and family counseling as well as information on financial assistance, support groups, lodging, employment and disability information, among other needs.
As you can imagine, multiple shift changes occur, so
familiarize yourself and your family with each member of the medical team.
3. What sort of recovery should I expect?
Recovery time in the ICU can be highly variable, from a few days to a few weeks. At times, it is too early to know how long recovery will take, but asking can help you plan your time and resources.
Stay in touch with the attending physician in a continued,
open relationship. This doctor and the medical team can advise you on the
condition of your loved one’s health and next steps.
4. How can I help with recovery?
There are times when you may have to let the team do a
procedure or let your loved one rest. But the rest of the time you can be doing
things to help – for example, bringing pictures of them and their loved ones,
or telling the care team what they like to eat, what TV programs they like to
watch or what music they like to hear.
You can help your loved one stay engaged by telling family
stories, reading to them, playing games or updating them on world news. Just be
sure to ask the care team if there are any restrictions on interactions you can
have with them. (Is it OK to give him a foot massage? Can I comb his hair? Move
Long gone are the times where patients where kept isolated
from their families. “We have learned a lot over the last decades,” Dr. Mireles-Cabodevila
says. “Family at bedside is welcomed and essential.”
You go through so many physical changes during pregnancy that you may not pay much attention to the break you get from your monthly periods. But what can you expect after pregnancy? Will your periods just pick up where they left off or will you face new challenges?
The answer? It could go either way.
“Women often complain of changes in their periods after having a baby,” says OB/Gyn Diane Young, MD. “For women who are not breastfeeding, there are three things that are likely to happen with the menstrual period — periods return to normal, periods get worse or periods get better.”
You likely won’t have a period while you’re breastfeeding, at least not for a few months.
To produce breast milk, your brain produces higher levels of the hormone prolactin. This typically means you won’t ovulate (your ovaries won’t release eggs). So you likely won’t have periods.
Getting back to normal
But what happens if you decide not to breastfeed or when you stop?
“Most women will resume normal periods after having a baby,” Dr. Young says. If your period is “normal,” it occurs every 21 to 35 days. Bleeding lasts from 2-7 days, she says.
“Back to normal” likely applies to whatever was going on before your pregnancy, as well. Here are two examples:
Birth control: Using birth control pills for contraception often results in skipped, shorter, lighter and/or less painful periods. If you go back to the pills after pregnancy, the lighter periods may resume. If you don’t, you likely will have normal, heavier periods.
Endometriosis: If you have endometriosis or a history of painful periods, you may have easier periods at first after your baby is born. But this change is typically only temporary. A holdover of increased levels of progesterone from pregnancy may cause endometrial implants to get smaller. The result is less painful periods. Your doctor will want to follow up with you regularly after your pregnancy, however. “Painful periods are likely to resume,” Dr. Young says.
How do the rigors of pregnancy and childbirth affect future periods?
Here again, things can go either way, Dr. Young says.
Some women experience heavier, longer or more painful periods after having a baby. These changes may relate to a larger uterine cavity causing more endometrium (mucous lining the uterus) to shed.
For some women, however, their periods improve.
This may occur after pregnancy and childbirth have stretched the uterus and dilated the cervix. This alone can improve future periods. Pregnancy also releases hormones that relax uterine muscles.
What else can make periods worse after pregnancy?
Three other conditions may cause more problematic periods after pregnancy:
Structural defects. Your doctor likely will treat defects such as polyps and submucosal fibroids with minimally invasive surgery.
Adenomyosis. Your doctor can manage this thickening of the uterus with minimally invasive surgery or hormone therapy.
Overactive or underactive thyroid disorder. Your doctor may use a range of treatments for these conditions.
Easier periods are not always good news
Some women may have light periods or no periods due to two
rare complications after pregnancy:
Sheehan’s syndrome. This occurs when severe blood loss or low blood pressure damage the pituitary gland. This disrupts normal ovary function and periods stop. Hormone therapy is a common treatment.
“The bottom line is that periods can change after having a baby,” Dr. Young says. “If you are concerned about your periods, make an appointment with your OB/Gyn. There are medical therapies to help your periods.”
For many of us, checking our weight on the bathroom scale can be anxiety-producing. While knowing your weight is important, Leslie Heinberg, PhD, Director of Enterprise Weight Management, says it’s also important to realize that sometimes the scale isn’t always telling the whole story.
“The scale is a horrible barometer of behavior change,” says Dr. Heinberg. “You can do everything right today — you can exercise, you can have great intake that really would make any dietitian thrilled — but then you get on the scale, and you’re up 2 pounds.”
When it comes to weighing in, even for people within a normal weight range, the average fluctuation is about 5 pounds, Dr. Heinberg notes. And for those who aren’t accustomed to the normal ups and downs of their weight, the numbers can be discouraging.
Why the scale fluctuates
Weight fluctuation can be a result of factors such as hormones, fluid retention or even constipation, Dr. Heinberg says.
Writing weight down can help people follow trends over time, she says. If someone notices that their weight is consistently up after days or weeks, then it probably really is up.
But obsessively weighing, or checking body fat, every day will likely make someone miserable.
Don’t abandon your scale altogether
However, Dr. Heinberg says folks shouldn’t bypass the scale entirely. That’s because when upward trends are caught early, it’s easier to make a course-correction.
“You have to get over a little bit of that anxiety — your weight is what it is, whether you’re measuring it or not — but, having that information is going to allow you to make the small tweaks to your lifestyle to continue toward what your goals are.”
So how often should you weigh yourself? Dr. Heinberg recommends picking two days a week to weigh in — and be consistent. Try to step on the scale at the same time of day, wearing the same amount of clothing each time.
If your child is constantly waking up early – like 4 or 5
a.m. early – it can wreak havoc on both you and your child. By dinnertime,
everyone is grumpy and at their wits’ end.
“A lot of our sleep habits develop at a really early age,”
says pediatrician Maria Tang, MD.
“So it’s important for a child to have good sleep habits for their overall health
Dr. Tang says that one of the biggest things that parents
can do is be consistent with keeping regular bedtime and sleep
It’s important to know the recommended amount of sleep per day
for each age group according to the American Academy of Pediatrics:
Newborn (0 to 3 months): 14 to 17 hours
Infants (4 to 11 months): 12 to 15 hours
Toddlers (1 to 2 years) 11 to 14 hours
Preschoolers (3 to 5 years) 10 to 13 hours
School-age children (6 to 13 years) 9 to 11
You shouldn’t wait until your child starts to show signs of
being sleepy, like yawning or rubbing his or her eyes. At that point, they’re
probably overly tired and it has begun to take a toll on them, says Dr. Tang.
Instead, be consistent about putting your son or daughter to bed at a specific
time each night.
Start by putting your child to bed 15 minutes earlier for a day or two ― and then continue moving it up by 15 more minutes each night. Do this until they’re sleeping the appropriate amount of time and their wake-up time is manageable for you both.
“Once kids have developed bad sleep habits, parents need to have patience with trying to reverse it,” says Dr. Tang. “Changing a bedtime and wake time can take about three weeks. And you’ve got to be consistent.”
Naps and bedroom environment
Nap time can be included in overall sleep time. But if you
find that your child’s having trouble falling asleep and still waking up early,
try limiting daytime naps to less than 45 minutes.
Also be sure that your child’s bedroom is associated with
sleep, and not necessarily as a place to play.
Establish a nighttime routine with things like story time, a
lullaby or dimming the lights. Your child will start to associate that these
things mean it’s time for bed. Also be sure to stop screen
time at least one hour before bed and try to keep tablets and phones
out of a child’s room to better promote sleep.
On weekends, Dr. Tang recommends that a child sleeps in no
later than one hour past their normal wake time. Letting them sleep longer
could hinder their internal clock and make it harder for them to fall asleep
“There are alarm clocks designed specifically to help
children learn good bedtime and wake up times,” says Dr. Tang. “But the biggest
thing is not to use a cell phone as an alarm clock because if it’s available
they might use it when no one else is around.”
Instead, try using a regular alarm clock and
explain that it’s OK to get out of bed when the clock says it’s a certain time
(say 7:30 a.m.).
Every child is different and sleep habits can vary. But if
you don’t notice any difference in your child after you’ve tried patiently to
change bedtime and wake times, it might be time to see the pediatrician.
“We’ll look for things like snoring
at night, any change in breathing or if the child is so sleepy in
the morning that they’ve started to perform poorly at school,” says Dr. Tang.
“Some kids need to see an ear, nose and throat doctor ― or even do a sleep
It does take a lot of time to build good sleep habits back
up, but there’s no point where it’s ever considered too late to change, says
Dr. Tang. Consistency and holding regular bedtime and morning routines is the
most important thing you can do to develop good sleep habits in your child.
And don’t worry too much – waking up at the crack of dawn
typically doesn’t last forever in kids.
“We saw something on your mammogram and want to check it out.” The words every woman dreads to hear.
But what if your physician tells you that your mammogram and
follow-up breast biopsy shows pseudoangiomatous stromal hyperplasia? What
exactly does that mean?
“Pseudoangiomatous stromal hyperplasia is a long name that
shouldn’t scare you,” says breast pathologist, Erinn
Downs-Kelly, DO. “It’s a benign, non-cancerous finding.”
Pseudoangiomatous stromal hyperplasia, referred to as “PASH” is a non-cancerous
(benign) breast lesion that may (or may not) cause breast enlargement. PASH can
sometimes be felt as a lump during a monthly self-breast
exam, but is most often found during a routine mammogram.
It can also be found during a biopsy for an unrelated breast condition.
PASH is not cancer and it doesn’t increase your risk for
developing breast cancer in the future. One study found that
some women with PASH actually had a lower risk of developing breast cancer than
those without PASH.
Generally speaking, a lesion is a term used to describe
anything abnormal. So when a radiologist sees a lesion on a mammogram, he or
she flags it for follow-up, explains Downs-Kelly.
PASH is thought to have a hormonal link that can influence
the size of the lesion. Most lesions that come to a doctor’s attention are
between 1 and 3 centimeters. Most females with PASH are premenopausal or
perimenopausal, meaning they are between the ages of 13 and 55. Other than
being hormone related, the cause of PASH is unknown.
“When it comes to treatment,
it’s really a personalized approach,” says Downs-Kelly. “It’s more tailored to
the individual and the imaging findings.”
Sometimes no treatment is needed, other than follow-up imaging through your yearly mammogram. Some women may prefer to have the mass removed, especially if it’s causing symptoms ― or just making them worry. Recently, the American Society of Breast Surgeons has suggested that women without symptoms and with appropriate imaging results don’t need to have the mass removed.
The bottom line? PASH is found in up to 23% of breast specimens. And importantly, it’s not cancer.
If you find anything that feels different during your
monthly self-breast exam, schedule an appointment with your doctor.