Peritoneal Dialysis

What is peritoneal dialysis and how does it work?

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Peritoneal dialysis is a treatment for kidney failure that uses the lining of your abdomen, or belly, to filter your blood inside your body. Health care providers call this lining the peritoneum.

A few weeks before you start peritoneal dialysis, a surgeon places a soft tube, called a catheter, in your belly.

When you start treatment, dialysis solution—water with salt and other additives—flows from a bag through the catheter into your belly. When the bag is empty, you disconnect it and place a cap on your catheter so you can move around and do your normal activities. While the dialysis solution is inside your belly, it absorbs wastes and extra fluid from your body.

 

After a few hours, the solution and the wastes are drained out of your belly into the empty bag. You can throw away the used solution in a toilet or tub. Then, you start over with a fresh bag of dialysis solution. When the solution is fresh, it absorbs wastes quickly. As time passes, filtering slows. For this reason, you need to repeat the process of emptying the used solution and refilling your belly with fresh solution four to six times every day. This process is called an exchange.

You can do your exchanges during the day, or at night using a machine that pumps the fluid in and out. For the best results, it is important that you perform all of your exchanges as prescribed. Dialysis can help you feel better and live longer, but it is not a cure for kidney failure.

How will I feel when the dialysis solution is inside my belly?

You may feel the same as usual, or you may feel full or bloated. Your belly may enlarge a little. Some people need a larger size of clothing. You shouldn’t feel any pain. Most people look and feel normal despite a belly full of solution.

What are the types of peritoneal dialysis?

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You can choose the type of peritoneal dialysis that best fits your life:

• continuous ambulatory peritoneal dialysis (CAPD)
• automated peritoneal dialysis

The main differences between the two types of peritoneal dialysis are

• the schedule of exchanges
• one uses a machine and the other is done by hand

If one type of peritoneal dialysis doesn’t suit you, talk with your doctor about trying the other type.

CAPD doesn’t use a machine. You do the exchanges during the day by hand.

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You can do exchanges by hand in any clean, well-lit place. Each exchange takes about 30 to 40 minutes. During an exchange, you can read, talk, watch television, or sleep. With CAPD, you keep the solution in your belly for 4 to 6 hours or more. The time that the dialysis solution is in your belly is called the dwell time. Usually, you change the solution at least four times a day and sleep with solution in your belly at night. You do not have to wake up at night to do an exchange.

Automated peritoneal dialysis. A machine does the exchanges while you sleep

With automated peritoneal dialysis, a machine called a cycler fills and empties your belly three to five times during the night. In the morning, you begin the day with fresh solution in your belly. You may leave this solution in your belly all day or do one exchange in the middle of the afternoon without the machine. People sometimes call this treatment continuous cycler-assisted peritoneal dialysis or CCPD.

Where can I do peritoneal dialysis?

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You can do both CAPD and automated peritoneal dialysis in any clean, private place, including at home, at work, or when travelling.

Before you travel, you can have the manufacturer ship the supplies to where you’re going so they’ll be there when you get there. If you use automated peritoneal dialysis, you’ll have to carry your machine with you or plan to do exchanges by hand while you’re away from home.

How do I prepare for peritoneal dialysis?

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Surgery to put in your catheter

Before your first treatment, you will have surgery to place a catheter into your belly. Planning your catheter placement at least 3 weeks before your first exchange can improve treatment success.

Although you can use the catheter for dialysis as soon as it’s in place, the catheter tends to work better when you have 10 to 20 days to heal before starting a full schedule of exchanges.

Your surgeon will make a small cut, often below and a little to the side of your belly button, and then guide the catheter through the slit into your peritoneal cavity. You’ll receive general or local anesthesia NIH external link, and you may need to stay overnight in the hospital. However, most people can go home after the procedure.

You’ll learn to care for the skin around the catheter, called the exit site, as part of your dialysis training.

Dialysis training

After training, most people can perform both types of peritoneal dialysis on their own. You’ll work with a dialysis nurse for 1 to 2 weeks to learn how to do exchanges and avoid infections. Most people bring a family member or friend to training. With a trained friend or family member, you’ll be prepared in case you have a sick day and need help with exchanges.

If you choose automated peritoneal dialysis, you’ll learn how to

• prepare the cycler
• connect the bags of dialysis solution
• place the drain tube

If you choose automated peritoneal dialysis, you also need to learn how to do exchanges by hand in case of a power failure or if you need an exchange during the day in addition to nighttime automated peritoneal dialysis.

How do I perform an exchange?

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You’ll need the following supplies:

• transfer set
• dialysis solution
• supplies to keep your exit site clean

If you choose automated peritoneal dialysis you’ll need a cycler.

Your health care team will provide everything you need to begin peritoneal dialysis and help you arrange to have supplies such as dialysis solution and surgical masks delivered to your home, usually once a month. Careful hand washing before and wearing a surgical mask over your nose and mouth while you connect your catheter to the transfer set can help prevent infection.

Use a transfer set to connect your catheter to the dialysis solution

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A transfer set is tubing that you use to connect your catheter to the bag of dialysis solution. When you first get your catheter, the section of tube that sticks out from your skin will have a secure cap on the end to prevent infection. A connector under the cap will attach to any type of transfer set.

Between exchanges, you can keep your catheter and transfer set hidden inside your clothing. At the beginning of an exchange, you’ll remove the disposable cap from the transfer set and connect the set to a tube that branches like the letter Y. One branch of the Y-tube connects to the drain bag, while the other connects to the bag of fresh dialysis solution.

Use dialysis solution as prescribed

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Dialysis solution comes in 1.5-, 2-, 2.5-, or 3-liter bags. Solutions contain a sugar called dextrose or a compound called icodextrin and minerals to pull the wastes and extra fluid from your blood into your belly. Different solutions have different strengths of dextrose or icodextrin. Your doctor will prescribe a formula that fits your needs.

You’ll need a clean space to store your bags of solution and other supplies.

Doing an exchange by hand

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• After you wash your hands and put on your surgical mask, drain the used dialysis solution from your belly into the drain bag. Near the end of the drain, you may feel a mild tugging sensation that tells you most of the fluid is gone. Close the transfer set.
• Warm each bag of solution to body temperature before use. You can use an electric blanket, or let the bag sit in a tub of warm water. Most solution bags come in a protective outer wrapper, and you can warm them in a microwave. Don’t microwave a bag of solution after you have removed it from its wrapper.
• Hang the new bag of solution on a pole and connect it to the tubing.
• Remove air from the tubes—allow a small amount of fresh, warm solution to flow directly from the new bag of solution into the drain bag.
• Clamp the tube that goes to the drain bag.
• Open or reconnect the transfer set, and refill your belly with fresh dialysis solution from the hanging bag.

Using a cycler for automated peritoneal dialysis exchanges

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In automated peritoneal dialysis, you use a machine called a cycler to fill and drain your belly. You can program the cycler to give you different amounts of dialysis solution at different times.

Each evening, you set up the machine to do three to five exchanges for you. You connect three to five bags of dialysis solution to tubing that goes into the cycler—one bag of solution for each exchange. The machine may have a special tube to connect the bag for the last exchange of the night.

At the times you set, the cycler

• releases a clamp and allows used solution to drain out of your belly into the drain line
• warms the fresh dialysis solution before it enters your body
• releases a clamp to allow body-temperature solution to flow into your belly

A fluid meter in the cycler measures and records how much solution the cycler removes. Some cyclers compare the amount that was put in with the amount that drains out. This feature lets you and your doctor know if the treatment is removing enough fluid from your body.

Some cyclers allow you to use a long drain line that drains directly into your toilet or bathtub. Others have a disposal container.

What changes will I have to make when I start peritoneal dialysis?

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Daily routine

Your schedule will change as you work your dialysis exchanges into your routine. If you do CAPD during the day, you have some control over when you do the exchanges. However, you’ll still need to stop your normal activities and take about 30 minutes to perform an exchange. If you do automated peritoneal dialysis, you’ll have to set up your cycler every night.

Physical activity

You may need to limit some physical activities when your belly is full of dialysis solution. You may still be active and play sports, but you should discuss your activities with your health care team.

Make changes to what you eat and drink

If you’re on peritoneal dialysis, you may need to limit

• sodium
• phosphorus
• calories in your eating plan

You may also need to

• watch how much liquid you drink and eat. Your dietitian will help you determine how much liquid you need to consume each day.
• add protein to your diet because peritoneal dialysis removes protein.
• choose foods with the right amount of potassium.
• take supplements made for people with kidney failure.

Eating the right foods can help you feel better while you’re on peritoneal dialysis. Talk with your dialysis center’s dietitian to find a meal plan that works for you.

Medicines

Your doctor may make changes to the medicines you take.

Coping

Adjusting to the effects of kidney failure and the time you spend on dialysis can be hard for both you and your family. You may

• have less energy
• need to give up some activities and duties at work or at home

A counselor or social worker can answer your questions and help you cope NIH external link.

Take care of your exit site, supplies, and catheter to prevent infections

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Your health care team will show you how to keep your catheter clean to prevent infections. Here are some general rules:

• Store your supplies in a cool, clean, dry place.
• Inspect each bag of solution for signs of contamination, such as cloudiness, before you use it.
• Find a clean, dry, well-lit space to perform your exchanges.
• Wash your hands every time you need to handle your catheter.
• Clean your skin where your catheter enters your body every day, as instructed by your health care team.
• Wear a surgical mask when performing exchanges.

What are the possible problems from peritoneal dialysis?

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Possible problems from peritoneal dialysis include infection, hernia, and weight gain.

Infection

One of the most serious problems related to peritoneal dialysis is infection. You can get an infection of the skin around your catheter exit site or you can develop peritonitis, an infection in the fluid in your belly. Bacteria can enter your body through your catheter as you connect or disconnect it from the bags.

Seek immediate care if you have signs of infection

Signs of an exit site infection include redness, pus, swelling or bulging, and tenderness or pain at the exit site. Health care professionals treat infections at the exit site with antibiotics.

Peritonitis may cause

• pain in the abdomen
• fever
• nausea or vomiting
• redness or pain around your catheter
• unusual color or cloudiness in used dialysis solution
• the catheter cuff to push out from your body—the cuff is the part of the catheter that holds it in place

Health care professionals treat peritonitis with antibiotics. Antibiotics are added to the dialysis solution that you can usually take at home. Quick treatment may prevent additional problems.

Hernia

A hernia is an area of weakness in your abdominal muscle.

Peritoneal dialysis increases your risk for a hernia for a couple of reasons. First, you have an opening in your muscle for your catheter. Second, the weight of the dialysis solution within your belly puts pressure on your muscle. Hernias can occur near your belly button, near the exit site, or in your groin. If you have a swelling or new lump in your groin or belly, talk with your health care professional.

Weight gain from fluid and dextrose

The longer the dialysis solution remains in your belly, the more dextrose your body will absorb from the dialysis solution. This can cause weight gain over time.

Limit weight gain

With CAPD, you might have a problem with the long overnight dwell time. If your body absorbs too much fluid and dextrose overnight, you may be able to use a cycler to exchange your solution once while you sleep. This extra exchange will shorten your dwell time, keep your body from absorbing too much fluid and dextrose, and filter more wastes and extra fluid from your body.

With automated peritoneal dialysis, you may absorb too much solution during the daytime exchange, which has a long dwell time. You may need an extra exchange in the midafternoon to keep your body from absorbing too much solution and to remove more wastes and extra fluid from your body.

Your dietitian can provide helpful guidance to reduce weight gain.

What are urinary catheters?

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A urinary catheter is a hollow, partially flexible tube that collects urine from the bladder and leads to a drainage bag. Urinary catheters come in many sizes and types.

They can be made of:

• rubber
• plastic (PVC)
• silicone

 

Catheters may be necessary in cases when you can’t empty your bladder. If the bladder isn’t emptied, urine can build up and lead to pressure in the kidneys. The pressure can lead to kidney failure, which can be dangerous and result in permanent damage to the kidneys.

Most catheters are necessary until you regain the ability to urinate on your own, which is usually a short period of time. Older adults and those with a permanent injury or severe illness may need to use urinary catheters for a much longer time or permanently.

Why are urinary catheters used?

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A doctor may recommend a catheter if you:

• can’t control when you urinate
• have urinary incontinence
• have urinary retention

The reasons why you may not be able to urinate on your own can include:

blocked urine flow due to:

• bladder or kidney stones
• blood clots in the urine
• severe enlargement of the prostate gland

Other Reasons:

• surgery on your prostate gland
• surgery in the genital area, such as a hip fracture repair or hysterectomy
• injury to the nerves of the bladder
• spinal cord injury
• a condition that impairs your mental function, such as dementia
• medications that impair the ability of your bladder muscles to squeeze, which causes urine to remain stuck in your bladder

What are the types of urinary catheters?

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There are three main types of catheters:

• indwelling catheters
• external catheters
• short-term catheters

Indwelling catheters (urethral or suprapubic catheters)

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An indwelling catheter is a catheter that sits in the bladder. It may also be known as a Foley catheter. This type can be useful for short and long periods of time.

A nurse usually inserts an indwelling catheter into the bladder through the urethra. Sometimes, they will instead insert the catheter into the bladder through a tiny hole in the abdomen. This type of indwelling catheter is known as a suprapubic catheter.

A tiny balloon at the end of the catheter is inflated with water to prevent the tube from sliding out of the body. The balloon can then deflate when the catheter needs to be removed.

External catheters

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A condom catheter is a catheter placed outside the body. It’s typically necessary for people with a penis who don’t have urinary retention problems but have serious functional or mental disabilities, such as dementia.

A device that looks like a condom covers the penis head. Then, a tube leads from the condom device to a drainage bag.

These catheters are generally more comfortable and carry a lower risk of infection than indwelling catheters. Condom catheters usually need to be changed daily, but some brands are designed for longer use. These can cause less skin irritation than condom catheters that require daily removal and reapplication.

A wound, ostomy, and continence nurse (WOCN) can help make these recommendations.

Short-term catheters (intermittent catheters)

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In some cases, you may only need a catheter for a short period of time after surgery until the bladder empties. After the bladder empties, it’s necessary to remove the short-term catheter. Healthcare professionals refer to this as an in-and-out catheter.

In a home setting, people are trained to apply the catheter themselves or with the help of a caregiver. It can be done through the urethra or through a hole created in the lower abdomen for catheterization.

What are the potential complications of urinary catheters?

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Urinary catheters are the leading cause of healthcare-associated urinary tract infections (UTIs). Therefore, it’s important to routinely clean catheters to prevent infections.

The symptoms of a UTI may include:

• fever
• chills
• headache
• cloudy urine due to pus
• burning of the urethra or genital area
• leaking of urine out of the catheter
• blood in the urine
• foul-smelling urine
• low back pain and achiness

Other complications from using a urinary catheter include:

• allergic reaction to the material used in the catheter, such as latex
• bladder stones
• blood in the urine
• injury to the urethra
• kidney damage (with long-term indwelling catheters)
• septicemia, or infection of the urinary tract, kidneys, or blood

How do you care for a urinary catheter?

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One-time use catheters and reusable catheters are available. For reusable catheters, be sure to clean both the catheter and the area where it enters the body with soap and water to reduce the risk of a UTI. One-time use catheters come in sterile packaging, so only your body needs cleaning before inserting the catheter.

You should also drink plenty of water to keep your urine clear or only slightly yellow. This will help prevent infection.

Empty the drainage bag used to collect the urine at least every 8 hours and whenever the bag is full. Use a plastic squirt bottle containing a mixture of vinegar and water or bleach and water to clean the drainage bag. Read more on clean intermittent self-catheterization.

Urinary catheter side effects

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While UTIs are the most common side effects associated with urinary catheters, there are other potential side effects that you may discuss with your doctor. These include:

• bladder spasms and pain, which may feel like stomach cramps
• blood or other debris getting trapped inside the catheter tube, which may stem from blockage in the catheter’s drainage system
• catheter leakage, which may happen from a blockage in the system, or from pushing during toileting if you’re constipated
• urethra or bladder injuries (less common)
• bladder stones (less common, but may be more likely after long-term catheter use)

Risk factors

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While not all side effects from urinary catheter use are completely avoidable, you may help reduce your risk with certain dietary and hygiene steps, as well as preventing blockages in the catheter’s drainage system.

Discuss the following risk factors with your doctor:

• Not getting enough fluids. This could lead to dehydration and subsequent UTI. Pale urine indicates that you’re getting enough water.
• Lack of fiber in your diet. Eating enough high fiber foods, such as vegetables, grains, and fruits, can keep your bowel movements regular and prevent constipation-induced catheter leakage.
• Catheter disorganization. Any twists or bends in the catheter, as well as urine bag displacement, may also lead to blocks or leaks.
• Problems keeping your skin or the equipment clean. You may consider asking for help from a caregiver to make sure all items are cleaned regularly, if you’re unable to do so on your own.

Coronary catheterization is a relatively new, safe and effective minimally invasive procedure that allows access to the circulatory system and heart without the need for invasive open heart surgery. Coronary catheterization can be used for both the diagnosis and treatment of many common cardiovascular conditions. In some cases, the diagnostic procedure and treatment can be performed in the same procedure, minimizing downtime and improving the patient experience.

Coronary catheterization is most often employed for:

• Balloon angioplasty and stent placement
• Ablation of heart tissue to treat arrhythmias or irregular heartbeats such as atrial fibrillation
• The replacement of a malfunctioning valve employing a procedure known as TAVR

Cardiac catheterizations are performed in an advanced setting known as a cath lab. The time it takes for a cardiac catheterization to be performed varies between procedures and whether the catheterization is purely for diagnostic reasons or if there will be an intervention to follow. Some catheterizations may take just a few hours of prep and procedure time, while others may take the better part of the day. However, most procedures performed with a cardiac catheter represent a reduced procedure time, hospital stay and recovery versus an open-heart surgery option.

Benefits of Cardiac Catheterization

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The most obvious benefit of cardiac catheterization is that it can often replace the need for invasive open techniques for certain procedures and in patients that qualify.

Patients that have intermediate risk of open surgery, and who otherwise may not have been able to have surgery, may benefit from the minimally invasive nature of cardiac catheterization. Further, the benefits extend to the postoperative period, where the risk of infection, blood loss, death and other serious complications are significantly reduced when compared to more invasive options.

Risks of Cardiac Catheterization

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Of course, as with any procedure, risks do exist with cardiac catheterization. Many of these risks are specific to the procedure being performed and will be discussed during a consultation with one of our surgeons. However, the most common risks of cardiac catheterization are the perforation of the wall of a blood vessel through which the catheter is being placed, as well as infection at the insertion site. Both complications are rare, with the former mitigated by choosing an experienced surgeon.

Most cardiac catheterizations use fluoroscopy or continuous X-rays that helps the surgeon see exactly where the catheter is located. For patient populations that are sensitive to a relatively high dose of radiation, further discussion is warranted to ensure the benefits of the procedure outweigh the risks.

Cardiac catheterization has allowed for the improvement of safety and effectiveness of many of the procedures we offer. As such, this technique has become a growing part of our practice’s focus. Cardiac catheterization represents a technological leap that has improved the patient experience immensely.

For many people, a physical exam and answering questions (medical history) are all that’s needed for a doctor to diagnose erectile dysfunction and recommend a treatment. If you have chronic health conditions or your doctor suspects that an underlying condition might be involved, you might need further tests or a consultation with a specialist.

Tests for underlying conditions might include:

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• Physical exam. This might include careful examination of your penis and testicles and checking your nerves for sensation.
• Blood tests. A sample of your blood might be sent to a lab to check for signs of heart disease, diabetes, low testosterone levels and other health conditions.
• Urine tests (urinalysis). Like blood tests, urine tests are used to look for signs of diabetes and other underlying health conditions.
• Ultrasound. This test is usually performed by a specialist in an office. It involves using a wandlike device (transducer) held over the blood vessels that supply the penis. It creates a video image to let your doctor see if you have blood flow problems. This test is sometimes done in combination with an injection of medications into the penis to stimulate blood flow and produce an erection.
• Psychological exam. Your doctor might ask questions to screen for depression and other possible psychological causes of erectile dysfunction.

Treatment

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The first thing your doctor will do is to make sure you’re getting the right treatment for any health conditions that could be causing or worsening your erectile dysfunction.

Depending on the cause and severity of your erectile dysfunction and any underlying health conditions, you might have various treatment options. Your doctor can explain the risks and benefits of each treatment and will consider your preferences. Your partner’s preferences also might play a role in your treatment choices.

Oral medications

Oral medications are a successful erectile dysfunction treatment for many men. They include:

• Sildenafil (Viagra)
• Tadalafil (Adcirca, Cialis)
• Vardenafil (Levitra, Staxyn)
• Avanafil (Stendra)

All four medications enhance the effects of nitric oxide — a natural chemical your body produces that relaxes muscles in the penis. This increases blood flow and allows you to get an erection in response to sexual stimulation.

Taking one of these tablets will not automatically produce an erection. Sexual stimulation is needed first to cause the release of nitric oxide from your penile nerves. These medications amplify that signal, allowing normal penile function in some people. Oral erectile dysfunction medications are not aphrodisiacs, will not cause excitement and are not needed in people who get normal erections.

The medications vary in dosage, how long they work and side effects. Possible side effects include flushing, nasal congestion, headache, visual changes, backache and stomach upset.

Your doctor will consider your particular situation to determine which medication might work best. These medications might not treat your erectile dysfunction immediately. You might need to work with your doctor to find the right medication and dosage for you.

Before taking any medication for erectile dysfunction, including over-the-counter supplements and herbal remedies, get your doctor’s OK. Medications for erectile dysfunction do not work in everyone and might be less effective in certain conditions, such as after prostate surgery or if you have diabetes. Some medications might also be dangerous if you:

• Take nitrate drugs — commonly prescribed for chest pain (angina) — such as nitroglycerin (Nitro-Dur, Nitrostat, others), isosorbide mononitrate (Monoket) and isosorbide dinitrate (Isordil, Bidil)
• Have heart disease or heart failure
• Have very low blood pressure (hypotension)

Other medications

Other medications for erectile dysfunction include:

• Alprostadil self-injection. With this method, you use a fine needle to inject alprostadil (Caverject, Edex) into the base or side of your penis. In some cases, medications generally used for other conditions are used for penile injections on their own or in combination. Examples include alprostadil and phentolamine. Often these combination medications are known as bimix (if two medications are included) or trimix (if three are included).Each injection is dosed to create an erection lasting no longer than an hour. Because the needle used is very fine, pain from the injection site is usually minor.Side effects can include mild bleeding from the injection, prolonged erection (priapism) and, rarely, formation of fibrous tissue at the injection site.
• Alprostadil urethral suppository. Alprostadil (Muse) intraurethral therapy involves placing a tiny alprostadil suppository inside your penis in the penile urethra. You use a special applicator to insert the suppository into your penile urethra.The erection usually starts within 10 minutes and, when effective, lasts between 30 and 60 minutes. Side effects can include a burning feeling in the penis, minor bleeding in the urethra and formation of fibrous tissue inside your penis.
• Testosterone replacement. Some people have erectile dysfunction that might be complicated by low levels of the hormone testosterone. In this case, testosterone replacement therapy might be recommended as the first step or given in combination with other therapies.

Penis pumps, surgery and implants

If medications aren’t effective or appropriate in your case, your doctor might recommend a different treatment. Other treatments include:

• Penis pumps. A penis pump (vacuum erection device) is a hollow tube with a hand-powered or battery-powered pump. The tube is placed over your penis, and then the pump is used to suck out the air inside the tube. This creates a vacuum that pulls blood into your penis.Once you get an erection, you slip a tension ring around the base of your penis to hold in the blood and keep it firm. You then remove the vacuum device.The erection typically lasts long enough for a couple to have sex. You remove the tension ring after intercourse. Bruising of the penis is a possible side effect, and ejaculation will be restricted by the band. Your penis might feel cold to the touch.

  If a penis pump is a good treatment choice for you, your doctor might recommend or prescribe a specific model. That way, you can be sure it suits your needs and that it’s made by a reputable manufacturer.

• Penile implants. This treatment involves surgically placing devices into both sides of the penis. These implants consist of either inflatable or malleable (bendable) rods. Inflatable devices allow you to control when and how long you have an erection. The malleable rods keep your penis firm but bendable.Penile implants are usually not recommended until other methods have been tried first. Implants have a high degree of satisfaction among those who have tried and failed more-conservative therapies. As with any surgery, there’s a risk of complications, such as infection. Penile implant surgery is not recommended if you currently have a urinary tract infection.

Exercise

Recent studies have found that exercise, especially moderate to vigorous aerobic activity, can improve erectile dysfunction.

Even less strenuous, regular exercise might reduce the risk of erectile dysfunction. Increasing your level of activity might also further reduce your risk.

Discuss an exercise plan with your doctor.

Psychological counseling

If your erectile dysfunction is caused by stress, anxiety or depression — or the condition is creating stress and relationship tension — your doctor might suggest that you, or you and your partner, visit a psychologist or counselor.

Lifestyle and home remedies

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For many people, erectile dysfunction is caused or worsened by lifestyle choices. Here are some steps that might help:

• If you smoke, quit. If you have trouble quitting, get help. Try nicotine replacement, such as over-the-counter gum or lozenges, or ask your doctor about a prescription medication that can help you quit.
• Lose excess pounds. Being overweight can cause — or worsen — erectile dysfunction.
• Include physical activity in your daily routine. Exercise can help with underlying conditions that play a part in erectile dysfunction in a number of ways, including reducing stress, helping you lose weight and increasing blood flow.
• Get treatment for alcohol or drug problems. Drinking too much or taking certain illegal drugs can worsen erectile dysfunction directly or by causing long-term health problems.
• Work through relationship issues. Consider couples counseling if you’re having trouble improving communication with your partner or working through problems on your own.

Alternative medicine

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Before using any supplement, check with your doctor to make sure it’s safe for you — especially if you have chronic health conditions. Some alternative products that claim to work for erectile dysfunction can be dangerous.

The Food and Drug Administration (FDA) has issued warnings about several types of “herbal viagra” because they contain potentially harmful drugs not listed on the label. The dosages might also be unknown, or they might have been contaminated during formulation.

Some of these drugs can interact with prescription drugs and cause dangerously low blood pressure. These products are especially dangerous for anyone who takes nitrates.

Coping and support

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Whether the cause is physical, psychological or a combination of both, erectile dysfunction can become a source of mental and emotional stress for you and your partner. Here are some steps you can take:

• Don’t assume you have a long-term problem. Don’t view occasional erection problems as a reflection on your health or masculinity, and don’t automatically expect to have erection trouble again during your next sexual encounter. This can cause anxiety, which might make erectile dysfunction worse.
• Involve your sexual partner. Your partner might see your inability to have an erection as a sign of diminished sexual interest. Your reassurance that this isn’t the case can help. Communicate openly and honestly about your condition. Treatment can be more successful for you when you involve your partner.
• Don’t ignore stress, anxiety or other mental health concerns. Talk to your doctor or consult a mental health provider to address these issues.

Polycystic ovary syndrome (PCOS) is a problem with hormones that happens during the reproductive years. If you have PCOS, you may not have periods very often. Or you may have periods that last many days. You may also have too much of a hormone called androgen in your body.

With PCOS, many small sacs of fluid develop along the outer edge of the ovary. These are called cysts. The small fluid-filled cysts contain immature eggs. These are called follicles. The follicles fail to regularly release eggs.

The exact cause of PCOS is unknown. Early diagnosis and treatment along with weight loss may lower the risk of long-term complications such as type 2 diabetes and heart disease.

What is polycystic ovarian syndrome?

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Polycystic ovarian syndrome (PCOS) is a hormonal imbalance caused by the ovaries (the organ that produces and releases eggs) creating excess male hormones. If you have PCOS, your ovaries produce unusually high levels of hormones called androgens. This causes your reproductive hormones to become imbalanced. As a result, people with PCOS often have erratic menstrual cycles, missed periods and unpredictable ovulation. Small cysts may develop on your ovaries (fluid-filled sacs) due to lack of ovulation (anovulation). However, despite the name “polycystic,” you do not need to have cysts on your ovaries to have PCOS.

PCOS is one of the most common causes of female infertility. It can also increase your risk for other health conditions. Your healthcare provider can treat PCOS based on your symptoms and if you have plans for having children.

Who can get PCOS?

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A woman can get PCOS any time after puberty. Most people are diagnosed in their 20s or 30s when they are trying to get pregnant. You may have a higher chance of getting PCOS if you are overweight or have obesity, or if other people in your family have PCOS.

What are the symptoms of PCOS?

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The symptoms of PCOS may include:

• Missed periods, irregular periods, or very light periods
• Ovaries that are large or have many cysts
• Excess body hair, including the chest, stomach, and back (hirsutism)
• Weight gain, especially around the belly (abdomen)
• Acne or oily skin
• Male-pattern baldness or thinning hair
• Infertility
• Small pieces of excess skin on the neck or armpits (skin tags)
• Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts

How is PCOS diagnosed?

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Your health care provider will ask about your medical history and your symptoms. You will also have a physical exam. This will likely include a pelvic exam. This exam checks the health of your reproductive organs, both inside and outside your body.

Some of the symptoms of PCOS are like those caused by other health problems. Because of this, you may also have tests such as:

• This test uses sound waves and a computer to create images of blood vessels, tissues, and organs. This test is used to look at the size of the ovaries and see if they have cysts. The test can also look at the thickness of the lining of the uterus (endometrium).
• Blood tests. These look for high levels of androgens and other hormones. Your health care provider may also check your blood glucose levels. And you may have your cholesterol and triglyceride levels checked.

Hat is the main cause of polycystic ovarian syndrome?

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The exact cause of PCOS is unknown. There is evidence that genetics play a role. Several other factors also play a role in causing PCOS:

• Higher levels of male hormones called androgens: High androgen levels prevent the ovaries from releasing eggs (ovulation), which causes irregular menstrual cycles. Irregular ovulation can also cause small, fluid-filled sacs to develop in the ovaries. High androgen also causes acne and excess hair growth in women.
• Insulin resistance: Increased insulin levels cause the ovaries to make and release male hormone (androgens). Increased male hormone, in turn, suppress ovulation and contribute to other symptoms of PCOS. Insulin helps your body processes glucose (sugar) and uses it for energy. Insulin resistance means your body doesn’t process insulin correctly, leading to high glucose levels in your blood. Not all individuals with insulin resistance have an elevated glucose or diabetes, but insulin resistance can lead to diabetes. Having overweight orobesity can also contribute to insulin resistance. An elevated insulin level, even if your blood glucose is normal, can indicate insulin resistance.
• Low–grade inflammation: People with PCOS tend to have chronic low-grade inflammation. Your healthcare provider can perform blood tests that measure levels of C-reactive protein (CRP) and white blood cells, which can indicate the level of inflammation in your body.

How is PCOS treated?

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Treatment for PCOS depends on a number of factors. These may include your age, how severe your symptoms are, and your overall health. The type of treatment may also depend on whether you want to become pregnant in the future.

If you do plan to become pregnant, your treatment may include:

• A change in diet and activity. A healthy diet and more physical activity can help you lose weight and reduce your symptoms. They can also help your body use insulin more efficiently, lower blood glucose levels, and may help you ovulate.
• Medications to cause ovulation.Medications can help the ovaries to release eggs normally. These medications also have certain risks. They can increase the chance for a multiple birth (twins or more). And they can cause ovarian hyperstimulation. This is when the ovaries release too many hormones. It can cause symptoms such as abdominal bloating and pelvic pain.

If you do not plan to become pregnant, your treatment may include:

• Birth control pills. These help to control menstrual cycles, lower androgen levels, and reduce acne.
• Diabetes medication. This is often used to lower insulin resistance in PCOS. It may also help reduce androgen levels, slow hair growth, and help you ovulate more regularly.
• A change in diet and activity. A healthy diet and more physical activity can help you lose weight and reduce your symptoms. They can also help your body use insulin more efficiently, lower blood glucose levels, and may help you ovulate.
• Medications to treat other symptoms. Some medications can help reduce hair growth or acne.

When should I seek medical care?

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If you have missed or irregular periods, excess hair growth, acne, and weight gain, call your doctor for an evaluation.

Key points

• PCOS is a very common hormone problem for women of childbearing age.
• Women with PCOS may not ovulate, have high levels of androgens, and have many small cysts on the ovaries.
• PCOS can cause missed or irregular menstrual periods, excess hair growth, acne, infertility, and weight gain.
• Women with PCOS may be at higher risk for type 2 diabetes, high blood pressure, heart problems, and endometrial cancer.
• The types of treatment for PCOS may depend on whether or not a woman plans to become pregnant. Women who plan to become pregnant in the future may take different kinds of medications.

Next steps

Tips to help you get the most from a visit to your health care provider:

• Before your visit, write down questions you want answered.
• Bring someone with you to help you ask questions and remember what your provider tells you.
• At the visit, write down the names of new medicines, treatments, or tests, and any new instructions your provider gives you.
• If you have a follow-up appointment, write down the date, time, and purpose for that visit.

In vitro fertilization (IVF) is a complex series of procedures used to help with fertility or prevent genetic problems and assist with the conception of a child.

During IVF, mature eggs are collected (retrieved) from ovaries and fertilized by sperm in a lab. Then the fertilized egg (embryo) or eggs (embryos) are transferred to a uterus. One full cycle of IVF takes about three weeks. Sometimes these steps are split into different parts and the process can take longer.

IVF is the most effective form of assisted reproductive technology. The procedure can be done using a couple’s own eggs and sperm. Or IVF may involve eggs, sperm or embryos from a known or anonymous donor. In some cases, a gestational carrier — someone who has an embryo implanted in the uterus — might be used.

Your chances of having a healthy baby using IVF depend on many factors, such as your age and the cause of infertility. In addition, IVF can be time-consuming, expensive and invasive. If more than one embryo is transferred to the uterus, IVF can result in a pregnancy with more than one fetus (multiple pregnancy).

Your doctor can help you understand how IVF works, the potential risks and whether this method of treating infertility is right for you.

What Is IVF?

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IVF is an assisted reproductive technology ideal for couples who haven’t been able to conceive naturally. The IVF process mimics natural fertilisation by uniting sperm and eggs in a petri dish, in a fastidiously controlled, carefully sanitised environment. Then, once fertilisation occurs, one or more embryos is transferred to the uterus for implantation.

Why it’s done

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In vitro fertilization (IVF) is a treatment for infertility or genetic problems. If IVF is performed to treat infertility, you and your partner might be able to try less-invasive treatment options before attempting IVF, including fertility drugs to increase production of eggs or intrauterine insemination — a procedure in which sperm are placed directly in the uterus near the time of ovulation.

Sometimes, IVF is offered as a primary treatment for infertility in women over age 40. IVF can also be done if you have certain health conditions. For example, IVF may be an option if you or your partner has:

• Fallopian tube damage or blockage. Fallopian tube damage or blockage makes it difficult for an egg to be fertilized or for an embryo to travel to the uterus.
• Ovulation disorders. If ovulation is infrequent or absent, fewer eggs are available for fertilization.
• Endometriosis. Endometriosis occurs when tissue similar to the lining of the uterus implants and grows outside of the uterus — often affecting the function of the ovaries, uterus and fallopian tubes.
• Uterine fibroids. Fibroids are benign tumors in the uterus. They are common in women in their 30s and 40s. Fibroids can interfere with implantation of the fertilized egg.
• Previous tubal sterilization or removal. Tubal ligation is a type of sterilization in which the fallopian tubes are cut or blocked to permanently prevent pregnancy. If you wish to conceive after tubal ligation, IVF may be an alternative to tubal ligation reversal surgery.
• Impaired sperm production or function. Below-average sperm concentration, weak movement of sperm (poor mobility), or abnormalities in sperm size and shape can make it difficult for sperm to fertilize an egg. If semen abnormalities are found, a visit to an infertility specialist might be needed to see if there are correctable problems or underlying health concerns.
• Unexplained infertility. Unexplained infertility means no cause of infertility has been found despite evaluation for common causes.
• A genetic disorder. If you or your partner is at risk of passing on a genetic disorder to your child, you may be candidates for preimplantation genetic testing — a procedure that involves IVF. After the eggs are harvested and fertilized, they’re screened for certain genetic problems, although not all genetic problems can be found. Embryos that don’t contain identified problems can be transferred to the uterus.
• Fertility preservation for cancer or other health conditions. If you’re about to start cancer treatment — such as radiation or chemotherapy — that could harm your fertility, IVF for fertility preservation may be an option. Women can have eggs harvested from their ovaries and frozen in an unfertilized state for later use. Or the eggs can be fertilized and frozen as embryos for future use.

Women who don’t have a functional uterus or for whom pregnancy poses a serious health risk might choose IVF using another person to carry the pregnancy (gestational carrier). In this case, the woman’s eggs are fertilized with sperm, but the resulting embryos are placed in the gestational carrier’s uterus.

Who Is Best Suited for IVF?

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IVF is often considered a last-line treatment when other treatments like ovulation induction and intrauterine insemination (IUI) have failed. For couples with some forms of infertility, it may be recommended as a first-line treatment. Some cases best suited for IVF include:

• Tubal infertility: A case of blocked or absent fallopian tubes, which prevents sperm from travelling to the egg, or blocks a fertilised egg from reaching the uterus

• Compromised sperm function: Problems with sperm production, morphology or motility

• Polycystic ovarian syndrome: A hormonal disorder that impedes ovulation and increases the risk of miscarriage

• Endometriosis: A condition where uterine tissue grows outside the uterus, causing scarring and adhesions

• Irregular menstrual cycles: Ovulatory dysfunction which leads to compromised egg quality and infrequent ovulation, minimising chances of conception

• Surrogacy: If a gestational carrier is opted for, IVF is essential to transfer the embryo to the surrogate’s uterus.

How you prepare

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Before beginning a cycle of IVF using your own eggs and sperm, you and your partner will likely need various screenings, including:

• Ovarian reserve testing. To determine the quantity and quality of your eggs, your doctor might test the concentration of follicle-stimulating hormone (FSH), estradiol (estrogen) and anti-mullerian hormone in your blood during the first few days of your menstrual cycle. Test results, often used together with an ultrasound of your ovaries, can help predict how your ovaries will respond to fertility medication.
• Semen analysis. If not done as part of your initial fertility evaluation, your doctor will conduct a semen analysis shortly before the start of an IVF treatment cycle.
• Infectious disease screening. You and your partner will both be screened for infectious diseases, including HIV.
• Practice (mock) embryo transfer. Your doctor might conduct a mock embryo transfer to determine the depth of your uterine cavity and the technique most likely to successfully place the embryos into your uterus.
• Uterine exam. Your doctor will examine the inside lining of the uterus before you start IVF. This might involve a sonohysterography — in which fluid is injected through the cervix into your uterus — and an ultrasound to create images of your uterine cavity. Or it might include a hysteroscopy — in which a thin, flexible, lighted telescope (hysteroscope) is inserted through your vagina and cervix into your uterus.

What Are the Steps of IVF?

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IVF usually follows a seven-step process, given below.

Step 1. Ovulation Induction

As a first step, fertility medication is administered to encourage the maturation of ovarian follicles. During this time, the fertility specialist will closely monitor hormone levels and ovarian progress to ensure the follicles are responding optimally.

Step 2. Egg Collection

Egg collection is a straightforward procedure, performed under anaesthesia. A fine needle is passed through the vagina to retrieve eggs from mature follicles.

Step 3. Fertilisation

Once the eggs and sperm have been collected, they are fused together to create several embryos. This process may or may not be performed using additional technologies, including PGS, PGD and ICSI.

Step 4. Embryo Development

Embryos are left to develop over a period of four to five days, until they have reached the blastocyst stage. They are then graded for quality and integrity.

Step 5. Embryo Transfer

Once the embryo is four or five days old, and has become a blastocyst, it is transferred to the uterus for implantation. You can choose to cryopreserve your remaining embryos for future use.

Step 6. Pregnancy

Two weeks after your embryo transfer, comes judgement day – the day you finally discover whether your procedure has been successful. If it has, it’s time for a little celebration. And two weeks later, time for an ultrasound scan to check for a heartbeat.

Step 7. Follow-Ups

Regular follow-ups are recommended after a successful IVF cycle, to rule out potential complications. You can use this time to ask your doctor questions and prepare yourself for the wonderful months ahead!

Advin IVF Kit

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• Sterile IUI Catheter
• Disposable Speculum
• Specimen Container
• Pasteur Pipette
• Sterile Centrifuge Test Tube

Heart transplant surgeries are a life-saving procedure for several people these days. People with diseased or weak hearts can lead a life like normal people. Their hearts can normally work after the transplantation.

In this procedure, the patient’s damaged heart is substituted with the donor’s healthy heart. The donor can either be a dead person or a patient whose brain is dead. You, of course, require their family’s consent to get the heart.

It is not a small surgery. A lot of things come around with it. That is why people have many myths and curiosities.

So, to quench your thirst for curiosities, we have brought the eight most important things that you must know about heart transplants.

Age is no barrier for heart transplants

There is no such age limit for a heart transplant. Even young children might suffer from a diseased heart and require heart transplantation. People in their old age, like the ’70s or ’80s, also get this surgery. Like the people in their twenties or thirties, the younger generation has also gone through heart transplant surgery. So there are no specific age criteria for heart transplantation.

You can lead a normal life after the transplant

The most important question is would the patient be normal after the transplantation? The survival chances after heart transplant surgeries have improved over the years. You can give birth to babies, normally work in your office, go on a vacation and do anything you want. You have to be a little careful that you do not exert much exertion.

The donor’s previous illness does not matter

If your heart’s donor was suffering from a fatal disease, it does not make a difference till his heart is healthy. You could borrow his heart even if he had kidney problems, viral disease, or any other illness apart from heart disease, for that matter.

Posttransplantation care is the root of a healthy life

The patient is a little fragile for the first six months after the transplantation. Therefore, they require extra care and monitoring. A special diet, regular check-ups, medications, everything has to be monitored. There will be some medicines that will go on for a lifetime. So, you will have to take care that you give them to your loved ones from time to time.

More than one organ transplantation is possible

A lot of heart transplant patients also have kidney damage. Therefore, the medical industry allows two or more organs to be transplanted. First, the heart is transplanted, and after a day or two, the second organ is transplanted.

Just physical care is not enough

Remember that a patient went through a heart transplant surgery because he was in immense pain. That pain has, of course, left him in a devastating condition, not just physically but also mentally. So, it becomes your utmost duty to support your loved ones mentally. They will gradually get over their physical pain, but it becomes your duty to improve their condition mentally.

Everyone has a different resistance strength

The fact that someone else’s heart is inserted changes the body. Everyone has a different resistance to a new heart. Each patient’s journey is different from how their bodies react to the new heart. Hence, you should not be influenced by someone else’s heart transplant journey. Some bodies accept the new heart immediately, while some never accept it.

The doctor might only consider a heart transplant if all other therapies have failed

Even if there is a little-bit ray of hope through another treatment or therapy, the doctor will not go for the transplant. Instead, the doctors choose this remedy when there is no other option left. And not just one doctor will decide it, but you need two or more consents to go ahead with a heart transplant surgery.

These were all the important points you must know regarding Heart transplant surgery. Always remember that panicking will not lead you anyway. So, please do not pay much attention to the myths regarding the surgery. Never get influenced by anybody else’s experience. You are supposed to make sure you stay calm and make the most crucial decision for yourself and your loved ones.

Pulmonology is a branch of medicine and a subspecialty of internal medicine. It specialises in the treatment of diseases that affect the respiratory system. It deals with all disorders of the lungs, upper airways, thoracic cavity, and the chest wall. It also deals with all problems that involve the nose, pharynx, larynx, trachea, bronchi, bronchioles, and alveoli.

Pulmonology is also part of intensive care medicine because it involves providing life support and mechanical ventilation to patients who need them. It is also known as pneumology and respiratory medicine. Its subspecialties include:

• Interstitial lung disease, which focuses on lung diseases caused by lung inflammation and scarring
• Interventional pulmonology, which deals with airway disorders, lung cancer, and pleural diseases
• Neuromuscular disease, which focuses on lung disorders caused by respiratory muscle failure
• Obstructive lung disease, which focuses on conditions caused by the narrowing or obstruction of the airways
• Lung transplantation
• Sleep-related breathing problems
• Paediatric pulmonology

What is pulmonology?

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Internal medicine is the type of medical care that deals with adult health, and pulmonology is one of its many fields. Pulmonologists focus on the respiratory system and diseases that affect it. The respiratory system includes your:

• Mouth and nose
• Sinuses
• Throat (pharynx)
• Voice box (larynx)
• Windpipe (trachea)
• Bronchial tubes
• Lungs and things inside them like bronchioles and alveoli
• Diaphragm

History of pulmonology

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One of the first major discoveries relevant to the field of pulmonology was the discovery of pulmonary circulation. Originally, it was thought that blood reaching the right side of the heart passed through small ‘pores’ in the septum into the left side to be oxygenated, as theorized by Galen; however, the discovery of pulmonary circulation disproves this theory, which had previously been accepted since the 2nd century. Thirteenth-century anatomist and physiologist Ibn Al-Nafis accurately theorized that there was no ‘direct’ passage between the two sides (ventricles) of the heart. He believed that the blood must have passed through the pulmonary artery, through the lungs, and back into the heart to be pumped around the body. This is believed by many to be the first scientific description of pulmonary circulation.

Although pulmonary medicine only began to evolve as a medical specialty in the 1950s, William Welch and William Osler founded the ‘parent’ organization of the American Thoracic Society, the National Association for the Study and Prevention of Tuberculosis. The care, treatment, and study of tuberculosis of the lung is recognised as a discipline in its own right, phthisiology. When the specialty did begin to evolve, several discoveries were being made linking the respiratory system and the measurement of arterial blood gases, attracting more and more physicians and researchers to the developing field.

Types Of Disease

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Lung Disease

Airway diseases — These diseases affect the tubes (airways) that carry oxygen and other gases into and out of the lungs. They usually cause a narrowing or blockage of the airways. Airway diseases include asthma, chronic obstructive pulmonary disease (COPD), bronchiolitis, and bronchiectasis (which also is the main disorder for persons with cystic fibrosis). People with airway diseases often say they feel as if they’re “trying to breathe out through a straw.”

Lung tissue diseases — These diseases affect the structure of the lung tissue. Scarring or inflammation of the tissue makes the lungs unable to expand fully (restrictive lung disease). This makes it hard for the lungs to take in oxygen and release carbon dioxide. People with this type of lung disorder often say they feel as if they are “wearing a too-tight sweater or vest.” As a result, they can’t breathe deeply. Pulmonary fibrosis and sarcoidosis are examples of lung tissue disease.

Lung circulation diseases — These diseases affect the blood vessels in the lungs. They are caused by clotting, scarring, or inflammation of the blood vessels. They affect the ability of the lungs to take up oxygen and release carbon dioxide. These diseases may also affect heart function. An example of a lung circulation disease is pulmonary hypertension. People with these conditions often feel very short of breath when they exert themselves.

Asthma

Asthma is a condition in which your airways narrow and swell and may produce extra mucus. This can make breathing difficult and trigger coughing, a whistling sound (wheezing) when you breathe out and shortness of breath.

For some people, asthma is a minor nuisance. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack.

Asthma can’t be cured, but its symptoms can be controlled. Because asthma often changes over time, it’s important that you work with your doctor to track your signs and symptoms and adjust your treatment as needed.

Pulmonary fibrosis

Pulmonary fibrosis is a lung disease that occurs when lung tissue becomes damaged and scarred. This thickened, stiff tissue makes it more difficult for your lungs to work properly. As pulmonary fibrosis worsens, you become progressively more short of breath.

The scarring associated with pulmonary fibrosis can be caused by a multitude of factors. But in most cases, doctors can’t pinpoint what’s causing the problem. When a cause can’t be found, the condition is termed idiopathic pulmonary fibrosis.

The lung damage caused by pulmonary fibrosis can’t be repaired, but medications and therapies can sometimes help ease symptoms and improve quality of life. For some people, a lung transplant might be appropriate.

Pneumonia

Pneumonia is an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus (purulent material), causing cough with phlegm or pus, fever, chills, and difficulty breathing. A variety of organisms, including bacteria, viruses and fungi, can cause pneumonia.

Pneumonia can range in seriousness from mild to life-threatening. It is most serious for infants and young children, people older than age 65, and people with health problems or weakened immune systems.

Chronic obstructive pulmonary disease (COPD)

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. Symptoms include breathing difficulty, cough, mucus (sputum) production and wheezing. It’s typically caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. People with COPD are at increased risk of developing heart disease, lung cancer and a variety of other conditions.

Emphysema and chronic bronchitis are the two most common conditions that contribute to COPD. These two conditions usually occur together and can vary in severity among individuals with COPD.

Chronic bronchitis is inflammation of the lining of the bronchial tubes, which carry air to and from the air sacs (alveoli) of the lungs. It’s characterized by daily cough and mucus (sputum) production.

Emphysema is a condition in which the alveoli at the end of the smallest air passages (bronchioles) of the lungs are destroyed as a result of damaging exposure to cigarette smoke and other irritating gases and particulate matter.

Although COPD is a progressive disease that gets worse over time, COPD is treatable. With proper management, most people with COPD can achieve good symptom control and quality of life, as well as reduced risk of other associated conditions.

Radiation therapy is a type of cancer treatment that uses beams of intense energy to kill cancer cells. Radiation therapy most often uses X-rays, but protons or other types of energy also can be used.

The term “radiation therapy” most often refers to external beam radiation therapy. During this type of radiation, the high-energy beams come from a machine outside of your body that aims the beams at a precise point on your body. During a different type of radiation treatment called brachytherapy (brak-e-THER-uh-pee), radiation is placed inside your body.

Radiation therapy damages cells by destroying the genetic material that controls how cells grow and divide. While both healthy and cancerous cells are damaged by radiation therapy, the goal of radiation therapy is to destroy as few normal, healthy cells as possible. Normal cells can often repair much of the damage caused by radiation.

Why it’s done

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More than half of all people with cancer receive radiation therapy as part of their cancer treatment. Doctors use radiation therapy to treat just about every type of cancer. Radiation therapy is also useful in treating some noncancerous (benign) tumors.

How radiation therapy is used in people with cancer?

Your doctor may suggest radiation therapy as an option at different times during your cancer treatment and for different reasons, including:

• As the only (primary) treatment for cancer
• Before surgery, to shrink a cancerous tumor (neoadjuvant therapy)
• After surgery, to stop the growth of any remaining cancer cells (adjuvant therapy)
• In combination with other treatments, such as chemotherapy, to destroy cancer cells
• In advanced cancer to alleviate symptoms caused by the cancer

How you prepare

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Before you undergo external beam radiation therapy, your health care team guides you through a planning process to ensure that radiation reaches the precise spot in your body where it’s needed. Planning typically includes:

• Radiation simulation. During simulation, your radiation therapy team works with you to find a comfortable position for you during treatment. It’s imperative that you lie still during treatment, so finding a comfortable position is vital. To do this, you’ll lie on the same type of table that’s used during radiation therapy. Cushions and restraints are used to position you in the right way and to help you hold still. Your radiation therapy team will mark the area of your body that will receive the radiation. Depending on your situation, you may receive temporary marking with a marker or you may receive small permanent tattoos.
• Planning scans. Your radiation therapy team will have you undergo computerized tomography (CT) scans to determine the area of your body to be treated.

After the planning process, your radiation therapy team decides what type of radiation and what dose you’ll receive based on your type and stage of cancer, your general health, and the goals for your treatment.

The precise dose and focus of radiation beams used in your treatment is carefully planned to maximize the radiation to your cancer cells and minimize the harm to surrounding healthy tissue.

What you can expect

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External beam radiation therapy is usually conducted using a linear accelerator — a machine that directs high-energy beams of radiation into your body.

As you lie on a table, the linear accelerator moves around you to deliver radiation from several angles. The linear accelerator can be adjusted for your particular situation so that it delivers the precise dose of radiation your doctor has ordered.

You typically receive external beam radiation on an outpatient basis five days a week over a certain period of time. In most instances, treatments are usually spread out over several weeks to allow your healthy cells to recover in between radiation therapy sessions.

Expect each treatment session to last approximately 10 to 30 minutes. In some cases, a single treatment may be used to help relieve pain or other symptoms associated with more-advanced cancers.

During a treatment session, you’ll lie down in the position determined during your radiation simulation session. You might be positioned with molds to hold you in place.

The linear accelerator machine may rotate around your body to reach the target from different directions. The machine makes a buzzing sound.

You’ll lie still and breathe normally during the treatment, which takes only a few minutes. For some patients with lung or breast cancer, you might be asked to hold your breath while the machine delivers the treatment.

Your radiation therapy team stays nearby in a room with video and audio connections so that you can talk to each other. You should speak up if you feel uncomfortable, but you shouldn’t feel any pain during your radiation therapy session.

Results

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If you’re receiving radiation to a tumor, your doctor may have you undergo periodic scans after your treatment to see how your cancer has responded to radiation therapy.

In some cases, your cancer may respond to treatment right away. In other cases, it may take weeks or months for your cancer to respond. Some people aren’t helped by radiation therapy.

The rest of the professional world might have embraced “continuous professional development” a decade or so ago, but it has always been a necessity for the medical professionals.

Billions are spend every year in lectures, seminars, conferences, training programs and related materials for keeping doctors and hospital staff up to date with the latest developments and technologies.

Those are not just for career advancement, as is often the case in other industries, but are demanded by law as a means for medical professionals to maintain their clinical competence.

Such laws can vary by country and specialty (with Arizona, for example, requiring an average of 40 hours of CME every two years, while some countries demand frequent re-certification for doctors and nurses to maintain their licenses).

eLearning technologies are a perfect fit for many aspects of continuing medical education, as they have lower costs, higher flexibility regarding time, require few resources and personnel to deploy, and can be easily updated as material changes.

eLearning is especially apt for situations were clinical or lab practice is not required, but with a capable learning management system it can also work alongside these, in a blended learning scenario.

Let’s see the benefits of E-Learning for CME one by one

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Cost

In today’s competitive medical landscape, spending tens of thousands of dollars (or millions, depending on your scale) on fancy training facilities and classrooms is a needless luxury. Factor in the cost of educators and the disruption in your clinic’s workflow due to the scheduling of classes and seminars, and it quickly adds up.

eLearning costs are comparatively trivial, costing less monthly for their overall operation than what it costs to send a single doctor to one of those frequent medical conferences. And, if you opt for a privately hosted or a public Cloud solution, you’ll be able to accommodate the training of tens to tens of thousands of doctors.

Time

As a healthcare professional or hospital manager, you know how precious a resource time is for doctors. Healthcare professionals are notoriously busy and overworked, and finding time for training can be problematic.

With eLearning, which is by nature asynchronous, doctors, nurses and other healthcare professionals can educate themselves at their own pace. And of course eLearning works remotely, enabling them to follow lessons from their office or home.

Updatability

Yes, that’s a word, and yes, it describes the ease with which you can update eLearning content perfectly.

And with techniques, medical theories and medical getting frequently outdated, new drugs being introduced all the time, and doctors having to learn to operate new (and very costly) equipment, you really want that updatability in your learning management system.

A modern LMS platform can trivially incorporate study material provided by the drug company or the medical equipment manufacturer, and of course all kinds of images, videos, visualizations and interactive animations.

This is especially important for medicine, where images and visualizations (x-rays, ECGs, ultrasounds, MRIs, anatomical diagrams and all kinds of scans, graphs and visuals) play a crucial role.

Accountability

eLearning can also be easily monitored, as it offers all the important feedback mechanisms (such as reporting and detailed statistics) to track the progress of individuals and teams and assess their performance.

For example, with the advanced reporting capabilities of our software, you can keep track of courses, groups of learners, or even specific individuals, and even automatically award specific certifications upon the successful completion of a course or a set of courses.

Onboarding

Another use of an eLearning management system in a medium or large medical facility is for employee orientation.

This is the task of introducing new hires to their working environment and giving them the basic information the need to start being productive.

This includes your hospital’s or clinic’s operating procedures, policies, restrictions and guidelines, as well as the ever more important education in professional ethics, and sexual and racial discrimination issues.

Conclusion

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eLearning is a perfect fit for a knowledge based profession such as medicine, where being kept up to date is not often crucial but a matter of life and death, time is a scarce resource, and competitiveness means you need to get maximum results with reduced costs.

If you work in a medical organization that hasn’t embraced eLearning yet, it’s not a question of “if” it will eventually embrace it, but of “when”. And that’s not just our opinion, but something that has been proven by the market: healthcare has been the industry with the most eLearning deployments in the US (followed by software and marketing companies).