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Actos Lawsuit : You can live without a bladder. However, you still need something that can perform the two basic func­tions of the bladder: storing and emptying of urine. Physicians have come up with many ways over the years to accomplish these tasks, many of which are still used today. The simplest alternative is to place drainage tubes into the kidneys that come out through the skin and connect to bags on the abdomen. These tubes are known as nephrostomy tubes. Nephrostomy tubes are typically inserted into a person in the X-ray department by an interventional radiologist who uses some light sedation. For the patient, the bag provides an easy way to store urine and can be drained several times a day when convenient by opening a small valve on the bag. These tubes can be uncomfortable, however, and may also be easily removed if tugged; therefore, they are only reasonable solutions for a short period of time or for patients who are too ill to undergo surgery. It is also possible to surgically bring the ureters directly to the skin surface (called a cutaneous ureterostomy). The urine then can be collected with a bag attached to the skin around the opening. Unfortunately, the ureters are rela­tively small, and thus any scarring or narrowing of the opening can cause a blockage of urine. This tendency to get blocked also makes cutaneous ureterostomies a poor long-term solution.

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To provide a good long-term solution, surgeons most commonly use a portion of the small bowel to act as the new bladder. The identified piece of small bowel is removed from the main portion and is fashioned for its new use (see Question 79 for details). The urine that collects within this piece of bowel will ultimately be drained in one of three ways. First, the bowel can simply be left open at the skin for the urine to drain passively out into a bag that is attached to the abdomen. This type of drainage is known as a conduit, and the opening onto the skin is called a urostomy. Urine collects in the bag, which is then drained into a toilet several times each day. Second, the bowel can be sewn into a rough sphere con­nected to the skin by only a small, long channel. This channel prevents urine from leaking out but easily accommodates a small catheter. This is called a conti­nent urinary diversion. With this type of diversion, you must pass a catheter into the new bladder several times a day to drain the urine. This allows you to live without an ostomy bag, but for some patients, passing the catheter several times a day may be difficult or impossible. Third, the new bladder can be directly reattached to the urethra (called an orthotopic neobladder). This allows you to urinate almost normally, although you do need to learn to use different muscles, as the new bladder replacement.

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To understand cancer, we must first understand nor­mal functioning of the body. The body is made up of billions of cells. Each organ of the body is made up of several different types of specialized cells. For example, the liver has cells that filter toxins from the blood, and the brain has nerve cells (called neurons) that are able to conduct electrical signals. Perhaps the most familiar cells are skin cells. Every flake of dry skin is made of millions of cells that are constantly dying and being replaced with new cells. The growth of new cells is care­fully balanced to occur at the same rate as the death of old cells. Your body has many mechanisms in place to regulate the timing of the birth and death of cells. Unfortunately, if one of these mechanisms malfunc­tions, the careful balance can be disrupted. Environ­mental toxins such as cigarette smoke, chemicals, and radiation can damage DNA and can disrupt these control mechanisms. A tumor may develop when new cells are created faster than old cells die. Tumors can be either benign or malignant. A benign tumor is an overgrowth of cells that is unchecked by the body’s normal mechanisms; thus, it will keep getting bigger. It is called benign because it does not cause you illness. Some benign tumors can get to be so large that they do cause problems, especially if they are in a confined space, such as your skull. A malignant tumor is also an overgrowth of cells. The tumor is considered malignant, however, because the cells are no longer confined to the tumor. Cells may spread from the main tumor through the blood and lymph system or grow directly into nearby structures. As the cells begin to grow unchecked in new organs, they gradually cause dysfunction all over the body and may eventually even cause death.

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Actos Lawsuit : The bladder is the container in the body that stores urine. The other term for bladder is “vesical,” which is derived from the Latin word vesicular. The bladder is a soft, round structure that is located in the pelvis. The pubic bone is in front of the bladder; the rectum in men or the uterus in women is behind the bladder. Urine drains into the bladder through an opening on each side at the bottom of the bladder. Urine is stored in the bladder until a person is ready to urinate. In order to urinate, the muscle in the bladder wall squeezes, push­ing the urine out of the bladder through the urethra. In women, the urethra is short, only approximately 1 inch long. In men, it is much longer because it has to pass through the prostate and then the penis before finally opening at the tip of the penis.

In the middle of the abdomen, just beneath the lower ribs, are the kidneys. The kidneys filter the blood to produce urine. The urine that the kidneys produce exits the kidney through the renal pelvis and flows into the ureters. The ureters are soft, muscular tubes that are about the width of a pencil. They carry the urine from the kidneys down to the bladder, where they open into the base of the bladder.

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The adult bladder normally holds approximately 400 ml of urine. The bladder wall has three separate layers. The innermost layer that is in contact with the urine is a thin layer called the urothelium. The middle layer is made of muscle fibers that can squeeze. When the muscles contract, they increase the pressure inside the bladder, squeezing the urine out of the bladder. The outermost layer is a thin but protective layer called serosa.

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The bladder has two functions. The first is the storage of urine, and the second is the emptying of urine. In an infant, the bladder constantly fills and empties without any control by the brain. During toilet training, the brain learns to control the bladder, enabling it to hold (store) the urine until a time when it is socially accept­able to urinate. Emptying is the second function that the bladder must perform. In infancy, before toilet train­ing, this is actually the most important function of the bladder.

Although most of us take these two processes for granted, either one or both can malfunction. If the stor­age function fails, the bladder can become very small and contracted, holding just a tiny amount of urine before it needs to empty. In contrast, it may become floppy and dilated, holding several liters of urine before it is ready to empty. It can also become “overactive,” causing feelings of urgency and the need to urinate more than eight times per day. When the actual emptying function goes wrong, the bladder may only partially empty each time, leaving a high remaining amount of urine (the so-called postvoid residual). The bladder muscle may also weaken to the point where one is completely unable to urinate. This is called urinary retention.

When storing urine, the bladder must do so at a low pressure. This allows the new urine made in the kidneys to flow downward into the bladder. A safe bladder pres­sure is less than 40 cm H2O. When the pressures are higher than this, the urine may “back up” in the kidneys. High pressures in the kidneys over a long period of time may damage the kidneys. During urination, the bladder must squeeze to force the urine out. The pressure in the bladder at these times may be much higher than 40 cm H₂O, but it does not usually damage the kidneys.

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Actos Lawsuit News- 1/26/2012: Surgery can be as effective in elderly patients as in younger patients, but it does have a higher rate of postoperative complications in older individuals who have other medical problems (comorbidities). Elderly people are particularly sensitive to long-term complications, lilce the metabolic dis­turbances that can follow urinary diversion. In those aged 80 or older, the role of radical cystectomy is controversial. Although newer surgical techniques and improvements in care, before and after the operation, make this an option for increasing numbers of older patients, several studies suggest that its benefit is at best quite minimal, even in relatively fit octogenarians. You need to carefully weigh the benefits and risks of radical cystectomy with your multidisciplinary team before going through such an aggressive operation.

Because bladder cancer surgery can cause serious side effects and debilitation that requires significant healing time and energy, older patients usually tolerate neoadjuvant chemotherapy (given before surgery) better than adjuvant chemotherapy (given after surgery). On the other hand, because not all bladder cancer patients need chemotherapy, giving it after surgery (adjuvant therapy) offers the advantages of treating only those patients who absolutely need it. You should discuss the advantages and disadvantages of both approaches with your multi­disciplinary team.

With regard to choice of chemotherapy, healthy older patients can receive the same regimens as their younger counterparts, including those that are anthracycline-based, like MVAC (see Chapter 3). However, older patients are at increased risk of developing congestive heart failure from these regimens, and gemcitabine-cisplatin is probably a better choice, especially in those with a significant cardiac risk for anthracyclines. Recent studies have shown this regimen to be just as effective as MVAC but with fewer- side effects.

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Managing chemotherapy-associated toxicity with appropri­ate supportive care is crucial in the elderly population to give them the best chance of cure and survival or to provide the best palliation. Reducing tire dose of chemotherapy (or radiation therapy) based purely on chronological age may seriously affect the effectiveness of treatment. Those with metastatic disease may tolerate single-agent chemotherapy better, but tire presence of severe comorbidities, age-related frailly, or underlying severe psychosocial problems may be obstacles, even for these treatment plans. As in younger patients, trimodal therapy with bladder preservation may be an option for selected older individuals with bladder cancer (see Chapter 3). It is an aggressive treatment approach that involves radiation therapy, chemotherapy, and surgery. If an older person is too frail to undergo radical cystectomy, he or she is usually too frail to get trimodal therapy. There are a few exceptions to this general rule, and it is essential that you weigh all of the risks and benefits with your multidisciplinary care team. In frail patients, radiation therapy is sometimes used to control the symptoms of bladder cancer, but it is rarely curative.

The fatigue that usually accompanies radiation therapy can be quite profound in the elderly, even in those who are fit. Often, the logistical details (like daily travel to the hospi­tal for a 6-week course of treatment) are the hardest for older people. It is important that you discuss these potential problems with your family and social worker before starting radiation therapy. Anemia (low red blood cell count) is common in the elderly, especially the frail elderly. It decreases the effectiveness of chemotherapy and often causes fatigue, falls, cognitive decline (for example, dementia, disorientation or confusion), and heart problems. Therefore it is essential that anemia be recognized and corrected with red blood cell transfusions or the appropriate use of erythropoiesis-stimulating agents.

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Kidney function declines as we age. Some of the medicines that older patients take to treat both their cancer (for example, cisplatin, carboplatin, methotrexate, zoledronic acid, nonsteroidal anti-inflammatory drugs) and noncancer- related problems might make this worse. The dehydration that often accompanies cancer and its treatment can put additional stress on the kidneys. Fortunately, it is often possible to minimize these effects by carefully selecting and dosing appropriate drugs, managing “polypharmacy,” and preventing dehydration. Fatigue is a near universal complaint of older cancer patients. It is particularly a problem for those who are socially isolated or depend on others to help them with activities of daily living. It is not necessarily related to depression, but it can be. Depression is quite common in the elderly. In contrast to younger patients who often respond to a cancer diagnosis with anxiety, depression is the more common disorder in older cancer patients. With proper support and medical attention, many of these patients can safely receive anticancer treatment.

fter receiving the diagnosis of cancer, many patients report that they hear very little else their doctor tells them. Although this information will be repeated and clarified over the ensuing visits with your physician, it can also be empowering to find out more information on your own. When searching for information about any healthcare topic, you should look for two criteria. First, the information should be published by a reliable source. Articles or reviews by experts are often the high­est quality resources. Second, the information should be written at an appropriate level for the reader. Very technical writing may not be appropriate for everyone, whereas some patients may want more detailed scientific information. The following resources meet these criteria, are either expert written or reviewed, and offer varying levels of scientific detail.

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Actos Lawsuit : Cigarette smoking accounts for 25% to 65% of all cases of bladder cancer in the United States. It increases the risk of bladder cancer by up to four times compared with someone who has never smoked. As you might expect, the risk increases as the number of cigarettes increases, the number of years of smoking increases, and by the degree of inhalation with each puff. This applies to both men and women. The risk is even higher with the use of air-cured “black” tobacco because it has a higher concentration of chemicals than flue- cured “blond” tobacco. The good news is that quit­ting smoking decreases your risk; thus, it is never too late to quit. Other forms of tobacco, such as cigars and smokeless tobacco, also increase the risk of cancer, although to a lesser degree. It is not clear what chemical in the cigarette smoke is responsible for bladder cancer. Some people clear the chemicals from cigarette smoke more slowly than others do. These people, called slow acetylators, appear to be at increased risk for bladder cancer.

Chemotherapy with the drug cyclophosphamide (cytoxan) is asso­ciated with up to a ninefold increased risk of developing bladder cancer. These cancers tend to be more aggressive as a group. The use of the medication MESNA at the time of cyclophos­phamide administration helps protect the bladder from irritation and decreases the risk of developing bladder cancer. A similar chemotherapy agent, ifos- famide (Ifex) is also associated with increased risk of developing bladder cancer. Also, patients who have had a kidney transplant or other organ transplants and are on immunosuppression (steroids and other medications) are known to have a higher risk for bladder cancer.

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The risk of developing bladder cancer appears to corre­late with fat and cholesterol intake. Some studies have suggested that eating a low-fat, low-cholesterol diet that is high in fruits and vegetables may decrease your risk of developing bladder cancer. A recent study from Japan showed a decreased risk of bladder cancer in patients who had diets that were high in green vegetables or carrots. Those who ate five or more servings per week were half as likely to develop bladder cancer, as were those who ate one to three servings per month. Soy protein and garlic intake may also decrease the risk. Garlic has been shown to have a direct toxic effect on bladder cancer cells grown in a culture dish in the laboratory. This effect may be due to stimulating the body’s natural defenses to kill cancerous cells.

The overall chance of developing bladder cancer dur­ing your lifetime is 3% to 4%. This type of number, however, lumps the entire world into one group. In order to create a more meaningful number, researchers try to identify who is at a higher or lower risk. Factors in the environment or one’s lifestyle that increase the risk of developing cancer are called risk factors. There are two types of risk factors. Risk factors that we are born with, such as our family genetics or race, are called unmodifiable risk factors because we cannot change them. For example, a man is two and a half times more likely to develop bladder cancer than is a woman, and there is no way for him to decrease this risk. The second type of risk factor is called a modifiable risk factor. You can change these risk factors to decrease your odds of developing cancer. The most obvious modifiable risk factor is tobacco. Smoking dramatically increases your risk of developing cancer, and quitting smoking dramatically decreases that risk. The next two questions discuss these risks in more detail.

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For those patients with tumors that have invaded the bladder muscle, cure is still possible. Either part or all of the bladder can be removed. If the surgeon is able to remove the entire tumor, then you are said to be cured of the cancer. Surgery will cure approximately 80% of the tumors that are confined to a person’s bladder. Unfortunately, again, it is impossible to know for certain that the entire tumor has been removed. Microscopic amounts of tumor may have escaped the bladder, and the surgeon has no way of detecting when this happens. In cases in which this is suspected, such as the presence of tumor cells at the edge of the removed tissue, chemotherapy or radiation may be added to improve the chances of curing the microscopic tumor that remains in the body. Patients with locally advanced cancer have only about a 20% to 30% chance of cure with surgery alone. Surveillance by a urologist after surgery is always important to ensure that the tumor does not recur.

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Actos Lawsuit : During a cystectomy, an incision is made through the abdominal wall, so you can expect some mild discomfort at the incision site. The incision will be covered after the sur­gery is finished, and you probably wont be able to shower or get the incision wet for about a week to 10 days. Your surgeon may have inserted a drain from the incision site, a flexible tube with a hollow bulb on the end that you will remove, empty, flush out, and reattach as needed. Your doc­tor will remove the drain (a painless procedure) and any stitches or staples in a follow-up visit to his or her office 10 days or so after your surgery.

Cystectomy has some possible complications, including infection, bleeding, blood clots, or intestinal obstruction. You may experience some difficulties with your urinary diversion system. (See the section about urinary diversion systems later in this chapter.) It is also likely that you will have a permanent scar in the abdominal wall—-you should ask your surgeon how big that scar is likely to be.

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You will be instructed to wait for a few weeks after sur­gery before you resume driving, and your doctors are likely to want you to refrain for several weeks from doing anything that strains your abdomen, such as pushing and pulling a vacuum cleaner or lifting heavy objects or engaging in any other activity that might damage the scar or even pull the scar tissue apart, thereby risking the formation of a hernia. A hernia occurs when your surgical scar pulls apart under the skin and allows a part of the underlying bowel to poke forward, creating a noticeable lump. Hernias can interfere with the functioning of the bowel and must be repaired, either with an external truss or support, or possibly through another surgical operation. It is smarter to avoid the risk in the first place by not stressing the scar soon after surgery. This is the time to take it easy and, when possible, allow friends or family to pamper you by helping with chores and housework. Just don’t get too used to having someone bring you the morning newspaper and a cup of coffee! Generally it is a good idea to review your postoperative instructions with your surgeon so you understand what you can and can­not safely do.

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Cystectomy has some negative consequences that you should discuss thoroughly with your medical team. As mentioned above, there may be changes in urinary func­tion. What type of change takes place depends largely on the type of surgery and on whether an artificial bladder has been created. Sometimes while the abdominal tissues are healing after surgery there will be a period of irregular bowel function, during which you will unexpectedly have to deal with diar­rhea or constipation. Occasionally there will be some swelling in one or both legs, due either to fluid retention or the formation of scar tissue around the lymph vessels that drain the legs. Often there will be the presence of an asymptomatic, low-grade chronic urinary tract infection that will be iden­tified upon routine testing. This occurs because of the changed pattern of emptying the new bladder. Usually it causes no problems and doesn’t require active treatment with antibiotics.

Other issues may also arise. Worries about possible changes in sexual function are common, and very normal. Sexual function often does change after cystectomy. That doesn’t mean you can’t have an active, playful, pleasurable sex life with your partner. It does mean that you’ll probably explore innovative strategies as you seek comfortable ways to experience fulfillment.

Men experience more extreme changes in sexual func­tion after surgery than women do. About half the men who undergo cystectomy experience nerve damage that leaves them impotent after the surgery, a serious lifestyle change that is not only physical but emotional, requiring much thoughtful discussion among you, your partner, and your medical team both before surgery and after.

Our use of the term or terms Actos Lawsuit is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Lawsuit : With a new diagnosis of bladder cancer, several tests need to be completed. Initially, your urine may be sent to a pa­thologist, who looks for the presence of cancer cells. Then, imaging of your body using a CT or MRI of the abdomen and pelvis and an x-ray or CT of your chest wall be per­formed and read by the radiologist to discern whether the cancer has spread outside of the bladder. Next, a cystoscopy (a surgical procedure done under anesthesia to look at the cancer inside the bladder using a small-caliber telescopic camera) with biopsy, often with resection (removal), of the bladder cancer is performed. The material from the biopsy is sent to the pathologist for microscopic determination of the grade (aggressiveness of the cancer cells) and stage (extent of involvement of your bladder with tumor).

While under anesthesia, a physical examination (called an EUA – examination under anesthesia) is done to assess the can­cer in the bladder. This provides the surgeon with clues as to his or her ability to successfully remove the cancer at the time of definitive surgical treatment of your bladder cancer. Blood is also taken to assess your overall health and physiological preparedness for surgery. Additionally, con­sultations with the anesthesiologist, your primary care phy­sician, a cardiologist, or other medical professional may be required. They will request any additional tests they believe are appropriate to ensure your preparedness for, and safely during, surgery.

The first person you will meet with a new diagnosis of blad­der cancer is your urologic oncologist. When you call to make the appointment, you will be asked whether or not a surgeon (usually a urologist) has already performed a biopsy to confirm that you indeed have bladder cancer. If they have, you will be asked to bring with you (or have sent to the urologic oncologist’s office) the glass slides of the actual pathological material taken at the time of the biopsy for review by another pathologist. You will also be asked for the written report of the original pathologist’s interpreta­tion of your biopsy material, all images taken in evaluation of your bladder cancer (either on CD or printed film) along with the written report of then interpretation, and any sur­gical operative notes from procedures performed by sur­geons seen in the initial evaluation and diagnosis of your bladder cancer.

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Be sure to obtain the address and clear directions, if neces­sary, of specifically where you are to go and what time you are to be at your initial appointment. If you haven’t been to the facility before, allow yourself extra drive time to find it, find parking, and get to the location where the doctor will be. Being late only frustrates and distracts you from your ultimate goal of determining the treatment to help you arrive at your desired outcome. Bring the information requested above to ensure that your visit is as productive and efficient as possible for you and the doctor who will be seeing you. Often, the urologic oncologist or his or her of­fice may have requested that the pathology slides be sent in advance with the goal that his or her urological pathologist can look at them before your arrival and render an opinion about the accuracy of the information provided in the typed report that you will bring from the outside evaluation.

It is also helpful to know in advance if your insurance company requires you to get preauthorization for having additional tests done, such as a CT or MRI. There are situations in which the urologic oncologist, once he or she has reviewed the films, may find them inadequate. If this occurs, he or she may want to get additional imaging done while you are there for this visit. It is also likely the urologic oncolo­gist will want you to leave your imaging studies with them to be reviewed by a radiologist. The imaging studies per­formed on your behalf are your property, but your urologic oncologist may need to retain them for use during your surgical care. Once the surgery and associated care for your bladder cancer is completed, the imaging studies can be returned.

It is helpful if you bring a trusted family member or friend with you. When stressed, we often only hear and retain some of the information that is discussed. You may feel overwhelmed, and the urologic oncologist will have a lot to explain to you. Trying to keep it all straight in your mind can be difficult. Bringing someone with you is helpful in that respect, and they may help you to feel a little more comfortable.

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Surgery plays an important role in both the staging and subsequent treatment of bladder cancer. Transurethral resection of a bladder tumor (TURBT) is the initial treat­ment step in the vast majority of patients with bladder cancer. TURBT provides valuable staging information, and pathological results from these procedures are used to make further decisions regarding what, if any, addi­tional therapy is needed. The gold standard treatment for muscle-invasive bladder cancer is radical cystectomy (removal of the bladder). Advances in surgical technique and anesthesia have reduced the complications associated with this procedure in the last two decades. The develop­ment of continent urinary diversion, which allows one to empty the bladder through the urethra, is an option for certain patients.

Minimally invasive procedures such as laparoscopic or robotic-assisted radical cystectomy may also be treatment options. In addition, bladder-sparing procedures (either with partial removal of the bladder or aggressive TURBT frequently in combination with che­motherapy and/or radiation therapy) have allowed some patients to treat their cancer while leaving their blad­ders intact. Advances in surgical techniques continue to this day with the development of minimally invasive approaches to cystectomy. Both robotic-assisted and lapa­roscopic radical cystectomy have been performed safely in highly specialized centers and have the potential for decreased morbidity and a shorter period of recovery, but longer term follow-up is needed to determine if these pro­cedures are equivalent to open surgical techniques.

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Actos Lawsuit : A continent urinary reservoir can be recon­structed using small or large bowel. Unlike noncontinent diversions, larger segments (up to 60 cm [2 feet]) of bowel are configured into a pouch that can store urine. There are two main types of continent diversions: orthotopic and continent-cutaneous. An orthotopic continent diversion is one in which the newly reconstructed pouch is reconnected back to your urethra and voiding occurs in much the same manner as before cystectomy. Continent-cutaneous diversions use a small channel made of bowel that is brought up through the skin on the abdominal wall. Un­like the noncontinent diversions, this type of diversion does not constandy drain urine but instead collects it in the pouch. Several times a day a catheter is passed through this channel in the sldn to empty the urine from the reservoir. Although these diversions allow for urinary continence, which most replicates normal function, they are associated with increased complication rates and require much more effort to maintain compared to the ileal conduit. Addition­ally, multiple studies have not shown that quality of life is significantly improved with continent diversion compared to noncontinent diversion.

Sexual dysfunction after pelvic surgery can have a major impact on quality of life for both men and women. In recent years radical cystectomy with the aim of preserving sexual function has been explored in both men and women. Patients with evidence of cancer invading through the blad­der wall either on preoperative imaging or at the time of surgery are not ideal candidates for this type of procedure. In men this entails sparing of die nerves involved with potency that run along and underneath the prostate. In doing so, sexual potency may be preserved in a significant percentage of men. More recently, some surgeons have explored the possibility of preserving a portion of the pros­tate or seminal vesicles, which are traditionally removed at the time of surgery. Preservation of these structures also decreases the risk of erectile dysfunction after surgery by not damaging the nerves that run in close proximity to diem. Preservation of a portion of the prostate at the time of surgery also may improve continence in men undergoing an orthotopic bladder reconstruction.

Although nerve spar­ing can be performed with little risk of decreased cancer control in appropriately selected patients, prostate- and seminal vesicle-sparing surgery are more controversial because there is potential for an increased risk of cancer recurrence and also die potential for leaving undiagnosed prostate cancer behind. In women, sexual function pre­serving radical cystectomy has also been explored. This involves preservation of the nerves important in both clitoral engorgement and sensation. Preserving organs traditionally removed at the time of surgery, including the uterus, fallopian tube, ovaries, and portion of vagina, may also allow for improved sexual function after surgery. It should be remembered that die first goal of surgery is cancer control, and organ- and nerve-sparing procedures may not be appropriate in all cases.

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Radical cystectomy is one of the biggest and most complex procedures performed by urologists. In addition to its complexity from a technical standpoint, you will likely have many questions not only related to cancer control but also to quality of life after surgery. Cystectomy can affect your quality of life from both an emotional and physical standpoint. After surgery, you may face specific physical adjustments to die urinary diversion, possible changes in sexual function, and changes in bowel habits and function. Specific side effects and complications related to cystectomy and urinary diversion are discussed in Chapter 4. An essential aspect to enhanced quality of life after surgery is to be proactive in the decision-making process before surgery. Ask your surgeon many questions before surgery, because knowing what to expect after surgery will ease this transition. A cancer diagnosis is a difficult time for anyone, and thoughts and questions will race through your head faster than you can remember them. Write them down as you think of them, so you can have a complete discussion at the time of consultation with your physician.

As stated previously this is a big surgery, and your surgeon may have you see other specialists before your procedure to ensure you are in the best medical condition to undergo surgery. You may be admitted to the hospital the day before your scheduled surgery for any remaining tests and to prepare your bowel for surgery. In the last decade, however, medicine has become increasingly more out­patient based, and many surgeons have eliminated the preoperative admission and have you report to the hospital the morning of surgery. Your surgeon will most likely have you only consume clear liquid on the day before surgery to clear out your GI tract, which allows for a technically easier urinary diversion and may also decrease your risk of complications. Along this same line, most surgeons will have you do some form of bowel preparation the day or two leading up to surgery. This is also used to cleanse your GI tract before surgery.

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Immediately after surgery you will generally stay in the hospital 5-10 days. Postoperative practice varies from surgeon to surgeon, but most leave a small drain in the abdomen to monitor for leakage of urine from the newly created diversion and intestinal contents from the recon­nected bowel. If there is no evidence of an internal leak, the drain routinely is removed at the bedside (with minimal dis­comfort) before discharge from the hospital. Your surgeon may also leave a nasogastric tube in for the first day or so after surgery. This is a tube that goes from your nose to your stomach and keeps your stomach decompressed, which prevents abdominal bloating and vomiting.

Generally, starting on the day after surgery you will be out of bed and with assistance from the hospital staff will start walking. It is very important to begin walking as soon as possible because it will make you feel better, will help with early return ofbowel function, and will decreasethe chances of developing blood clots in your legs and pelvic veins. You will also be instructed on breathing exercises while in bed and sitting to help expand your lungs after surgery and to prevent pneumonia. One of the major obstacles before discharge is return ofbowel function and resumption of a regular diet. Your GI tract can be slow to return to normal function, largely related to the bowel work required for the urinary diversion. This will take time, and it is important to not force your diet too soon after surgery because this will increase your chances of nausea and vomiting. In general, your body will tell you when you are ready to eat.

Use your time in the hospital to learn as much as you can about your urinary diversion. Most centers in which cystec­tomies are performed have an enterostomal therapist with expertise in taking care of patients with urinary diversions. If you have a new ileal conduit, they will go over the general maintenance of the abdominal stoma and urinary appliance bags. This will make you more comfortable and confident in dealing with your diversion at the time of discharge from the hospital. Upon discharge from the hospital, your sur­geon will give you precise instructions regarding physical activity, exercise, and resumption of sexual intercourse. It is important to follow these instructions carefully to ensure a smooth postoperative recovery.

Our use of the term or terms Actos Lawsuit is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Lawsuit : A diagnosis of bladder cancer is overwhelming. You may ask yourself “Why me? What now?” In our practice we find that understanding the disease, your prognosis, the plan of therapy, and the details of what your care will mean are reassuring to you and your family. By learning about your problem, you can take control of it rather than it having control over you. For this reason it is critical to have a family member, a loved one, a com­panion, or a friend accompany you on the road to learning about this disease. Like any complicated problem, there is much to learn about bladder cancer, and having more than one head working on the problem makes the whole pro­cess easier for you. You will have to decide who from your circle of family and friends is best suited to make this jour­ney with you. Having the support of a loved one through

these troubled times is very important. You may not want to tell everyone about your disease until you are better able to come to grips with it. This will be a very emotional time for you, and you may feel you are on a roller coaster with your feelings. One day you will be fine, the next you may feel depressed. All of these feelings are normal, and keep­ing a positive attitude will help you endure the days ahead.

To come to terms with this disease, you will have to become a student again to some degree. We are surrounded by readily available information, but there are still enormous amounts of information out there to try to understand and comprehend. We often meet patients who have consulted the Internet and believe they are well prepared before their consultation. More often than not, these enthusiastic learn­ers are frustrated by the complexity of information they have discovered and the difficult time they are having in making sense of their particular situation. Therefore before trying to do this research on your own, it is wise to first start with a frank discussion with your treating physician, the person who discovered your cancer: your urologist.

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As a cancer patient, you may feel like a politician running for reelection. You may experience interest and concern (some welcome, some not) from many, and you will develop a personal strategy and style for dealing with three particular constituencies who are supporting your efforts in diverse ways: your advisors or professional healthcare providers; people who love you but may not depend on you, such as your friends and colleagues; and people who love and depend on you in some way, either practical or emotional, like your spouse or significant other, parents, and children. Let’s talk about communication with health­care professionals first.

Doctors, nurses, and other caregivers you encounter are just people too. Your relationship with the members of your team will mirror, in many ways, relationships you have in other parts of your life. Bring your natural courtesy and friendliness to the relationship and you are likely to get the same in return. Medicine is a service profession, and you should expect good service from your team members. However, unlike a restaurant or department store, a medical office may be forced to attend to the needs of customers who were behind you in line first if their problems require immediate attention. So, please bring your patience with you as well.

When speaking with your doctor and other team members, be as clear as you can be when it comes to how much you really wantto know. Some patients want every detail, whereas others hardly want any information. Your cancer should not seem like an obligation to go to graduate school, but you should feel infonned to your satisfaction. The amount of information is very personal, and you should make it known how much you really want to know.

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Partner with your caregivers wheneveryou can. Ifsomething does not make sense to you, there is a reasonable chance that it does not make sense at all. Much of medicine is vocabulary, and learning the words that your team uses to communicate with each other will help you communicate with them as well. Does your doctor remember that you are allergic to penicillin? That you have a knee replacement? That you require antibiotics for a heart murmur before a procedure? Sure, but most professionals will be pleased if you help them remember these special details about you drat affect your care.

Bring someone with you when you go for your consultations with your urologist. Two sets of ears hear more than one. Ask if you can bring a tape recorder and record the session so you can review it later at home. This also helps the concerned people in your life who could not accompany you understand the specific details of what your doctor is recommending. Make a list of questions to ask during the consultation. Print a copy for your doctor and present it to him or her at the beginning of the visit. This ensures that your questions are answered in a complete and unhurried fashion. Be sure that you ask questions as your care evolves. Ask if your doctor has other patients like yourself with whom you can discuss treatment and daily life. Talking to someone who has been where you are can be very helpful.

Talking to your boss, coworker, and friends is tricky and very personal. There is no rule on how to handle this part of your life. In most cases, you will want to let people at work know your diagnosis if it will significantly impact on your job. Most workplaces have clear-cut rules about this; in addition, make sure you are aware of the details regarding the Family Medical Leave Act so you and your family members can take advantage of this when appropriate. Hospitals have social workers to help you if assistance is needed. What you discuss with your healthcare team is private and protected by HIPPA (the Health Information Privacy and Portability Act). If you would like information shared with family or others in your circle, you must officially notify your doctor in writing. Most offices have a simple form you can fill out to facilitate this process.

Our use of the term or terms Actos Lawsuit is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

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Actos Lawsuit : If you should have a recurrence of superficial urothelial cancer, there is a greater than 50 percent chance that it will happen in the first year after treatment. And there is up to a 30 percent chance that a recurrence will have progressed to a higher, more invasive, stage of the disease.

The stage, grade, and type of your cancer will strongly influence treatment options. (These will be discussed in the next two chapters.) They also are clues to whether your cancer might be aggressive, whether you might have a relapse or recurrence after treatment, and how hopeful the outlook is for a cure.

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If your doctor tells you that you have bladder cancer, what you talk about next depends upon the answers to two questions:

What kind of bladder cancer do I have?

Expect your doctor to tell you whether your cancer is urothelial or transitional cell cancer, squamous cell, adenocarcinoma, or a rarer form of cancer, and to give you a general explanation of how the type of cancer you have generally behaves, including whether your type of cancer often recurs, metastasizes, or is considered highly treatable.

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What stage and grade is my tumor, and what does that mean?

Your doctor is likely to categorize your cancer with a letter, numeral, and stage-—-perhaps something like “T2aNlM0 Stage I”-—and will explain what those symbols mean by describing how deeply the cancer has invaded your body, how abnormal the tumor cells are, and whether the cancer has spread.

When you are comfortable with the answers to your questions, you will be ready to talk about treatment options and your treatment team. You 11 want to know who will be on it, what part each team member will play in your care, and who will serve as your contact point for questions or concerns.

Our use of the term or terms Actos Lawsuit is for descriptive purposes only.  There is no relationship between the owners of this website and the maker of the product discussed in this post.  Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred.  Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls.  If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

To keep up to date on Actos Lawsuit visit our site often.

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Actos Lawsuit : To Help You Talk about Cancer

• The National Cancer Institute offers articles such as “What It’s Like for You” and “Taking Time: Support for People with Cancer” at its website (www.cancer.gov). You can also call 800-422-6237 (800-4-CANCER) to find out about available publications and brochures,

♦ The American Cancer Society offers a number of articles on coping with cancer, including “Helping Children When a Family Member Has Cancer” and “Talking with Children about Cancer” at www.cancer.org. You can also call 800227-2345 (800-ACS-2345) for information on ordering.

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• The Cancer Survivors Network is a forum or message board at the American Cancer Society website (www.cancer.org) where people can ask questions and share information and. resources with other people who are dealing with cancer.
• Your hospital’s social work department will have counseling and resources available for you and your family. Just ask your doctor to put you in touch with the appropriate office.

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• When possible, couch discussions in hopeful and reassuring words by telling your loved ones that you feel positive about your treatment.
• When talking about cancer with children, keep information age-appropriate. The National Cancer Institute offers a guide called Tips for Talking with Children of Different Ages, which you can obtain at www. cancer, gov.
• With your family members, agree to give each other permission to feel stressed or worried or angry—or even happy—without feeling guilty.
• Acknowledge that there may be tough times ahead, but recognize that caring and love will help get you through them.
• Acknowledge that things will change. Talk about changes as they occur.
• Talk often with family and loved ones. Speak from your heart.
• Expect lots of questions. Expect some disagreements. Expect times when you wish that things could go back to the way they were before you had cancer. And expect deeply meaningful moments with the people you love most.

Our use of the term or terms Actos Lawsuit is for descriptive purposes only. There is no relationship between the owners of this website and the maker of the product discussed in this post. Our use of the words Recall, Class Action Lawsuit and other similar words related to an event do not necessarily mean that this event has occurred. Refer to the website of the United States Food and Drug Administration for information on drug or medical device recalls. If a Class Action Lawsuit is formed in relation to the product discussed in this post we will provide that information at the time the Class Action is formed. A Class Action Lawsuit is not required to exist for you to file a lawsuit if you have been injured by the product discussed in this post.

To keep up to date on Actos Lawsuit visit our site often.

http://www.seedol.com