Cancer Update: Diagnosis & Treatment of Urologic Cancers

Medivision presents an excerpt from our 120 minute medical education video Cancer Update: Diagnosis and Treatment of Urologic Cancers, featuring Richard Williams Md. discussing Chemotherapy and Immunotherapy of Superficial Bladder Cancer. The full length film, along with many other medical education titles, is available on VHS or DVD from health-e-mall.com, and also includes Seth Lerner, MD., Ron Bukowski, MD., Chris Logothetis, MD. and Michael Sorodsky, MD. discussing testes cancer, bladder cancer, BCG, alternatives to BCG therapy, and metastatic bladder cancer; also covers renal cell cancer - single agent therapies including IL-2 high dose and alpha interferon, combination therapy of IL-2 low dose and alpha interferon, and surgery to treat renal cells.

Superficial bladder carcinoma includes a diverse group of lesions, ranging from Ta grade I to T1 grade III tumors and high-grade flat CIS. Although it is crucial to distinguish the small group of lesions that carry a serious risk of progression to life-threatening muscle invasive and metastatic disease, the vast majority of superficial tumors have low rates of progression. Rather, they have a significant tendency to recur at multiple sites throughout the urothelium. 

Bacillus Calmette-Guerin (BCG) is a live bacterium related to cow tuberculosis. It is a common treatment for non-muscle invasive bladder cancer, particularly for cancers that have a risk of worsening over time. BCG is believed to work by triggering the body's immune system to destroy any cancer cells that remain in the bladder after TURBT (transurethral resection of bladder tumor). BCG is in a liquid solution that is put into the bladder with a catheter. The person then holds the solution in the bladder for two hours before they urinate. The treatment is usually given once per week for six weeks, starting approximately two to three weeks after the last TURBT. Further booster (maintenance) treatments can extend the benefit of BCG.
Intravesical BCG, in combination with TURBT, is the most effective treatment for non-muscle invasive bladder cancer. BCG therapy has been shown to delay (although not necessarily prevent) tumor growth to a more advanced stage, decrease the need for surgical removal of the bladder at a later time, and improve overall survival

Management of Anorexia and Bulimia

Medivision presents an excerpt from our 60 minute medical education video Management of Anorexia and Bulimia, featuring Mary E. Muscari, PhD, CRNP, CS and Marrian Farrell, PhD, RNC, CS. The full length film, along with many other medical education titles, is available on VHS or DVD from health-e-mall.com and describes the clinical manifestations and potential complications associated with anorexia and bulimia nervosa; the nursing techniques used to prevent and manage the physiologic consequences, and assists the physician in developing an understanding of the psychosocial needs of clients with eating disorders while examining various psychosocial interventions based on appropriate theoretical perspectives for clients with eating disorders.


Competent and comprehensive care of eating disorders must involve understanding the medical aspects of these illnesses, not just for physicians but for any clinician treating them. A therapist must know what to look for, what certain symptoms might mean and when to send a patient for medical evaluation. A dietitian will likely be a team member who performs the nutrition evaluation and must have adequate knowledge of all medical/nutritional aspects of eating disorders. A psychiatrist may prescribe medication for an underlying mood or thought disorder and must coordinate this with the rest of the treatment.

Eating disorder medical complications vary with each individual; some patients who self-induce vomiting have low electrolytes and a bleeding esophagus while others can vomit for years without ever developing these symptoms. It is necessary to have a well-trained and experienced physician as part of the treatment team of an eating disordered patient. Not only do these physicians have to treat symptoms that they find, but they have to anticipate what is to come and discuss what is not revealed by medical lab data. Unfortunately, physicians with special training and/or experience in diagnosing and treating eating disorders are not very common, and patients who seek psychotherapy for an eating disorder often have their own family doctors which they prefer over a therapist referral.

Most eating disorder complaints like headaches, stomachaches, insomnia, fatigue, weakness, dizzy spells, and even fainting do not show up on lab results. Parents, therapists and doctors too often make the mistake of expecting to scare patients into improving their behaviors by having them get a physical exam in order to discover whatever damage has been done. Patients are rarely motivated by medical consequences and often have the attitude that being thin is more important than being healthy, or nothing bad is really going to happen to them, or they don't care if it does. Furthermore, patients can appear to be healthy and receive normal lab results even though they have been starving or vomiting for months or years.

Managing binge eating disorder patients most likely involves the same medical considerations to be taken into account when treating obese individuals, such as heart or gallbladder disease, diabetes, high blood pressure, and so on. Most symptoms of binge eating will be a result of the accompanying weight gain associated with this disorder. Occasionally people have binged to the point of becoming breathless when their distended stomachs press up on their diaphragms. In very rare cases a medical emergency may occur if the stomach wall becomes so stretched that it is damaged or even tears. 

While many people with an eating disorder will recover fully, relapse is common and may occur months or even years after treatment. An estimated 5 to 10 percent of anorexics will die from the disorder; their deaths most commonly result from starvation, suicide or electrolyte imbalance. More favorable outcomes for anorexics have been associated with a younger age of onset of the disorder, less denial, less immaturity, and improved self-esteem.
The outcome for bulimia nervosa is not as well documented, and mortality rates are not yet known. It is a chronic, cyclic disorder. Of those bulimics who are treated for the disorder, fewer than one-third will be fully recovered three years after treatment, more than one-third will show some improvement in their symptoms at a three-year follow-up, and about one-third will resume chronic symptoms within three years.

Management of Heart Failure: Secondary to Left Ventricular Systolic Disfunction

Medivision presents an excerpt from our 60 minute medical education video Management of Heart Failure: Secondary to Left Ventricular Systolic Disfunction, featuring Denise Drummond Hayes MSN, RN, CCRN from Allegheny University Hospitals.
The full length film, along with many other medical education titles, is available on VHS or DVD from health-e-mall.com and discusses the physicians need to differentiate between heart failure secondary to left-ventricular systolic dysfunction and heart failure secondary to left-ventricular diastolic dysfunction, describe the initial pharmacologic management for patients with heart failure in the setting of reduced left-ventricular systolic function, as well as the current AHCPR recommendations for patient and family education and counseling in reference to left - ventricular systolic dysfunction.

Older people living with heart abnormalities that could lead to heart failure may have never had those abnormalities diagnosed, meaning they miss out on treatments that could help. But deciding whether someone would benefit from taking these drugs in the last stages of life is also important.

The heart naturally gets weaker as people age, but scientists don't often study heart failure in the elderly. A new study looked at 375 people ages 87 to 89 in northeast England, and found that about one-third of them had a reduced ability to pump blood due to a left ventricular systolic dysfunction. Another 20 percent had a diastolic dysfunction; heart muscles that could not relax enough to allow the heart's chambers to fill with blood, which keeps the heart from pumping enough blood to the rest of the body.
These abnormalities increase as people age and develop cardiovascular diseases, such as high blood pressure and coronary artery disease. They can also lead to heart failure.

For 26 percent of the people in the study, the problems had never been diagnosed by a physician.

About 5.8 million Americans have heart failure according the National Heart Lung and Blood Institute, and as greater numbers of people age and survive heart attacks in Western countries it's possible that that number will grow.

Doctors say although the symptoms of these heart abnormalities seem common for older people, it's important that they not be dismissed as simply signs of "old age."
There are few treatment options for patients whose hearts don't relax enough to fill with blood, but patients whose hearts don't pump hard enough can take classes of drugs called beta blockers and ACE inhibitors, both of which increase the heart's ability to pump blood effectively. Those drugs come with side effects such as weakness, drowsiness or dizziness that may make it not feasible to give them to an older person.

 http://heart.bmj.com/site/misc/heartjnl-2012-302457.pdf

Recent Advances in the Management of IBS

Medivision presents an excerpt from our 60 minute medical education video Recent Advances in the Management of IBS (Irritable Bowel Syndrome), featuring Brenda Toner, PhD. The full length film, along with many other medical education titles, is available on VHS or DVD from health-e-mall.com and describes the application of symptom-based criteria for diagnosis of IBS, the role of dysmotility and visceral hypersensitivity in IBS, patient care and the role of pharamacotherapeutic agents.

Irritable bowel syndrome (IBS), a functional gastrointestinal disorder long considered a diagnosis of exclusion, has chronic symptoms that vary over time and overlap with those of non-IBS disorders. Traditional symptom-based criteria effectively identify IBS patients but are not easily applied in clinical practice, leaving over 40% of patients to experience symptoms up to 5 years before diagnosis.

The myoelectric activity of the colon is composed of background slow waves with superimposed spike potentials. Colonic dysmotility in irritable bowel syndrome manifests as variations in slow-wave frequency and a blunted, late-peaking, postprandial response of spike potentials. Patients who are prone to diarrhea demonstrate this disparity to a greater degree than patients who are prone to constipation.
Small bowel dysmotility manifests in delayed meal transit in patients prone to constipation and in accelerated meal transit in patients prone to diarrhea. In addition, patients exhibit shorter intervals between migratory motor complexes (the predominant interdigestive small bowel motor patterns).
Current theories integrate these widespread motility aberrations and hypothesize a generalized smooth muscle hyperresponsiveness. They describe increased urinary symptoms, including frequency, urgency, nocturia, and hyperresponsiveness to methacholine challenge.

Visceral hypersensitivity (the experience of pain in internal organs at an increased level than what is normally expected) may also play a role in irritable bowel syndrome (IBS). This pain sensitivity is usually studied using some variation of balloon distention in the rectum, and as an overall research trend people who suffer from IBS experience discomfort and pain in the rectal area at lower levels of pressure than individuals who do not suffer from IBS. But the issue is not a simple one; it appears likely that the visceral hypersensitivity seen in some IBS patients is a result of changes in nervous system functioning on both the level of the intestines and the brain. At the level of the gut, it seems as if nerve pathways in the gastrointestinal tract become sensitized to stimulation, resulting in over-reactivity and resulting in pain amplification. Brain imaging studies provide more clues; in individuals who do not have IBS, rectal distension triggers a response in parts of the brain that are associated with modulating pain. In IBS patients, this same rectal stimulation triggers a response in the parts of the brain associated with vigilance and anxiety -- parts of the brain that serve to amplify the sensation of pain.

Certain types of psychotherapy have been shown to be effective in reducing IBS symptoms. Although it is not known precisely why therapy is beneficial, it is thought to be related to the effect of the therapy on the close interconnections between the brain and the intestinal system.

Cardiology Perspectives: Effective Management of Cholesterol

Medivision.com is pleased to present an excerpt from our 2 hour educational video; Cardiology Perspectives: Effective Management of Cholesterol, featuring John Kane, MD; Alan Chait, MD; John LaRose, MD; Tom Bersot, MD; Stephen G. Young, MD; Gustav Schoenfeld, MD and Virgil Brown, MD. The full length video is available on DVD or VHS from health-e-mall.com and discusses the importance of controlling cholesterol in patients with heart disease and other high risk individuals.

High cholesterol is a well-known risk factor in heart disease, the number one killer of both women and men in the United States, with more than a million heart attacks and about a half million deaths annually.
High cholesterol doesn't cause overt symptoms, and many people are unaware of elevated cholesterol levels and how it may influence their cardiac risk. To complicate matters, high cholesterol is not the only predictor of cardiovascular events such as heart attack and stroke; somewhere between 30-50 percent of first heart attacks occur in people with normal cholesterol levels, but it is essential to test and monitor cholesterol levels, especially for anyone with a family history of heart disease. Lowering high cholesterol does seem to lessen the risk for developing heart disease, and reduces the chance of a heart attack or dying of heart problems if you already have them. However, some research has indicated that all-cause mortality (that is, dying from any disease, not just heart disease) actually increases when cholesterol is lowered in those over age 65.

Genetics and lifestyle both combine in individuals to create high levels of cholesterol in the blood. Those who are overweight tend to have increased cholesterol.
Diet is an important component of controlling cholesterol ratios and maintaining heart health. Recent evidence indicates that added sugar and overabundance of flour in the diet are probably greater contributors to heart disease than saturated fat; certain components of full-fat dairy foods may be cardio-protective.
However, a chemically altered type of fat known as trans fatty acids (TFAs) can worsen cholesterol ratios. TFAs are mostly found in animal fats and vegetable oils, and are also created in the hydrogenation process that makes fats more stable, giving them a longer shelf-life.
In addition to diet, LDL cholesterol levels appear to be heavily dependent on genetic factors. Anyone at increased risk of heart disease should have tests for LDL particle size in addition to the basic lipid profile. Best results show low numbers of LDL particles overall.
A different cholesterol problem is present when one shows a tendency towards low HDL cholesterol and high triglycerides. This pattern, sometimes called “Syndrome X,” is associated with insulin resistance. It is frequently influenced by diet and lifestyle, but is also genetically driven and appears to affect at least 30 percent of the population. It carries with it an increased risk of high blood pressure and diabetes as well as heart disease. Dietary and nutritional supplement treatments are often quite effective in treating this pattern, but are a bit different from those for high total and LDL cholesterol levels.

High cholesterol is treated conventionally with lifestyle changes focusing on diet, physical activity and weight management. For patients seen in busy medical practices this approach is frequently difficult to fully implement and utilize. If lifestyle changes are not effective, drug therapy is often recommended. Statin drugs are commonly used to lower cholesterol and protect against heart disease and heart attacks by blocking an enzyme that is necessary for the synthesis of cholesterol in the liver. They can be very effective, and there is growing medical enthusiasm for them because they also seem to provide antioxidant and anti-inflammatory properties. These drugs can reduce plaque formation in coronary arteries by preventing the oxidation of LDL ("bad") cholesterol, and their anti-inflammatory properties may help prevent plaque from rupturing.
Despite their benefits, they do have adverse effects including liver toxicity: physicians need to monitor liver function carefully in patients with liver disease of any kind.

Understanding the Role of Estrogen: What is Menopause?

Medivision presents an excerpt from our 90 minute medical education video Obstetrics and Gynecology: Understanding the Role of Estrogen, featuring Matan Yemini, MD. on the topic of "What is Menopause?". The full length film, along with many other medical education titles, is available on VHS or DVD from health-e-mall.com and covers the following topics: Comprehensive Health Care to the Peri-Menopause, Current Research Trends, Hormone Replacement Therapy and Nursing Perspectives in Menopause Management.

Hormone replacement therapy was recently considered to be a standard treatment for women with hot flashes and other menopause symptoms, and was also thought to have the long-term benefits of preventing heart disease and possibly dementia. However the use of hormone therapy changed abruptly when a large clinical trial found that one type of hormone therapy actually posed more health risks than benefits, particularly when given to older postmenopausal women. As the concern about health hazards attributed to hormone therapy grew doctors became less likely to prescribe it, and it is no longer recommended for s heart disease or memory loss.

However, further review of clinical trials and new evidence show that hormone therapy may still be a good choice for certain women, depending on their risk factors and on whether they take systemic hormone therapy or low-dose vaginal preparations of estrogen. For women who experience menopause naturally, estrogen is typically prescribed along with progesterone or progestin because estrogen alone can stimulate growth of the lining of the uterus, increasing the risk of uterine cancer.

Despite the health risks, systemic estrogen is still the most effective treatment for menopausal symptoms. The benefits of hormone therapy may outweigh the risks if you're healthy and:

• Experience moderate to severe hot flashes or other menopausal symptoms
• Have lost bone mass and either can't tolerate or aren't benefitting from other treatments
• Stopped having periods before age 40 (premature menopause) or lost normal function of your ovaries before age 40 (premature ovarian insufficiency)

Women who experience an early menopause, particularly those who had their ovaries removed and don't take estrogen therapy until at least age 45, have a higher risk of:

• Osteoporosis
• Coronary heart disease (CHD)
• Earlier death
• Parkinsonism (Parkinson's-like symptoms)
• Dementia
• Anxiety or depression
• Sexual function concerns

Early menopause typically lowers the risk of most types of breast cancer and ovarian cancer. For women who reach menopause prematurely, protective benefits of hormone therapy usually outweigh the risks.

To determine if hormone therapy is a good treatment option for you, talk to your doctor about your individual symptoms and health risks. As researchers learn more about hormone therapy and other menopausal treatments, recommendations may change. If you continue to have bothersome menopausal symptoms, review treatment options with your doctor on a regular basis.

 Further Reading:
Hormone therapy: Is it right for you? - MayoClinic.com

Care of the Morbidly Obese Trauma Patient

Medivision.com presents an excerpt from "Care of the Morbidly Obese Trauma Patient", with Susan M. Gallagher (RN, MSN, CNS) on a nurses' perspective on the challenges of caring for morbidly obese patients in a hospital setting. The full one hour educational video available at health-e-mall.com also features Blanca Crandall, Patricia S. Choban, MD and Rosaline Parson, RN, BSN, CEN, CCRN and covers ways to improve the physical, emotional, and social needs of obese patients; why patients are reluctant to accept care and how that impacts skin and wound care in the hospital setting; common, predictable and preventable skin and wound complications, care suggestions; the value of using appropriate equipment and the safety risks standard hospital equipment may pose for the obese patient.

Obesity is now recognized as a major health problem in the United States; over 32% of the U.S. population is obese and the problem is not limited to adults. Although increases in the prevalence of overweight and obesity have been observed around the world, the United States has the highest prevalence of obesity among the developed nations.

The number of hospitalizations in which obesity was noted on admission has increased significantly compared to the overall increase in hospitalizations for any condition. While obese individuals undergoing weight reduction surgery account for some of these patients, many of them also seek health care for treatment of co-morbidities such as diabetes, sleep apnea, or orthopedic problems or for matters unrelated to the obesity, such as trauma or childbirth. The morbidly obese patient presents particular challenges to nurses providing their care.
Earlier nursing literature on weight reduction surgeries cautioned nurses to have additional staff available to assist in providing care, and to assemble specialized equipment to cope with providing care and transferring a patient with a large body mass, yet the requirement of increased staff to provide care for the morbidly obese  has received only limited additional attention in the literature.

ICU physicians also need to be aware of physiologic changes occurring with obesity that become relevant during critical illness. Special challenges are encountered when caring for the obese patient in the ICU, including airway management, bedside procedures and testing, nutritional support, drug dosing and nursing care.