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Actos Side Effects:  When applied to TCC, the term “superficial” can be misleading, and some doctors would like to see the term discontinued. Many people equate the term “superficial” with “not very risky,” which isn’t always the case. In general, superficial TCC at the low or intermediate risk levels is a highly treatable form of bladder cancer with a good chance for an excellent outcome despite a moderate to high rate of recurrence (depending on the extent and nature of the tumor). But as we discussed in Chapter 3, some superficial TCCs are considered high risk and cariy an elevated chance that the cancer will not onfy recur, but may have progressed to a more dangerous stage when it does recur.

Luckily, only about 20 percent of those who experience a recurrence are diagnosed with a more advanced type of bladder cancer. What this means is that “superficial” bladder cancer, if and when if recurs, will usually come back again as a superficial cancer that can be managed by local means. However/ understanding your prognosis and being informed about the cancer’s possibility of recurrence are important parts of your overall treatment process.

Make sure that your multidisciplinary team – which may include your urologist, oncologist, pathologist, and radiation oncologist – welcomes your active involvement in your treatment plan and thoroughly explains each step of the process to you. It is worth mentioning that noninvasive bladder cancer is usually managed by a urologist with support from the pathologist and usually does not require a full multidisciplinary team unless it recurs repeatedly.

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Most likely at this point you’ve undergone some of the diagnostic tests discussed in Chapter 2.YouVe had tissue biopsied and classified as superficial TCC, and you probably underwent a flexible cystoscopy, during which your doctor thoroughly examined your bladder wall and made a “map” of the location of abnormal tissue or tumors that other diagnostic tests have confirmed. Sometimes more than one tumor will be present in the bladder, so your urologist will be veiy careful to look at the whole organ from the inside. The next step for you is likely to be resection (removal of the tumor), unless youVe already had a surgical biopsy or rigid cystoscopy. In that case, your doctor may have done a resection to avoid your having to undergo a second surgical procedure under anesthesia.

Undergoing a resection sounds more intimidating than it actually is. Think of it as the removal of the piece of the bladder where the tumor or abnormal cells are growing. This may effectively clear the bladder of tumor, bringing it to a state where only healthy tissue remains. When you have a bladder resection by means of a cystoscopy, as opposed to invasive surgery, you won’t have an incision or stitches, as no external cutting or incision is required.

Resecting (sometimes called endoscopic resection) is performed under general anesthesia in a hospital setting. Your doctor will use a resectoscope, which resembles a somewhat larger cystoscope. Like a cystoscope, it has a lighted lens and is introduced into your bladder through your urethra. (Don’t worry; you’ll be asleep under anesthesia and receiving pain medication while this is happening.)

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Your doctor will fill your bladder with water or a nonirritating clear liquid such as glycine, which expands the bladder walls and makes it easier to see tumors and abnormalities. Guided by the map made during the initial cystoscopy your doctor will use a small wire loop (through which a high-energy electrical current runs) to remove the cancer, a margin of healthy tissue, and a small amount of muscle. Any remaining cells are removed with an electric current or sometimes a high-powered laser. Sometimes your doctor will also take a few random tissue samples from other areas of your bladder to make sure that abnormal cells aren’t developing elsewhere. The tumor, healthy tissue, and muscle are then sent to your pathologist for examination. A small amount of muscle tissue is included in the tissue sample so that the pathologist can make sure the tumor hasn’t spread into the muscle wall. A margin of healthy tissue is taken to help decrease the chances that abnormal cells remain in the bladder.

Resection is usually carried out as outpatient surgery. This means that you probably will be able to go home the same day. (You’ll need to bring a driver with you as you’ll still be recovering from anesthesia and won’t be sufficiently alert to drive a car.) You may have some blood in your urine for a few days after a resection, and you may experience pain or stinging upon urination. The stinging urination can be eased by drinking lots of fluids and by taking simple pain medications prescribed by your urologist. If either condition lingers longer than two or three days, if other painful conditions occur, or if the bleeding becomes extensive, call your doctor right away.

In some circumstances, your doctor may choose to insert a catheter into your bladder for a short time (usually only one to two days) after the surgery, to prevent blood clots from obstructing the flow of urine and causing discomfort. The catheter allows blood and urine to gently drain out of the bladder and also allows your doctor to irrigate your bladder to promote complete healing of the resected area. On rare occasions, doctors will recommend another resection procedure. Sometimes the pathologist wants to biopsy muscle tissue from deeper in the bladder wall. And sometimes the tumor is too large to be safely removed all at once.

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

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Actos Side Effects: The bladder is a balloon-shaped, muscular organ tucked into the pelvis and held in place by fibrous bands and muscle. The bladder is part of a system that includes the kidneys, ureters, and urethra. These work to process the waste products left behind after your body has taken out the nutrients it needs from the food you eat.

The bladder is lined on the inside by a tissue known as “urotheli- um,” the smooth layer that stretches as the bladder fills and prevents excreted material from being reabsorbed into the body. Underneath the urothelium is a mix of fibrous or supporting tissue and muscle, both of which help the bladder to expand (when full) and to contract and excrete urine at the appropriate time.

Not only does the urothelium line the bladder; it also is found as the lining tissue elsewhere in the urinary tract system, including in the ureters (the tubes that drain the kidneys), the urethra (the tube that drains urine from the bladder to the exterior of the body), and parts of the male prostate. Urothelial tissue, too, can sometimes develop cancer­ous changes known as urothelial malignancy. The most common type of urothelial malignancy is “transitional cell carcinoma.” (See Chapter 3.)

It’s important to note that when the urothelial tissue is exposed to cancer-causing substances, such as the breakdown products of ciga­rette smoke, the potential exists for cancerous changes to occur in multiple areas. That’s why when bladder cancer is suspected or con­firmed, the whole urinary tract is screened for the possible presence of other cancerous deposits. Other organs, such as the lungs, liver, skin, and intestinal tract, also process waste. These systems work together to balance the chemicals and water that your body needs to function properly.

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The urinary system processes urea, a specific waste product that is produced when protein-containing foods (such as a meat) are broken down in the digestive process.Urea is filtered through the kidneys and together with other waste by-products and water, becomes urine. This is carried by thin tubes called ureters to the bladder, where it is stored. Muscles in the walls of the ureters squeeze out small amounts of urine into the bladder on a constant basis, about every 10 seconds. A healthy bladder can hold about two cups of urine for up to five hours. Healthy adults produce about six cups of urine a day.

A strong muscle somewhat like a rubber band circles your bladder and keeps the urethra tightly closed until nerves in the bladder signal you that the bladder is full and it is time to urinate. Urinary problems include the inability to retain the urine in the normal fashion or to void urine from the body. Sometimes people experience the urge to urinate even if the bladder is not full. Sometimes this is caused by bacteria in the bladder, which can cause an infection called cystitis. This symptom can also be caused by local bladder irritation or by the development of cancer. As with all parts of the human body, the bladder can develop cancer, which can also cause problems with retaining or voiding urine.

The most common symptom of bladder cancer is hematuria, or blood visible in the urine, either with or without any accompanying pain. About 85 percent of the people diagnosed with bladder cancer notice blood in their urine, and it’s often what prompts them to seek med­ical attention.

In some cases, the presence of blood isn’t noticeable to the naked eye and can only be seen through a microscope, usually when a urine test is being done during a routine physical or when an infection of the urinary tract or bladder is suspected. A urine test can detect whether blood is present in the urine and can also rule out whether other things, such as food or medicines, are the cause of red or rusty-colored urine.

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Noticeable blood in the urine is a tricky symptom. It appears in varying colors and at irregular intervals, and as a result, you might overlook its significance or decide to wait and see whether it happens again before checking it out. For example, you may notice blood in your urine or drops of blood in your underwear two or three times in as many days, or you may see it on one occasion but after that your urine appears normal for days or weeks. The same thing can happen with a laboratory urinalysis, where red blood cells may be visible microscopically only intermittently.

You might experience a gush of With the major symptoms bright red blood or notice pink or rusty of bladder cancer acting in brown urine or even little clots of such a variable fashion, blood. To complicate things even appearing in different ways more, foods you eat such as beets or and sometimes disappearing blackberries may produce colored altogether, it’s important to urine, as do a number of medicines, see your doctor immediately food additives, and vitamins. If you notice blood or what

With the major symptoms of bladder you think might be blood in cancer acting in such a variable fash- your urine. ion, appearing in different ways and sometimes disappearing altogether, it’s important to see your doctor immediately if you notice blood or what you think might be blood in your urine. As with most cancers, the key to successfully managing bladder cancer is detecting it early and starting treatment as soon as possible.

Bladder cancer does not have a long list of symptoms, and many of the symptoms are typical of other, less severe conditions such as infections or benign tumors. Besides blood in the urine, your symp­toms can include pain or burning during urination, a feeling of having to urinate because of an uncomfortable fullness, or the need to get up frequently at night to urinate. You may also have symptoms such as backache, abdominal pain, and unplanned weight loss, or you may feel more tired and achy than usual.

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

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After the initial shock of being given a new diagnosis of cancer, a flood of emotions follow with fear and anxiety being foremost. Questions fill your mind:

How serious is it?

Can 1 be cured?

Am I going to die?

Will I suffer?

What treatments are available?

Can 1 do anything to improve my odds?

What side effects will occur from the treatments?

Will I lose time from work?

Will my insurance cover the cost?

Will I be disfigured?

Will my spouse and family be supportive?

Do 1 have a good doctor?

Bladder cancer, or any serious potentially life threatening illness is generally alien to most individuals. Suddenly, lives are changed and a new reality must be dealt with. Becoming a “patient” or worse “a cancer patient” is not only threatening, but a dreaded proposition. Cancer patients are not happy with the loss of autonomy, the invasion of privacy, the discomfort inflicted upon them and the demands on their time and quality of life. As a patient, being thrust into this altered identity, it is essential to seek out the information you need. Having a fundamental base of knowledge is a must when facing the issues and treatment decisions which lie ahead. In the following pages, together we will explore bladder cancer, a disease which is totally foreign to most of us until the diagnosis is made. I have chosen to present the information in a question and answer format, written in a conversational tone, as if I were having an extended consultation with one of my patients. The questions are typical of what individuals have asked over the years. 1 have covered the key issues and decisions the individual with bladder cancer may face. The answers are to the point and cover the essentials required to make an informed decision for most individuals. For others, a more detailed resource may be required. For helpful sources of additional information see the Appendix.

Each individual’s situation is unique. Decisions on treatment may be modified based on the patient’s preferences and values and altered by other considerations such as age and coexisting conditions. By becoming an individual knowledgeable of bladder cancer, you will be prepared to fully partner with your physician for your best possible outcome. To your companions and family members, this book will serve to answer the many questions and doubts that may arise. Having your loved ones informed and supportive is a big plus for the individual facing this new challenge.

The book is written in a logical sequence starting with finding a qualified urologist to the basics on bladder cancer, its assessment and treatment. At the end of the book, you will find chapters on complementary medicine, advance care planning, and hospice care. The book can be read in sequence or each chapter can serve as a resource covering the basics of the topic. It is my hope this book will help clarify the many issues and options individuals must face with bladder cancer. For family members, significant others and concerned friends, this resource should help improve your understanding and thus your ability to assist your loved one.

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Understanding bladder cancer is a tremendous first step that will assist you in your treatment. Having a qualified urologist administer the actual treatments and care for you is essential for the best possible outcome. In the following chapter, we will explore what you need to know to assure you have the right urologist.

BESIDES LEARNING ABOUT MY DISEASE, WHAT IS MY MOST IMPORTANT FIRST STEP?

Make sure you have an excellent urologist supervising your care. A urologist is a surgical specialist trained to care for conditions involving the male and female urinary tracts and the male reproductive system. The bladder is part of the urinary system, and a urologist is trained to care for problems involving it, including cancer.

IS IT IMPORTANT TO HAVE A BOARD CERTIFIED UROLOGIST?

A urologist board certified by The American Board of Urology has gone through an accredited urology training program (generally a four year program), following two years of internship and residency in surgery after four years of medical school. The urologist must be in practice after training and provide a detailed list of surgeries, including complications, over a twelve month period. The doctor will then take a two day oral and written test covering a wide spectrum of urology. If he passes, he is certified for a period of ten years. At the end of the ten year period, he must recertify to maintain his board status. Recertification entails a three month surgical and procedure log and a written test as well as reference letters from those in a position to judge the practicing urologist’s work. Any malpractice or judgments are also reviewed. Although being board certified does not guarantee you have an excellent urologist, it demonstrates that he has the fund of knowledge to practice urology competently. Even though board certification is voluntary, in today’s competitive environment more and more hospitals and insurance plans are requiring their specialists to be certified.

HOW CAN I TELL IF MY UROLOGIST IS BOARD CERTIFIED?

The urologist has worked hard to obtain board certification. The certificate from The American Board of Urology is often displayed openly in his office. If you do not see it, you can simply ask him or you can call 1-866-275-2267 or use this web site: www.certified doctor.org

SHOULD I TRY TO FIND A UROLOGIST WHO HAS BEEN IN PRACTICE FOR YEARS OR A NEWLY TRAINED ONE?

Surgery is a skill which can only be mastered with experience. The saying “practice makes perfect” definitely pertains to surgery. Although a urology training program offers the new physician years of training, his surgical skills will continue to improve with further experience. However, each individual physician has his own innate skills. Some more quickly learn and are simply better at the technical craft of surgery than others. For the most part, urologists finishing an accredited urology program have the training and skill set required to care for patients with bladder cancer.

Experience also counts. As a physician practices the art of medicine, his depth of knowledge and ability to treat grows. Ask your physician how long he has been treating patients with bladder cancer. If you require major surgery ask how many he has performed and if his complication rate matches what is expected.

Physicians by and large do improve as they practice, and all physicians are required to show that they are continuing to learn by partaking in continuing medical education, a requirement to remain licensed. Most physicians are compulsive in their medical practice and care deeply in the care they deliver. They continually strive to improve.

Some physicians may become “burned out” over the years as they continue to face the pressures of a busy medical practice. Similarly, towards the end of a surgeon’s career, technical skills may slip due to aging. New urologists are trained in the latest techniques and are familiar with recent medical literature, but may lack practical experience. In the end, recommendations from others and reputation may be your best guide to finding a qualified physician.

WHAT QUALITIES SHOULD MY UROLOGIST HAVE?

Ideally, you should have a competent, technically skilled surgeon who is also approachable and compassionate. You should be able to freely ask questions pertaining to your disease and treatment. Your physician should answer your questions forthrightly. Although some patients prefer a surgeon who will take over all aspects of care with no questions asked, most prefer in depth explanations, especially when alternatives exist and risks are involved.

Your urologist must be an individual who takes your concerns, priorities and values seriously. Your urologist should be a good communicator. It is his responsibility to keep you fully informed of your progress, make you aware immediately if things are not going well, and educate you fully in treatment alternatives. Your specific values should be incorporated into the decision process if alternatives are available. Even if your urologist makes a recommendation and you choose an alternative course (unless you are putting yourself in extreme jeopardy), he should honor your choice and continue his care of you. Becoming an educated patient will make your decision making process easier. Granted, your physician should provide you with the basics, however having time to review and digest the material will allow you to fully understand and accept your treatment regimen, providing you with peace of mind.

Beware of the physician who bombards you with statistics and studies and leaves the decision making to you. After all, you are not a physician and don’t have the practical hands on experience he does. Your physician should provide the facts and the statistics, guide you through the information, and make treatment recommendations based on your preferences.

You may find yourself emotionally distraught and overwhelmed. Having a physician on your side is invaluable. You should be able to trust your physician. Complete honesty on the part of your doctor in his care of you is a must. From the doctor’s point of view, trust is also a necessity. Physicians have an extremely difficult time dealing with individuals who do not trust them. Without trust, the physician patient relationship is extremely hindered.

Lastly, your urologist should be compassionate. Having cancer is tough enough, you shouldn’t have to deal with a rude or arrogant physician. Your urologist should be supportive at all times. He should treat you as an individual and not just as “another cancer patient.” People with bladder cancer will require long term follow up and care. Having a compassionate individual to work with will make a tremendous difference

HOW DO I FIND A GOOD BOARD CERTIFIED UROLOGIST?

A good starting point is your primary care physician. He will generally have a number of specialists to whom he generally refers his urology patients. If the primary care physician has been working with these urologists, he should have an appreciation of their skills and temperament. However, this does not mean he is referring you necessarily to the best available urologist in your area. His choices may be limited by insurance or hospital networks. An excellent source of information would be nurses who work in the operating room, recovery room or on the surgical floor where the urologist does his surgery. Asking friends or other individuals who have had experience with the urologist can also prove useful. After a little digging, you can often quickly learn what type of reputation the urologist has in the community. Generally, if an established urologist has a “good reputation” this is an indication that he has pleased many individuals with his care.

SHOULD I CHECK TO SEE HOW MANY TIMES MY UROLOGIST HAS BEEN SUED?

Given the litigious society we live in, most physicians can face at least one malpractice lawsuit during their careers. In urology, two of the most common causes of litigation would be a surgical mishap leading to a complication, or failure to diagnose cancer in a timely fashion.

Medicine is based on science, but also is an “art.” Individuals do not walk into their physicians offices with a diagnosis and treatment plan always readily apparent. Even the best intentioned, thorough physician will make mistakes. Most of these errors do not result in harm. On occasion they do, and a law suit may follow. If a physician develops a good working relationship with a patient, these bad outcomes more often than not are acknowledged and accepted without legal entanglement. Competent, busy physicians may be dealing with a higher mix of complicated patients, leading to a higher number of potential suits. Physicians who have poor “bed side manner” may find themselves dealing with more suits. If a physician has an inordinate number of suits, “red flags” should go up, as competency may be an issue.

For those individuals who wish to check out the malpractice history of their physician, you may request an inquiry from the National Practitioners Data Bank at: 1-800-767-6732 or check the web site: www.npdb-hipdb.com

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

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MY FAMILY WANTS ME TO GO FOR TREATMENT OF MY BLADDER CANCER TO THE “TEACHING HOSPITAL” IN THE CITY MY LOCAL UROLOGIST IS COMPETENT AND CARING AND I TRUST HIS JUDGEMENT SHOULD I LISTEN TO MY FAMILY AND SWITCH UROLOGISTS?

As we have discussed in the preceding questions, finding an excellent urologist to partner with is a must. A physician established at a “teaching hospital” (a hospital where physicians are trained in their respective fields of specialty) is at the minimum, competent. A large teaching or academic center would not risk its reputation on an individual who is sub par. Some individuals may be world class surgeons, but not all will be. An individual may be an average surgeon, but a gifted teacher or researcher, making them invaluable to their academic center. Your local community urologist will likely be an individual trained at one of these academic teaching hospitals. In addition, community hospitals also have credentialing and quality review programs to weed out incompetent physicians. In general, it is true the academic center will have more stringent standards and review of their staff. Nevertheless, excellent physicians can be found at the community hospital as well.

ISN’T IT TRUE THAT ACADEMIC OR TEACHING HOSPITALS WILL HAVE THE BEST TECHNOLOGY OR MOST UP TO DATE INFORMATION TO TREAT MY CANCER?

These hospitals generally are at the forefront of innovation regarding technological advances, testing and implementation of new surgical techniques and chemotherapeutic regimens. However, no one center can be excellent in all spheres of medicine. Each will have particular strengths and weaknesses. We are however, fortunate medical knowledge and innovation are shared openly via medical journals and conferences and other means of information exchange. New information and proven effective techniques are rapidly disseminated throughout the medical community. Some teaching hospitals may be “centers of excellence” for a particular procedure or innovative approach that is available at only a few sites in the country. There is naturally a lag time for some procedures to spread to the local level, and if in fact a new procedure carries substantial benefits compared to the standard, and is not available locally, then a referral may be appropriate.

Medical information is scrutinized in journals and reviewed at conferences. The newest treatment regimens for advanced cancer are explored in clinical trials to determine their efficacy and safety. It is only after they are proven that they become adopted as standard practice by most physicians. For the vast majority of individuals with bladder cancer, excellent, comprehensive treatment can be obtained at the local level. For those requiring more specialized care or for those unfortunate individuals with advanced cancer who desire experimental therapy via a clinical trial for their cancer, a referral to the appropriate center may be appropriate.

IF I HAVE MY MAJOR SURGERY PERFORMED AT A TEACHING HOSPITAL, WILL THE ATTENDING PHYSICIAN PERFORM MY SURGERY AND TAKE CARE OF ME AFTERWARDS?

At a teaching hospital, physicians are in training to master their skills before going out into “practice” in their respective fields. Interns are fresh out of medical school with limited practical training. Often they are referred to as PGY 1 (post graduate year 1). Years of training follow (PGY2, PGY3 etc.). Urology residents are required to generally have at least two years of training in a surgical program followed by four years in urology residency. It is the responsibility of the residency director to provide adequate training for these future urologists while assuring patient safety. Practically speaking, there are usually one or more attending physicians who supervise the work of the physicians in training. The attending physicians are board certified, experienced physicians who treat patients while simultaneously training physicians. The residents will be a key component in your care. They will be assessing you both pre- and post-operatively and will be writing orders directing your care. How much of the surgery they get to do is dependent on their years of training and their skills. They will be under the direct supervision of the attending physician. If you have concerns, you should address them with your attending physician.

MY UROLOGIST ALWAYS KEEPS ME WAITING, DOES THIS MEAN HE DOESN’T CARE?

Given the monetary pressures in today’s medical practice, some physicians are over booked and cannot see the allotted number of patients scheduled without delays. The theory behind this schedule is the expectation that a number of patients will not show for their appointment, allowing the physician to stay true to the schedule and not fall behind.

However, sometimes all of the patients do show, and the physician is delayed. Even with a carefully thought out schedule, emergencies may arise and some visits unexpectedly take longer than scheduled. The physician wants to devote the time and attention required for each individual. After all, you also expect the same time and attention during your visit. Even the most conscientious physician may find himself running behind in a busy medical practice. This lateness should be recognized by the physician who will often acknowledge it with an apology. If you find it distressing to wait more than fifteen minutes (a reasonable time to wait), you should discuss your feelings with your physician, who often can arrange an appointment at the beginning of the schedule when he will almost be guaranteed to be on time.

WILL THERE BE OTHER PHYSICIANS INVOLVED IN MY TREATMENT OF BLADDER CANCER?

You may need to be referred to an oncologist, a physician specialist in the medical therapy of cancer. At times, a referral to a radiation oncologist, a specialist who treats cancer with radiation, may be required. Other individuals may need to be consulted as well. It is important for your urologist to keep your primary care physician up to date so that he can coordinate your care and if required by your insurance plan, make the appropriate referrals.

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On a regular basis, magazine articles, books, and television shows implore those with major illnesses to seek out a second opinion. The general consensus is there is much to be gained and little to be lost, so why not seek out a second opinion? The issue certainly is more complicated than generally addressed, and deserves a review. The following chapter provides a second opinion on second opinions.

WHAT ABOUT SECOND OPINIONS?

In general, a competent physician will recommend a second opinion if there is uncertainty regarding your care. This uncertainty could involve the pathology report or debate regarding the most appropriate treatment options. Certainly if the pathology report is in question, a second opinion is mandatory! Your urologist should be able to spell out his treatment plans for you, what to expect and what alternatives may be required, depending on the seriousness of your disease. The plan may change over time as your disease improves or worsens.

You may need a second opinion if you are not doing well and your physician is unable to provide satisfactory explanations and solutions. Occasionally, your urologist may recommend a second opinion if your problem is unusual or particularly complicated. Having a physician you can trust is mandatory when dealing with cancer. Don’t let anyone pressure you into a second opinion if you feel confident in your physician’s abilities. On the other hand, if you are uncomfortable with your progress or a treatment recommendation, if you are not satisfied with the explanations given to you, don’t hesitate to seek out a second opinion. Your urologist should not feel threatened by this request as he wants you to feel comfortable with the plan of action. Only by partnering with your physician can he be most effective.

WILL MY UROLOGIST BE UPSET WHEN I REQUEST A SECOND OPINION?

Many physicians may feel slighted when a patient requests a second opinion. Your urologist may feel somehow you don’t trust his explanations, skill, or judgment. On the other hand, when a new patient faces a difficult or unexpected diagnosis, the urologist may find the request not at all unusual. It is important you explain to your urologist why you feel a second opinion is warranted. Urologists are professionals and will graciously facilitate your request. The experienced urologist comes to realize that despite his best efforts, some patients will seek a second opinion. If a patient is particularly concerned or nervous about a proposed treatment regimen, your urologist may welcome your request. Your urologist should facilitate your second opinion by sending appropriate records and telling you whether or not it is necessary for you to bring X rays or pathology slides with you. Your primary care physician may need to be contacted for the referral if your insurance requires it.

WHY DOESN’T MY UROLOGIST WANT ME TO GO FOR A SECOND OPINION?

Often, the urologist may believe the second opinion is unnecessary and will delay treatment. He may be concerned you will not only have a second opinion, but transfer your future care to the urologist providing the second opinion. He may believe that you may get bad advice. It is possible he may feel threatened the next urologist will not agree with his work up or care of you to date.

WHERE DO I FIND A SPECIALIST FOR A SECOND OPINION?

Start by asking your primary care physician. You may be able to see another urologist in your community. Do not see another urologist in the same group as a conflict of interest may deter a different opinion. If you are considering a different course of action, such as radiation or chemotherapy, a referral to the appropriate specialist should be made.

Many times your urologist will be highly supportive and suggest a second opinion. He will offer his recommendations and facilitate your visit to the appropriate physician. If there is an issue regarding the care given at your local hospital, you may wish a referral to a “tertiary” or teaching hospital. In most areas, a referral for this reason is unnecessary, as excellent care is obtainable in the community hospital.

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

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Actos Side Effects: The basic building block of the body is the cell. Cells are specialized to perform a particular function. Skin cells are distinctly different from liver cells which are different from bladder cells. An organ is composed of various cells working in unison to carry out a body function. Cells eventually get old and die. New cells are created by cell division. When cells are behaving normally, they only generate enough new cells to replace the old dying ones. Occasionally, cell growth becomes unchecked. As the cells continue to divide, a tumor (abnormal growth of cells) may form. Such tumors may be benign (no ability to spread beyond their organ of origin) or cancerous (a malignant tumor with the ability to spread beyond their organ of origin and cause harm and possibly death).

Cell growth is closely regulated by genes which are composed of DNA located in the command center of the cell, the nucleus. When the genes become defective, cell growth can become unregulated, and tumors can develop. Oncogenes, also called cancer genes, can be activated, resulting in uncontrolled cell growth. Other genes which help prevent abnormal cell growth called tumor suppressor genes may be inactivated. Genes can be activated which enhance the tumor cell’s ability to spread throughout the body. The body’s immune system is a critical safeguard against the formation of cancerous tumors, often destroying the abnormal cells before they have a chance to grow and divide.

Cancer cells can spread throughout the body. They can spread through the lymphatic system, composed of lymph channels and lymph nodes, or distantly to other organs or the skeleton via the blood stream (hematogenous spread). In the case of bladder cancer, the cells can also spread by being carried in the urine and implanting in other locations in the urinary tract.

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In the case of bladder cancer, pathologists classify them into 3 grades based on a number of criteria:

Grade 1: low grade, well differentiated Grade 2: intermediate grade, moderately differentiated Grade 3: high grade, poorly differentiated The higher grade tumors have a greater propensity to metastasize- spread throughout the body.

For bladder cancer, another key indicator for likelihood to spread is the depth of penetration into the bladder wall. The bladder wall is composed of an inner lining called the urothelium (made up of transitional cells) which rests on a membrane layer called the basement membrane, below which is the connective tissue layer (support tissues) called the lamina propria. Within the lamina propria lies a small amount of muscle called the muscularis mucosa. Deep to the lamina propria is the deep muscle of the bladder arranged in three layers. This layer is called the muscularis propria. Tumors located in the inside, superficial layers of the bladder wall are unlikely to spread. Tumors that grow into the deeper layers (down into the muscle of the bladder wall) are much more likely to spread. Furthermore, there is a definite link between the grade of the tumor and its likelihood of invasion. Low grade tumors are almost always noninvasive, while high grade tumors are usually invasive.

In general, papillary tumors, which are delicate and frond like in appearance are usually low grade and superficial. This is to be contrasted to sessile tumors which appear solid, are often high grade and invasive. Depth of invasion is critical in establishing prognosis. The tumor which invades into the lamina propria is a far more serious tumor than the superficial tumor which demonstrates no invasion. It has a much higher propensity to progress to the muscle invasive tumor, a much more dangerous cancer, with a high risk for spreading beyond the bladder.

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When an individual has gross hematuria or persistent microscopic hematuria, a complete assessment of the urinary tract is required. Although cystoscopy is the test of choice for examination of the bladder, imaging studies are required to make sure there is no disease in the upper tracts (kidneys and ureters). Bleeding can be caused from many different disorders including transitional cell carcinoma of the upper tracts, kidney or ureteral stones, or renal cell carcinoma (cancer of the parenchyma or fleshy part of the kidneys). Your urologist has a number of options to choose from. There are advantages and disadvantages of each.

Intravenous pyelogram (IVP) is accomplished by injecting a contrast agent into your vein and then obtaining X ray images. The contrast is excreted by your kidneys, subsequently filling the lumen of the kidneys, ureters and the bladder. The contrast allows one to see subtle filling defects within chambers of the urinary tract, possibly representing tumor, stone or blood clot. Tumors of the fleshy part of the kidneys can also be seen. The study also allows for an assessment of renal function. It is a sensitive test for renal obstruction, which can occur because of cancer. Disadvantages of the study include the possibility of an IV contrast agent allergy, which occasionally may be serious.

You will be asked whether you have a sea food allergy, a known allergy to iodine or to IV contrast. If this is the case, you may need to be premedicated prior to the exam to avoid a reaction. Although the study is quite useful at visualizing the upper tracts, it is not very good at picking up subtle tumors on the bladder surface. If your kidneys do not function well (you have renal insufficiency), the contrast may cause harm to your kidneys and the imaging will not be as good. For pregnant women, any X ray exam could be potentially damaging to the fetus and therefore, will not be performed.

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

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

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Actos Side Effects: Saridon (phenacetin) and Cytoxan (cyclophosphamide) are two other substances that can increase your risk of bladder cancer. Phenacetin is a pain medicine that is no longer used that was previously shown to be associated with bladder cancer. Cytoxan is a drug used for chemotherapy that has been associated with bladder cancer. This may sound puzzling as you wonder, “how does one drug used to treat cancer cause another cancer?” Cytoxan itself is not the problem. Most medications are broken down by our bodies into components before being eliminated in our stool or urine. One of the byproducts of cyclophosphamide, called acrolein, can irritate the wall of your bladder, causing a lot of blood in your urine. Over time, this can increase the risk of developing bladder cancer.

A history of radiation therapy for a pelvic cancer may increase your risk of bladder cancer. Radiation has a role in the treatment of prostate, cervical, and ovarian cancers. Although the radiation is focused on the involved organ, the bladder and other surrounding structures also absorb radiation that sometimes damages the urothelium and leads to cancer.

Much attention has been paid to the influence of diet on cancer risk and treatment. Thus far, some scientists have suggested that vegetables, fresh fruits, and some fermented milk products appear to decrease one’s risk of developing bladder cancer. A few foods thought to increase the risk of developing bladder cancer are foods rich in animal fat, diose containing a lot of cholesterol, fried foods, and pro­cessed meat with various additives. We are not sure of the exact influence of diet on bladder cancer at this point in time. Scientists around the world are working on uncover­ing potential links between diet and bladder cancer.

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As with other cancers that affect different body parts, there are multiple types of bladder cancer. To better understand them, let’s separate bladder cancer into two different groups: primary tumors that originate in the bladder and secondary tumors that spread to the bladder from other places. Primary bladder cancers form within the bladder. Over 90 percent of primary bladder cancers in the United States are of the urothelial or transitional subtype. These form along the inner lining of the bladder. The second most common type of primary bladder cancer in the United States is squa­mous cell carcinoma, making up approximately 5 percent of all cancers diagnosed. These are often diagnosed in indi­viduals whose bladder has been chronically irritated by an infection, stones, or an indwelling catheter. The third most common subtype of bladder cancer in the United States is adenocarcinoma, accounting for approximately 2 percent of all diagnosed cases. These typically form near the dome of the bladder. There are other types of primary bladder cancer, but these are very rare. If necessary, your urologist will speak to you about these rare types.

Secondary cancers form somewhere else in the body and spread to the bladder. Other tumors can get to the blad­der by using the bloodstream, your lymphatic system, or directly from an organ close to the bladder. Other cancers that spread to the bladder, in order of decreasing frequency, are melanoma, colon cancer, prostate cancer, lung cancer, and breast cancer. Now that we’ve discussed some of the basics concerning bladder cancer, let’s examine how you should go about choosing a medical team to treat your cancer.

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You want your team to be knowledgeable and experienced in the care of patients with bladder cancer. Don’t rely on self-promoting advertisements on television as your way to select a facility and doctor. While you may seek out a com­prehensive cancer center (look for one accredited by Amer­ican College of Surgeons or National Cancer Institute), the important thing is that you select a facility that has bladder cancer specialists. These include urologists that specialize in cancer surgeries (not general urologists or surgeons who rarely perform cancer-related surgery), medical oncologists who specialize in bladder cancer, radiation oncologists, urologic pathologists, radiologists, genetics counselors, oncology nurses, and psychosocial support staff for cancer patients. It’s a highly specialized group. Your doctors and their staffs can be some of your best resources.

When you see your urologist, ask questions:

• How many bladder cancer surgeries do you do a year?

• What other types of surgeries do you do, and therefore how much time do you spend doing bladder cancer treatment?

• How often do your patients require additional treat­ment such as chemotherapy or radiation after surgery?

• What is the best urinary diversion option for me (ileal conduit, catheterizable stoma, neobladder) and why?

• Are you board certified? In what specialty?

• How long have you been in practice?

• Do you regularly attend urologic cancer tumor boards to present cases for team discussion?

• Do you work with a multidisciplinary team of oncolo­gists who also specialize in bladder cancer so that con­tinuity of care can be maintained?

• What is your philosophy on educating patients about their treatment options?

These are all questions that you have the right to have an­swered before deciding that this doctor is to be your uro- logic oncology surgeon. If he or she hesitates before an­swering, consider that this person may not be the doctor you want to have performing your surgery.

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

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

Actos Side Effects: Saridon (phenacetin) and Cytoxan (cyclophosphamide) are two other substances that can increase your risk of bladder cancer. Phenacetin is a pain medicine that is no longer used that was previously shown to be associated with bladder cancer. Cytoxan is a drug used for chemotherapy that has been associated with bladder cancer. This may sound puzzling as you wonder, “how does one drug used to treat cancer cause another cancer?” Cytoxan itself is not the problem. Most medications are broken down by our bodies into components before being eliminated in our stool or urine. One of the byproducts of cyclophosphamide, called acrolein, can irritate the wall of your bladder, causing a lot of blood in your urine. Over time, this can increase the risk of developing bladder cancer.

A history of radiation therapy for a pelvic cancer may increase your risk of bladder cancer. Radiation has a role in the treatment of prostate, cervical, and ovarian cancers. Although the radiation is focused on the involved organ, the bladder and other surrounding structures also absorb radiation that sometimes damages the urothelium and leads to cancer.

Much attention has been paid to the influence of diet on cancer risk and treatment. Thus far, some scientists have suggested that vegetables, fresh fruits, and some fermented milk products appear to decrease one’s risk of developing bladder cancer. A few foods thought to increase the risk of developing bladder cancer are foods rich in animal fat, diose containing a lot of cholesterol, fried foods, and pro­cessed meat with various additives. We are not sure of the exact influence of diet on bladder cancer at this point in time. Scientists around the world are working on uncover­ing potential links between diet and bladder cancer.

More information on Actos Side Effects

As with other cancers that affect different body parts, there are multiple types of bladder cancer. To better understand them, let’s separate bladder cancer into two different groups: primary tumors that originate in the bladder and secondary tumors that spread to the bladder from other places. Primary bladder cancers form within the bladder. Over 90 percent of primary bladder cancers in the United States are of the urothelial or transitional subtype. These form along the inner lining of the bladder. The second most common type of primary bladder cancer in the United States is squa­mous cell carcinoma, making up approximately 5 percent of all cancers diagnosed. These are often diagnosed in indi­viduals whose bladder has been chronically irritated by an infection, stones, or an indwelling catheter. The third most common subtype of bladder cancer in the United States is adenocarcinoma, accounting for approximately 2 percent of all diagnosed cases. These typically form near the dome of the bladder. There are other types of primary bladder cancer, but these are very rare. If necessary, your urologist will speak to you about these rare types.

Secondary cancers form somewhere else in the body and spread to the bladder. Other tumors can get to the blad­der by using the bloodstream, your lymphatic system, or directly from an organ close to the bladder. Other cancers that spread to the bladder, in order of decreasing frequency, are melanoma, colon cancer, prostate cancer, lung cancer, and breast cancer. Now that we’ve discussed some of the basics concerning bladder cancer, let’s examine how you should go about choosing a medical team to treat your cancer.

Information from other sources on Actos Side Effects

You want your team to be knowledgeable and experienced in the care of patients with bladder cancer. Don’t rely on self-promoting advertisements on television as your way to select a facility and doctor. While you may seek out a com­prehensive cancer center (look for one accredited by Amer­ican College of Surgeons or National Cancer Institute), the important thing is that you select a facility that has bladder cancer specialists. These include urologists that specialize in cancer surgeries (not general urologists or surgeons who rarely perform cancer-related surgery), medical oncologists who specialize in bladder cancer, radiation oncologists, urologic pathologists, radiologists, genetics counselors, oncology nurses, and psychosocial support staff for cancer patients. It’s a highly specialized group. Your doctors and their staffs can be some of your best resources.

When you see your urologist, ask questions:

• How many bladder cancer surgeries do you do a year?

• What other types of surgeries do you do, and therefore how much time do you spend doing bladder cancer treatment?

• How often do your patients require additional treat­ment such as chemotherapy or radiation after surgery?

• What is the best urinary diversion option for me (ileal conduit, catheterizable stoma, neobladder) and why?

• Are you board certified? In what specialty?

• How long have you been in practice?

• Do you regularly attend urologic cancer tumor boards to present cases for team discussion?

• Do you work with a multidisciplinary team of oncolo­gists who also specialize in bladder cancer so that con­tinuity of care can be maintained?

• What is your philosophy on educating patients about their treatment options?

These are all questions that you have the right to have an­swered before deciding that this doctor is to be your uro- logic oncology surgeon. If he or she hesitates before an­swering, consider that this person may not be the doctor you want to have performing your surgery.

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

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

http://www.seedol.com

Actos Side Effects: The urethra is a hollow tube lined with transitional cells at its beginning that connects the bladder to the outside world. The structure of the urethra is different in men and women. The urethra is short in women and is much longer in men due to the presence of the penis. The cells lining the urethra change along its length. The inner cells, closest to the bladder, are transitional cells, whereas the cells closest to the outside of the body are squamous cells resembling skin. Although the urethra has different lengths in men and women, it functions the same. In men, the urethra passes through the prostate gland near the bladder.

The prostate, a walnut-sized organ that lies at the base of the bladder in men, plays a role in male fertility. Along with the seminal vesicles, the prostate gland produces fluid that helps sperm after ejaculation. Although the urethra passes through the prostate, the gland itself does not add much, if anything, to the volume of urine that reaches the bladder. As the urethra passes through the prostate, it is lined by transitional cells comprising the urothelium. Therefore, tilings that affect the urothelium can affect the prostate as well. This is very important when it comes to staging bladder cancer.

Cancer is defined as a group of diseases characterized by uncontrolled growth and spread of abnormal cells. Cells are the small building blocks of our body and most other living organisms. If the spread of these abnormal cells is not controlled, it can result in organ dysfunction and death. There are several cancers, each affecting various portions of the body. Cancer can be caused by external factors like ciga­rette smoking, exposure to certain chemicals, radiation, or infectious organisms. Internal factors that can lead to can­cer include inherited mutations, hormones, and conditions affecting your immune system. Mutations are permanent changes in your hereditary material, and hormones are products of certain cells in our body that influence the function of other cells.

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Although scientists have been able to uncover the cause of some cancers, there is still a great deal to be learned. One may go through his or her entire life without exposure to any of the previously mentioned factors and develop can­cer. Men have a higher risk of developing cancer, with a slightly less than i in 2 lifetime risk in the United States compared with 1 in 3 for women. Although cancer is more common than you may think, doctors have figured out new ways to diagnose and treat cancer. By no means is cancer a death sentence; it can be managed and a lot of people diag­nosed go on to live healthy and productive lives for many years after treatment.

Epidemiology is essentially the study of factors affecting the health and illness of populations. Before moving on with our discussion about bladder cancer, it’s important to gain perspective on how many people live with bladder cancer.

There are over 1 million people throughout the world liv­ing with bladder cancer. Bladder cancer is the seventh or ninth most common cancer, depending on where you live. Most individuals with bladder cancer live in industrialized countries and geographical areas where infection with the parasite Schistosoma haematobium is common. In the United States bladder cancer is the fourth most common cancer in men and the ninth most frequently diagnosed cancer in women. The male-to-female ratio is 3 to 1. Two- thirds of cases are diagnosed in people over age So, but it can occur very early in life. Two times as many whites will be diagnosed with bladder cancer compared with African Americans. The reasons for this are unclear.

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Ludwig Rehn, a German surgeon during the 19th centu­ry, is credited with the first explanation of one of the root causes of bladder cancer. He established a link between exposure to chemicals used in the production of colored textiles and the development of bladder cancer in factory workers. Although his discovery was not initially accepted, bladder cancer was soon recognized as an occupational cancer in factory workers. This may help explain the higher incidence of bladder cancer in industrialized nations. Exposure to a number of chemicals has been associated with the development of bladder cancer. These include ani­line dyes and other members of the aromatic amine family. People who work in occupations where exposure to these chemicals is common include textile workers, dye workers, rubber workers, painters, and even hairdressers.

Smoking is the most common cause of bladder cancer today. It increases your risk of developing bladder cancer 2- to 4-fold compared with people who don’t smoke. The risk of bladder cancer increases with the frequency and duration of smoking. For example, someone who smokes one pack a day for 20 years has a higher risk of bladder cancer than someone who smokes a few cigarettes on week­ends. When you stop smoking you can slowly decrease the risk of bladder cancer, over the course of 20-30 years. If you currently smoke, it would be best to stop smoking.

Chronic inflammation of your bladder may also place you at an increased risk of developing a specific type of bladder cancer called squamous cell carcinoma. Inflammation occurs when one has an untreated urinary tract infection, bladder stones, an indwelling bladder catheter, or an infec­tion with a parasite called Schistosoma haematobium. Para­plegics or quadriplegics who require a catheter to drain their bladders and those who live in areas where S. haema­tobium is common are at greatest risk.

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

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

http://www.seedol.com

Actos Side Effects:  Bladder cancer, or any serious potentially life threatening illness is generally alien to most individuals. Suddenly, lives are changed and a new reality must be dealt with. Becoming a “patient” or worse “a cancer patient” is not only threatening, but a dreaded proposition. Cancer patients are not happy with the loss of autonomy, the invasion of privacy, the discomfort inflicted upon them and the demands on their time and quality of life. As a patient, being thrust into this altered identity, it is essential to seek out the information you need. Having a fundamental base of knowledge is a must when facing the issues and treatment decisions which lie ahead. In the following pages, together we will explore bladder cancer, a disease which is totally foreign to most of us until the diagnosis is made. I have chosen to present the information in a question and answer format, written in a conversational tone, as if I were having an extended consultation with one of my patients. The questions are typical of what individuals have asked over the years. 1 have covered the key issues and decisions the individual with bladder cancer may face. The answers are to the point and cover the essentials required to make an informed decision for most individuals. For others, a more detailed resource may be required.

Each individual’s situation is unique. Decisions on treatment may be modified based on the patient’s preferences and values and altered by other considerations such as age and coexisting conditions. By becoming an individual knowledgeable of bladder cancer, you will be prepared to fully partner with your physician for your best possible outcome. To your companions and family members, this book will serve to answer the many questions and doubts that may arise. Having your loved ones informed and supportive is a big plus for the individual facing this new challenge.

The book is written in a logical sequence starting with finding a qualified urologist to the basics on bladder cancer, its assessment and treatment. At the end of the book, you will find chapters on complementary medicine, advance care planning, and hospice care. The book can be read in sequence or each chapter can serve as a resource covering the basics of the topic. It is my hope this book will help clarify the many issues and options individuals must face with bladder cancer. For family members, significant others and concerned friends, this resource should help improve your understanding and thus your ability to assist your loved one.

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A urologist board certified by The American Board of Urology has gone through an accredited urology training program (generally a four year program), following two years of internship and residency in surgery after four years of medical school. The urologist must be in practice after training and provide a detailed list of surgeries, including complications, over a twelve month period. The doctor will then take a two day oral and written test covering a wide spectrum of urology. If he passes, he is certified for a period of ten years. At the end of the ten year period, he must recertify to maintain his board status. Recertification entails a three month surgical and procedure log and a written test as well as reference letters from those in a position to judge the practicing urologist’s work. Any malpractice or judgments are also reviewed. Although being board certified does not guarantee you have an excellent urologist, it demonstrates that he has the fund of knowledge to practice urology competently. Even though board certification is voluntary, in today’s competitive environment more and more hospitals and insurance plans are requiring their specialists to be certified.

Surgery is a skill which can only be mastered with experience. The saying “practice makes perfect” definitely pertains to surgery. Although a urology training program offers the new physician years of training, his surgical skills will continue to improve with further experience. However, each individual physician has his own innate skills. Some more quickly learn and are simply better at the technical craft of surgery than others. For the most part, urologists finishing an accredited urology program have the training and skill set required to care for patients with bladder cancer. Experience also counts. As a physician practices the art of medicine, his depth of knowledge and ability to treat grows. Ask your physician how long he has been treating patients with bladder cancer. If you require major surgery ask how many he has performed and if his complication rate matches what is expected.

Physicians by and large do improve as they practice, and all physicians are required to show that they are continuing to learn by partaking in continuing medical education, a requirement to remain licensed. Most physicians are compulsive in their medical practice and care deeply in the care they deliver. They continually strive to improve.

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Your urologist must be an individual who takes your concerns, priorities and values seriously. Your urologist should be a good communicator. It is his responsibility to keep you fully informed of your progress, make you aware immediately if things are not going well, and educate you fully in treatment alternatives. Your specific values should be incorporated into the decision process if alternatives are available. Even if your urologist makes a recommendation and you choose an alternative course (unless you are putting yourself in extreme jeopardy), he should honor your choice and continue his care of you. Becoming an educated patient will make your decision making process easier. Granted, your physician should provide you with the basics, however having time to review and digest the material will allow you to fully understand and accept your treatment regimen, providing you with peace of mind.

Beware of the physician who bombards you with statistics and studies and leaves the decision making to you. After all, you are not a physician and don’t have the practical hands on experience he does. Your physician should provide the facts and the statistics, guide you through the information, and make treatment recommendations based on your preferences.

You may find yourself emotionally distraught and overwhelmed. Having a physician on your side is invaluable. You should be able to trust your physician. Complete honesty on the part of your doctor in his care of you is a must. From the doctor’s point of view, trust is also a necessity. Physicians have an extremely difficult time dealing with individuals who do not trust them. Without trust, the physician patient relationship is extremely hindered.

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

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

http://www.seedol.com