Medical Problems & Navigatingthe Health Care System Chapters 22 & 23 By: Lilibeth Barclay
Chapter 22:Selected Medical Problems Breast Uterus & Cervix Ovaries Selected Reproductive Tract Problems Vulva The Vagina The Bladder Other Pelvic Conditions
Medical Problems- Breasts:Breast Lumps: Breast Cancer: Cysts: fluid filled sacs that develop - 1 in 9 women can develop breast from dilated lobules or ducts (common during our 40’s-50’s) cancer Fibroadenomas: benign growths that - 70-80% of women whom develop it form mostly during teens & 20’s; do not have any risk factors besides rarely associated w/ cancer. age Pseudolumps: areas of dense normal - 40,000 women die per year breast tissue, usually during premenopausal yrs. Risk Factors- Age, personal history of breast cancer, genetics, reproductive- More than 80% are not cancerous but they should be checked to put ones mind at factors, hormonal factors, also consuming ease. alcohol, lack of exercise, history of high dose radiation exposure to chest area.- The physician can perform a physical examination, a mammogram or an - It is recommended that women over ultrasound and can refer one to a breast the age of 50’s (every year) and even in specialist if needed. their 40’s (every 2 years) should get- They should be operated if they cause examined. pain or if they are big and surround the breast tissue.
Diagnosing & Types of Breast CancersScreening for Breast Cancer: Mammography- used to identify malignant tumors with a low dose of radiation Ultrasound/Sonography- used to evaluate abnormalities that appear on mammograms; it distinguishes between solid tumors & fluid-filled cysts. MRI (Magnetic Resonance Imaging)- detects invasive breast cancer yet can falsely identify benign lesions as malignant. PEM (Positron Emission Mammography), BSGI (Breast-Specific Gamma Imaging), ThermographyTypes of Breast Cancers: LCIS (Lobular Carcinoma in situ)- low risk factor in developing cancer; 20-40% developed cancer over 20 yrs. DCIS (Ductal Carcinoma in situ)- noninvasive cancer can become invasive within time passing; 96-98% of women are alive ten yrs. after diagnosis, should be removed to reduce local recurrence. Invasive/Infiltrating Breast Cancer- breast cancer cells have moved outside the ducts or lobules and into the surrounding tissue; would require local surgery or radiation therapy along with hormone-locking medicines &/or chemotherapy.
The Uterus, Cervix & OvariesUterus: Fibroids (Leiomyomas, Myomas)- solid benign Cervix: smooth-muscle tumors that appear, often in groups Cervical Cancer- most often caused by HPV outside, inside & within the uterine wall, which can infections; a routine pap test can screen for abnormal, possibly change the size & shape of it. precancerous or cancerous changes in cervical cells. Can cause heavy vaginal bleeding, abdominal/back Early diagnosis can increase the rate of survival; pain, urinary problems & constipation; can make it 10,000-11,000 cases are presented a year resulting in difficult to conceive or have a full term pregnancy. 3,000-4,000 deaths. Certain procedures performed to remove or alleviate Treatments- for invasive cervical cancer a hysterectomy they symptoms can include a is recommended to remove lymph nodes in the pelvis; Hysterectomy, Myomectomy, Embolization of uterine if it has progressed radiation or a hysterectomy with the arteries, focused ultrasound surgery, Lupron the most additional removal of the ovaries is performed. recent is an IUD- Mirena Cervical Dysplasia- precancerous cervical problems; Uterine Cancer (Endometrial Cancer): 80% of dysplasia cases do not develop into cancer, cells can return to normal. Most common pelvic cancer affecting 14 out of 10,000 women Should be treated if severe an if it progresses; types can include colposcopy, punch biopsy & Symptoms can include: Bleeding after cone biopsy which should be done by menopause, increased menstrual flow & bleeding specialized practitioners with experience other between periods. options can include cryotherapy or Loop Early intervention has a high success rate, methods used Electrical Excision Procedure. are surgeries, radiation or chemotherapy. Cervicitis, Cervical Eversion, Cervical Erosion & Polyps, Hyperplasia & Abnormal Uterine Bleeding Cervical Polyps (AUB) Ovaries: Diagnosing methods- Endometrial Ovarian Cysts & Ovarian Cancer Biopsy, Transvaginal Ultrasound, Sonohysterogram & Hysteroscopy.
Selected Reproductive Tract Problems & Procedures• Pelvic Inflammatory Disease: an infection that affects the lining of the uterus, the fallopian tubes, and/or the ovaries; it affect nearly 1 million women 300,000 of which become hospitalized. Primarily caused by sexually transmitted infections and can develop into peritonitis or a tuboovarian abscess. Symptoms can include: pain in lower abdomen, tightness/pressure in reproductive organs, occasional dull ache, may include abnormal or foul discharge from vagina or urethra, pain/bleeding during intercourse, irregular bleeding or spotting, increased menstrual cramps, pain during ovulation, frequent or burning urination, inability to empty bladder, swollen abdomen, sudden high fever or low grade fever, chills, swollen lymph nodes, lack of appetite, nausea/vomiting, pain around kidneys/liver, pain in the lower back or legs, weakness, tiredness, depression, diminished sex drive. Treatment can include: taking two different types of antibiotics for 10-14 days even after symptoms are gone and may be hospitalized; you may need a hysterectomy if damage has occurred to organs, Endometriosis: hormonal & immune system disease in which tissue grows outside the uterus; Estimated 6 million girls & women in the US are affected. Symptoms can include pain before & during menstrual periods as well as during or after sexual activity, infertility, fatigue, heavy bleeding, lower back pain w/ periods, intestinal upset w/ periods; these women can be at a high risk of developing chronic autoimmune diseases like fatigue syndrome, fibromyalgia, hypothyroidism, lupus, multiple sclerosis, rheumatoid arthritis & Sjogren’s syndrome. DES (Diethylstilbestrol): a powerful synthetic hormone that crosses the placenta of pregnant women which can damage the reproductive system of the developing fetus; can affect the endocrine, immune, skeletal & neurological systems. This was prescribed to women roughly 4.8 million women between 1938-1971 thinking to prevent miscarriage. Hysterectomy: removal of the uterus; either total, total with bilateral salpingooophorectomy or supracervical . Oophorectomy: removal of either one or both ovaries and may also remove the fallopian tubes.
The Vulva, Vagina & BladderThe Vulva: The Bladder: Vulvitis: Inflammation of the vulva that may be caused by several medical conditions, medical creams or external Urinary Tract Infection: Can be caused by bacteria getting irritants; into the urethra & bladder from the gastrointestinal system; also poor diet, stress trauma from childbirth to the Symptoms: itching, redness, swelling, burning & pain. urethra. Pregnant women & postmenopausal women are Treatment: antifungal creams or antibacterial treatment; more prone. if worsens may need vulvar biopsy. Cystitis: Most common UTI, it’s the inflammation or Vulvodynia: chronic vulvar pain, with severe infection of the bladder burning, pain, itching, stinging &/or irritation. Most common symptoms include: a frequent Vulvar Cancer: rare yet women with a history of HPV urinating feeling that burns yet nothing comes infections are at higher risk. out; pain above the pubic bone, food allergiesThe Vagina: Urinary Incontinence: a condition where women, involuntarily lose urine. Can appear during pregnancy, Vaginal Infections: can produce abnormal discharge, mild damage due to birth trauma, pelvic surgery or advanced or severe itching, burning of the vulva, chafing of the age. thighs & frequent urination. May be caused by lowered resistance, douching, scented sprays, birth control pills, etc. Can be treated by antibiotics or natural/herbal Painful Bladder Syndrome/Interstitial Cystitis: chronic remedies. pain syndromes that may develop for many reasons; Yeast Infections: caused by yeast like organism, that grow clinical diagnosed by urgency/frequency of urination (60- profusely & cause thick white discharge with a bad odor. 80x’s) or pain in the bladder and/ or the pelvis; other Causes burning or irritation. Treated by vaginal symptoms include, vaginal/rectal pain & pain during suppository, cream or oral antifungal intercourse. Affects about 500,000 women mainly in their 40’s. May be misdiagnosed, tests can show negative Bacterial Vaginosa: disturbance of the ecology of the results. Provided treatments consist of medication, low- vagina, with an overgrowth of certain microorganisms. dose antidepressants, diet changes, transcutaneous electric Treated with metronidazole or clindamycin for 5-7 days. nerve stimulation; surgery may be performed yet pose risks and positive outcomes are guaranteed.
Other Pelvic Conditions Obstetric Fistula: An injury caused during labor Polycystic Ovarian Syndrome (PCOS): in which the prolonged pressure caused by the Most common hormonal & reproductive baby’s head on the vagina creates a hole between problem affecting women of childbearing the bladder (or rectum) & the vagina. Occurs age; it’s characterized by two of either an mostly in under developed countries, Africa & irregular menstrual cycle/ lack of ovulation South Asia. for a prolonged time, elevated levels of androgens in the blood and/or many small Female Genital Cutting: Also known as female follicles on the ovaries. circumcision or genital mutilation cultural practice by some countries in African, Asia or in Symptoms: irregular/infrequent/absent the Middle East where certain parts of a girls or menstrual periods, acne/oily skin, fertility young women’s genitalia (the whole, parts or the problems, overweight/obesity, male-pattern baldness, etc. hood of the clitoris, the labia minora or the external genitalia) are cut, narrowed or stitched to Treatments: weight loss, oral curb sexuality or as a rite of passage into contraceptives, cyclic progesterone, diabetes womanhood. There can be some difficulties that medication, spironolactone. these women can experience such as excessive bleeding, infections & shock; also painful intercourse, dermoid cyst, UTI’s, pelvic infection When facing any health issue or among other recurrent symptoms. concern, “Although most doctors have good intentions, they tend to offer only the Pelvic Relaxation: When the muscles of the pelvic floor become slack & no longer support the pelvic treatment they know best. It’s wise to get a organs as they should. Severe cases where the second opinion before committing yourself ligament tissues holding the uterus are weakened to a plan, even if you feel confident with allowing the uterus to fall into the vagina is known your first doctor. (pg599)” as Uterine Prolapse.
Chapter 23Navigating the Health Care Making Health Care Decisions: System “A good decision involves gathering and evaluating information, weighing, what’s important to you, finding the resources needed to maximize the quality of care you receive, and dealing with the associated costs.” One must weigh the benefits of tests/treatment & possible negative effects associated with treatments one receives. Positive- • Gaining information about ones health and care, achieving a pregnancy, Getting welcome relief from symptoms, increasing chance of living longer Negative- • Possible of ineffective results, unreliable Determining When We Need Health Care: information, financial costs, effects on ability to work, pain & discomfort, as well as emotional “We regularly make decisions that affect our effects. health… these self-care decisions… can have profound effects on our well-being and need for medical care (pg.652).”
How the new health reform law affects women’s access to health care and health insurance: A national comprehensive healthcare reform law was enacted in 2010, making it more accessible to affordable health care & insurance. Help finding health insurance: By going online to healthcare.gov one can be directed to answers about insurance plans offered & finding low-cost health care. Coverage of important health care services: Certain preventive care & screenings are available to women under this new law, including mammograms, Pap tests without co-pays, maternity care, prescription drugs & mental health care. Additional provisions affecting women: Women will have direct access to obstetrical & gynecology care, pregnant women will have additional options for labor & birth, children can remain in their parents insurance plan until age 26, the Medicare “donut hole” will be eliminated for older women. Restrictions on immigrant women and women seeking abortions: Immigrant women must wait 5 yrs. before becoming eligible for Medicaid for sliding scale insurance subsidies, if they lack documentation on their legal status they become ineligible; for women seeking abortions they will have to pay two separate payments one for the abortion coverage and another for the remainder of the premium. Sources of health information: One has to trust their own judgment on how their body feels, the symptoms, prior/current health problems, the partners health status & family history.
Information From Health Care Providers Providers’ information may be influenced by financial incentives that benefit the institution, pressure from drug companies for the use of certain medications/drugs, particular “standards of care” that work for some may not work on others, fear of lawsuits, lack of knowledge/negative attitudes toward cares &/or treatments; It’s important for the individual to be informed, ask questions, state doubts & fears confidently to make a knowledgeable decision that supports our beliefs and desires; There are support, self-care & self-help groups, one can go to seek more reliable information, as well as discuss topics & treatments available; There is excess information also available online yet one has to make sure it is from a reliable source with accurate and up to date information; The media can be a source of misguided material used only to draw attention to companies and their products, so research should be done on the validity of the advertisements being presented; Research literature & research studies are also obtainable with recent studies done on various topics of interest which can help in getting the most up to date information, especially from peer-reviewed articles; keeping in mind that results may vary person-to-person so one can’t expect the same outcomes.
Our Rights to Informed Consent & Accessing Health Care Refusal o Choosing a health care provider: male vs. One has the right to decide what is done female, does your insurance cover to their own body so communication with them, experience they have, etc. the physician is important and a better o The imbalance of power in the decision is made when one is informed Doctor/Patient relationship: make sure properly and understands what will take you don’t feel intimidated by your place. The risks & benefits of physician, that he listens to your questions procedures, alternatives to & answers them so you understand, hears treatments, specific health issue, success your concerns & deals with them rates, anticipate problems & costs. accordingly, etc. o Making the most of your health care visit: Refusing treatment can be done even come prepared with questions, medicines after a procedure has been set, as long as taken, medical history, bring a person you the person is competent and understands trust & will make sure your questions & the information presented by their your best interests are being met, ask for providers, even if it may lead to their test results if any were done. deaths. o Patient Advocates: Important to bring to an appointment a person one trusts, who can help when deciding on treatment options being presented.
Recognizing & Overcoming Barriers to Getting Good Health Care Financial Barriers: Extending Medicaid Coverage: Health Care Disparities: Bias Against Substance Abusers: Language & Culture: Disability Issues: Homophobia, Transphobia & Heterosexism: Multiple Barriers for Incarcerated Women:Women should be aware of these barriers that may present themselves and beinformed on how to deal with them because it can affect they type of care they receive.
Conclusion My Thoughts… I believe that at times people give their physicians the power to make their health decisions and feel intimidated when stating any concerns they have. Recurrent illness Enforcing Our Rights or symptoms are things that should beo Women need to enforce their rights when it taken serious and a person needs to take comes to their health & body. We have to live the steps to acquire the information needed with the symptoms of our illness & no about the benefits and negative effects that physician can know better than ourselves what that could happen. we are going through. If there are any issues, concerns or complaints, we have a right to be heard and the issue to be discussed to make a knowledgeable consent or refuse if there is some doubts. Question ??? Do you use any specific resources when facing a health issue before going to your physician? If so where do you get your information & how do you know it’s reliable?