Stem Cell Transplants in Cancer Treatment

Stem cell transplants help restore blood-forming stem cells in people who have had theirs destroyed by certain cancer treatments.

Credit: National Cancer Institute

Stem cell transplants are procedures that restore blood-forming stem cells in people who have had theirs destroyed by the very high doses of chemotherapy or radiation therapy that are used to treat certain cancers.

Blood-forming stem cells are important because they grow into different types of blood cells. The main types of blood cells are:

  • White blood cells, which are part of your immune system and help your body fight infection
  • Red blood cells, which carry oxygen throughout your body
  • Platelets, which help the blood clot

You need all three types of blood cells to be healthy.

Types of Stem Cell Transplants

In a stem cell transplant, you receive healthy blood-forming stem cells through a needle in your vein. Once they enter your bloodstream, the stem cells travel to the bone marrow, where they take the place of the cells that were destroyed by treatment. The blood-forming stem cells that are used in transplants can come from the bone marrow, bloodstream, or umbilical cord. Transplants can be:

  • Autologous, which means the stem cells come from you, the patient
  • Allogeneic, which means the stem cells come from someone else. The donor may be a blood relative but can also be someone who is not related.
  • Syngeneic, which means the stem cells come from your identical twin, if you have one

To reduce possible side effects and improve the chances that an allogeneic transplant will work, the donor’s blood-forming stem cells must match yours in certain ways. To learn more about how blood-forming stem cells are matched, see Blood-Forming Stem Cell Transplants.

How Stem Cell Transplants Work against Cancer

Stem cell transplants do not usually work against cancer directly. Instead, they help you recover your ability to produce stem cells after treatment with very high doses of radiation therapy, chemotherapy, or both.

However, in multiple myeloma and some types of leukemia, the stem cell transplant may work against cancer directly. This happens because of an effect called graft-versus-tumor that can occur after allogeneic transplants. Graft-versus-tumor occurs when white blood cells from your donor (the graft) attack any cancer cells that remain in your body (the tumor) after high-dose treatments. This effect improves the success of the treatments.

Who Receives Stem Cell Transplants

Stem cell transplants are most often used to help people with leukemia and lymphoma. They may also be used for neuroblastoma and multiple myeloma.

Stem cell transplants for other types of cancer are being studied in clinical trials, which are research studies involving people. To find a study that may be an option for you, see Find a Clinical Trial.

Stem Cell Transplants Can Cause Side Effects

The high doses of cancer treatment that you have before a stem cell transplant can cause problems such as bleeding and an increased risk of infection. Talk with your doctor or nurse about other side effects that you might have and how serious they might be. For more information about side effects and how to manage them, see the section on side effects.

If you have an allogeneic transplant, you might develop a serious problem called graft-versus-host disease. Graft-versus-host disease can occur when white blood cells from your donor (the graft) recognize cells in your body (the host) as foreign and attack them. This problem can cause damage to your skin, liver, intestines, and many other organs. It can occur a few weeks after the transplant or much later. Graft-versus-host disease can be treated with steroids or other drugs that suppress your immune system.

The closer your donor’s blood-forming stem cells match yours, the less likely you are to have graft-versus-host disease. Your doctor may also try to prevent it by giving you drugs to suppress your immune system.

How Much Stem Cell Transplants Cost

Stem cells transplants are complicated procedures that are very expensive. Most insurance plans cover some of the costs of transplants for certain types of cancer. Talk with your health plan about which services it will pay for. Talking with the business office where you go for treatment may help you understand all the costs involved.

To learn about groups that may be able to provide financial help, go to the National Cancer Institute database, Organizations that Offer Support Services and search “financial assistance.” Or call toll-free 1-800-4-CANCER (1-800-422-6237) for information about groups that may be able to help.

What to Expect When Receiving a Stem Cell Transplant

Where You Go for a Stem Cell Transplant

When you need an allogeneic stem cell transplant, you will need to go to a hospital that has a specialized transplant center. The National Marrow Donor Program® maintains a list of transplant centers in the United States that can help you find a transplant center.

Unless you live near a transplant center, you may need to travel from home for your treatment. You might need to stay in the hospital during your transplant, you may be able to have it as an outpatient, or you may need to be in the hospital only part of the time. When you are not in the hospital, you will need to stay in a hotel or apartment nearby. Many transplant centers can assist with finding nearby housing.

How Long It Takes to Have a Stem Cell Transplant

A stem cell transplant can take a few months to complete. The process begins with treatment of high doses of chemotherapy, radiation therapy, or a combination of the two. This treatment goes on for a week or two. Once you have finished, you will have a few days to rest.

Next, you will receive the blood-forming stem cells. The stem cells will be given to you through an IV catheter. This process is like receiving a blood transfusion. It takes 1 to 5 hours to receive all the stem cells.

After receiving the stem cells, you begin the recovery phase. During this time, you wait for the blood cells you received to start making new blood cells.

Even after your blood counts return to normal, it takes much longer for your immune system to fully recover—several months for autologous transplants and 1 to 2 years for allogeneic or syngeneic transplants.

How Stem Cell Transplants May Affect You

Stem cell transplants affect people in different ways. How you feel depends on:

  • The type of transplant that you have
  • The doses of treatment you had before the transplant
  • How you respond to the high-dose treatments
  • Your type of cancer
  • How advanced your cancer is
  • How healthy you were before the transplant

Since people respond to stem cell transplants in different ways, your doctor or nurses cannot know for sure how the procedure will make you feel.

How to Tell If Your Stem Cell Transplant Worked

Doctors will follow the progress of the new blood cells by checking your blood counts often. As the newly transplanted stem cells produce blood cells, your blood counts will go up.

Special Diet Needs

The high-dose treatments that you have before a stem cell transplant can cause side effects that make it hard to eat, such as mouth sores and nausea. Tell your doctor or nurse if you have trouble eating while you are receiving treatment. You might also find it helpful to speak with a dietitian. For more information about coping with eating problems see the booklet Eating Hints or the section on side effects.

Working during Your Stem Cell Transplant

Whether or not you can work during a stem cell transplant may depend on the type of job you have. The process of a stem cell transplant, with the high-dose treatments, the transplant, and recovery, can take weeks or months. You will be in and out of the hospital during this time. Even when you are not in the hospital, sometimes you will need to stay near it, rather than staying in your own home. So, if your job allows, you may want to arrange to work remotely part-time.

Many employers are required by law to change your work schedule to meet your needs during cancer treatment. Talk with your employer about ways to adjust your work during treatment. You can learn more about these laws by talking with a social worker.


Posted: April 29, 2015

This content is provided by the National Cancer Institute (www.cancer.gov)

Syndicated Content Details:
Source URL: https://www.cancer.gov/publishedcontent/syndication/915540.htm
Source Agency: National Cancer Institute (NCI)
Captured Date: 2018-08-08 16:10:21.0

How Cancer Is Diagnosed

How Cancer Is Diagnosed

X-rays use low doses of radiation to create pictures of the inside of your body.

If you have a symptom or your screening test result suggests cancer, the doctor must find out whether it is due to cancer or some other cause. The doctor may ask about your personal and family medical history and do a physical exam. The doctor also may order lab tests, scans, or other tests or procedures.

Lab Tests

High or low levels of certain substances in your body can be a sign of cancer. So, lab tests of the blood, urine, or other body fluids that measure these substances can help doctors make a diagnosis. However, abnormal lab results are not a sure sign of cancer. Lab tests are an important tool, but doctors cannot rely on them alone to diagnose cancer.

Imaging Procedures

Imaging procedures create pictures of areas inside your body that help the doctor see whether a tumor is present. These pictures can be made in several ways:

  • CT Scan:
    An x-ray machine linked to a computer takes a series of detailed pictures of your organs. You may receive a dye or other contrast material to highlight areas inside the body. Contrast material helps make these pictures easier to read.
  • Nuclear scan:
    For this scan, you receive an injection of a small amount of radioactive material, which is sometimes called a tracer. It flows through your bloodstream and collects in certain bones or organs. A machine called a scanner detects and measures the radioactivity. The scanner creates pictures of bones or organs on a computer screen or on film. Your body gets rid of the radioactive substance quickly. This type of scan may also be called radionuclide scan.
  • Ultrasound:
    An ultrasound device sends out sound waves that people cannot hear. The waves bounce off tissues inside your body like an echo. A computer uses these echoes to create a picture of areas inside your body. This picture is called a sonogram.
  • MRI:
    A strong magnet linked to a computer is used to make detailed pictures of areas in your body. Your doctor can view these pictures on a monitor and print them on film.
  • PET scan:
    For this scan, you receive an injection of a tracer. Then, a machine makes 3-D pictures that show where the tracer collects in the body. These scans show how organs and tissues are working.
  • X-rays:
    X-rays use low doses of radiation to create pictures of the inside of your body.

Biopsy

In most cases, doctors need to do a biopsy to make a diagnosis of cancer. A biopsy is a procedure in which the doctor removes a sample of tissue. A pathologist  then looks at the tissue under a microscope to see if it is cancer. The sample may be removed in several ways:

  • With a needle: The doctor uses a needle to withdraw tissue or fluid.
  • With an endoscope: The doctor looks at areas inside the body using a thin, lighted tube called an endoscope. The scope is inserted through a natural opening, such as the mouth. Then, the doctor uses a special tool to remove tissue or cells through the tube.
  • With surgery: Surgery may be excisional or incisional.
    • In an excisional biopsy, the surgeon removes the entire tumor. Often some of the normal tissue around the tumor also is removed.
    • In an incisional biopsy, the surgeon removes just part of the tumor.

Posted: March 9, 2015

This content is provided by the National Cancer Institute (www.cancer.gov)

Syndicated Content Details:
Source URL: https://www.cancer.gov/publishedcontent/syndication/903689.htm
Source Agency: National Cancer Institute (NCI)
Captured Date: 2018-08-09 17:10:14.0
Credit: iStock

Symptoms of Cancer

Young woman receiving thyroid exam from her doctor

If you have symptoms that last for a couple of weeks, it is important to see a doctor.

Credit: iStock

Cancer can cause many different symptoms. These are some of them:

  • Skin changes, such as:
    • A new mole or a change in an existing mole
    • A sore that does not heal
  • Breast changes, such as:
    • Change in size or shape of the breast or nipple
    • Change in texture of breast skin
  • A thickening or lump on or under the skin
  • Hoarseness or cough that does not go away
  • Changes in bowel habits
  • Difficult or painful urination
  • Problems with eating, such as:
    • Discomfort after eating
    • A hard time swallowing
    • Changes in appetite
  • Weight gain or loss with no known reason
  • Abdominal pain
  • Unexplained night sweats
  • Unusual bleeding or discharge, including:
    • Blood in the urine
    • Vaginal bleeding
    • Blood in the stool
  • Feeling weak or very tired

Most often, these symptoms are not due to cancer. They may also be caused by benign tumors or other problems. If you have symptoms that last for a couple of weeks, it is important to see a doctor so that problems can be diagnosed and treated as early as possible.

Usually, early cancer does not cause pain. If you have symptoms, do not wait to feel pain before seeing a doctor.

To learn more about symptoms for a specific cancer, see the PDQ® cancer treatment summaries for adult and childhood cancers. These summaries include information about symptoms.

What is Myocardial infarction

Myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to a part of the heart, causing damage to the heart muscle. The most common symptom is chest pain or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Often it occurs in the center or left side of the chest and lasts for more than a few minutes. The discomfort may occasionally feel like heartburn. Other symptoms may include shortness of breath, nausea, feeling faint, a cold sweat, or feeling tired. About 30% of people have atypical symptoms. Women more often have atypical symptoms than men. Among those over 75 years old, about 5% have had an MI with little or no history of symptoms. An MI may cause heart failure, an irregular heartbeat, cardiogenic shock, or cardiac arrest.

Most MIs occur due to coronary artery disease. Risk factors include high blood pressure, smoking, diabetes, lack of exercise, obesity, high blood cholesterol, poor diet, and excessive alcohol intake, among others. The complete blockage of a coronary artery caused by a rupture of an atherosclerotic plaque is usually the underlying mechanism of an MI. MIs are less commonly caused by coronary artery spasms, which may be due to cocaine, significant emotional stress, and extreme cold, among others. A number of tests are useful to help with diagnosis, including electrocardiograms (ECGs), blood tests, and coronary angiography. An ECG, which is a recording of the heart’s electrical activity, may confirm an ST elevation MI (STEMI) if ST elevation is present. Commonly used blood tests include troponin and less often creatine kinase MB.

Treatment of an MI is time-critical. Aspirin is an appropriate immediate treatment for a suspected MI. Nitroglycerin or opioids may be used to help with chest pain; however, they do not improve overall outcomes. Supplemental oxygen is recommended in those with low oxygen levels or shortness of breath. In a STEMI, treatments attempt to restore blood flow to the heart, and include percutaneous coronary intervention (PCI), where the arteries are pushed open and may be stented, or thrombolysis, where the blockage is removed using medications. People who have a non-ST elevation myocardial infarction (NSTEMI) are often managed with the blood thinner heparin, with the additional use of PCI in those at high risk. In people with blockages of multiple coronary arteries and diabetes, coronary artery bypass surgery (CABG) may be recommended rather than angioplasty. After an MI, lifestyle modifications, along with long term treatment with aspirin, beta blockers, and statins, are typically recommended.

Worldwide, about 15.9 million myocardial infarctions occurred in 2015. More than 3 million people had an ST elevation MI and more than 4 million had an NSTEMI. STEMIs occur about twice as often in men as women. About one million people have an MI each year in the United States. In the developed world the risk of death in those who have had an STEMI is about 10%. Rates of MI for a given age have decreased globally between 1990 and 2010. In 2011, AMI was one of the top five most expensive conditions during inpatient hospitalizations in the US, with a cost of about $11.5 billion for 612,000 hospital stays.

Terminology

Myocardial infarction (MI) refers to tissue death (infarction) of the heart muscle (myocardium). It is a type of acute coronary syndrome, which describes a sudden or short-term change in symptoms related to blood flow to the heart. Unlike other causes of acute coronary syndromes, such as unstable angina, a myocardial infarction occurs when there is cell death, as measured by a blood test for biomarkers (the cardiac protein troponin or the cardiac enzyme CK-MB). When there is evidence of an MI, it may be classified as an ST elevation myocardial infarction (STEMI) or Non-ST elevation myocardial infarction (NSTEMI) based on the results of an ECG.

The phrase “heart attack” is often used non-specifically to refer to a myocardial infarction and to sudden cardiac death. An MI is different from—but can cause—cardiac arrest, where the heart is not contracting at all or so poorly that all vital organs cease to function, thus causing death. It is also distinct from heart failure, in which the pumping action of the heart is impaired. However, an MI may lead to heart failure.

Signs and symptoms

View of the chest with common areas of MI coloured
View of the back with common areas of MI coloured
Areas where pain is experienced in myocardial infarction, showing common (dark red) and less common (light red) areas on the chest and back.

Pain

Chest pain is the most common symptom of acute myocardial infarction and is often described as a sensation of tightness, pressure, or squeezing. Pain radiates most often to the left arm, but may also radiate to the lower jaw, neck, right arm, back, and upper abdomen. The pain most suggestive of an acute MI, with the highest likelihood ratio, is pain radiating to the right arm and shoulder. Similarly, chest pain similar to a previous heart attack is also suggestive. The pain associated with MI is usually diffuse, does not change with position, and lasts for more than 20 minutes.  Levine’s sign, in which a person localizes the chest pain by clenching one or both fists over their sternum, has classically been thought to be predictive of cardiac chest pain, although a prospective observational study showed it had a poor positive predictive value. Pain that responds to nitroglycerin does not indicate the presence or absence of a myocardial infarction.

Other symptoms

Chest pain may be accompanied by sweating, nausea or vomiting, and fainting, and these symptoms may also occur without any pain at all. In women, the most common symptoms of myocardial infarction include shortness of breath, weakness, and fatigue. Shortness of breath is a common, and sometimes the only symptom, occurring when damage to the heart limits the output of the left ventricle, with breathlessness arising either from low oxygen in the blood, or pulmonary edema. Other less common symptoms include weakness, light-headedness, palpitations, and abnormalities in heart rate or blood pressure. These symptoms are likely induced by a massive surge of catecholamines from the sympathetic nervous system, which occurs in response to pain and, where present, low blood pressure. Loss of consciousness due to inadequate blood flow to the brain and cardiogenic shock, and sudden death, frequently due to the development of ventricular fibrillation, can occur in myocardial infarctions.Cardiac arrest, and atypical symptoms such as palpitations, occur more frequently in women, the elderly, those with diabetes, in people who have just had surgery, and in critically ill patients.

“Silent” myocardial infarctions can happen without any symptoms at all. These cases can be discovered later on electrocardiograms, using blood enzyme tests, or at autopsy after a person has died. Such silent myocardial infarctions represent between 22 and 64% of all infarctions, and are more common in the elderly, in those with diabetes mellitus and after heart transplantation. In people with diabetes, differences in pain threshold, autonomic neuropathy, and psychological factors have been cited as possible explanations for the lack of symptoms. In heart transplantation, the donor heart is not fully innervated by the nervous system of the recipient.

Causes

The most prominent risk factors for myocardial infarction are older age, actively smoking, high blood pressure, diabetes mellitus, and total cholesterol and high-density lipoprotein levels. Many risk factors of myocardial infarction are shared with coronary artery disease, the primary cause of myocardial infarction,with other risk factors including male sex, low levels of physical activity, a past family history, obesity, and alcohol use. Risk factors for myocardial disease are often included in risk factor stratification scores, such as the Framingham risk score. At any given age, men are more at risk than women for the development of cardiovascular disease. High levels of blood cholesterol is a known risk factor, particularly high low-density lipoprotein, low high-density lipoprotein, and high triglycerides.

Many risk factors for myocardial infarction are potentially modifiable, with the most important being tobacco smoking (including secondhand smoke).Smoking appears to be the cause of about 36% and obesity the cause of 20% of coronary artery disease. Lack of physical activity has been linked to 7–12% of cases. Less common causes include stress-related causes such as job stress, which accounts for about 3% of cases, and chronic high stress levels.

Diet

There is varying evidence about the importance of saturated fat in the development of myocardial infarctions. Eating polyunsaturated fat instead of saturated fats has been shown in studies to be associated with a decreased risk of myocardial infarction, while other studies find little evidence that reducing dietary saturated fat or increasing polyunsaturated fat intake affects heart attack risk. Dietary cholesterol does not appear to have a significant effect on blood cholesterol and thus recommendations about its consumption may not be needed. Trans fats do appear to increase risk. Acute and prolonged intake of high quantities of alcoholic drinks (3–4 or more) increases the risk of a heart attack.

Genetics

Family history of ischemic heart disease or MI, particularly if one has a male first-degree relative (father, brother) who had a myocardial infarction before age 55 years, or a female first-degree relative (mother, sister) less than age 65 increases a person’s risk of MI.

Genome-wide association studies have found 27 genetic variants that are associated with an increased risk of myocardial infarction. The strongest association of MI has been found with chromosome 9 on the short arm p at locus 21, which contains genes CDKN2A and 2B, although the single nucleotide polymorphisms that are implicated are within a non-coding region. The majority of these variants are in regions that have not been previously implicated in coronary artery disease. The following genes have an association with MI: PCSK9, SORT1, MIA3, WDR12, MRAS, PHACTR1, LPA, TCF21, MTHFDSL, ZC3HC1, CDKN2A, 2B, ABO, PDGF0, APOA5, MNF1ASM283, COL4A1, HHIPC1, SMAD3, ADAMTS7, RAS1, SMG6, SNF8, LDLR, SLC5A3, MRPS6, KCNE2.

The Benefits of Breastfeeding for Both Mother and Baby | WebMD


In honor of Breastfeeding Awareness Month, we will be sharing a series of articles promoting breastfeeding.  This next one is about the “ABC’s” of breastfeeding – a brief overview of the basics you should know, republished in full from WebMD.


Breastfeeding Overview

Making the decision to breastfeed is a personal matter. It’s also one that’s likely to draw strong opinions from friends and family.

Many medical experts, including the American Academy of Pediatrics (AAP) and the American College of Obstetricians and Gynecologists, strongly recommend breastfeeding exclusively (no formula, juice, or water) for 6 months. And breastfeeding for a year at least with other foods which should be started at 6 months of age, such as vegetables, grains, fruits, proteins.

But you and your baby are unique, and the decision is up to you. This overview of breastfeeding can help you decide.

What Are the Benefits of Breastfeeding for Your Baby?

Breast milk provides the ideal nutrition for infants. It has a nearly perfect mix of vitamins, protein, and fat — everything your baby needs to grow. And it’s all provided in a form more easily digested than infant formula. Breast milk contains antibodies that help your baby fight off viruses and bacteria. Breastfeeding lowers your baby’s risk of having asthma or allergies. Plus, babies who are breastfed exclusively for the first 6 months, without any formula, have fewer ear infections, respiratory illnesses, and bouts of diarrhea. They also have fewer hospitalizations and trips to the doctor.

Breastfeeding has been linked to higher IQ scores in later childhood in some studies. What’s more, the physical closeness, skin-to-skin touching, and eye contact all help your baby bond with you and feel secure. Breastfed infants are more likely to gain the right amount of weight as they grow rather than become overweight children. The AAP says breastfeeding also plays a role in the prevention of SIDS (sudden infant death syndrome). It’s been thought to lower the risk of diabetes, obesity, and certain cancers as well, but more research is needed.

Are There Breastfeeding Benefits for the Mother?

Breastfeeding burns extra calories, so it can help you lose pregnancy weight faster. It releases the hormone oxytocin, which helps your uterus return to its pre-pregnancy size and may reduce uterine bleeding after birth. Breastfeeding also lowers your risk of breast and ovarian cancer. It may lower your risk of osteoporosis, too.

Since you don’t have to buy and measure formula, sterilize nipples, or warm bottles, it saves you time and money. It also gives you regular time to relax quietly with your newborn as you bond.

Will I Make Enough Milk to Breastfeed?

The first few days after birth, your breasts make an ideal “first milk.” It’s called colostrum. Colostrum is thick, yellowish, and scant, but there’s plenty to meet your baby’s nutritional needs. Colostrum helps a newborn’s digestive tract develop and prepare itself to digest breast milk.

Most babies lose a small amount of weight in the first 3 to 5 days after birth. This is unrelated to breastfeeding.

As your baby needs more milk and nurses more, your breasts respond by making more milk. Experts recommend breastfeeding exclusively (no formula, juice, or water) for 6 months. If you supplement with formula, your breasts might make less milk.

Even if you breastfeed less than the recommended 6 months, it’s better to breastfeed for a short time than no time at all. You can add solid food at 6 months but also continue to breastfeed if you want to keep producing milk.

What’s the Best Position for Breastfeeding?

The best position for you is the one where you and your baby are both comfortable and relaxed, and you don’t have to strain to hold the position or keep nursing. Here are some common positions for breastfeeding your baby:

  • Cradle position. Rest the side of your baby’s head in the crook of your elbow with his whole body facing you. Position your baby’s belly against your body so he feels fully supported. Your other, “free” arm can wrap around to support your baby’s head and neck — or reach through your baby’s legs to support the lower back.
  • Football position. Line your baby’s back along your forearm to hold your baby like a football, supporting his head and neck in your palm. This works best with newborns and small babies. It’s also a good position if you’re recovering from a cesarean birth and need to protect your belly from the pressure or weight of your baby.
  • Side-lying position. This position is great for night feedings in bed. Side-lying also works well if you’re recovering from an episiotomy, an incision to widen the vaginal opening during delivery. Use pillows under your head to get comfortable. Then snuggle close to your baby and use your free hand to lift your breast and nipple into your baby’s mouth. Once your baby is correctly “latched on,” support your baby’s head and neck with your free hand so there’s no twisting or straining to keep nursing.

How Do I Get My Baby to ‘Latch on’ During Breastfeeding?

Position your baby facing you, so your baby is comfortable and doesn’t have to twist his neck to feed. With one hand, cup your breast and gently stroke your baby’s lower lip with your nipple. Your baby’s instinctive reflex will be to open the mouth wide. With your hand supporting your baby’s neck, bring your baby’s mouth closer around your nipple, trying to center your nipple in the baby’s mouth above the tongue.

You’ll know your baby is “latched on” correctly when both lips are pursed outward around your nipple. Your infant should have all of your nipple and most of the areola, which is the darker skin around your nipple, in his mouth. While you may feel a slight tingling or tugging, breastfeeding should not be painful. If your baby isn’t latched on correctly and nursing with a smooth, comfortable rhythm, gently nudge your pinky between your baby’s gums to break the suction, remove your nipple, and try again. Good “latching on” helps prevent sore nipples.

What Are the ABCs of Breastfeeding?

  • A = Awareness. Watch for your baby’s signs of hunger, and breastfeed whenever your baby is hungry. This is called “on demand” feeding. The first few weeks, you may be nursing eight to 12 times every 24 hours. Hungry infants move their hands toward their mouths, make sucking noises or mouth movements, or move toward your breast. Don’t wait for your baby to cry. That’s a sign he’s too hungry.
  • B = Be patient. Breastfeed as long as your baby wants to nurse each time. Don’t hurry your infant through feedings. Infants typically breastfeed for 10 to 20 minutes on each breast.
  • C = Comfort. This is key. Relax while breastfeeding, and your milk is more likely to “let down” and flow. Get yourself comfortable with pillows as needed to support your arms, head, and neck, and a footrest to support your feet and legs before you begin to breastfeed.

Are There Medical Considerations With Breastfeeding?

In a few situations, breastfeeding could cause a baby harm. You should not breastfeed if:

  • You are HIV positive. You can pass the HIV virus to your infant through breast milk.
  • You have active, untreated tuberculosis.
  • You’re receiving chemotherapy for cancer.
  • You’re using an illegal drug, such as cocaine or marijuana.
  • Your baby has a rare condition called galactosemia and cannot tolerate the natural sugar, called galactose, in breast milk.
  • You’re taking certain prescription medications, such as some drugs for migraine headaches, Parkinson’s disease, or arthritis.

Talk with your doctor before starting to breastfeed if you’re taking prescription drugsof any kind. Your doctor can help you make an informed decision based on your particular medication.

Having a cold or flu should not prevent you from breastfeeding. Breast milk won’t give your baby the illness and may even give antibodies to your baby to help fight off the illness.

Also, the AAP suggests that — starting at 4 months of age — exclusively breastfed infants, and infants who are partially breastfed and receive more than one-half of their daily feedings as human milk, should be supplemented with oral iron. This should continue until foods with iron, such as iron-fortified cereals, are introduced in the diet. The AAP recommends checking iron levels in all children at age 1.

Discuss supplementation of both iron and vitamin D with your pediatrician Your doctor can guide you on recommendations about the proper amounts for both your baby and you, when to start, and how often the supplements should be taken.

Why Do Some Women Choose Not to Breastfeed?

  • Some women don’t want to breastfeed in public.
  • Some prefer the flexibility of knowing that a father or any caregiver can bottle-feed the baby any time.
  • Babies tend to digest formula more slowly than breast milk, so bottle feedings may not be as frequent as breastfeeding sessions.

The time commitment, and being “on-call” for feedings every few hours of a newborn’s life, isn’t feasible for every woman. Some women fear that breastfeeding will ruin the appearance of their breasts. But most breast surgeons would argue that age, gravity, genetics, and lifestyle factors like smoking all change the shape of a woman’s breasts more than breastfeeding does.

What Are Some Common Challenges With Breastfeeding?

  • Sore nipples. You can expect some soreness in the first weeks of breastfeeding. Make sure your baby latches on correctly, and use one finger to break the suction of your baby’s mouth after each feeding. That will help prevent sore nipples. If you still get sore, be sure you nurse with each breast fully enough to empty the milk ducts. If you don’t, your breasts can become engorged, swollen, and painful. Holding ice or a bag of frozen peas against sore nipples can temporarily ease discomfort. Keeping your nipples dry and letting them “air dry” between feedings helps, too. Your baby tends to suck more actively at the start. So begin feedings with the less-sore nipple.
  • Dry, cracked nipples. Avoid soaps, perfumed creams, or lotions with alcohol in them, which can make nipples even more dry and cracked. You can gently apply pure lanolin to your nipples after a feeding, but be sure you gently wash the lanolin off before breastfeeding again. Changing your bra pads often will help your nipples stay dry. And you should use only cotton bra pads.
  • Worries about producing enough milk.A general rule of thumb is that a baby who’s wetting six to eight diapers a day is most likely getting enough milk. Avoid supplementing your breast milk with formula, and never give your infant plain water. Your body needs the frequent, regular demand of your baby’s nursing to keep producing milk. Some women mistakenly think they can’t breastfeed if they have small breasts. But small-breasted women can make milk just as well as large-breasted women. Good nutrition, plenty of rest, and staying well hydrated all help, too.
  • Pumping and storing milk. You can get breast milk by hand or pump it with a breast pump. It may take a few days or weeks for your baby to get used to breast milk in a bottle. So begin practicing early if you’re going back to work. Breast milk can be safely used within 2 days if it’s stored in a refrigerator. You can freeze breast milk for up to 6 months. Don’t warm up or thaw frozen breast milk in a microwave. That will destroy some of its immune-boosting qualities, and

it can cause fatty portions of the breast milk to become super hot. Thaw breast milk in the refrigerator or in a bowl of warm water instead.

  • Inverted nipples. An inverted nipple doesn’t poke forward when you pinch the areola, the dark skin around the nipple. A lactation consultant — a specialist in breastfeeding education — can give simple tips that have allowed women with inverted nipples to breastfeed successfully.
  • Breast engorgement. Breast fullness is natural and healthy. It happens as your breasts become full of milk, staying soft and pliable. But breast engorgement means the blood vessels in your breast have become congested. This traps fluid in your breasts and makes them feel hard, painful, and swollen. Alternate heat and cold, for instance using ice packs and hot showers, to relieve mild symptoms. It can also help to release your milk by hand or use a breast pump.
  • Blocked ducts. A single sore spot on your breast, which may be red and hot, can signal a plugged milk duct. This can often be relieved by warm compresses and gentle massage over the area to release the blockage. More frequent nursing can also help.
  • Breast infection (mastitis). This occasionally results when bacteria enter the breast, often through a cracked nipple after breastfeeding. If you have a sore area on your breast along with flu-like symptoms, fever, and fatigue, call your doctor. Antibiotics are usually needed to clear up a breast infection, but you can most likely continue to breastfeed while you have the infection and take antibiotics. To relieve breast tenderness, apply moist heat to the sore area four times a day for 15 to 20 minutes each time.
  • Stress. Being overly anxious or stressed can interfere with your let-down reflex. That’s your body’s natural release of milk into the milk ducts. It’s triggered by hormones released when your baby nurses. It can also be triggered just by hearing your baby cry or thinking about your baby. Stay as relaxed and calm as possible before and during nursing — it can help your milk let down and flow more easily. That, in turn, can help calm and relax your infant.
  • Premature babies may not be able to breastfeed right away. In some cases, mothers can release breast milk and feed it through a bottle or feeding tube.
  • Warning signs. Breastfeeding is a natural, healthy process. But call your doctor if:
  • Your breasts become unusually red, swollen, hard, or sore.
  • You have unusual discharge or bleeding from your nipples.
  • You’re concerned your baby isn’t gaining weight or getting enough milk.

Where Can I Get Help With Breastfeeding?

Images of mothers breastfeeding their babies make it look simple — but most women need some help and coaching. It can come from a nurse, doctor, family member, or friend, and it helps mothers get over possible bumps in the road.

Reach out to friends, family, and your doctor with any questions you may have. Most likely, the women in your life have had those same questions.

SOURCE: WebMD Medical Reference Reviewed by Dan Brennan, MD on December 5, 2017

Sources

 

SOURCES:

News release, American Academy of Pediatrics.

Baker, R. Pediatrics, November 2010.

American Academy of Pediatrics: “Policy Statement: Breastfeeding and the Use of Human Milk.”

American College of Obstetricians and Gynecologists: “Breastfeeding Your Baby.”

CDC: “Proper Handling and Storage of Human Milk.”

National Women’s Health Information Center: “Benefits of Breastfeeding.”

National Women’s Health Information Center: “Questions and Answers About Breastfeeding.”

National Women’s Health Information Center: “How Lifestyle Affects Breast Milk.”

La Leche League International: “How Do I Position My Baby to Breastfeed?”

American Academy of Family Physicians: “Breastfeeding: Hints To Help You Get Off to a Good Start.”

National Library of Medicine: “Overcoming Breastfeeding Problems.”

KidsHealth.org: “Feeding Your Newborn.”

American College of Nurse-Midwives, GotMom.org: “Breastfeeding with Confidence.”

© 2017 WebMD, LLC. All rights reserved.

Breastfeeding saves lives, boosts economies in rich and poor countries


In honor of Breastfeeding Awareness Month, we will be sharing a series of articles promoting breastfeeding.  This one focuses on breastfeeding as the most exquisite form of personalized medicine.


SOURCE:  By Catharine Paddock PhD, Published

The decision not to breastfeed harms the long-term health, nutrition and development of children – and the health of women – around the world, conclude leading experts in a new series of papers on breastfeeding published in The Lancet. They also detail how this loss of opportunity damages the global economy.

The authors say countries should see promoting breastfeeding as an investment that benefits not only their public health, but also their economies. The two-part series is the most detailed analysis of levels, trends and benefits of breastfeeding around the world.

By not being exclusively breastfed for the first 6 months of their lives, and not continuing to receive their mother’s milk for another 6 months, millions of children are being denied the important health benefits of breastfeeding, note the authors.

Figures estimated for the series suggest if all countries were to increase breastfeeding for infants and young children to near-universal levels, over 800,000 child deaths (13% of all deaths in the under-2s), 20,000 breast cancer deaths and $302 billion in costs to the global economy could be prevented every year.

The authors say that by not doing enough to promote and encourage breastfeeding, the world’s nations – both rich and poor – are overlooking one of the most effective ways of improving health of children and mothers.

Cesar Victora, a professor from the Federal University of Pelotas in Brazil and a leading author in the series, says the need to tackle this global issue is greater than ever. She notes:

“There is a widespread misconception that the benefits of breastfeeding only relate to poor countries. Nothing could be further from the truth. Our work for this Series clearly shows that breastfeeding saves lives and money in all countries, rich and poor alike.”

Breast milk is a ‘very exquisite personalized medicine’

The experts say their analyses – comprising 28 systematic reviews of available evidence, 22 of which were prepared for the series – show, for example, that breastfeeding has a significant benefit to life expectancy.

In wealthy countries, breastfeeding reduces sudden infant deaths by over a third, and in low and middle-income countries, breastfeeding halves cases of diarrhea and reduces respiratory infections by a third.
In a podcast interview for the series, Prof. Victora says while we are only “beginning to scratch the surface,” a lot of evidence is emerging about the biology of breastfeeding and the components and properties of breast milk.

He quotes a colleague who likens breast milk to “very exquisite personalized medicine” because it reflects the biological interaction between the mother and her child, “something that formula will never be able to imitate,” he notes.

Prof. Victora cites as an example the effect that receiving breast milk has on the development of the microbiome – the trillions of friendly bacteria that live in and on our bodies and play a key role in our health.
He says we are also beginning to understand that breast milk has epigenetic effects – that is, it influences the expression of genes that control cell activity and development. And, another recent discovery is that breast milk contains stem cells.

There is evidence, the authors note, that breastfeeding increases intelligence and may protect against obesity and diabetesin later life. And for mothers, breastfeeding for longer reduces their risk of breast cancer and ovarian cancer.

Promoting breastfeeding makes economic sense

The authors say countries should see promoting breastfeeding as an investment that benefits not only their public health, but also their economies.  They estimate that loss to economies due to impact of not breastfeeding on intelligence amounted to $302 billion in 2012, or 0.49% of world gross national income.

Prof. Victora and colleagues also calculate that if rates of breastfeeding in babies under 6 months were to increase to 90% in the US, China and Brazil, and to 45% in the UK, they would save these countries $2.45 billion, $223.6 million, $6.0 million and $29.5 million, respectively, due to reductions in treating common childhood illnesses like pneumonia, diarrhea and asthma.

This loss of opportunity to boost public and economic health is further highlighted by the fact that worldwide rates of breastfeeding are low, particularly in wealthy countries – for example the UK, Ireland and Denmark have some of the lowest rates of breastfeeding at 12 months in the world (under 1%, 2% and 3%, respectively).

Prof. Victora remarks that breastfeeding is one of the few “positive health behaviors” that is more prevalent in poor countries than in wealthy countries. Also, in poor countries, it is the poorer mothers that practice it more. He notes:

“The stark reality is that in the absence of breastfeeding, the rich-poor gap in child survival would be even wider.”

He urges policymakers to take note of this and be reassured that promoting breastfeeding provides a rapid return on investment that takes less than a generation to come to fruition.

Aggressive formula marketing undermines breastfeeding promotion

One of the papers also touches on the effects that aggressive marketing of “formula” or breast milk substitutes is having, despite countries attending the World Health Assembly in 1981 adopting the World Health Organization (WHO) International Code of Marketing of Breast-Milk Substitutes, which the authors note has not been enforced effectively.

The multi-billion dollar breast milk substitute industry must be reined in, they urge, or it will continue to undermine breastfeeding as the best feeding practice in early life.

The WHO recommend babies start breastfeeding within 1 hour of life, are exclusively breastfed for 6 months. After this, there should be gradual introduction of adequate, safe and properly fed complementary foods with babies continuing to breastfeed for up to 2 years of age or more.

The authors note that global sales of breast milk substitutes are expected to reach $70.6 billion by 2019, as co-author Dr. Nigel Rollins, from the Department of Maternal, Newborn, Child and Adolescent Health at the WHO in Geneva, explains:

Saturation of markets in high-income countries has caused the industries to rapidly penetrate emerging global markets. Almost all growth in the foreseeable future in sales of standard milk formula (infants <6 months) will be in low-income and middle-income countries, where consumption is currently low,…”

He cites the example of the Middle East and Africa, where estimates show per-child consumption of breast milk substitutes will likely grow by over 7% in the period 2014-2019.  And in wealthy nations, growth in breast milk substitutes will be largely driven by sales of follow-on and toddlers milk, which are set to increase by 15% by 2019, he notes.

Breastfeeding must become a key public health issue

The authors say governments and international organizations have to show powerful political commitment and provide the financial backing needed to protect, promote and support breastfeeding at all levels – national, community, family and workplace.

In an accompanying comment paper, leading experts in the field – including Frances Mason from Save the Children UK and Dr. Alison McFadden from the School of Nursing and Health Sciences at the University of Dundee, UK – say world leaders must not repeat the mistake of leaving out breastfeeding from the Millennium Development Goals when it sets the Sustainable Development Goals later this year.

They plead for breastfeeding not be tagged onto the child nutrition agenda but to be treated as a key public health priority that reduces disease, infant deaths and inequity, and also urge leaders at all levels to “end promotion of products that compete with breastfeeding.”

Prof. Victora concludes:  “There is a widespread misconception that breast milk can be replaced with artificial products without detrimental consequences.”
In October 2015, Medical News Todaylearned of a report from the Centers for Disease Control and Prevention (CDC) that shows while breastfeeding support at US hospitals has improved since 2007, there are still many ways it could be better. Improved hospital care could increase breastfeeding rates nationwide, it concludes.


If you are looking for a physician to care for you along your birthing journey or to support you in your efforts to breastfeed, you might connect with them in HealthLynked.  WE are the first of its kind social ecosystem designed specifically for physicians and patients to collaborate in the efficient exchanges of health information.

Ready to get Lynked for free?  Go to HealthLynked.com right not to Improve HealthCare!

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Say goodbye to pinkeye. Find out how to soothe your red, itchy eye and keep the infection from spreading.

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Lipase Tests: MedlinePlus Lab Test Information

 

What is a lipase test?

Lipase is a type of protein made by your pancreas, an organ located near your stomach. Lipase helps your body digest fats. It’s normal to have a small amount of lipase in your blood. But, a high level of lipase can mean you have pancreatitis, an inflammation of the pancreas, or another type of pancreas disease. Blood tests are the most common way of measuring lipase.

Other names: serum lipase, lipase, LPS

What is it used for?

A lipase test may be used to:

  • Diagnose pancreatitis or another disease of the pancreas
  • Find out if there is a blockage in your pancreas
  • Check for chronic diseases that affect the pancreas, including cystic fibrosis

Why do I need a lipase test?

You may need a lipase test if you have symptoms of a pancreas disease. These include:

You may also need a lipase test if you certain risk factors for pancreatitis. These include:

You may also be at a higher risk if you are a smoker or heavy alcohol user.

What happens during a lipase test?

A lipase test is usually in the form of a blood test. During a blood test, a health care professional will take a blood sample from a vein in your arm, using a small needle. After the needle is inserted, a small amount of blood will be collected into a test tube or vial. You may feel a little sting when the needle goes in or out. This usually takes less than five minutes.

Lipase can also be measured in urine. Usually, a lipase urine test can be taken at any time of day, with no special preparation needed.

Will I need to do anything to prepare for the test?

You may need to fast (not eat or drink) for 8–12 hours before a lipase blood test. If your health care provider has ordered a lipase urine test, be sure to ask if you need to follow any special instructions.

Are there any risks to the test?

There is very little risk to having a blood test. You may have slight pain or bruising at the spot where the needle was put in, but most symptoms go away quickly.

There are no known risks to a urine test.

What do the results mean?

A high level of lipase may indicate:

A low level of lipase may mean there is damage to cells in the pancreas that make lipase. This happens in certain chronic diseases such as cystic fibrosis.

If your lipase levels are not normal, it doesn’t necessarily mean you have a medical condition needing treatment. Certain medicines, including codeine and birth control pills, can affect your lipase results. If you have questions about your lipase test results, talk to your health care provider.

Is there anything else I need to know about a lipase test?

A lipase test is commonly used to diagnose pancreatitis. Pancreatitis can be acute or chronic. Acute pancreatitis is a short-term condition that usually goes away after a few days of treatment. Chronic pancreatitis is a long-lasting condition that gets worse over time. But it can be managed with medicine and lifestyle changes, such as quitting drinking. Your health care provider may also recommend surgery to repair the problem in your pancreas.

References

  1. Hinkle J, Cheever K. Brunner & Suddarth’s Handbook of Laboratory and Diagnostic Tests. 2nd Ed, Kindle. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. Lipase, Serum; 358 p.
  2. Johns Hopkins Medicine [Internet]. Johns Hopkins Medicine; Health Library: Chronic Pancreatitis [cited 2017 Dec 16]; [about 3 screens]. Available from: https://www.hopkinsmedicine.org/healthlibrary/conditions/adult/digestive_disorders/chronic_pancreatitis_22,chronicpancreatitis
  3. Junglee D, Penketh A, Katrak A, Hodson ME, Batten JC, Dandona P. Serum pancreatic lipase activity in cystic fibrosis. Br Med J [Internet]. 1983 May 28 [cited 2017 Dec 16]; 286(6379):1693–4. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1548188/pdf/bmjcred00555-0017.pdf
  4. Lab Tests Online [Internet]. Washington D.C.; American Association for Clinical Chemistry; c2001–2018. Lipase [updated 2018 Jan 15; cited 2018 Feb 20]; [about 3 screens]. Available from: https://labtestsonline.org/tests/lipase
  5. Lab Tests Online [Internet]. Washington D.C.; American Association for Clinical Chemistry; c2001–2018. Glossary: Random Urine Sample [cited 2017 Dec 16]; [about 3 screens]. Available from: https://labtestsonline.org/glossary#r
  6. Mayo Clinic: Mayo Medical Laboratories [Internet]. Mayo Foundation for Medical Education and Research; c1995–2017. Test ID: FLIPR: Lipase, Random Urine: Specimen [cited 2017 Dec 16]; [about 3 screens]. Available from: https://www.mayomedicallaboratories.com/test-catalog/Specimen/90347
  7. National Cancer Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; NCI Dictionary of Cancer Terms: pancreas [cited 2017 Dec 16]; [about 3 screens]. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=46254
  8. National Heart, Lung, and Blood Institute [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Blood Tests [cited 2018 Feb 20]; [about 3 screens]. Available from: https://www.nhlbi.nih.gov/health-topics/blood-tests
  9. National Institute of Diabetes and Digestive and Kidney Diseases [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Definitions & Facts for Pancreatitis; 2017 Nov [cited 2017 Dec 16]; [about 4 screens]. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/pancreatitis/definition-facts
  10. National Institute of Diabetes and Digestive and Kidney Diseases [Internet]. Bethesda (MD): U.S. Department of Health and Human Services; Treatment for Pancreatitis; 2017 Nov [cited 2017 Dec 16]; [about 4 screens]. Available from: https://www.niddk.nih.gov/health-information/digestive-diseases/pancreatitis/treatment
  11. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2017. Health Encyclopedia: Lipase [cited 2017 Dec 16]; [about 2 screens]. Available from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=lipase
  12. University of Rochester Medical Center [Internet]. Rochester (NY): University of Rochester Medical Center; c2017. Health Encyclopedia: Microscopic Urinalysis [cited 2017 Dec 16]; [about 2 screens]. Available from: https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=167&contentid=urinanalysis_microscopic_exam
  13. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2017. Health Information: Lipase: Test Overview [updated 2017 Oct 9; cited 2017 Dec 16]; [about 2 screens]. Available from: https://www.uwhealth.org/health/topic/medicaltest/lipase/hw7976.html
  14. UW Health [Internet]. Madison (WI): University of Wisconsin Hospitals and Clinics Authority; c2017. Health Information: Lipase: Why It Is Done [updated 2017 Oct 9; cited 2017 Dec 16]; [about 3 screens]. Available from: https://www.uwhealth.org/health/topic/medicaltest/lipase/hw7976.html#hw7984

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