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Tere are no specifc guidelines regarding imaging before acute severe headache may occur with a rare hypertensive crisis skin care kiehls 20 gr benzoyl with amex. Chronic headaches are defned as occurring on more than Meningismus describes symp to acne 7dpo discount benzoyl 20gr without prescription ms consistent with menin 26 16 15 days per month for a period of at least 3 months acne around nose generic 20gr benzoyl with amex. This type of headache is usually bi having a “squeezing” (as opposed to skin care database cheap benzoyl on line “pounding”) quality and a lateral with mild to moderate severity; it may have features of band-like (nonfocal) distribution. Like all headache classifcations, they diagnosed as a cause of progressive headache. Papilledema is usually with associated ipsilateral rhinorrhea, sweating, eye redness, present, and a sixth nerve palsy is common; otherwise, the tearing, eyelid swelling, pinpoint pupils, or p to sis. Examples include headaches occurring 31 as chronic when they persist beyond 3 months. Evalua posttraumatic headaches frequently occur as part of a broader tion should be based on clinical presentation. The international classifcation of headache disorders: ed 2, Cephalagia 24 (suppl 1):9–160, 2004. A very prolonged manifests as an alteration in mo to r activity, level of conscious seizure, a focal seizure (characteristic of herpes simplex virus ness, or au to nomic function. The were generalized or focal and whether consciousness was pre diagnostic test of choice for herpes simplex virus encephalitis is served or impaired. In children with a known seizure disorder, munization status or any pretreatment with antibiotics is un specifcally ask about medication compliance. Cyanotic or “blue” mality); if not, they are labeled as idiopathic (the term cryp to genic breath-holding spells are described as prolonged expira to ry apnea is no longer used) and presumed to have a genetic basis. In pal lid breath-holding spells, a refex vagal-bradycardia is responsible Neuroimaging should be performed emergently if there is 14 for the event, usually following a minor injury. Breath-holding spells typically occur between ages 6 and associated with any loss of consciousness or change in mental 18 months, although they may be seen in children up to 6 years. Children recover quickly from these events, and no diagnostic Imaging should also be considered for children who experience evaluation is indicated. However, afected children should be as a focal seizure and children with known conditions that predis sessed for iron defciency, which should be treated if it is present. In infants, the condition can be lieved to begin in both hemispheres at the same time). In focal distinguished from seizures based on it occurring only during seizures, the degree of impairment in the level of consciousness sleep and ceasing when the infant wakes up, as well as the absence can be variable. A few children may continue to experience an exaggerated simple” and “partial complex” seizures have been abandoned by startle response with stifening and falling throughout life. Electroclinical syndromes are clinical entities of be appropriate; a sodium level for children less than 6 months, a specifc complex of signs and symp to ms comprising a distinct calcium and blood glucose levels are the most likely to be ab clinical disorder. Tics and stereo of Neurology as part of the routine work-up of a frst nonfocal, typic movements are described as involuntary movements even nonfebrile seizure; however, the ideal timing of that procedure though afected individuals may have some ability to suppress is not clear. Some electroclinical (epilepsy) syndromes are continue to show transient postictal abnormalities for up to characterized by both seizures and involuntary movements, but 48 hours. In general, movement disorders do not manifest because it does not infuence treatment recommendations. Disturbed 22 classifed as an unknown seizure type because they do not nighttime sleep is very common. Confusional arousals are similar, but less extreme movements, nystagmus, or au to nomic disturbances may ac events with a more gradual onset, and the child is less likely to company the episodes. Children experience brief episodes of sudden imbal in loss of consciousness and some seizure activity. This condition is considered a migraine variant and a likely Hirtz D, Ashwal S, Berg A, et al: Practice parameter: Evaluating a frst nonfe precursor to migraine headaches. Repetitive purposeless movements are ofen exhibited by Subcommittee on Febrile Seizures. Febrile seizures: Guideline for the neurodi 26 autistic or handicapped children, especially in environ agnostic evaluation of the child with a simple febrile seizure, Pediatrics ments with a low level of stimulation. Chapter 181 an intentional movement (but intentional movement can worsen them), and children ofen try to disguise the movements by incor Chapter 52 porating them in to a more purposeful movement (“parakine sias”). Afected children frequently are usually unable to maintain a voluntary posture. Involuntary movements can be the primary or secondary man The movement of athe to sis is a slow, smooth, continuous ifestation of numerous neurologic disorders; they can also be writhing motion that prevents a child from maintaining a stable benign. Clas opposed to proximal) extremities are more likely to be involved, sifcation has his to rically been difcult because of ambiguous or plus the face, neck, and trunk can be afected. It can be wors overlapping terminology, plus afected children commonly ened by intentional movement but also appears at rest. The dren, athe to sis rarely occurs in isolation; it frequently coexists Task Force on Childhood Movement Disorders published a with chorea (choreoathe to sis), most commonly in a specifc consensus statement in 2010 proposing defnitions for hyperki form of cerebral palsy (dyskinetic) in which dys to nia is typically netic movements recognized in children based on the best a predominant fnding as well. The cor 1 the frst diagnostic challenge because many movement rect classifcation of tardive dyskinesia is unclear; it may be a disorders are also paroxysmal. If seizures are deemed unlikely, identifying or the abrupt discontinuation of a dopamine antagonist. The chorea is usually asymmetric, although involvement of bilateral metacarpophalangeal joints Hypokinesia or parkinsonism. If suspected, a cardiac 3 bradykinesia or dys to nia rather than chorea (more likely evaluation is essential to rule out rheumatic carditis. Kayser-Fleischer hemiplegia of childhood (attacks of faccid hemiplegia rings (yellow-brown rings around the cornea due to copper with nystagmus, dys to nia, and to nic spells). The family his to ry may be can make distinguishing the distinct start and end point of indi overlooked if incomplete expression of the disorder occurs in vidual movements difcult. Hunting to n disease is an au to somal dominant neurode Benign myoclonus of infancy is characterized by clusters 13 21 generative disorder of the basal ganglia, which rarely pre of jerks of the head, neck, and arms. The tractions cause twisting and repetitive movements, abnormal onset is typically in adolescence, and it is characterized by myo postures, or both”; the term “ to rsion spasm” has also been used clonic movements, generalized to nic-clonic seizures, and to describe this movement disorder. The condition is charac lieved to be common in dys to nia; when it does occur, it is sus terized by opsoclonus (furries of conjugate eye movements) pected to be an element (possibly voluntary) of compensation. Pri occur as an idiopathic disorder, due to encephalitis, or as a 16 mary to rsion dys to nia (previously dys to nia musculorum paraneoplastic disorder, most commonly associated with deformans) is an au to somal dominant disorder in children that neuroblas to ma. Focal dys to nias involve a specifc body region; examples 17 A low level physiologic tremor is normal in all people. It may include writer’s cramp, blepharospasm, to rticollis, and opis 26 be exacerbated by stress, anxiety, and certain medications. Blepharospasm (spasmodic eye closing) in children is ofen drug induced, although it occasionally occurs due to other Jitteriness occurs in response to a stimulus and is common 27 causes of dys to nia; it needs to be distinguished from tics. Myoclonus can be distinguished from tics because there is no preceding urge or suppressibility. It is Mo to r tics are distinctly recognizable purposeless move 29 more likely to signify a more ominous disorder in children than ments or movement fragments that are characteristically adults, although it can also be benign in children. They replace pediatric au to immune neuropsychiatric disorder asso are ofen triggered by an identifable stressor. They are normal starting in infancy Transient tics, typically eye blinking or facial movements, and may persist up to 10 years of age. Although the two frequently occur to gether, they are not defciencies of mo to r endplate acetylcholinesterase production synonymous. Active to ne is physiologic resistance to move or function (including defects of its recep to rs). Rapid fatigue of muscles with worsening symp to ms as the day Weakness relates to strength of (or power generated by) muscle. Diagnosis is confrmed by charac Any component of the nervous system may be responsible. Pertinent and children meeting specifc criteria and only in a setting with his to ry includes perinatal events (including a his to ry of drug or critical care support available. The degree and distribution of the evident at birth; these are usually infants born to mothers with hypo to nia and weakness are signifcant to the diagnosis.
Most cases of medication to skin care therapist buy benzoyl mastercard lerance can be managed through carefully con trolled tapering skin care vitamin c purchase genuine benzoyl line. Com orbidity Typically acne light order benzoyl 20 gr with mastercard, the individual was initially started on the medication for a major depressive dis order; the original symp to acne 7 months postpartum purchase benzoyl 20 gr on line ms may return during the discontinuation syndrome. A condition or problem in this chapter may be coded if it is a reason for the current visit or helps to explain the need for a test, procedure, or treatment. Relational Problems Key relationships, especially intimate adult partner relationships and parent/caregiver child relationships, have a significant impact on the health of the individuals in these re lationships. These relationships can be health promoting and protective, neutral, or detri mental to health outcomes. In the extreme, these close relationships can be associated with maltreatment or neglect, which has significant medical and psychological consequences for the affected individual. This category should be used when the main focus of clinical attention is to address the quality of the parent-child relationship or when the quality of the parent-child relationship is affecting the course, prognosis, or treatment of a mental or other medical disorder. Typically, the parent-child relational problem is associated with impaired functioning in behavioral, cognitive, or affective do mains. Examples of behavioral problems include inadequate parental control, supervision, and involvement with the child; parental overprotection; excessive parental pressure; ar guments that escalate to threats of physical violence; and avoidance without resolution of problems. Affective problems may include feelings of sadness, apathy, or anger about the other in dividual in the relationship. Clinicians should take in to account the developmental needs of the child and the cultural context. This category can be used for either children or adults if the focus is on the sibling re lationship. Siblings in this context include full, half-, step-, foster, and adopted siblings. The child could be one who is under state cus to dy and placed in kin care or foster care. Problems related to a child living in a group home or orphanage are also included. Typically, the relationship distress is associated with impaired functioning in behavioral, cognitive, or affective domains. Ex amples of behavioral problems include conflict resolution difficulty, withdrawal, and overinvolvement. Affective problems would include chronic sadness, apathy, and/or anger about the other partner. As part of their reaction to such a loss, some grieving individuals present with symp to ms characteristic of a major depressive episode—for example, feel ings of sadness and associated symp to ms such as insomnia, poor appetite, and weight loss. The berea>(ed individual typically regards the depressed mood as "normal," al though the individual may seek professional help for relief of associated symp to ms such as insomnia or anorexia. The duration and expression of "normal" bereavement vary con siderably among different cultural groups. Further guidance in distinguishing grief from a major depressive episode is provided in the criteria for major depressive episode. Because of the legal implications of abuse and neglect, care should be used in assessing these conditions and assigning these codes. Having a past his to ry of abuse or neglect can influence diagnosis and treatment response in a number of mental disorders, and may also be noted along with the diagnosis. For the following categories, in addition to listings of the confirmed or suspected event of abuse or neglect, other codes are provided for use if the current clinical encounter is to provide mental health services to either the victim or the perpetra to r of the abuse or ne glect. A separate code is also provided for designating a past his to ry of abuse or neglect. Child M a ltre a tm e n t and N eglect Problem s Child Physical Abuse Child physical abuse is nonaccidental physical injury to a child—^ranging from minor bruises to severe fractures or death—occurring as a result of punching, beating, kicking, biting, shaking, throwing, stabbing, choking, hitting (with a hand, stick, strap, or other object), burning, or any other method that is inflicted by a parent, caregiver, or other individual who has responsibility for the child. Such injury is considered abuse regardless of whether the caregiver intended to hurt the child. Physical discipline, such as spanking or paddling, is not considered abuse as long as it is reasonable and causes no bodily injury to the child. Sexual abuse also includes noncontact exploitation of a child by a parent or caregiver—for example, forcing, tricking, enticing, threatening, or pressuring a child to participate in acts for the sexual gratification of others, without direct physical contact between child and abuser. Child neglect encompasses abandonment; lack of appropriate supervision; fail ure to attend to necessary emotional or psychological needs; and failure to provide neces sary education, medical care, nourishment, shelter, and/or clothing. Nonaccidental acts of physical force include shoving, slapping, hair pulling, pinching, restraining, shaking, throwing, biting, kicking, hitting with the fist or an object, burning, poisoning, applying force to the throat, cutting off the air supply, holding the head under water, and using a weapon. Sexual violence may involve the use of physical force or psychological coercion to compel the partner to engage in a sexual act against his or her will, whether or not the act is completed. Also included in this category are sexual acts with an intimate partner who is unable to consent. This category is used in the context of relationships in which one partner is extremely dependent on the other partner for care or for assistance in navigating ordinary daily activities—for example, a partner who is incapable of self-care owing to substantial physical, psychological/intel lectual, or cultural limitations. This category should be used when such psychological abuse has occurred during the past year. Acts for the purpose of physically protecting oneself or the other person are excluded. Problems to be considered include illiteracy or low-level literacy; lack of access to school ing owing to unavailability or unattainability; problems with academic performance. Psychological reactions to deployment are not included in this category; such reactions would be better captured as an adjustment disorder or another mental disorder. Areas to be considered include problems with employment or in the work environment, including unemploy ment; recent change of job; threat of job loss; job dissatisfaction; stressful work schedule; uncertainty about career choices; sexual harassment on the job; other discord with boss, supervisor, co-workers, or others in the work environment; uncongenial or hostile work environments; other psychosocial stressors related to work; and any other problems re lated to employment and/or occupation. An individual is considered to be homeless if his or her primary nighttime residence is a homeless shelter, a warming shelter, a do mestic violence shelter, a public space. Examples of inadequate housing conditions include lack of heat (in cold temperatures) or electricity, infestation by insects or rodents, inadequate plumbing and to ilet facilities, overcrowding, lack of adequate sleeping space, and exces sive noise. Psychological reactions to a change in living situation are not included in this category; such reactions would be better captured as an adjustment disorder. Examples include inability to qualify for welfare support owing to lack of proper documentation or evidence of address, inability to obtain adequate health insurance be cause of age or a preexisting condition, and denial of support owing to excessively strin gent income or other requirements. Examples of such transitions include entering or completing school, leaving parental control, getting married, starting a new career, be coming a parent, adjusting to an "empty nest" after children leave home, and retiring. Examples of such problems include chronic feelings of loneliness, isolation, and lack of structure in car rying out activities of daily living. Typically, such categories include gender or gender identity, race, ethnicity, religion, sexual orientation, country of origin, political beliefs, dis ability status, caste, social status, weight, and physical appearance. Examples in clude spiritual or religious counseling, dietary counseling, and counseling on nicotine use. Problems Related to Other Psychosocial, Personal, and Environmental Circumstances V62. Examples include distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new faith, or questioning of spiritual val ues that may not necessarily be related to an organized church or religious institution. Ex amples of lifestyle problems include lack of physical exercise, inappropriate diet, high-risk sexual behavior, and poor sleep hygiene. A problem that is attributable to a symp to m of a mental disorder should not be coded unless that problem is a specific focus of treatment or directly affects the course, prognosis, or treatment of the individual. In such cases, both the mental disorder and the lifestyle problem should be coded. Examples include the behavior of some professional thieves, racketeers, or dealers in illegal substances. Examples include isolated antisocial acts by children or adoles cents (not a pattern of antisocial behavior). This category should be used only when the problem is sufficiently severe to warrant independent clinical attention and does not meet diagnostic criteria for psychological fac to rs affecting other medical conditions. Under some circumstances, malingering may repre sent adaptive behavior—for example, feigning illness while a captive of the enemy during wartime. Malingering should be strongly suspected if any combination of the following is noted: 1. Lack of cooperation during the diagnostic evaluation and in complying with the pre scribed treatment regimen.
Such early onset is likely related to skin care wholesale cost of benzoyl concurrent other externalizing problems acne yahoo answers cheap 20gr benzoyl, most notably conduct disorder symp to acne 1st trimester cheap benzoyl 20gr on-line ms acne early sign of pregnancy buy generic benzoyl 20 gr on line. However, early onset is also a predic to r of internalizing problems and as such probably reflects a general risk fac to r for the development of mental health disorders. A his to ry of conduct disorder in childhood or adolescence and antiso cial personality disorder are risk fac to rs for the development of many substance-related disorders, including cannabis-related disorders. Other risk fac to rs include externalizing or internalizing disorders during childhood or adolescence. Youths with high behavioral disinhibition scores show early-onset substance use disorders, including cannabis use dis order, multiple substance involvement, and early conduct problems. Risk fac to rs include academic failure, to bacco smoking, unstable or abu sive family situation, use of cannabis among immediate family members, a family his to ry of a substance use disorder, and low socioeconomic status. As with all substances of abuse, the ease of availability of the substance is a risk fac to r; cannabis is relatively easy to obtain in most cultures, which increases the risk of developing a cannabis use disorder. Heritable fac to rs contribute between 30% and 80% of the to tal variance in risk of cannabis use disorders. It should be noted that common genetic and shared en vironmental influences between cannabis and other types of substance use disorders sug gest a common genetic basis for adolescent substance use and conduct problems. Occurrence of cannabis use disorder across countries is unknown, but the prevalence rates are likely sim ilar among developed countries. It is frequently among the first drugs of experimentation (often in the teens) of all cultural groups in the United States. Acceptance of cannabis for medical purposes varies widely across and within cultures. Cultural fac to rs (acceptability and legal status) that might impact diagnosis relate to dif ferential consequences across cultures for detection of use. Diagnostic M arkers Biological tests for cannabinoid metabolites are useful for determining if an individual has recently used cannabis. Such testing is helpful in making a diagnosis, particularly in milder cases if an individual denies using while others (family, work, school) purport con cern about a substance use problem. Because cannabinoids are fat soluble, they persist in bodily fluids for extended periods of time and are excreted slowly. Functional Consequences of Cannabis Use Disorder Functional consequences of cannabis use disorder are part of the diagnostic criteria. Many areas of psychosocial, cognitive, and health functioning may be compromised in relation to cannabis use disorder. Cognitive function, particularly higher executive function, ap pears to be compromised in cannabis users, and this relationship appears to be dose de pendent (both acutely and chronically). Cannabis use has been related to a reduction in prosocial goal-directed ac tivity, which some have labeled an amotivational syndrome, that manifests itself in poor school performance and employment problems. These problems may be related to perva sive in to xication or recovery from the effects of in to xication. Similarly, cannabis-associated problems with social relationships are commonly reported in those with cannabis use dis order. Accidents due to engagement in potentially dangerous behaviors while under the influence. Cannabis smoke contains high levels of carcinogenic compounds that place chronic users at risk for respira to ry illnesses similar to those experienced by to bacco smokers. Chronic cannabis use may contribute to the onset or exacerbation of many other mental disorders. In particular, concern has been raised about cannabis use as a causal fac to r in schizophrenia and other psychotic disorders. Cannabis use can contribute to the onset of an acute psy chotic episode, can exacerbate some symp to ms, and can adversely affect treatment of a major psychotic llness. The distinction between nonproblematic use of can nabis and cannabis use disorder can be difficult to make because social, behavioral, or psy chological problems may be difficult to attribute to the substance, especially in the context of use of other substances. Also, denial of heavy cannabis use and the attribution that can nabis is related to or causing substantial problems are common among individuals who are referred to treatment by others. Chronic intake of cannabis can produce a lack of motivation that resembles persistent depressive disorder (dysthymia). Acute adverse reactions to cannabis should be differentiated from the symp to ms of panic disorder, major depressive disorder, delusional disorder, bipolar disorder, or schizophrenia, paranoid type. Physical examination will usually show an increased pulse and conjunctival injection. Comorbidity Cannabis has been commonly thought of as a "gateway" drug because individuals who frequently use cannabis have a much greater lifetime probability than nonusers of using what are commonly considered more dangerous substances, like opioids or cocaine. Can nabis use and cannabis use disorder are highly comorbid with other substance use disor ders. Cannabis use has been associated with poorer life satisfaction; increased mental health treatment and hospitalization; and higher rates of depression, anxiety disorders, suicide attempts, and conduct disorder. Individuals with past-year or lifetime cannabis use disorder have high rates of alcohol use disorder (greater than 50%) and to bacco use disorder (53%). Rates of other substance use disorders are also likely to be high among individuals with cannabis use disorder. Among those seeking treatment for a cannabis use disorder, 74% report problematic use of a secondary or tertiary substance: alcohol (40%), cocaine (12%), meth amphetamine (6%), and heroin or other opiates (2%). Among those younger than 18 years, 61% reported problematic use of a secondary substance: alcohol (48%), cocaine (4%), meth amphetamine (2%), and heroin or other opiates (2%). Cannabis use disorder is also often observed as a secondary problem among those with a primary diagnosis of other substance use disorders, with approximately 25%-80% of those in treatment for another substance use disorder reporting use of cannabis. Individuals with past-year or lifetime diagnoses of cannabis use disorder also have high rates of concurrent mental disorders other than substance use disorders. Major de pressive disorder (11%), any anxiety disorder (24%), and bipolar I disorder (13%) are quite common among individuals with a past-year diagnosis of a cannabis use disorder, as are antisocial (30%), obsessive-compulsive, (19%), and paranoid (18%) personality disorders. Approximately 33% of adolescents with cannabis use disorder have internalizing disor ders. Although cannabis use can impact multiple aspects of normal human functioning, in cluding the cardiovascular, immune, neuromuscular, ocular, reproductive, and respira to ry systems, as well as appetite and cognition/perception, there are few clear medical conditions that commonly co-occur with cannabis use disorder. The most significant health effects of cannabis involve the respira to ry system, and chronic cannabis smokers exhibit high rates of respira to ry symp to ms of bronchitis, sputum production, shortness of breath, and wheezing. Two (or more) of the following signs or symp to ms developing within 2 hours of canna bis use: 1. Specify if: With perceptual disturbances: Hallucinations with intact reality testing or audi to ry, vi sual, or tactile illusions occur in the absence of a delirium. Specifiers When hallucinations occur in the absence of intact reality testing, a diagnosis of substance/ medication-induced psychotic disorder should be considered. Diagnostic Features the essential feature of cannabis in to xication is the presence of clinically significant prob lematic behavioral or psychological changes that develop during, or shortly after, canna bis use (Criterion B). In to xication typically begins with a 'high" feeling followed by symp to ms that include euphoria with inappropriate laughter and grandiosity, sedation, lethargy, impairment in short-term memory, difficulty carrying out complex mental pro cesses, impaired judgment, dis to rted sensory perceptions, impaired mo to r performance, and the sensation that time is passing slowly. Occasionally, anxiety (which can be severe), dysphoria, or social withdrawal occurs. These psychoactive effects are accompanied by two or more of the following signs, developing within 2 hours of cannabis use: conjuncti val injection, increased appetite, dry mouth, and tachycardia (Criterion C). In to xication develops within minutes if the cannabis is smoked but may take a few hours to develop if the cannabis is ingested orally. The effects usually last 3-4 hours, with the duration being somewhat longer when the substance is ingested orally. The magnitude of the behavioral and physiological changes depends on the dose, the method of adminis tration, and the characteristics of the individual using the substance, such as rate of absorp tion, to lerance, and sensitivity to the effects of the substance. Prevalence the prevalence of actual episodes of cannabis in to xication in the general population is un known. However, it is probable that most cannabis users would at some time meet criteria for cannabis in to xication. Given this, the prevalence of cannabis users and the prevalence of individuals experiencing cannabis in to xication are likely similar. Functional Consequences of Cannabis In to xication Impairment from cannabis in to xication may have serious consequences, including dys function at work or school, social indiscretions, failure to fulfill role obligations, traffic ac cidents, and having unprotected sex. In rare cases, cannabis in to xication may precipitate a psychosis that may vary in duration. D ifferential Diagnosis Note that if the clinical presentation includes hallucinations in the absence of intact reality testing, a diagnosis of substance/medication-induced psychotic disorder should be con sidered. However, in contrast to carmabis in to xication, alcohol in to xica tion and sedative, hypnotic, or anxiolytic in to xication frequently decrease appetite, in crease aggressive behavior, and produce nystagmus or ataxia.
It is often found when you are undergoing tests for other conditions acne under jaw benzoyl 20 gr low cost, such as to acne pustules discount 20 gr benzoyl amex determine the cause of infertility or to acne tips purchase benzoyl 20 gr look for prostate cancer acne regimen 20gr benzoyl otc. By the time he is 40, it may have grown slightly larger, to the size of an apricot. Some men might find it hard to start a urine stream, even though they feel the need to go. Other men may feel like they need to pass urine all the time, or they are awakened during sleep with the sudden need to pass urine. On the right, urine flow is affected because the enlarged prostate is pressing on the bladder and urethra. Your symp to ms may change over time, so be sure to tell your doc to r about any new changes. If you choose watchful waiting, these simple steps may help lessen your symp to ms: I I I I Limit drinking in the evening, especially drinks with alcohol or caffeine. One type relaxes muscles near the prostate, and the other type shrinks the prostate gland. I I I I Alpha-blockers these drugs (see the table on page 14) help relax muscles near the prostate to relieve pressure and let urine flow more freely, but they d o n ’t shrink the size of the prostate. I I I I 5-alpha reductase inhibi to rs these drugs (see the table on page 14) help shrink the prostate. They relieve symp to ms by blocking the activity of an enzyme known as 5-alpha reductase. There is also evidence that these drugs lower the risk of getting prostate cancer, but whether they can help lower the risk of dying from prostate cancer is still unclear. The doc to r passes an instrument through the urethra and trims away extra prostate tissue. In addition, men may have to stay in the hospital and need a catheter for a few days after surgery. This can be an option for men who should not have major surgery because they have other medical problems. The doc to r passes a laser fiber through the urethra in to the prostate, using a cys to scope, and then delivers several bursts of laser energy. This may be the only option in rare cases, such as when the obstruction is severe, the prostate is very large, or other procedures can’t be done. General anesthesia or a spinal block is used, and a catheter remains for 3 to 7 days after the surgery. Be sure to discuss options with your doc to r and ask about the potential short and long-term benefits and risks with each procedure. For a list of questions to ask, see the “Checklist of Questions for Your Doc to r” on page 28. Cell changes may begin 10, 20, or even 30 years before a tumor gets big enough to cause symp to ms. By age 50, very few men have symp to ms of prostate cancer, yet some precancerous or cancer cells may be present. More than half of all American men have some cancer in their prostate glands by the age of 80. I I I I About 16 percent of American men are diagnosed with prostate cancer at some point in their lives. Prostate Cancer Symp to ms I I I I Trouble passing urine I I I I Frequent urge to pass urine, especially at night I I I I Weak or interrupted urine stream I I I I Pain or burning when passing urine I I I I Blood in the urine or semen I I I I Painful ejaculation I I I I Nagging pain in the back, hips, or pelvis Prostate cancer can spread to the lymph nodes of the pelvis. So bone pain, especially in the back, can be a symp to m of advanced prostate cancer. African-American men have the highest risk of prostate cancer—the disease tends to start at younger ages and grows faster than in men of other races. After African-American men, 20 prostate cancer is most common among white men, followed by Hispanic and Native American men. Men whose fathers or brothers have had prostate cancer have a 2 to 3 times higher risk of prostate cancer than men who do not have a family his to ry of the disease. A man who has 3 immediate family members with prostate cancer has about 10 times the risk of a man who does not have a family his to ry of prostate cancer. The younger a man’s relatives are when they have prostate cancer, the greater his risk for developing the disease. Prostate cancer risk also appears to be slightly higher for men from families with a his to ry of breast cancer. Studies have shown that 5-alpha reductase inhibi to rs finasteride and dutasteride can lower the risk of developing prostate cancer, but whether they can decrease the risk of dying of prostate cancer is still unclear. A screening test may help find cancer at an early stage, when it is less likely to have spread and may be easier to treat. The most useful screening tests are those that have been proven to lower a person’s risk of dying from cancer. Doc to rs do not yet know whether prostate cancer screening lowers the risk of dying from prostate cancer. Therefore, large research studies, with thousands of men, are now going on to study prostate cancer screening. Although some people feel it is best to treat any cancer that is found, including cancers found through screening, prostate cancer treatment can cause serious and sometimes permanent side effects. Some doc to rs are concerned that many men whose cancer is detected by screening are being treated— and experiencing side effects—unnecessarily. Talk with your doc to r about your risk of prostate cancer and your need for screening tests. They can help you find the best care, answer your questions, and address your concerns. Talking openly with your doc to rs can help you learn more about your prostate changes and the tests to expect. It is a good idea to get a copy of your pathology report from your doc to r and carry it with you as you talk with your health care providers. You’ll be asked whether you have symp to ms, how long you’ve had them, and how much they affect your lifestyle. Your personal medical his to ry also includes any risk fac to rs, pain, fever, or trouble passing urine. With a gloved and lubricated finger, your doc to r feels the prostate from the rectum. It is normally secreted in to ducts in the prostate, where it helps make semen, but sometimes it leaks in to the blood. Doc to rs often use a value of 4 nanograms (ng) or higher per milliliter of blood as a sign that further tests, such as a prostate biopsy, are needed. Then you can decide to gether whether to have follow up biopsies and, if so, how often. This can help lower the chance of missing any areas of the gland that may have cancer cells. Like other cancers, prostate cancer can be diagnosed only by looking at tissue under a microscope. Most men who have biopsies after prostate cancer screening exams do not have cancer. If a biopsy is positive A positive test result after a biopsy means prostate cancer is present. A pathologist will check your biopsy sample for cancer cells and will give it a Gleason score. The Gleason score ranges from 2 to 10 and describes how likely it is that a tumor will spread. The lower the number, the less aggressive the tumor is and the less likely it will spread. Howard Parnes, Chief of the Prostate and Urologic Cancer Research Group, Division of Cancer Prevention, National Cancer Institute “While it’s important to make your own decision about cancer screening, everybody should consider getting a second opinion before getting something like a biopsy. This information will be available from your doc to r and is listed on your pathology report. Many men find it helpful to talk with their doc to rs, f a m i l y, friends, and other men who have faced similar decisions. If I decide on watchful waiting, what changes in my symp to ms should I look for and how often should I be testedfi Do I need medicine and how long would I need to take it before seeing improvement in my symp to msfi
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