Stroke

 Stroke is a condition of blood arteries goint to and in the brain, in which, becomes blocked and the blood supply is no longer to transverse the artery.  As the blood does not reach its intended brain cells, the cells begin to die due to the lack of oxygen within minutes (CDC, 2023)(Cleveland Clinic, 2023).  Globally, stroke is the second most common cause of death (Cleveland Clinic, 2023).  Stroke is additionally a leading cause of disability.

There are two types of strokes: Ischemic stroke and Hemorragic stroke.  A Transient Ischemic Attack (TIA), which are at times referred to as mini strokes, are medical emergencies as are stokes, however, are differentiated from strokes as it lasts for five minutes or less (CDC, 2023).  Ischemic strokes occurs when either blood clots, fatty deposits (plaques), or other particles block the blood arteries (CDC, 2023).  These types of strokes account for 87% of strokes (ASA, 2023).  Hemorrhagic strokes occur when a blood artery ryptures or leaks blood and accounts for 13% of strokes (CDC, 2023)(ASA, 2023).  Two types of blood vessel malformations that can cause hemorragic strokes are aneurysms and arteriovenous malformations (AVMs) (ASA, 2023).  Uncontrolled hypertention is the most common cause of hemorrhagic stroke.  Hemorrhagic strokes can be either intracerebral, within the brain, or subarachnoid, between the inner and outer layer of dura that covers the brain (ASA, 2023).

Because death to brain cells can occur within minutes, it is important to recognize the signs and symptoms of stroke quickly and obtain treatment even quicker.  Symptoms of stroke include:

• Trouble speaking
• Trouble understanding what people are saying
• Paralysis or numbness of face, arm or leg
• Loss of muscle control on one side of face
• Blurry or blackened vision
• Sudden partial or total loss of one or more of senses
• Neck stiffness
• Emotional instability
• Dizzines
• Nausea
• Vomiting (Cleveland Clinic, 2023)(Mayo Clinic, 2023)

There are several risk factors for stroke.  They can be divided into Lifestyle, Medical and other types of risk factors and include:

• Lifestyle
• Obesity
• Physical inactivity
• Heavy or binge drinking
• Illegal drug use
• Medical
• Hypertension
• High Cholesterol
• Smoking
• Second hand smoke exposure
• Diabetes
• Obstructive Sleep Apnea
• Cardiovascular Disease
• Personal or family history of stroke
• COVID - 19 infection
• Clotting Disorders
• Atrial Fibrillation
• Migraine Headaches - there is an increased risk with migraines, especially if migraines are preceeded by auras
• Other
• Age - people 55 years of age and older are at greater risk
• Race or ethnicity -  African Americans and Hispanics have a greater risk
• Sex - men have a higher risk than women
• Hormones -  birth control pills or hormonal therapy with estrogen can increase risk (Mayo Clinic, 2023)(Cleveland Clinic, 2023)

Once diagnosed, it is important to treat a stroke as quickly as possible.  Regardless of what type of stroke is being treated, Blood Pressure management should be part of the treatment plan.  When treating an Ischemic Stroke, it is important to restore blood flow to the brain.  For Ischemic Strokes, treatments include:

• tissue plasminogen activator (TPA) - must be given within 4 1/2 hours from the start of symptoms.  Helps to dissolve blood clot.
• Emergency Endovascular procedures - medications can be delivered directly to the brain through a catheter that is inserted into the artery in order to deliver the medication directly to where the stroke is occuring,
• Removing clot with stent remover - useful with large clots and can be done with or without TPA
• Carotid Endarterectomy - removes plaques that are specifically blocking carotid arteries
• Angioplasty and stents - catheter is inserted into artery.  Stent can be placed to help support section of narrowed artery that was expanded.  (Cleveland Clinic, 2023)(Mayo Clinic, 2023)

With Hemmorhagic strokes, treatments include:

• Blood thining medications
• Medications to decrease pressure in the brain
• Surgery -  with large bleeds, blood vessels may be repaired
• Surgical Clipping - clamps can be placed the base of aneurysms to stop blood flowing to it
• Surgical AVM removal - when accesible, smaller AVMs can be removed
• Stereotactic Radiosurgery - multiple beams of highly focused radiation can be used to repair blood vessel malformations (Cleveland Clinic, 2023)(Mayo Clinic, 2023).

Once someone has had a stroke, they may experience complications, such as:

• Paralysis - particularly on one side
• Difficulty talking or swallowing - stroke can affect mouth and throat muscles
• Memory Loss
• Emotional Problems - may have difficulty in controlling emotions and/or develop depression
• Pain - pain and/or numbness may occur in parts of body associated with locations in the brain that were affected by the locations in the brain that were affected by the stroke
• Changes in behavior and self-care ability (Mayo Clinic, 2023)

There are things people can do to try to prevent strokes, including:

• Controlling hypertension
• Lowering cholesterol and saturated fat intake
• Quitting smoking and other tobacco use
• Managing Diabetes
• Maintaining a healthy weight
• Eating fruits and vegetables
• Regular exercise
• Limit alcohol intake
• Treat Obstructive Sleep Apnea
• Avoid illegal drugs

Attached is the Cleveland Clinic's FAST reminder card.

For more information on stroke, visit one of the three references below.

ASA. (2023) About Stroke.  American Stroke Association.  Retrieved form https://www.stroke.org/en/about-stroke

Cleveland Clinic. (2023)  Stroke.  Cleveland Clinc.  Retrieved from https://my.clevelandclinic.org/health/diseases/5601-stroke#symptoms-and-causes

Mayo Clinic (2023) Stroke.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/stroke/symptoms-causes/syc-20350113

Menopause

 Menopause is a phase within a woman's reproductive cycle where there have been twelve consecutive months without a mentrual cycle.  Menopause can occur naturally or be the result of surgery (where the ovaries and/or uterus is removed), chemotherapy, radiation therapy, or primary ovarial insufficiency (Mayo, 2023).  Although menopause can occur during your 40s or 50s, the average age for menopause to occur is 51 (Mayo, 2023).

When occurring naturally, ovaries stop producing estrogen and progesterone.  It is a gradual process that occurs in stages.  The first stage is perimenopause that can begin anywhere between eight to ten years before monopause.  During this period, estrogen and progesterone are produced at different levels and decrease durin this period.  The next period is menopause where the  ovaries cease to release eggs and producing estrogen for twelve consecutive months.  During this time, women tend to have increased symptoms.  The last stage is postmenopause.  In this stage, symptoms decrease and there is an increased risk of certain health conditions such as osteoporosis, stroke, and heart disease (Cleveland Clinic, 2023)(OASH, 2023(Duke, 2023).

There are many signs and symptoms of menopause to include:

• Hot flashes (vasomotor symptoms) - sudden feeling of warmth that encompasses the entire body
• Night sweats
• Cold flashes
• Vaginal dryness
• Urinary urgency
• Urinary Tract Infections
• Insomnia
• Emotional changes - irritability, mood swings, anxiety
• Dry skin
• Dry eyes
• Dry mouth
• Racing heart rate
• Weight gain
• Joint and muscle aches
• Difficulty concentrating
• Changes in libido
• Breast tenderness
• Increasing symptoms of PMS
• Irregular periods
• Hair loss (Cleveland Clinic, 2023)

These symotoms can occur over the span of several years.

Menopause is diagnosed after twelve months without a menstrual cycle.  Some blood tests may be helpful when menstruation is or becomes irregular such as:

• Estrogen levels
• Follicle Stimulating Hormone (FSH)
• Luteinizing Hormones (LH) (Medline, 2020)

There are several treatments available for menopause including:

• Hormone therapy - can replace hormones that ovaries no longer make.  Helps symptoms like hot flashes and vaginal dryness.  Can also help to prevent Osteoporosis.
• Estrogen therapy (ET) - can be used only with women that have had their uterus removed.  There is a risk with ET when used with women who still have their uterus in tact of endometrial cancer.
• Hormone Thereapy with both Estrogen and Progesterone (EPT) - can be used with women  who still have their uterus in tact.
• Risks of hormone therapy include:
• Gallstones
• Deep Vein Thrombosis
• Pulmonary Embolism
• Stroke
• Risks are lower when therapy is started within 10 years of menopause
• Non Hormonal therapy 
• Changing diet - limit caffiene and spicy foods
• Avoiding triggers of hot flashes
• keep bedroom cool at night
• Quitting smoking
• Losing weight
• Excercise - can help with insomnia
• Support groups - outlet for emotions
• Anti-depressants - can manage mood swings 
• Gabepentin - decreases hot flashes
• Clonidine - decreases hot flashes
• Fezolinetant - decreases hot flashes
• Medications to prevent or treat Osteoporosis (Mayo, 2023)

Although women who are in the post menopausal phase are not able to get pregnant, they should still take precautions to practice safe sex, such as using condoms, in order to protecct themselves from sexual transmitted diseases.  If a woman experiences vaginal bleeding after menopause, she should seek medical attention as it can be a sign of serious medical conditions including:

• Endometrial or vaginal atrophy
• Uterine or endometrial cancer
• Endometrial hyperplasia
• Uterine polyps
• Cervical cancer
• Cervicitis
• Endometritis (Cleveland Clinic, 2023)

Cleveland Clinic. (2023)  Menopause. Cleveland Clinc. Retrieved from https://my.clevelandclinic.org/health/diseases/21841-menopause#symptoms-and-causes

Cleveland Clinic. Post-Menopausal Bleeding.  Cleveland Clinic.  Retrieved from https://my.clevelandclinic.org/health/diseases/21549-postmenopausal-bleeding

Duke. (2023) Menopause Treatment. Duke. Retrieved from https://www.dukehealth.org/treatments/obstetrics-and-gynecology/menopause?utm_source=google&utm_medium=cpc&cr=obgyn_treatments&utm_campaign=OB+GYN+-+Condition+-+NB&keyword=menopause&gclid=Cj0KCQjw6cKiBhD5ARIsAKXUdybehANc9eRjm6npusX8I1nH28VI6GXo5RbOovSGFWttSkfbp807hMsaArDjEALw_wcB

Mayo Clinic. (2023)  Menopause.  Mayo Clilnic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/menopause/diagnosis-treatment/drc-20353401

Medline. (2023) Menopause.  Medline Plus.  Retrieved from https://medlineplus.gov/menopause.html

NIH. (2023) What are the symptpms of menopause.  National Institutes of Health.   Retrieved from https://www.nichd.nih.gov/health/topics/menopause/conditioninfo/symptoms

OASH. (2023)  Menopause.  Office of Women's Health.  Retrieved from https://www.womenshealth.gov/menopause/menopause-basics

Endometriosis

 Endometriosis is a condition that affects the female reproductive system.  It is estimated that up to 10% of women between the ages of 15 and 44 suffer from endometriosis (John Hopkins, 2023).  Typically, every month, the endometrium lines the uterus in preparation for a potential pregnancy (fertilized egg).  If a fertilized egg does not implant into the endometrium, then it is broken down and shed during a women's menses (monthly period).  In the case of endometriosis, the endometrium grows outside the uterus and can involve the ovaries, fallopian tubes, and pelvis (Mayo Clinic, 2018).  Regardless of whether inside or outside the  uterus, the endometrium is broken down each month.  When inside the uterus, the endometrium exits the uterus through the cervix and the vagina.  With Endometriosis, there is no exit point for the endometrium and it therefore is trapped (Mayo Clinic, 2018).  This can cause tissues to become irritated and therefore scar tissue or adhesions may develop.  Adhesions occur when fibrous tissues create bands that cause organs and tissues to stick together (Mayo Clinic, 2018).  

The cause of Endometriosis has not conclusively been determined (John Hopkins, 2023).  Some possible causes include:

• Retrograde Menstruation-  menstrual blood flows backwards through the fallopian tubes
• Transformation of peritoneal cells -  hormonal factors cause peritoneal cells to transform into endometrial cells
• Embryonic cell transformation - hormones cause embryonic cells (present in early development) to transform into endometrial like cells and to implant into the pelvis during puberty
• Surgical scar Implantation - endometrial cells may attach to surgical scar after surgeries such as a cesarian section 
• Endometrial cell transport -  endometrial cells are transported through blood vessels or lymphatic system 
• Direct transplantation:  after an abdominal surgery, endometrial cells may attach themselves to other parts of the body(Mayo Clinic, 2018)(John Hopkins, 2023)

Locations that Endometriosis can occur include:

• Fallopian tubes
• Ovaries
• Vagina
• Peritoneum
• Bladder and Ureters
• Intestines
• Rectum
• Diaphragm (Cleveland Clinic, 2022)

There are several risk factors for Endometrosis.  They include:

• age
• family history
• race
• having never given birth
• early age of menarche (start of period)(before 11 years old)
• going through menopause at older age
• short menstrual cycles
• heavy menstrual cycles
• high levels of estrogen
• low BMI
• one or more relative with Endometriosis
• other reproductive tract disorders (Cleveland Clinic, 2022)(Mayo Clinic, 2023)(Healthline, 2021)

A few things that can reduce the risk of endometriosis.  They include:

• pregnency
• breastfeeding
• healthy weight
• mestrual period starting at a later age (Cleveland Clinic, 2022)

Signs and symptoms of endometriosis include:

• painful menstrual cramps
• abdominal or back pain during or between periods
• pain during sex
• heavy bleeding during period
• spotting between periods
• infertility
• bloating
• lower back pain
• Painful bowel movements
• diarrhea
• constipation
• nausea (Cleveland Clinic, 2022)(Mayo Clinic, 2023)(Healthline,  2021)

There are several tools used to diagnose Endometriosis including a medical history and physical exam which includes a pelvic exam.  A procedure that can provide a definite diagnosis is a laparoscopy where a thin tube that has a camera attached on the end is inserted through a small insertion ad is used to remove any suspicious tissue (John Hopkins, 2023).  Other tests that may also be helpful include:

• ultrasound - creates an image of internal organs
• CT scan - creates images of successive planes of the body
• MRI - creates a two dimensional view of internal organs (Mayo Clinic, 2018)(John Hopkins, 2023)

There are several options for the treatment of Endometiosis.  The options include both medications or surgery.  The options include:

• NSAIDS:  can be used for pain relief
• Hormone Therapy: can be used to reduce or eliminate pain through slowing the growth of endometrial lining and preventing implantation of endometrial tissue
• Hormonal Contraceptives:  control the hormones involved in endometrial tissue building up
• Gonadotropin-releasing hormone (Gn-RH) agonists and  antagonists:  these drugs  block ovarian stimulating hormones from being produced.  With these drugs, endometrial tissue can shrink.
• Progestin therapy: progestin can relieve the signs and symptoms by halting periods and halting endometrial implants from growing.  Therapies may be delivered through intrauterine deices, implants or injections
• Aromatase inhibitors:  reduce estrogen
• Surgery:  endometriosis implants can be removed either laporoscopically or abdominally.  A hysterectomy to include the ovaries may also be done.
• Fertility treatment:  range from ovary stimulation in order to produce eggs to in vitro fertilization. (Mayo Clinic, 2018)

For more information watch our video

For more information, go to the Mayo Clinic website:

https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661

Cleveland Clinic. (2022)  Endometriosis.  Cleveland Clinic.  Retrieved from https://my.clevelandclinic.org/health/diseases/10857-endometriosis

Healthline. (2021)  Endometriosis.  Healthline.  Retrieved from https://www.healthline.com/health/endometriosis#Takeaway

John Hopkins Medicine. (2023)  Endometriosis.  John Hopkins Medicine.  Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/endometriosis

Mayo Clinic. (2018)  Endometriosis.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/endometriosis/diagnosis-treatment/drc-20354661

Cervical Cancer

The cervix is part of the female reproductive system and is located at the base of the Uterus and is connected to the vagina.  Cancer, regardless of where it occurs in the body, occurs when cells grow out of control.  There may not be symptoms of cervical cancer initially.  When symptoms do occur, they can include:

• Abnormal vaginal bleeding
• Unusual vaginal discharge
• Pain during sex
• Pelvic pain
• With advanced disease:
• Swelling in legs
• Blood in urine
• Problems with urination and defecation
• Kidney failure
• Bone pain
• Weight loss
• Lack of appetite
• Fatigue (WebMD, 2021)(ACS, 2020)

There are several risk factors for Cervical Cancer.  Human Papillomavirus (HPV) is a risk factor for Cervical Cancer.  HPV is a virus spread through sexual contact.  Most women who contract HPV do not develop Cervical Cancer, however, there are several strains of  that can cause Cervical Cancer (Medline, 2021)(Mayo, 2021).  Other risk factors include:

• Many sexual partners - increases potential exposure to HPV.  Increased number of partners increases risk.
• Early sexual activity - the younger a woman is when she initiates sexual activity, the increased exposure, potentially, to an increased number of partners.
• Other sexually transmitted infections 
• Weakened immune system - due to diminished ability to fight infections
• Smoking
• Exposure to miscarriage prevention drug, diethylstilbestrol
• Using Birth Control Pills for more than 5 years - risk decreases after stopping use
• Giving birth to more than 3 children - due to possible increased exposure.  Studies also show that hormonal changes during pregnancy may possibly make women more susceptible.
• Young age with first full term pregnancy 
• Economic status - can affect a woman's access to health care.
• Diet - a diet low in fruits and vegetables increases risk
• Family history (ACS, 2020)(Medline Plus, 2021)(CDC, 2021)(Mayo Clinic, 2021)(WebMD, 2021)

There are several types of Cervical Cancer.  These types include:

• Squamous Cell Carcinoma - occurs in the squamous cells that line the cervix on the portion projecting into the vagina.  Makes up approximately 90% of cases.
• Adenocarcinoma - occurs in glandular cells in the cervical canal that produce mucous.
• Mixed carcinoma - has features of both Squamous Cell Carcinoma and Adenocarcinoma.  (WebMD, 2021)(Mayo Clinic, 2021).

In order for Cervical Cancer to be diagnosed, certain tests can be performed.  The primary test to screen for Cervical Cancer is the Pap Smear.  The Pap Smear involves obtaining cells from the cervix in order to detect precancerous or cancerous cells.  Another screening test that can be helpful is an HPV test (Mayo Clinic, 2021).  After these screening tests are performed, if Cervical Cancer is suspected, other tests can be done to confirm the diagnosis.  These tests include:

• Colposcopy - colposcope (magnifying instrument) is used to help identify abnormal cells in cervix,
• Punch Biopsy - can be performed with Colposcopy and small samples are removed from the cervix for examination.
• Endocervical Curettage - either a small spoon shaped instrument or a brush scrapes a cervical sample for examination.
• Electrical Wire Loop - low voltage electrified wire is used to remove a sample of tissue for examination.
• Cone Biopsy - deeper layers of cervix are removed as a cone shaped sample to include the transformation zone.  This is the boundary between the exocervix (outer layer of cervix) and endocervix (inner layer of cervix).  It is in this zone that precancerous cells and cancers are most likely to be found and begin.
• Loop Electrosurgical Excursion Procedure (LEEP) -  a wire loop, heated by electricity, is used to remove a tissue sample for examination (ACS, 2020)(Mayo Clinic, 2021)(WebMD, 2021).

Once Cervical Cancer is diagnosed, tests can be performed to assess whether the cancer has metastasized, or moved to other areas of the body.  These tests may include:

• Cystoscopy: - tube with lens and light is inserted into bladder to assess cells.
• Proctoscopy - a tube with light is inserted into rectum to inspect visually.
• Imaging studies 
• Chest X-ray - used to view the lungs
• Computed Tomography (CT Scan) - used to find larger tumors and looking for metastasis
• Magnetic Resonance Imaging (MRI) - examines soft tissues
• Positron Emission Tomography (PET Scan) -  radioactive sugar is injected into blood where it will collect in cancer cells.  When used with CT scan can produce detailed picture (Mayo Clinic, 2021)(ACS, 2020)

After diagnosis, treatments are available.  Which treatments are used may depend on how far along the cancer is, or which stage it is.  When Cervical Cancer is diagnosed and treated early, the survival rate is high.  If cell changes are found before the become cancerous (precancerous), with treatment, the survival rate is almost 100%.  For stage 0, the survival rate is 90%.  In Stage I, the survival rate is 80-93%.  Once Cervical Cancer reaches stage II, survival drops to 58-63%.  Stage III survival is 32-35% and Stage IV survival rate is 16% (WebMD,  2021).  Treatments include:

• Cone Biopsy - technique used for diagnosis can also be used as treatment when cancer is early
• Cryosurgery -  cold probe freezes cells, killing them
• Laser Ablation - laser is used to vaporize abnormal cells
• Surgery - typically with early stages where the cancer is removed.
• Trachelectomy -  removal of  cervix and upper vagina
• Hysterectomy - uterus and cervix are removed.  Ovaries and lymph nodes may or may not be removed.
• Chemotherapy - medications are used to kill cancer cells
• Targeted Therapy -  medication therapy focuses on the weaknesses of the cancer cells, killing them.
• Radiation - high powered beams kill cancer cells.
• Immunotherapy - Medications that help immune system attack cancer cells (ACS, 2020)(Mayo Clinic, 2021).

There are ways to protect yourself from Cervical Cancer.  First, limit the number of sexual partners.  This limits exposure to HPV.  Routinely be screened for Cervical Cancer with Pap Smears and HPV.  Also, don't smoke.  If you currently smoke, take steps to quit.

If you have been diagnosed with Cervical Cancer, use this link to an American Cancer Society website for resources:  https://www.cancer.org/treatment/understanding-your-diagnosis.html

ACS. (2020)  About Cervical Cancer.  American Cancer Society.  Retrieved from https://www.cancer.org/cancer/cervical-cancer/about.html

CDC. (2021)  Basic Information About Cervical Cancer.  Center for Disease Control and Prevention.  Retrieved from https://www.cdc.gov/cancer/cervical/basic_info/index.htm

Mayo Clinic. (2021) Cervical Cancer.  Mayo clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/cervical-cancer/symptoms-causes/syc-20352501

Medline Plus. (2021)  Cervical Cancer.  Medline Plus.  Retrieved from https://medlineplus.gov/cervicalcancer.html#cat_92

WebMD. (2021)  Cervical Cancer.  WebMD.  Retrieved from https://www.webmd.com/cancer/cervical-cancer/cervical-cancer

Prostate Cancer

The prostate is a small gland present in males that produces seminal fluid.  It is shaped like a walnut.  Prostate Cancer is a common cancer and typically is a slow growing cancer that tends to remain confined to the prostate (Mayo, 2023).  There are some Prostate Cancers, however, that are aggressive, grow and spread.  The estimates for Prostate Cancer in the United States in 2021 are 248,530 new cases and 34,130 deaths (ACS, 2021).  Approximately 1 out of every 8 men will be diagnosed with Prostate Cancer is more likely to develop in older men and non-Hispanic men of African descent (ACS, 2021).

There are several symptoms of Prostate Cancer including:

• Frequent urination
• Blood in urine
• Erectile dysfunction
• Painful ejaculation
• Loss of appetite
• Weight loss (UCF, 2018)(Mayo, 2023).

There are also several risk factors including:

• Age: risk increases with age
• Race: men of African descent are at greater risk overall and at increased risk for aggressive or advanced disease
• Family history:  increased with relative being diagnosed
• Obesity:  increased risk overall and of aggressive disease
• Geography:  more common in North America, Northwestern Europe, Australia, and Caribbean
• Genetics: BRCA1, BRCA2, and HNPCC genes increase risk
• Diet: increased intake of dairy products increases risk
• Chemical exposures: exposure to chemicals such as agent orange may increase risk
• Vasectomy: slight increased risk
• Smoking: increases risk (ACS, 2020)(Mayo, 2023)(UCF, 2021)

There are several tests, screenings and parts of the physical exam that can be used to help diagnose Prostate Cancer.  These include:

• Digital rectal exam:  the prostate is palpated physically for abnormalities
• Prostate Specific Antigen (PSA):  PSA is normal in small amounts but increases with infection, inflammation, enlargement and with cancer.
• Ultrasound: determines size and shape of prostate
• MRI: creates detailed picture of prostate
• Prostate Biopsy: cells are collected from the prostate (ACS, 2020)(Mayo, 2023)(UCF, 2021)

Once Prostate Cancer has been diagnosed, these tests can help determine whether the cancer has spread and if so, to where.

• Bone scan
• Ultrasound
• Computerized Tomography (CT scan)
• Positron Emission Tomography (PET scan)
• MRI (ACS, 2020)(Mayo, 2023)(UCF, 2021)

Treatments are available for Prostate Cancer.  Treatment can depend on the stage and grade of the cancer, age, and preferences for long and short term side effects (UCF, 2021).  Treatments can be broken down into:

• Surveillance:
• Active Surveillance - monitors cancer with PSA tests, Digital rectal exams, and biopsies
• Watchful waiting: uses less involved system to monitor
• Surgery:
• Radical Prostatectomy - prostate is removed
• Radiation Therapy:
• External Beam Radiation - external radiation is used to kill cancer cells
• Brachytherapy: radioactive sources, sometimes called seeds are placed in prostate tissue
• Cryotherapy:  prostate tissue is frozen in order to kill cancer cells
• High-Intensity Focused Ultrasound and Focal Therapy: concentrated ultrasound energy heats and                                                                                           kills cancer cells
• Hormone Therapy (Androgen Suppression Therapy)
• Block Testosterone production: Luteinizing hormone-releasing hormone (LHRH) and                                                             Gonadotropin - Releasing Hormone (GRH) agonists and                                                         antagonists
• Block Testosterone from reaching and impacting cancer cells:  LHRH agonists
• Orchiectomy:  testicles are removed
• Immunotherapy:  can engineer immune cells to fight cancer cells or help immune cells to identify cancer cells (ACS, 2020)(Mayo, 2023)(UCF, 2021)

For more information on Prostate Cancer, visit the American Cancer Society site at https://www.cancer.org/cancer/prostate-cancer.html.

To learn more about Prostate Cancer, watch our video:

UPDATED 5/6/2023

ACS. (2020) Prostate Cancer.  American Cancer Society.  Retrieved from https://www.cancer.org/cancer/prostate-cancer.html

Mayo Clinic. (2023)  Prostate Cancer.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/prostate-cancer/symptoms-causes/syc-20353087 

Urology Health. (2021) Prostate Cancer.  Urology Health.  Retrieved from https://www.urologyhealth.org/urologic-conditions/prostate-cancer#Surgery

Sickle Cell Disease

Sickle Cell Disease is a group of disorders that are inherited and affect red blood cells.  It is inherited by both parents passing a Sickle Cell gene to the child.  Normally, red blood cells are round, smooth, and can bend.  Because of these qualities and the presence of Hemoglobin, red blood cells are able to carry Oxygen within blood and travel well in blood vessels.  The Sickle Cell gene causes the red blood cell to change shape to look like a sickle (GBT, 2020).  The change in shape of the red blood cell causes it to not be able to bend.  This lack of flexibility causes the red blood cells to block blood vessels and therefore, they get "stuck" in blood vessels and obstruct them (CDC, 2020).  Their decreased ability to travel in blood vessels affects their ability to deliver Oxygen to the body.  The change in shape also affects the length of time they are viable.  Typically, red blood cells remain in the body for up to 120 days.  Sickled red blood cells only remain in the body for 10 - 20 days (JHM, 2021).  The shorter life of sickled red blood cells causes an individual to suffer from chromic anemia.  Additionally, as they are filtered through the spleen, which filters the blood and is important in the immune system, they get stuck and damage the spleen. The damage to the spleen causes someone to be at an increased risk for infections (JHM, 2021).

There are several types of Sickle Cell Disease.  The most common is Sickle Cell Anemia (HbSS).  With HBSS, an individual has inherited two sickle cell genes (S), one from each parent.  This is the most severe form of Sickle Cell disease as symptoms occur more often and are more severe.  Other types of Sickle Cell Disease include:

• HbSC disease:  individual inherits a sickle cell gene (S) and an abnormal Hemoglobin gene (C).  This form is milder than HbSS.
• HbSBeta Thalassemia: individual inherits a sickle cell gene (S) and a Beta Thalassemia gene.  Because there are two types of Beta Thalassemia, + and 0.  HbSB+ is a mild form of Sickle Cell Disease.  HbSB0 is a severe form similar to HbSS.
• HbAS: also known as Sickle Cell Trait.  Individual inherits one Sickle Cell gene (S) and 1 normal gene (A).  There are usually no symptoms of disease. (CDC, 2020)(Healthline. 2017)

Symptoms typically begin within the first year of life.  Symptoms and complications of Sickle Cell Disease include:

• Fatigue
• Fussiness in babies
• Bedwetting - due to kidney problems
• Jaundice
• Hand - Foot syndrome - swelling and pain in hands and feet.  Accompanied by fever.
• Frequent infections - there is increased risk, especially of bacterial infections due to splenic damage.  A leading cause of death in infants and children is Pneumonia.
• Acute Chest Syndrome - chest pain, coughing, difficulty breathing, and fever.  Can be life-threatening.
• Anemia - due to red blood vessels dying after 10 to 20 days.
• Delayed growth or puberty
• Vision issues - sickle cells block blood vessels in eye damaging retina.
• Pain Crisis - sickled red blood cells get stuck and block blood vessels causing sudden mild to severe pain.
• Splenic Sequestration - occurs when many sickle cells get stuck within the spleen causing it to enlarge.  This enlargement causes sudden weakness, pale lips, fast breathing, extreme thirst, abdominal pain and fast heartbeat.
• Leg ulcers - several factors cause ulcers, usually in lower leg.  They occur more commonly in men and between 10 to 50 years old.
• Stroke - occurs when sickle cells block blood vessel to brain.
• Deep Vein Thrombosis (DVT) & Pulmonary Embolism (PE): sickled cells contribute to blood coagulation and increase risk of blood clots either in deep veins or lungs.
• Gallstones: the increased rate at which sickled red blood cells die cause increased byproducts that form gallstones.
• Pregnancy problems: increased risk of Hypertension and blood clots during pregnancy. (CDC, 2021)(Healthline, 2017)

Approximately 90% of those diagnosed with Sickle Cell Disease in the United States are of African descent with about 1 in every 365 individuals of African descent being affected and 1 in 13 having Sickle Cell Trait (NIH, 2020).  In order to be diagnosed with Sickle Cell Disease, a blood test must be done which is typically done as one of the screening tests done with newborns (CDC, 2021).  Blood tests can also determine type of Sickle Cell Disease.

There are several treatments for Sickle Cell Disease including:

• Medications:
• Voxelotor - prevents sickle shape.
• Crizanlizumab - tmca - used to treat pain crises.
• Penicillin - decreases risk of severe infections particularly by pneumococcus bacteria.
• Hydroxyurea - decreases complications and should not be used during pregnancy.
• L - glutamine oral powder -  decrease pain crises.
• Hydration - help to keep cells from deforming.
• Regular exercise and reducing stress - reduce pain crises
• Transfusions - help to treat and prevent complications.
• Blood and Bone Marrow Transplant: the only cure for Sickle Cell Disease.  Risky in adults.  Individual must have a matched donor. (Mayo, 2020)(Healthline, 2017)

To learn more about Sickle Cell Disease, watch our Youtube video:

For more information on Sickle Cell Disease, view the CDC factsheet at https://www.cdc.gov/ncbddd/sicklecell/documents/SCD-factsheet_What-is-SCD.pdf

CDC. (2021) What is Sickle Cell Disease?.  Center for Disease Control and Prevention.  Retrieved from https://www.cdc.gov/ncbddd/sicklecell/facts.html

GBT. (2020) Sickle Cell Disease.  Global Blood Therapeutics.  Retrieved from https://www.gbt.com/research/sickle-cell-disease/

  

Healthline. (2017) Sickle Cell Anemia.  Healthline.  Retrieved from https://www.healthline.com/health/sickle-cell-anemia#risk-factors

JHM. (2021) Sickle Cell Disease.  John Hopkins Disease.  Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/sickle-cell-disease

Mayo Clinic. (2020) Sickle Cell Anemia.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/diagnosis-treatment/drc-20355882

NIH. (2020) Sickle Cell Disease.  National Heart, Lung, and Blood Institute.  Retrieved from https://www.nhlbi.nih.gov/health-topics/sickle-cell-disease

Heart Disease

The term heart disease is used when describing several condition.  Conditions which are included as types of heart disease are:

• Arrhythmia: an irregular heart rhythm.
• Atherosclerosis: hardening of arteries.
• Cardiomyopathy: condition that leads to the hardening or weakening of heart muscles.
• Congenital Heart Defects: irregularities that someone is born with.
• Coronary Artery Disease: buildup of plaque in arteries.
• Heart infections: infections caused by bacteria, viruses or parasites.
• Heart valve disease: damaged valves lead to narrowing, leaking, or improper closing.
• Myocardial Infarctions (Heart Attack): the flow of blood to the heart is disrupted.
• Congestive Heart Disease: the heart's ability to pump is diminished (MNT, 2020)(Healthline, 2017)(Mayo, 2021).

There are symptoms of each of these conditions.  Individuals may experience a myriad of symptoms or possibly no symptoms at all.  Symptoms for each of the conditions include:

• Arrhythmias: 
• lightheadedness
• racing heartbeat
• slow pulse
• fluttering
• fainting spells
• dizziness
• chest pain
• Atherosclerosis
• chest pain
• shortness of breath
• coldness in extremities
• numbness in extremities
• unusual/unexplained pain
• weakness in extremities
• Congenital heart defects
• blue tinged skin
• swelling in extremities
• shortness of breath
• fatigue
• irregular heart rhythm
• Coronary Artery Disease
• fatigue
• bloating
• swollen legs
• shortness of breath
• rapid pulse
• Heart infections
• chest pain
• weakness
• fatigue
• shortness of breath
• coughing
• fever
• chills
• skin rash
• Cardiomyopathy
• breathlessness
• swelling of legs, ankles and feet
• fatigue
• irregular heartbeats
• dizziness
• lightheadedness
• fainting
• Heart valve disease
• fatigue
• shortness of breath
• irregular heartbeats
• swollen feet or ankles
• chest pain
• fatigue
• Myocardial Infarction
• chest pain
• shortness of breath
• heart palpitations
• nausea
• stomach pain
• sweating
• arm, jaw, or leg pain
• chocking sensation
• swollen ankles
• fatigue
• irregular heartbeat (Mayo, 2020)(Healthline, 2017)(MNT, 2020).

There are several risk factors for Hear disease.  These risk factors of Heart disease include:

• Age:  increased risk with increased age.
• Sex:  although generally speaking men are at greater risk, risk for women increases after menopause.
• Family History:  having a positive family history for heart disease increases risk.
• Smoking: Nicotine and Carbon Monoxide damage blood vessels.
• Poor diet:  increased amounts of fat, salt, sugar and cholesterol increases risk.
• Hypertension: uncontrolled Hypertension hardens arteries.
• High Cholesterol: increased cholesterol level increases risk of plaque formation.
• Diabetes: Diabetes and Heart Disease share risk factors.
• Obesity: increased weight increases risk.
• Physical Activity: lack of exercise increases risk.
• Stress: damages arteries.
• Poor dental health: if antigens enter the blood, they can increase risk.
• Ethnicity: Native Americans have lower risk. (Mayo, 2020)(Healthline, 2017)(MNT, 2020).

In order to diagnose heart disease, a combination of a physical exam, blood tests, noninvasive tests and invasive tests should be completed.  During the physical exam, a family history and personal history should be completed.  Blood tests completed should include:

• Cholesterol levels
• High Sensitivity C-Reactive protein: test for inflammation
• Lipoprotien(a): type of cholesterol determined by genes
• Brain Natriuretic Peptide: protein made by heart and blood vessels.  More is released when heart is damaged.
• Troponin T: protein in heart muscle.  Increased levels associate with increased risk.

Both noninvasive and invasive tests can be done in order to diagnose heart disease and the type of heart disease.  

Noninvasive tests include:

• Electrocardiogram (EKG): records electrical signals of heart.
• Holter Monitoring: records heart rhythm for 24 to 72 hours.
• Echocardiogram: creates image of heart using sound waves.
• Stress Test: tests heart's response to exercise or medications.
• Cardiac Computerized Tomography: X-rays create a series of images of heart.
• Cardiac Magnetic Resonance Imaging: radio waves create series of images of heart.
• Carotid Ultrasound: provides imaging of carotid arteries.

Invasive tests include:

• Cardiac Catherization: a sheath is inserted in a vein or artery in groin or arm, guided by x-ray to the heart where pressure can be measured and dye can be injected to help view blood flow, blood vessels and valves. 
• Electrophysiology study: catheter used to attach electrodes to heart in order to send electric pulses and to record the heart's responses (Mayo, 2020)(Healthline, 2017)(MNT, 2020).

The treatment of heart disease depends on the type and severity of heart disease.  Treatments fall into three categories:  Lifestyle changes, medications, and surgery.

Lifestyle changes are:

• Diet: rich in fruits and vegetables
• Manage stress
• Control Diabetes
• Exercise
• Tobacco cessation
• Decrease alcohol consumption
• Maintain a healthy weight

Medications use may include:

• Anticoagulants (blood thinners): prevent blood clots.
• Antiplatelet therapies: prevent blood clots.
• Angiotensin-Converting Enzyme Inhibitors: cause blood vessels to expand lowering blood pressure.
• Angiotensin II Receptor Blockers: control blood pressure.
• Angiotensin Receptor Neprilysin Inhibitors: open narrowed arteries.
• Beta Blockers: decrease heart rate and blood pressure.  Treat arrhythmias and angina.
• Calcium Channel Blockers: decrease blood pressure and prevent arrhythmias through relaxing blood vessels.
• Cholesterol lowering medications: decrease cholesterol levels.
• Digitalis: increases heart's ability to pump.
• Diuretic: remove water in order to decrease heart's workload.
• Vasodilators: decrease blood pressure by relaxing blood vessels.
• Antiarrhythmics: treat irregular heart rhythms.
• Nitrates: treat angina and chest pain due to blocked blood vessels.

Surgeries that may be useful in correcting or treating heart conditions include:

• Coronary Artery Bypass Surgery: a healthy blood vessel is used to repair a blocked blood vessel.
• Valve Replacement/Repair: valve that is improperly functioning is replaced and repaired.
• Device Implantation: devices such as balloon catheters or pacemakers are implanted (Mayo, 2020)(Healthline, 2017)(MNT, 2020).

For resources and more information on heart disease go to the American Heart Association's, Heart Help website at https://www.heartfoundation.org.nz/your-heart/hearthelp.

To learn about Heart Disease, watch video below.

https://www.youtube.com/watch?v=nYiAcPEQnsA&t=7s

American Heart Association. (2021) Heart Help.  American Heart Association. Retrieved at https://www.heartfoundation.org.nz/your-heart/hearthelp

Healthline, (2017) Everything you need to know about Heart Disease.  Healthline.  Retrieved from https://www.healthline.com/health/heart-disease#symptoms-of-heart-disease

Mayo Clinic. (2020) Heart Disease.  Mayo Clinic.  Retrieved from https://www.mayoclinic.org/diseases-conditions/heart-disease/diagnosis-treatment/drc-20353124

Medical News Today. (2020) Everything there is to know about Heart Disease.  Medical News Today.  Retrieved from https://www.medicalnewstoday.com/articles/237191