Actos Litigation: External pouches are designed to lie flat against your body and can be discreetly worn under most clothing (even body-shaping underwear for women or athletic supporters for men). Pouches are available in different sizes and with waterproof or protective coverings. Internal reservoirs are even easier to conceal. You are probably still not convinced that you can look and feel as feminine or masculine as you did without a pouch or reservoir. Your team will make a recommendation about treat­ment after carefully evaluating important factors such as the extent of invasion by tumor cells (the stage), the normal or disorganized/abnormal appearance of the cancer cells under the microscope (grade), whether the cancer cells have invaded lymphatic channels or blood vessels, whether can­cer cells are growing within the lymph nodes, and whether a specific cell control gene called P53 is normal.

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If your cancer is organ-confined (i.e., if the cancer cells have not spread beyond the boundaries of the bladder and its immediate surrounding tissues), if it has not penetrated beyond the first layers of surrounding muscle, if there is no lymphatic or vascular invasion, and if lymph nodes are nega­tive (they contain no cancer cells), the chance of permanent cure by cystectomy alone is about 80 percent.

If, on the other hand, your cancer has penetrated deeply into muscle or has a very poor level of cellular organiza­tion (high grade), perhaps if the P53 gene has mutated, or if invasion of lymphatic tissues or blood vessels (lympho- vascular invasion) is present, the chance of permanent cure may be much lower. If things go badly after cystectomy, the problem is usually that cancer cells show themselves in other parts of the body (metastases)—a very dangerous situation. Over the past half century, doctors have tried many approaches to improve the outcome for patients, including the use of radiotherapy or the combination of radiotherapy and cystectomy. But neither of these approaches appears to have provided the solution. A more proactive approach was devised in the 1970s, when it became clear that cancer- killing drugs (chemotherapy) sometimes shrink bladder can­cer that has spread through the body, and sometimes can completely eliminate deposits of cancer in different parts of the body. In the past 25 years, studies have looked at the impact of combining chemotherapy with cystectomy or with radiotherapy in an attempt to improve survival figures. Before that discussion, let’s talk a bit about chemotherapy.

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Chemotherapy refers to the use of drugs to kill cancer cells. Chemotherapy is usually given by intravenous injection (injection by needle directly into the vein), but sometimes it can be administered as a tablet or even through a urinary catheter (intravesical) for a patient with superficial bladder cancer (see chapter 4). There are many different types of chemotherapy, and a detailed discussion is beyond the scope of this book. Your medical team will talk with you about what type of chemotherapy is best for you and why.

In brief, chemotherapy drugs mostly act to interfere with the ability of cancer cells to divide and multiply, often by inhibiting the function of enzymes within the cells or by blocking cell division and the formation of RNA and DNA, the substances of life. Because these drugs act on cells that are dividing and multiplying, they can also affect some nor­mal tissues and, therefore, can cause a range of side effects. Common side effects may include nausea and/or vomiting, hair loss, suppression of the bone marrow (bone marrow forms the blood; its suppression may cause increased risk of fatigue, infection, or bleeding), and occasionally specific reactions to individual drugs (such as allergic reactions and lung inflammation).

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Actos Litigation:  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. If you are able to have an erection after surgery you won’t be able to ejaculate, because without a prostate, your body is no longer able to produce semen. You will find that the physical sensation of orgasm is different from what you are accustomed to. It’s not unpleasant; just different. In general, the younger you are at the time of surgery, the more likely you will be to have erections or to regain over time the capa­bility of having them. There are surgical procedures, such as penile inserts, that can help make sexual activity possible.

For women, a cystectomy includes the removal of the uterus and part of the vaginal wall. What does that mean for you? Well, for one thing, your vagina may be narrower as a result of the surgery. Usually it is possible to continue to have intercourse, although sometimes there can be some pain involved. Be sure to talk to your doctor if you do expe­rience pain, as there are methods of reducing this.

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Most women diagnosed with bladder cancer already have experienced menopause. For younger women, that may not be the case. (Typically, women who receive diagno­ses of bladder cancer are older.) The removal of the uterus and possibly of other female organs near the bladder brings an abrupt end to the childbearing years. It may also set off typical menopausal symptoms such as hot flashes or mood swings if the ovaries have been removed at surgery (removal of ovaries is unusual). If you find yourself feeling depressed or blue or uncomfortable from hot flashes, talk to your doc­tor. You don’t have to feel that way; there are options avail­able for you to consider.

As is recommended for men, talking with your partner and your medical team about the physical and emotional changes that you may experience after a cystectomy is an important part of the process, one that deserves as much consideration as the more immediate decisions about which treatment options you want to pursue.

Keep in mind that cystectomy is a life-preserving weapon against invasive cancer. That doesn’t mean you cant or shouldn’t consider the possibility of impotence or altered sexual function with your partner, or the inability to carry a child. It does offer the hope that you can celebrate many more years of healthy, loving life with your friends and fam­ily. That’s an important thing to remember at a time when life may seem to be serving you big helpings of despair.

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Sometimes an internal bladder connected to the urethra (the tube that carries urine to the outside of the body) isn’t possible and you will instead be fitted with a continent urinary diversion system. This means that you will have a pouch or reservoir, either external or more commonly inter­nal, that collects your urine, and you will have to empty the pouch. This is also known as an ostomy or ileal conduit system.

Your doctor, may, however, recommend an external pouch that is situated outside your body and attaches to your abdomen through a stoma. You must manually empty the external pouch and cleanse the stoma. Either alternative sounds unpleasant, but having a pouch (particularly an internal reservoir) wont interfere with your life or self-image as much as you might expect, if at all. You can still snorkel and swim. You can dance in a clingy, swingy dress or bike in Spandex shorts. You can do your job, whether it’s manning a drill press or managing a Fortune 500 company. And you can still look and feel sexy and enjoy a satisfying intimate relationship with your partner.

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Actos Litigation:  Years ago, doctors held off prescribing drugs for pain until the pain was unrelenting. Those days are long gone, and doctors today subscribe to the theory that no ones life should be interrupted by severe pain of any sort. With all the options available for pain management today, most of them nonintrusive and without significant side effects, there is no reason for anyone to endure even minimal pain.

A medical team is likely to suggest hospice care when there are no drugs or therapies left that are likely to cure a patients disease or significantly prolong his or her life and when emotional or spiritual comfort and care are needed. Most doctors recommend that patients begin thinking about hos­pice when an end-of-life diagnosis has been made, so that they can begin discussing and making decisions about their care and wishes.

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Hospice offers an interdisciplinary approach that extend past medical services to embrace and coordinate professional services from many disciplines. A hospice team typically includes a patients personal doctor, a hospice physician, nurses, home health aides, social workers, clergy, counselors, other therapists as needed, and a core of trained volunteers. The hospice team coordinates all aspects of a patients care: medical needs, medications, pain, help at home, bereavement counseling, help in a hospital or nursing- home setting, and support for emotional, psychosocial, and spiritual aspects of dying. The hospice team also supports a patient’s family and loved ones.

Anyone can call a hospice provider and ask for help, although in most cases, a referral is made by a doctor. In either case, a physician must certify eligibility for hospice services. Eli­gibility generally means that a patient has been diagnosed with a terminal illness or condition with a life expectancy measured in months rather than years.

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Choosing hospice does not mean giving up hope. It does mean choosing a strategy to maximize quality of life while stabilizing a patients medical condition and getting practi­cal help in planning a comfortable, supported, and pain-free end of life. Sometimes facing the prospect of death over­powers the remaining gifts that life has to offer. Hospice eases some of the burdens—financial, medical, and emo­tional and offers opportunities to savor each sunrise, each crisp apple or juicy peach, each hug from a friend or loved one, and the gifts of laughter and love and memories.

Medicare and most private insurance companies pay for hospice expenses. Most hospices are certified by Medicare, and most people who use hospice are over 65, the age of gen­eral eligibility for Medicare. The Medicare Hospice Benefit, available to people with Part A Medicare, pays for virtually every cost associated with hospice care, from medications to counseling services.

One type of advance directive is a living will, a legal docu­ment that describes what kind of life-sustaining medical treat­ments you want, if any. A second document, a durablepowei of health care (sometimes called a health care proxy or a medical power of attorney), lets you identify the person you want to make health-care decisions for you, if necessary. A Do Not Resuscitate (DNR) document instructs medical professionals not to perform cardiopulmonary resuscitation (CPR) or other life-saving efforts if you stop breathing or your heart stops. These documents are legal in most states, and your doctor’s office or hospice team can tell you where to get forms.

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Actos Litigation: End-of-life decisions are difficult, painful, and heart­breaking. They raise issues we don’t want to face, either for ourselves or with someone we love. Yet at times, despite aggressive and thorough care, there are no further drugs or therapies or surgeries or clinical trials with curative possibilities, and the only option a patients medical team has to recommend is hospice care. The goal of hospice care is not to cure disease; its goal is to provide palliative care—comfort, pain relief, and sup­port for those facing end-of-life choices. Hospice care addresses quality of life. It involves a team approach similar to the medical team model. Hospice providers offer pallia­tive care specific to people facing an end-of-life diagnosis and their families.

Hospice care does not mean that a patient wont take any more medications or that there may not be some continuing therapies to help with symptoms and quality of life. In the case of advanced bladder cancer, it means that a patients medical team has determined that further medical strategies are not likely to cure his or her bladder cancer and are not likely to prolong life. Death is the likely outcome, and the emphasis of treatment will change to focus on control of symptoms.

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Palliative care is a broad term that describes a supportive approach to treating anyone dealing with a serious or life- threatening illness. Someone who has AIDS, for example, may benefit from palliative care. Palliative care focuses not on curing a patients medical situation, but on providing comfort and relief from suffering during or after treatment. Most hospitals have a palliative care team that is separate from hospice. The palliative care team helps with symptom control for patients who are receiving treatment and may recover from the cancer.

Hospice is a specific, defined type of compassionate palli­ative care offered to patients facing an end-of-life diagnosis. There are private hospice organizations, both for-profit and nonprofit; in some cases, hospitals have an in-house hospice team. Hospice care can be administered at a patients home or in a medical setting such as a hospital or nursing home.

For example, a tender, aching pain in the upper back or shoulder may indicate that cancer has moved into the chest cavity or bones. A patient might feel a squeezing cramp in the abdomen or a shooting pain that feels like an electrical current. It is important to remember that the presence of a new pain doesn’t necessarily mean that cancer is active at that site, as pain can be caused by many other factors, such as infection or inflammation. Each type of pain tells doctors something different and requires a different combination of drugs and therapies to help minimize discomfort while managing the progression of the disease.

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There may be circumstances when narcotic drugs such as morphine are the best option for pain relief. But usu­ally doctors can combine non-narcotic anti-inflammatory or nonsteroidal anti-inflammatory drugs (such as ibupro­fen) that will do the trick, leaving patients alert and able to participare in some of the things they love to do, whether sewing or baking apple pie or even golfing. There can be side effects from these drugs, such as nausea, shortness of breath, or itching, athough most are either temporary or can be controlled with other drugs.

Thats not to say that a patients days will be a constant íound of taking pills and more pills. Some medications are easily absorbed through the skin from a patch or a supposi­tory. Other medications can be injected at regular inter­vals or even dispensed through a pump (usually implanted under the skin). Additionally, not all pain relief relies on drugs. Radia­tion therapy can relieve some types of bone pain, and doc­tors can surgically block a nerves pathway, interrupting the transmission of pain signals to the brain. Acupuncture or electronic nerve stimulation are still other ways of manag­ing pain.

Our use of the term or terms Actos Litigation 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 Litigation:  Does referral to a clinical trial mean that there is no hope of your surviving this illness? Not at all! There is always hope of survival, and any doctor can tell you about people who have responded positively to treatment and not only sur­vived, but thrived. Participating in a clinical trial doesn’t mean that you wont continue to receive medical treatment; you will, and since the trial is a voluntary process, you have the right to stop participating in the trial at any time. As with any aspect of your treatment plan, you’ make the decision about whether to proceed. Don’t feel pressured to participate in a trial if it doesn’t feel right for you, but do give it objective thought and consideration.

As with any treatment, you should ask about possible risks, benefits, and side effects, how the treatment works, and what results doctors expect from the study. You will want to know who is conducting the clinical trial and what kind of oversight is in place. Also ask what is expected of you. Where will you go for the treatments? How often will you go? Are there more tests or office visits than you might have with standard treatment? Who administers the treat­ments and how are the results measured? Do you have to report regularly to the people who are conducting the trial? Who pays for it all? Will there be extra costs to you as a result of your participation? Will the team conducting the trial (or the doctors involved) stand to benefit personally from the results of the trial or its conduct?

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There are many kinds of clinical trials. Some test preven­tion, such as whether vitamin C prevents colds. Some test whether particular screening tests, such as mammograms for breast cancer, are effective. The clinical trials your team is likely to mention are treatment trials, whereby a new drug, a new treatment, or even a new way of applying a standard treatment will be examined and tested. Each treatment trial will have a very detailed and spe­cific plan called a protocol. Think of a protocol as a recipe or instructions that describe what will be done in the trial, why the trial is necessary, who is eligible to participate, and how it will be conducted. Any doctor or researcher who takes part in die trial uses the trial’s protocol to ensure consistent results and to make sure that the new drug or treatment is given properly and with maximum safety.

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Within treatment trials, there are four categories, or phases. You should ask the members of your medical team which phase of clinical trial they are recommending to you and find out specific details about the trial, such as the num­ber of people involved, where the testing is being done, what benefits or drawbacks are expected for you personally, and how long the trial is expected to last.

Phase I trials study how to administer a new drug or treat­ment and how much of the drug or treatment can be safely tolerated. The drugs or treatment in a phase I trial have been extensively tested in a lab and in animal studies, but not in humans. If a drug is being rested, researchers may start by giving a very low dose of the drug to those participating in the trial, then increase it gradually to derermine when side effects appear and what dosage is tolerable, yet effec­tive. Phase I trials usually enroll a small number of people at a limited number of locations. In general, they are the least likely to be of direct personal benefit to a patient, as the drugs are less well known, but occasionally they can lead to significant tumor shrinkage with side effects well within the tolerable range.

Phase II trials take the studies a step farther. From the phase I results, researchers know what dosage to give with a good margin of safety; in phase II they are ready to test whether the drug really works as well as anticipated. They carefully monitor patients in the study for side effects and observe closely how the drug affects the cancer. A phase II study usually targets a particular disease or type of cancer and includes fewer than 100 people.

Our use of the term or terms Actos Litigation 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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