Usually, when something takes your breath away you feel shortness of breath, it’s a good thing. But what if even basic tasks like walking a block or climbing a flight of stairs leaves you huffing and puffing?
If you’re finding yourself feeling short of breath all the time, your body might be giving you a warning sign that something needs a physician’s attention.
Dr. Jason Fritz, pulmonologist at Penn Medicine, often sees patients who are living with shortness of breath. If you have concerns about shortness of breath and aren’t quite sure where to start, Dr. Fritz shares several insights to help you breathe a little easier.
Q: What condition are patients in when they first come to you?
Dr. Fritz: It spans a wide spectrum, depending on the severity of the shortness of breath. If it’s significant, it can impact day-to-day functioning and quality of life. It’s not uncommon for people to say that even climbing one flight of stairs or simply walking one block causes difficulty breathing.
Q: What causes shortness of breath?
Dr. Fritz: Shortness of breath is a symptom of an underlying problem or problems, not a disease of its own. There is a whole spectrum of things that can cause people to be short of breath, but it frequently stems from a problem that’s pulmonary (related to the lungs) or cardiovascular (related to the heart).
Sudden onset of shortness of breath may indicate something quite serious requiring immediate medical attention, such as a heart attack, a blood clot in the lungs or a problem with the aorta.
Q: For shortness of breath that doesn’t come on suddenly, what are some of the underlying problems that cause it?
Dr. Fritz: From a pulmonary standpoint, it can be caused by disorders that affect the air passages, like asthma or chronic obstructive pulmonary disease (COPD). Less common pulmonary causes of shortness of breath include various types of pulmonary fibrosis or pulmonary hypertension.
Being overweight can contribute to a sense of difficult breathing, as can certain neuromuscular conditions or having a low blood count (anemia).
From a cardiovascular standpoint, it’s common to see people short of breath if they’re experiencing heart failure. It commonly exists in conjunction with diabetes, high blood pressure, or atrial fibrillation. Leaky or stenotic (too narrow) heart valves can similarly cause shortness of breath.
It is also possible that someone could have more than one diagnosis accounting for breathing trouble.
Q: Which gender and age group come in for evaluation most often?
Dr. Fritz: It’s a pretty even split between genders; however, we are seeing more and more elderly folks coming in with breathing complaints. It can be more challenging to diagnose what’s causing shortness of breath in older people because they can have multiple medical problems that could contribute to breathing difficulty.
In the elderly population, a form of heart failure called diastolic dysfunction (a problem with relaxation of the heart muscle) is an increasingly recognized cause of shortness of breath.
Q: What’s the worst-case scenario in someone with shortness of breath?
Dr. Fritz: Again, it comes back to the underlying cause. When it comes to shortness of breath, we really need to figure out what condition is causing it. There isn’t a “shortness of breath pill,” so the treatment is really directed at the underlying cause, making accurate diagnosis crucial.
The worst-case scenario would be not finding the cause and missing the opportunity to intervene on a treatable condition. In severe cases, not treating the underlying cause can be fatal. However, with our current diagnostic tools, we have a very reasonable chance of diagnosing and treating the problem.
Q: If people are experiencing shortness of breath, when should they see a physician?
Dr. Fritz: There are symptoms that patients need to pay attention to:
These are all indicators that something serious may be going on and that you should come in to see a physician. The abrupt onset of the above symptoms warrants immediate evaluation. The earlier you find something, the greater chance you have to do something before there is progressive or irreversible damage.
“If patients can think back and say, ‘I used to be able to do X, Y and Z — and now I can’t because of shortness of breath,’ that’s a good time to come in.”
Q: Do they need to see a specialist right away?
Dr. Fritz: If symptoms are not severe, primary care providers (PCPs) are usually equipped to do an initial evaluation, which may include some basic tests aimed at detecting heart or lung problems. They will be able to do a workup in the most efficient way possible and send patients to the correct specialist, if necessary.
Consultation with a pulmonologist or cardiologist and additional studies may be required based on the results of these initial tests, or if uncertainty remains regarding the diagnosis.
If you have been having problems with shortness of breath over a period of time, it might be time to see a provider.
NOTE : This article has been taken from pennmedicine.org as it is. Click here to read original article.
2007 was supposed to be an exciting time for my family. My wife and I were expecting our second daughter in September. That summer, however, I began to experience a chronic sinus issue. A minor surgery to remove a cyst in August resulted in a diagnosis of maxillary sinus cancer.
As luck would have it, I was able to make an appointment with Dr. Jason Newman at Pennsylvania Hospital (PAH) during one of my wife’s final checkups with her obstetrician. Dr. Newman sat with us and discussed the road ahead. It all sounded overwhelming but I felt reassured: I was where I needed to be.
The road began with my nine-hour surgery. Exactly one week later—with only six days of recovery—I returned to PAH, but this time as a visitor for the birth of my daughter, Taylor. Less than a month later, I began eight weeks of radiation and chemo. I was lucky to be on prolonged paternity leave: While treatment was difficult, this time with my newborn was the silver lining I needed.
As I started back to work in February—while doing our best to manage our newborn as well as a rambunctious three-year-old—I found myself back in the hospital, where they discovered another tumor, this time near my temple. This meant another nine-hour surgery with Dr. Newman and Dr. Liza Wu, where they removed my left fibula to help reconstruct my right jaw.
Because Penn was still in the process of constructing its Roberts Proton Center, my care team needed to refer me elsewhere. I was turned down by several other centers, but Penn didn’t give up and neither did I. Working tirelessly, they managed to get me referred to Massachusetts General Hospital (MGH) in Boston for proton therapy. While I would have preferred to stay in Philadelphia, due to the complexity and location of my tumor, I was relieved that MGH would take me.
This time in Boston offered yet another unlikely opportunity to make memories with my family. They came to stay with me for a few weeks. I cherish those memories and the distraction from my treatment. My wife and daughters have been my constant comfort during this entire experience.
Unfortunately, my cancer journey didn’t stop when my treatment ended in August 2008, not even close. I spent the next decade in and out of reconstructive surgeries, but Penn has been there with me the entire time. When they couldn’t treat me, they found me the best physician who could—even if it was at another institution. At Penn, you are never just a number. They make you feel as if you are their most important patient, and care for you as a whole person.
As a former swimmer, I have found recovery in athletics. Beginning in 2009, I began biking. Three 100-plus-mile “century rides” and countless other long treks later, I started competing in triathlons, runs, and open-water swims. I also became the coach of my older daughter Alexandra’s field hockey and lacrosse teams. After relocating our family to San Francisco for work, I competed in my last triathlon, which included a swim from Alcatraz!
Today, as we practice social distancing, I try to stay safely busy coaching lacrosse for my girls, working, and enjoying the natural beauty of Northern California as a family. I do miss all of the important people in the great city of Philadelphia: our friends, family, and my exceptional care team at Penn. I don’t know where I would be without them.
That is why I look forward to getting my family together this summer to be part of the virtual Breakthrough Bike Challenge to help support novel cancer research at Penn Medicine’s Abramson Cancer Center. I am so grateful for everything, and I want to do all I can to pay it forward to help other families, the way Penn helped me and mine.
NOTE : This article has been taken from pennmedicine.org as it is. Click here to read original article.
We understand that people who have, or have had cancer, have many questions about getting vaccinated, and we are here to help. Below are the answers to commonly asked questions about the COVID-19 vaccine and cancer. For more general information about the COVID-19 vaccine, please read our COVID-19 Vaccine FAQs page.
Yes, COVID-19 vaccines should be given to all cancer patients when they are eligible to receive the vaccine. Immunization is recommended for all patients receiving active therapy and cancer survivors, with the understanding that there are limited safety and efficacy data in these patients.
Studies have shown that cancer patients are at a high-risk for serious COVID-19 complications, which is why there is a clear need to vaccinate cancer patients. There is a possibility that your oncology care team may advise you to delay vaccination after receiving specific treatments.
Yes, vaccination is being done in several phases. The plan is to give the vaccine to frontline essential workers, older adults, and adults with certain high-risk medical conditions before giving the vaccine to everyone else. According to recommendations from the National Comprehensive Cancer Network, individuals with active cancer on treatment, those planning to start treatment, or those immediately post treatment will be prioritized for vaccination. Each state or local health department will have their own plans for who exactly to give the vaccine to and in what order – in many cases full details are not yet available. Please see individual state websites for the most up to date information. Penn Medicine Abramson Cancer Center is currently working on the first phase of administering COVID-19 vaccines to cancer patients.
Vaccinations are being done based on your place of residence, by state and county. Right now, in our downtown hospitals we can only vaccinate patients who live in Philadelphia. We have started with cancer patients, along with patients who have other high-risk medical conditions, and people 75 and over. Due to a very limited supply, Penn Medicine is contacting those patients who are at the highest risk first. When it is your turn, someone from Penn will reach out to you directly either through myPennMedicine or by phone. Your providers are not able to schedule vaccine appointments for patients.
We are awaiting guidance for the counties that surround Philadelphia and expect to be offering the vaccine at more of our locations soon. Information about the vaccine is constantly changing. We encourage you to register with your county’s health department website and regularly check Penn Medicine’s COVID-19 Vaccine website, which we are updating as we learn more. If you are a patient at Penn Medicine Chester County Hospital, Penn Medicine Lancaster General Health or Penn Medicine Princeton Health, please check their websites for more information.
If you are eligible and live in Philadelphia, you should receive an email or phone call from us in the coming weeks. We encourage you to sign up for a myPennMedicine account to make it easier to receive important messages from us and schedule your vaccine appointment when it is available.
No. You cannot get COVID-19 from the vaccine. None of the vaccines under development are “live” vaccines so it is not possible to get COVID-19 from the vaccine.
The two currently authorized vaccines under the FDA’s emergency use authorization (Pfizer and Moderna) contain messenger RNA. After injection, mRNA instructs human cells to make the spike protein of the virus, which is how the virus attaches to cells. Antibodies are generated against the spike protein, which block the virus from attaching to cells if you are exposed. Other parts of the immune system are also activated by the vaccine to provide protection against future COVID-19 infection.
Currently approved vaccines require 2 doses (3 weeks apart for the Pfizer vaccine and 4 weeks apart for the Moderna vaccine). Even after both doses have been given, mask wearing and social distancing is still recommended. The COVID-19 vaccines studies showed they were about 95% effective in preventing disease and helped protect people from becoming more severely ill or having complications if they did get COVID-19. It is important to understand that the 95% effectiveness is not achieved until at least 7 days after the 2nd dose of your COVID vaccine.
You may have some side effects, which are normal signs that your body is building protection against COVID-19. Commonly reported side effects after vaccination include: pain or swelling at the site of the injection, fevers, chills, tiredness, headache, and flu-like symptoms are possible. In some cases, these side effects may affect your ability to do daily activities, but they should go away in a few days. If these symptoms are lasting longer, please contact your oncology care team.
As a cancer patient, if you are on active therapy, it is very important that you contact your care team if you develop any fevers above 100.4F after your COVID-19 vaccination. When doing so, make your team aware that you were recently vaccinated. More information is available on the CDC website.
Yes. The CDC recommends getting the vaccine even if you have already had COVID-19, because the vaccine may help protect you from getting COVID-19 again. However, you should wait 90-days after infection before getting the vaccine.
Rare cases of severe allergic reactions have been reported with both currently available vaccines. If you have had a severe allergy to one of the ingredients in the vaccine, you should not get it (ingredients are listed online). The Pfizer and Moderna vaccines do not include any antibiotics or egg proteins.
If you have ever had a severe allergic reaction to other vaccines or injectable therapies, you should talk to your doctor about whether you should get the vaccine. If you have had other severe allergic reactions, such as allergies to food, pets, venom, environmental exposures, or latex, the CDC recommends that you still get the vaccine. If you have had previous severe allergic reactions, you should be monitored for 30 minutes after getting the vaccine instead of the normal 15 minutes. If you have an Epi-Pen or other medication you use for allergic reactions you should bring it when you get your vaccine, although treatments should also be available at the vaccine location. If you have a severe allergic reaction after getting the first shot, you should not get the second shot. Your doctor may refer you to a specialist in allergies and immunology to provide more care or advice.
No. At this time there is no evidence to suggest stopping a medication will make the vaccine work better. Stopping medications could negatively affect your health in other ways. Some medications may influence how well the COVID-19 vaccine works, but most people on active treatment are still expected to have a good response to the vaccine. Talk with your oncologist to discuss the risks and benefits of vaccination, as in some cases it may be recommended to delay vaccination or treatment.
We recommend getting the vaccine no matter which medications you are taking. It is possible that certain medications could affect how well the vaccine works, but most medicines will probably have very little effect on vaccine efficacy. We expect that most people will still benefit from the vaccine. Some medicines may have a bigger effect, but even people on these treatments can still benefit from the vaccine. Mask wearing and social distancing are still recommended for everyone after receiving the vaccine.
Pregnancy is not a contraindication to receiving the vaccine, but pregnant women were not studied in the vaccine trials, so there is no information about the use of the vaccine among this group of people. If you are currently pregnant, it is recommended that you discuss the vaccine with your care provider first. If you are breastfeeding, you can still have the vaccine. You do not need to stop breastfeeding. You should discuss all these options with your healthcare provider if you wish to receive the vaccine.
It is important to remember that everyone needs to continue to follow the national and state guidelines on mask-wearing, social distancing, and other measures to keep you and everyone around you safe. If you have any additional questions, please contact your oncologist.
NOTE : This article has been taken from pennmedicine.org as it is. Click here to read original article.
Some medical conditions have the potential to change your life, and once diagnosed, you’ll naturally want to learn as much as possible about them.
Polycystic ovary syndrome (PCOS) is a perfect example. Women with PCOS have a hormonal imbalance and metabolism problems that may affect their health. The condition is common among women of reproductive age and can include symptoms such as an irregular menstrual cycle, acne, thinning hair and weight gain.
Here we will dispel five myths about PCOS.
While the exact cause of PCOS is unknown, one thing is certain: You are not to blame.
However, several factors — including genetics — are widely believed to play a role.
Androgens, or male hormones, control the development of male traits. “While all women produce small amounts of androgens, those with PCOS have more androgens than normal, which can prevent ovulation and make it difficult to have regular menstrual cycles,” explained Justin Sloane, MD, physician at Penn Ob/Gyn Chester County.
The follicles grow and build up fluid, but the eggs do not get released. Ovulation does not occur, and the follicles might turn into cysts. If this happens, your body might fail to make the hormone progesterone, which is needed to keep your cycle regular.
“Women with PCOS also produce excess estrogen, or female hormones. While this does not contribute to the symptoms above, long term “unopposed estrogen” can lead to a build-up of the lining of the uterus which is a major risk factor for uterine cancer,” said Dr. Sloane.
Some scientists think that another hormone — insulin — may play a role in the body’s increased androgen production. Many women with PCOS have insulin resistance. This is most common in women who are overweight or obese, have unhealthy diet and exercise habits or have a family history of type-2 diabetes.
Women whose mothers and sisters have PCOS are more likely to be affected by this condition, too.
Unfortunately, there is no cure for PCOS, but overweight and obese women can help balance their hormone levels by losing weight. Otherwise, treatment is aimed at managing symptoms.
A wide range of treatment options can help prevent any potential problems.
Lifestyle changes, such as healthy eating and regular exercise, improve the way your body uses insulin and, therefore, regulates your hormone levels better.
Birth control pills can also be a good treatment option if you aren’t interested in getting pregnant any time soon, because they can regulate your menstrual cycle and reduce androgen levels. Dr. Sloane added that “birth control pills also seem to mitigate the increased risk of endometrial cancer by decreasing the amount of time the uterus is exposed to unopposed estrogen.” He continues to note that “birth control pills are associated with an increased risk of blood clots, especially in obese patients and women over 40, so you should speak with your doctor to see if this option is right for you.”
Fertility medications also can help stimulate ovulation if you want to get pregnant. In some cases, that may be enough to spur the process for women with a lack of ovulation — the main reason women with PCOS struggle with fertility.
A surgical procedure known as ovarian drilling can also increase your chances of successful ovulation. While the operation can temporarily lower your androgen levels, it does pose the risk of creating scar tissue.
It is estimated that between five to 10 percent of U.S. women of childbearing age have Polycystic Ovary Syndrome. That’s about 5 million women, which makes the condition one of the most common hormonal endocrine disorders among women of reproductive age.
But, according to the PCOS Foundation, less than half of all women with PCOS are actually diagnosed correctly, meaning that millions of women are potentially unaware of their condition.
The PCOS Foundation estimates that this condition is the cause of fertility issues in women who have trouble with ovulation around 70 percent of the time.
This isn’t true for everyone. Give your body a chance by talking with your doctor about fertility treatment. A number of medications can stimulate ovulation, which is the main issue that women with PCOS face.
Other fertility treatments for women with PCOS include assisted reproductive technologies such as in vitro fertilization.
“If you have PCOS and are not trying to get pregnant, don’t assume that you’re in the clear. While it is certainly harder to get pregnant with PCOS, many women still ovulate intermittently. Therefore, it’s important to still use contraception,” cautioned Dr. Sloane.
It is true that many women who have are overweight or obese. And it’s also true that obesity can make PCOS symptoms worse. However, Polycystic Ovary Syndrome does not discriminate and can affect women of all shapes and sizes.
The relationship between weight and Polycystic Ovary Syndrome has to do with the body’s inability to use insulin properly, which can lead to weight gain.
That’s why getting into the habit of eating healthy and exercising regularly is recommended as part of most women’s treatment plan.
By separating fact from myth, you can empower yourself to live a complete, healthy life with PCOS.
NOTE : This article has been taken from pennmedicine.org as it is. Click here to read original article.
When you think of common fertility treatments, in vitro fertilization (IVF) probably appears near the top of your list. There’s a reason for that.
IVF has been around for decades and you most likely already know the basic idea behind IVF: uniting egg and sperm outside the body in a culture. But there’s so much more to IVF that happens before and after that. Here’s a closer look at the IVF process in five steps.
IVF is commonly used to treat:
You’ll be given fertility drugs that will begin a process called stimulation—or superovulation, says the National Institutes of Health (NIH). In other words, the drugs—which contain Follicle Stimulating Hormone—will tell your body to produce more than just the normal one egg per month.
The more eggs you produce, the more chances you’ll have of a successful fertilization later on in the treatment.
You’ll receive transvaginal ultrasounds and blood tests on a regular basis during this step in the IVF process to check on your ovaries and monitor your hormone levels.
A little more than a day before your eggs are scheduled to be retrieved from your body, you’ll receive a hormone injection that will help your eggs mature quickly.
Then, you’ll have a minor surgical procedure—called follicular aspiration—to remove the eggs. This is generally done as an outpatient surgery in your doctor’s office, according to the NIH.
During the procedure, your doctor will use an ultrasound to guide a thin needle into each of your ovaries through your vagina. The needle has a device attached to it that suctions the eggs out one at a time.
If this part sounds painful, don’t worry—you’ll probably be given medication beforehand so that you won’t feel any discomfort. You may experience some cramping afterward, but this usually disappears within a day, the NIH explains.
While your eggs are being removed, your partner will provide a sperm sample. You also may choose to use donor sperm. The sperm are then put through a high-speed wash and spin cycle in order to find the healthiest ones.
Now comes the part of IVF that everyone’s the most familiar with—combining the best sperm with your best eggs. This stage is called insemination.
It usually takes a few hours for a sperm to fertilize an egg. Your doctor may also inject the sperm directly into the egg instead, a process known as intracytoplasmic sperm injection (ICSI).
Once your eggs have been collected you’ll receive yet another medication. This one is meant to prep the lining of your uterus to receive the embryos that will be transferred back into you.
About three to five days after fertilization, your doctor will place the embryos in your uterus using a catheter. Like step number three, this part of IVF is performed in your doctor’s office while you are awake.
Multiple embryos are transferred back into you in the hopes that at least one will implant itself in the lining of your uterus and begin to develop. Sometimes more than one embryo ends up implanting, which is why multiples are common in women who use IVF.
The IVF process basically replicates natural reproduction. The next step after the IVF process determines whether the procedure worked—the pregnancy test.
NOTE : This article has been taken from pennmedicine.org as it is. Click here to read original article.
If you and your partner are looking for a permanent birth control method, you may be considering a vasectomy.
“A vasectomy is permanent male sterilization,” explains Puneet Masson, MD, Assistant Professor of Urology and Director of the Male Fertility Program at Penn Fertility Care. “That being said, life changes—it’s a very dynamic process.”
Before you have a vasectomy, here’s what you should know:
The decision to have a vasectomy is not one that should be taken lightly. You and your partner should take time to really think about whether it is the right choice for you.
A vasectomy may be right for you if:
On the other hand, a vasectomy may not be right for you if:
A vasectomy can be done either under local anesthesia or conscious sedation (aka “twilight anesthesia”). If performed under local anesthesia, pain medicine will be administered directly to your scrotum to numb the area. You will be awake for the procedure. With conscious sedation, you will receive medications to sedate you and relieve any anxiety during the procedure in addition to receiving local anesthesia directly to your scrotum.
Regardless of the anesthesia, the procedure is the same. The physician will disconnect the vas deferens—the tubes that transport sperm from the testicles. After the surgery, sperm will not be able to leave the testicles.
You may be wondering what the vasectomy recovery period is like. After a vasectomy most men can:
Bruising and swelling should be gone within two weeks.
A vasectomy should not decrease your sex drive, nor should it negatively impact your ability to have an erection or orgasm. Only five to 10 percent of the ejaculate comes from the testicle. The remainder comes from upstream structures such as your prostate and seminal vesicles. Thus, ejaculation will still look and feel the same. Just microscopically, there will be no sperm in the semen.
If you experience any changes in your sexual drive or functioning after the procedure, contact your physician.
After the surgery, the sperm count in your ejaculate will begin to decrease gradually.
You will need to continue to use other birth control methods until your semen sample comes back completely sperm-free and you get the okay from your physician. This usually takes about two months or 20 ejaculations.
“Patients might desire children in the future. They may have a second marriage. Different sorts of things come up, and we have to respect that life is so dynamic,” says Dr. Masson.
There are a few options for achieving a pregnancy after vasectomy. “We can do a vasectomy reversal or a surgical sperm extraction,” explains Dr. Masson. “There’s a lot of counseling that goes on with this decision process as well.”
Whereas a vasectomy takes 20 minutes, a vasectomy reversal can take four to six hours. It’s a much more complicated, delicate procedure. And there is no guarantee that it will lead to pregnancy.
If you and your partner decide that you would like to have children after you have had a vasectomy, there are other ways to obtain your sperm than a vasectomy reversal.
“We can do a surgical sperm extraction in combination with in vitro fertilization,” says Dr. Masson.
These procedures, known as testicular sperm extraction (TESE) and percutaneous epididymal sperm aspiration (PESA) have a high success rate of about 98 percent.
Both procedures involve extracting sperm through a small incision in either the testes (TESE) or epididymis (PESA), the Urology Care Foundation explains.
NOTE : This article has been taken from pennmedicine.org as it is. Click here to read original article.