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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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WHAT IS THE FUNCTION OF THE BLADDER?

A bladder stores urine and expels it at a convenient time. The bladder is a very useful organ, (tissues working together to accomplish a function), but an individual can live a normal life without one, if required, by surgical creation of a substitute.

ARE THERE DIFFERENT TYPES OF BLADDER CANCER?

More than 90% of bladder cancers arise from the lining bladder cells called transitional cells. Bladder cancer is almost always transitional cell cancer. These cells are also present in the urethra (the body tube which drains the bladder), as well as the renal pelvis (inner lining of the kidneys), and the ureters (the body tube draining the kidneys).

Bladder cancer can vary from the non serious, low grade superficial type (approximately 70%), to the invasive, aggressive type that can spread and prove to be fatal (approximately 30%).

5% of bladder cancer is accounted for by squamous cell carcinoma. This cancer is usually secondary to long term inflammation or infection of the bladder. Even rarer is adenocarcinoma, which accounts for less than 2% of all bladder cancers.

HOW COMMON IS BLADDER CANCER?

The American Cancer Society estimates that in 2006,61,420 new cases of bladder cancer were diagnosed in the United States with approximately 73% of those occurring in men. In the same year, this cancer caused approximately 13,060 deaths with approximately two out of three of those being in men. The disease is more common in whites than blacks. The incidence of bladder cancer increases with age in both sexes. When bladder cancer occurs in young people, it tends to grow slower and not be as serious. In men, it is the fourth most common cancer. However, because of the rate of recurrences and long term survival, it is the second most prevalent cancer in middle aged and elderly men. In women, it is the eighth most common cancer. The average age at diagnosis is 65. Over the past decade, there has been both an increased incidence, but also an increased rate of survival for bladder cancer ^[1]

WHAT CAUSED MY CANCER?

A mutation is a disruption in the DNA of a cell, leading to a loss of regulated cell growth. Mutations can occur spontaneously as we age. It is truly amazing that all of us don’t develop cancer as we are composed of trillions of cells dividing regularly over decades. Fortunately, our cells have repair mechanisms which can often fix damaged cells before cancer arises. In addition, the immune system can destroy cancer cells before they have a chance to grow into tumors.

Mutations and cancer can also be triggered by environmental factors. Certain chemicals have been identified to be particularly effective at inducing mutations in our DNA and subsequent cancer. These chemicals are called carcinogens. Smoking is the most common culprit! Cigarette smoking has a strong link with bladder cancer. Studies have shown approximately 50% of bladder cancer is secondary to tobacco smoke. Smoking releases dozens of carcinogens into the lungs and then into the blood stream. Many of these carcinogens are excreted by the kidneys.

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IT IS TOO DIFFICULT TO QUIT SMOKING; IS THERE ANY SURE FIRE WAY TO QUIT?

Tobacco smoke contains nicotine, an extremely addictive chemical. Men overall find it easier to quit smoking than women. When facing the prospects of losing your bladder to cancer or possibly your life, most individuals will become convinced and many simply stop smoking “cold turkey.” Unfortunately, many choose not to quit until their cancer repeatedly recurs or becomes invasive, needlessly placing their health at risk. For those who need assistance in quitting, nicotine patches, gum, and lozenges are all available over the counter. These products allow the smoker to quit without experiencing the discomfort of withdrawal from nicotine. Many smokers also find hypnosis or support groups useful. In addition, prescription medication is available.

ARE THERE ANY OTHER KNOWN CAUSES?

Occupational exposure may account for up to 20% of bladder cancers. Those exposed to aniline dyes (used to color fabrics), aldehydes (used in chemical dyes and in the rubber and textile industries) and those using organic chemicals (used in a wide range of occupations) are all at increased risk. Individuals previously treated with radiation to the pelvis or having received cyclophosphamide (a type of chemotherapy) are at markedly increased risk for developing bladder cancer. If your well water is high in arsenic, your risk may also be increased. Studies have also correlated obesity and a high fat diet, especially with increased cholesterol, as a possible contributing factor.

CAN I HELP TO PREVENT BLADDER CANCER BY DRINKING MORE FLUIDS?

Surprisingly, the answer may be yes. In a recent study, the relationship of diet to cancer was analyzed in a group of47,000 health professionals.^[1] In the case of bladder cancer, those who drank the most fluid (greater than 10 cups/day) had half the risk as those who drank the least (less than 5 cups/day). The type of nonalcoholic beverage was less important than the total amount.

WILL MY CHILDREN BE AT HIGHER RISK OF DEVELOPING BLADDER CANCER?

Although there have been clusters of bladder cancer reported, most researchers believe these may be secondary to risk factors such as smoking and exposure to carcinogens. At this time, there is no convincing evidence bladder cancer risk is hereditary. If an environmental factor caused your cancer and your children are exposed as well, their risk of cancer may be increased.

WHAT IS CANCER?

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).

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HOW CAN I TELL IF MY BLADDER CANCER IS LIKELY TO SPREAD?

Larger tumors are more likely to spread than smaller tumors. Another critical concern is the grade of the tumor. Normal cells are specialized, differentiated to perform specific function, and have a typical structural arrangement with surrounding cells. As cancers worsen, the cells become less specialized, less differentiated, and lose their normal structural arrangement, resulting in a higher pathologic grade.

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. For further information see Chapter 6.

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: 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.

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.

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More than 90% of bladder cancers arise from the lining bladder cells called transitional cells. Bladder cancer is almost always transitional cell cancer. These cells are also present in the urethra (the body tube which drains the bladder), as well as the renal pelvis (inner lining of the kidneys), and the ureters (the body tube draining the kidneys). Bladder cancer can vary from the non serious, low grade superficial type (approximately 70%), to the invasive, aggressive type that can spread and prove to be fatal (approximately 30%). 5% of bladder cancer is accounted for by squamous cell carcinoma. This cancer is usually secondary to long term inflammation or infection of the bladder. Even rarer is adenocarcinoma, which accounts for less than 2% of all bladder cancers.

A mutation is a disruption in the DNA of a cell, leading to a loss of regulated cell growth. Mutations can occur spontaneously as we age. It is truly amazing that all of us don’t develop cancer as we are composed of trillions of cells dividing regularly over decades. Fortunately, our cells have repair mechanisms which can often fix damaged cells before cancer arises. In addition, the immune system can destroy cancer cells before they have a chance to grow into tumors.

Mutations and cancer can also be triggered by environmental factors. Certain chemicals have been identified to be particularly effective at inducing mutations in our DNA and subsequent cancer. These chemicals are called carcinogens. Smoking is the most common culprit! Cigarette smoking has a strong link with bladder cancer. Studies have shown approximately 50% of bladder cancer is secondary to tobacco smoke. Smoking releases dozens of carcinogens into the lungs and then into the blood stream. Many of these carcinogens are excreted by the kidneys. After years of being exposed to this toxic soup, a smoker’s bladder has a much greater chance of developing bladder cancer, two to three times, and in heavy smokers up to five times the rate compared to those people who have never smoked. The risk clearly correlates with the number of years the individual has smoked and the number of cigarettes smoked per year. Fortunately, after you stop smoking, your risk gradually decreases. Once you develop bladder cancer, it is mandatory to stop smoking. It is now known failure to stop smoking leads to a much worse outcome compared to those with bladder cancer that stop smoking.

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Tobacco smoke contains nicotine, an extremely addictive chemical. Men overall find it easier to quit smoking than women. When facing the prospects of losing your bladder to cancer or possibly your life, most individuals will become convinced and many simply stop smoking “cold turkey.” Unfortunately, many choose not to quit until their cancer repeatedly recurs or becomes invasive, needlessly placing their health at risk. For those who need assistance in quitting, nicotine patches, gum, and lozenges are all available over the counter. These products allow the smoker to quit without experiencing the discomfort of withdrawal from nicotine. Many smokers also find hypnosis or support groups useful. In addition, prescription medication is available.

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).

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 : Sometimes, in an alternative procedure/ lasers (high-energy light beams) are used to remove superficial TCC tumors. While this is slightly more comfortable than resection for you as a patient, the laser often destroys the tumor tissue, leaving nothing for pathologists to examine. The lack of pathology may limit your medical team’s ability to predict recurrence and target your follow-up plan.

If you have been diagnosed with a low-risk tumor, resection may be the only treatment recommended by your medical team. Or your team may recommend a course of intravesical therapy, too. Intravesical is a medical term meaning “within the bladder/’ Intravesical therapy, therefore, means that treatment – in this case a solution containing anti-cancer drugs – is placed directly in the blad­der instead of being given to you as a pill to swallow or as an injection.

The treatment is given as a liquid poured through an ordinary uri­nary catheter, the same device that is usually used to drain urine from the bladder. In this case, the flow of fluid is reversed, with the med­ication being injected gently up through the catheter into the inside of the bladder. Think of it this way: Remember when you were a kid and filled balloons with water? If you imagine the bladder as that bal­loon, filled not with water but with liquid medication sloshing around inside, you’ll ‘have a good idea of how intravesical therapy works.

Intravesical therapy has been used for about 30 years as a preven­tive treatment to reduce the recurrence rate for superficial bladder cancer. It is believed that intravesical therapy works because it destroys cancer cells that may remain “floating” in the bladder after resection, thereby reducing the possibility of a recurrence. It also may be absorbed directly into any remaining tumor tissue, causing destruction of the tumor. There are two types of intravesical therapy, chemotherapy and immunotherapy, with numerous treatment options within each therapy group.

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Your medical team will take a number of things into consideration when deciding which intravesical treatment option is best for you. Their goal is to balance the effectiveness of the treatment with possi­ble side effects and long-term risks based on the type and seriousness of your cancer. Aggressive treatment options with possibly serious side effects may well be the right choice if you’re dealing with a type of cancer that has a high recurrence rate and often comes back in a more life- threatening form. On the other hand, if your cancer is low risk and has a lesser chance of recurring, a more conservative approach might be taken.

Regardless of whether you’re advised to take chemotherapy or immunotherapy both are administered the same way The procedure can be performed either at the hospital about one to seven days after your resection or in your doctor’s office if a series of weekly treat­ments is recommended. The timing depends somewhat on how extensive the resection has been.

First your doctor will numb your urethra with a topical gel and insert a disposable catheter, which wall be used to fill the bladder with the solution. The catheter is removed after your bladder is full, and you’ll be asked to concentrate on not passing urine for a time, hold­ing the solution inside while you get up and move around. Walking, sitting, and standing while the solution is held in your bladder caus­es it to slosh around and completely coat inside the bladder walls. After an hour or so, you’ll void the solution just as you would pass urine. In most cases, you’ll be asked to minimize your fluid intake before the procedure so that your bladder won’t also be filling with urine that wall put additional pressure on your bladder.

The chemotherapy drugs that are used in this way include doxoru­bicin (brand name Adriamycin), epirubicin (Pharmorubidn), mitomycin C (Mutamydn), and occasionally thiotepa (Thioplex). Chemotherapy solutions have proved effective in reducing recurrence rates by about 30 percent. However, chemotherapy has little or no effect in prevent­ing superficial cancer from progressing to a more serious stage. What this means is that chemotherapy will often stop the superficial cancer

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Although BCG is highly effective, it also has some toxic side effects, and as such is used primarily as a treatment for patients with high-risk types of superficial bladder cancer and those who have had repeated recurrences or CIS. Side effects may include a burning sensation in the bladder as well as fatigue, chills, and fever. A prolonged high fever and general feel­ing of being ill may be a sign that the BCG bacteria have spread through the body. Because BCG is the bacterium that causes a type of tuberculosis, antibiotics used to treat tuberculosis are usually pre­scribed when an infection occurs shortly after BCG immunotherapy. Another type of immunotherapy is interferon.This is naturally pro­duced in your body’s cells and works much as BCG does in stimulat­ing your body to attack cancer cells in the bladder. Temporary side effects, which usually disappear once interferon therapy is stopped, include muscle and bone aches, fatigue, vomiting, and headaches.

In almost all cases, intravesical therapy (chemotherapy or immunotherapy) is most effective when the first dose is given 6 to 24 hours after resection. Sometimes a single dose is given as a prophy­lactic (preventative) measure and is not repeated. More commonly, you’ll have one dose immediately after resection and then five more treatments on a weekly basis in your doctor’s office. In some cases, if a large tumor has been resected, leaving a larger area of ulcerated bladder surface, intravesical chemotherapy will be delayed for a few days to prevent the drug’s being absorbed through the damaged sur­face lining of the bladder. Your doctor may recommend a follow-up cystoscopy after the intravesical treatments are completed.

Keep in mind that there are several types of superficial bladder cancer, some of which have a high risk of recurrence or progression to a more serious stage. Treatment options, including resection and intravesical therapy, are different for each person and depend upon each person’s circumstances, For example, you may start talking to someone in your urologist’s waiting room who has had great results and few side effects from a single dose of mitomycin C (MCC) chemotherapy. Even more impres­sive, he hasn’t had a recurrence since his diagnosis three years ago. You, on the other hand, are on your fourth BCG treatment, and each one leaves you feeling as if you have severe bladder irritation for several days afterwards. “No side effects and no recurrences” sounds like a better deal than what you’re experiencing. So why wasn’t MCC prescribed for you?

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:  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.

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Actos Side Effects : Roughly 5-10 percent of patients experience a fever after a transurethral procedure. This is almost always due to a urinary tract infection. The most common symptoms of a urinary tract infection in this setting are fever, chills, side pain, and frequent or painftil urination. If you experience a fever postoperatively, you should contact your physician immediately. The vast majority of infections can be treated as an outpatient with oral antibiotics and resolve in several days. Most urologists give you antibiotics during your procedure and for a few days thereafter to prevent infection, but unfortunately a small percentage of patients will still experience an infection despite taking antibiotics. It is important to note that most patients have lower urinary tract symptoms after surgery. This is directly related to the manipulation from the cystoscope and any biopsies or resection that were performed.

These procedures cause bladder and urethral inflammation, which may cause you to experience painful urination, urinary frequency, and urgency for several days after the procedure. These symp­toms are very similar to that of a urinary tract infection and can be confusing, but they do not cause fever like a urinary tract infection. If you are unsure whether your symptoms are a result of an infection or the procedure, the safest bet is to consult your urologist as soon as possible.

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Urinary retention (inability to pass the urine) is another uncommon and generally self-limiting complication one can experience after surgery. In men, this is often caused by swelling of the prostate due to manipulation from the cystoscope. Excessive bleeding may also result in clot formation that can obstruct the flow of urine. Patients who experience this side effect urinate in small volumes or not at all, even though their bladder is uncomfortably full. The treatment for this is simple; a catheter is placed in your bladder for a few days to allow any edema (swelling) to resolve. The catheter can then be removed several days later and most patients void without difficulty at that point.

At the time ofTURBT, perforation of the bladder can occur. This happens if the full thickness of the bladder wall is resected at the time of TURBT. This is often inadvertent, but it can also be done intentionally by your surgeon in the case of a tumor that grows deep into the wall of the muscle. Most perforations are small and will close on their own, without additional intervention. You may need to have a Foley catheter for several days to permit healing and minimize leakage of urine from the perforation. In rare circumstances a bladder perforation may be so large or in such a location that it is dangerous to allow it to heal on its own. Such cases require open surgery to suture the bladder closed. This is performed through a lower midline incision. A Foley catheter again would be left in the bladder for several days to permit healing.

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Radical cystectomy and associated urinary diversion is a complex procedure. Even in the best of hands, the potential for side effects and complications is significant. The most common side effects and complications related to this procedure are discussed below. Although this will give you a good understanding of what to expect after surgery, it is very important that you discuss the risks of cystectomy with your urologist before surgery to be as fully informed and prepared as possible.

As with any major surgery, there is potential for bleeding during your surgery. Twenty-five to 50 percent of patients need a blood transfusion either during surgery or in the immediate postoperative period. Your surgeon may ask you to donate your own blood before surgery, so that it can be given back to you at the time of your operation. This is to minimize the risk of infection with transfusion-related bloodbome illnesses such as HIV and hepatitis. Because this risk is extremely low, many surgeons do not require you to donate your own blood. Your blood count will be monitored for the first several days after surgery because in rare circumstances bleeding can occur after surgery. Depending on your blood count at the time of discharge, your physician may send you home on iron supplementation.

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Actos Bladder Cancer 12/20/2011: The elderly, frail individuals with multiple coexisting chronic illnesses, individuals that are weakened through mahiutrition or who have compromised immunity all would face substantially increased risk of complications from standard chemotherapy regimens for bladder cancer. Unfortunately, cisplatin is toxic to kidneys, and many individuals with bladder cancer have compromised kidney function which effectively rules out the use of platinum based chemotherapy. Other treatment regimens exist and are being worked on for these individuals, but none show the efficacy of the standard therapy which includes cisplatin.

Most individuals treated with standard chemotherapy regimens with metastatic bladder cancer will have recurrence and progression of their disease. Multiple treatment regimens have been utilized with overall response rates of 10-40%.^[1] To date, regimens have generally used taxanes, both docetaxel and paclitaxel. Ifosfamide has been shown to have significant single agent activity as well, but is extremely toxic. Combination therapy with taxanes and ifosfamide are presently being tested.

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Our use of the Terms Actos Lawsuit ,Actos Side Effects is not intended to imply or insinuate that there is any relationship or connection between Best Legal Source and the maker of Actos. “Actos” is a trademark of its manufacturer, Takeda Pharmaceutical Company Limited. Best Legal Source is not the maker of Actos nor do we have any connection with Takeda Pharmaceutical Company Limited.

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