Although testicular cancer is rare in comparison to other types of cancer, it is the leading form of cancer in males of peak reproductive age- 15 to 34. Approximately 8,000 new cases of testicular cancer are diagnosed annually in the United States and 2,000 in the United Kingdom. Of the cases diagnosed, the cure rate is very high.

Types of Testicular Cancer

The majority of testicular cancer tumors are forms of Germ Cell tumors. Germ cells are responsible for sperm production and account for 90% of all testicular cancer. Within this category, there are two specific categories of cancer cells.

Seminoma germ cell tumors are identified mainly in men in their late 30s to 50s. In a fifth of cases, pain is an initial symptom and for approximately 89%, there is a palpable mass upon physical examination.

This form accounts for approximately half of germ cell cancers and can be treated with external radiation treatment instead of chemotherapy if detected early. Statistics show a 99% Success rate with early (stage I) intervention. Seminomas have a relatively slow growth rate compared to Nonseminomas and the risk of the cancer spreading to other parts of the body is less than with other forms of cancer.

Nonseminomas Germ Cell tumors differ from Seminomas in that they are harder to treat, being less responsive to radiation treatment and require chemotherapy. This form is found in much younger males, beginning in the late teens to around forty. Nonseminomas germ cell tumors come in four forms:

• Embryonal Carcinoma- derives its name from the fact that the cells in question are left over from when the individual was an embryo and can appear similar to the tissue of an early embryo when viewed under a microscope. This form accounts for 3-10% of all germ cell tumors, but these cells can also be found mixed with other cells in up to 40% of tumors under different classifications. A primarily Embryonal carcinoma tumor can progress relatively fast. This form has the potential to spread outside of the testicles, with two thirds of cases spreading to other parts of the body. Embryonal carcinoma tumors are primarily found in men prior to middle age, with the average age being 31.
• Yolk Sac carcinoma- these cancer cells resemble the yolk sac of a human embryo and is the most common form of Testicular Cancer in children. When diagnosed in a child, there is a very high success rate. When found in adults, this form can present more of a danger and is treated with aggressive chemotherapy.
• Choriocarcinoma- is a rare, but very serious form of cancer. It is extremely aggressive and can quickly spread to other areas of the body, including the bones, brain, lungs and other organs. Prompt and aggressive treatment is required in this case.
• Teratoma- originates from germ cells and mimics the three layers of the human embryo. There are three types of Teratoma, which are Mature Teratomas, Immature Teratomas and Teratomas with Malignant transformation. Mature Teratomas can usually be cured by surgery to remove the testicle, however, the other two types are likely to spread to other parts of the body and require chemotherapy.

It is quite normal for there to be two types of Nonseminoma cancer cells involved in one patient. This however, does not affect the course of treatment.

Causes of Testicular Cancer

As with many cancers, the exact cause of Testicular Cancer is unknown. Cancer itself occurs when usually healthy cells become compromised and altered, affecting how they divide and proliferate. A normal cell divides at a set rate, but cancerous cells divide furiously, until there is a mass of altered cells attached to a healthy organ or tissue Researchers do not possess definitive answers about what causes Testicular Cancer,  however, there are theories and initial evidence of how tumors of the testes come about, including the following:

• Genetics may play a role in developing testicular cancer, as men who have a family history are more likely to develop cancer of the testes in their lifetime.
• Exposure to excessive Pesticides has been implicated in the development of Testicular Cancer.
• Suffering from an undescended testicle in early life, which can lead to insufficient sperm production and cancer in one or both testicles.
• The HIV virus has also been documented as a risk factor for Testicular Cancer.
• Klinefelter Syndrome can also place one at risk for Testicular Cancer. This condition is the existence of an extra X chromosome in males (female chromosome), which leads to enlarged breast, smaller testicles and infertility.
• Carcinoma in Situ is a gathering of abnormal cells that are usually detected during biopsies in fertility treatment and usually require the removal of the affected testicle.

Additional Risk Factors

• A previous case of Testicular Cancer provides a 3-4% chance of cancer occurring in the opposite testicle.
• White males are more likely than other ethnic groups to be diagnosed with Testicular Cancer.
• This form of cancer is also more prevalent in higher end socio-economic groups.
• Testicular cancer seems to appear more often in taller men.
• Smoking increases the risk of developing Testicular Cancer by 50%.

Symptoms of Testicular Cancer

Although cases of Testicular Cancer may present with no recognizable symptoms, it is more common for the patient to complain of one or more of the following:

• A discernable lump in the testicle
• Pain or discomfort in the testicle or scrotum
• Swelling of one or both testicles
• Lower back, chest or abdominal pain due to the cancer spreading through the lymph nodes
• Breast tenderness or swelling due to hormonal secretions of the cancer cells

Diagnosing Testicular Cancer

While in some cases, the patient presents with symptoms that are very indicative of testicular cancer, other cases are not that apparent. In order for a physician to make an accurate diagnosis, there are a number of diagnostic tools available. The initial evaluation will likely be performed by your family physician, with a referral to an oncology specialist if necessary.

In order to help the doctor assess your condition, have a list of any symptoms, duration,  frequency and severity of pain, any recent accidents, medication currently being taken, as well as documentation of any family history of cancer.

In the physical examination, the physician will examine the testicle for swelling, redness, heat and pain upon touch. Additional testing to determine the likelihood of testicular cancer includes:

An Ultrasound will be performed to provide a more accurate picture of the testicle and any lumps. In this procedure, a clear gel is applied to the testicles and a small device that emits sound waves is passed over the scrotum. This provides a picture of the testicles and any abnormalities. If there are any lumps, they should be evident on the ultrasound. The doctor will be able to tell if there is likely cancer evident or if the lump is a fluid filled cyst instead. The physician will also be able to tell if the mass is centralized inside or outside of the testicle.

Additional Blood Tests may be ordered to make a definitive analysis of cancer. The test will look for elevated levels of tumor markers that may be indicative of active cancer. Although not evident in all cases of testicular cancer, elevated tumor markers can confirm a suspected case of cancer. The common markers the physician will look for are:

AFP (alpha-fetoprotien) – This test may be by far the most indicative of malignant cancer. Although this element occurs naturally in the body, it is highly elevated in cases of cancer, specifically in Teratoma germ cell tumors.

HCG Levels (human chorionic gonadotrophin)- This is another test that provides information regarding a possible testicular tumor. HCG levels are noticeably elevated in 80-85% of cancer cases and the test can also provide an indication of the size of the tumor. HCG levels can be high in seminomas and nonseminomas

LDH (lactic dehydrogenase)- High LDH levels represent in increased amount of enzyme in the blood that is a result of damage to healthy cells. LDH levels can be elevated in many types of cancer and provide the physician with a general cancer diagnosis, while more tests are required to ascertain the specific type of cancer and the extent of the damage. This test can also help to gauge whether the cancer has spread to other parts of the body.

PLAP (placental alkaline phosphatase)- Elevated PLAP levels can be indicative of a seminoma tumor. Studies have shown that PLAP levels are elevated in 78% of men with seminomas.

Tumor marker tests are often conducted in order to confirm testicular cancer and also to monitor the progress of recovery after treatment.

Biopsies are another diagnostic option. In this procedure, a small piece of the testicle will be removed and examined in a laboratory for cancerous cells. There are two ways to perform the biopsy- an open biopsy, or a needle biopsy.

In both types of biopsy, the testicles are cleaned with a sterile solution and a local anesthesia is administered to numb the area. The surrounding area is carefully covered with a sterile cloth. In an open biopsy, the doctor makes a small incision in the testicle and removes a small piece of tissue from the testicle. One or two small stitches are required to close the incision. In a needle biopsy, the tissue is extracted by a surgical needle inserted into the testicle and no cuts or stitches are required. Both are outpatient procedures that can usually be performed in the physician’s office. However, it is important to note that a biopsy will not always be offered, because of the likelihood of spreading the cancerous cells.

Testicular Cancer Treatment

Surgery

Once a high likelihood of Testicular Cancer is confirmed, surgery must be performed to remove the affected testicle. This is the only way to verify the existence of cancer 100% and will often be coupled with follow-up treatment to prohibit a reoccurrence of cancer. These treatments may also be required to treat other areas of the body, to which the cancer has spread.

The surgical procedure to remove the testicle is called an Orchiectomy. In this procedure, the patient is given a local anesthesia and an incision is made in the lower groin, above the affected testicle. The testicle is gently moved up towards the incision, pushed out and removed. If necessary, nearby lymph nodes will be removed at this time as well. If desired, a prosthetic testicle can be placed into the scrotum to even out the appearance of the testicles.

The surgery is usually done within an hour and the patient is released to go home. A small number of cases may require a short hospital stay, but this is usually an outpatient procedure. The patient can usually resume normal activities within two weeks, although it may take up to four weeks or all discomfort and other signs of surgery to disappear.

Although an Orchiectomy is a relatively low risk procedure, there are still the risks associated with surgery, such as excessive bleeding, adverse reaction to anesthesia and infection. If the patient needs to have both testicles removed, there is the additional risk of a loss of testosterone, which can cause the following:

• Infertility
• Reduced Libido
• Erectile and ejaculation dysfunction
• Weight gain
• Increase in breast tissue
• Loss of muscle tissue
• Osteoporosis

Hormone therapy can be prescribed to alleviate some of the symptoms above. While it may seem a drastic procedure, removal of the affected testicle is the most reliable way to treat testicular cancer. In some cases, additional therapies will be implemented to fight cancer that has spread to other parts of the body. The type of additional treatment depends on the stage of the cancer.

Stages of Testicular Cancer

Once the testicle is removed, it is examined under a microscope by a pathologist to definitively diagnose cancer, as well as the type of cancer cells and provide information about what stage the cancer is in. The stage indicates whether the cancer has spread to other parts of the body and how far. In addition to the pathology report, a CAT scan will be ordered to provide a detailed look at the various organs and systems to identify additional tumors and cancerous cells.

During the CAT scan, the patient will be required to drink barium sulfate, a milky liquid that may cause some stomach discomfort. Additionally, the patient will likely receive an IV filled with contrast dye, which allows for a better image of the inside of the body. There may be some side affects of the dye, including a metallic taste in the mouth, nausea, warmth throughout the body and itching. These are routine and mild side affects, however difficulty breathing or swelling of the throat or other body parts should be reported immediately, as some people may be allergic to the iodine in the contrast dye.

The physician will usually examine images of the pelvis, abdomen and chest area in search of additional cancer cells. Based on the existence of additional cells and their location, a stage will be determined. The stage will determine the treatment plan for the patient going forward.

There are three specific stages, as follows:

Stage I- In this stage, the cancer is restricted to the testicles and has not spread to the lymph nodes or other areas of the body. 72% of Testicular cancer cases are classified as stage I.

Stage II- Also known as the Regional stage, this classification is for cases where the cancer has gravitated into the lymph nodes in the abdomen. Stage II accounts for approximately 19% of all cases.

Stage III- In this stage, not only are the lymph nodes affected, but the cancer has spread to other organs further away, including the heart, lungs, bones or brain. Stage III cancer accounts for 9% of all Testicular Cancer cases.

Treatment Based on Stage

Stage I Treatment- For localized cases, often the removal of the testicle is sufficient to cure the cancer. After successful surgery, the patient will enter a period called “surveillance”, in which they are closely monitored for a reoccurrence of cancer. During the surveillance period, the doctor will routinely check the patient’s tumor markers for signs of cancerous activity.

Also, based on the blood analysis and examination of the testicle after removal, some stage I patients will also receive external localized radiation treatment targeting lymph nodes in the abdomen. This is especially the case if the cancer is classified as a Seminoma and is used as a measure to prevent a reoccurrence of cancer. The patient will be monitored closely to detect any relapse.

If the stage I cancer is classified as Nonseminoma, more aggressive treatment is applied. The patient will likely be advised to have additional surgery to remove the lymph nodes in the pelvis and abdomen. Also, the patient must undergo blood testing on a monthly basis for a period of one year, and bimonthly the following year. A followup CAT scan may also be done during that time. If additional cancer cells are detected, the patient will likely have to undergo chemotherapy.

Stage II Treatment

In stage II cases that have spread to the lymph nodes, there are two options. The physician may elect to remove the affected testicle, then follow up with external radiation treatment of the lymph nodes. This is usually the case for tumors that are found to be Seminomas. In the case of NonSeminomas tumors, the lymph nodes will be surgically removed, followed by chemotherapy to combat any remaining cancer cells.

There have also been cases where the physician is able to clearly identify stage II testicular cancer based on physical examinations and ultrasound images. In this case, the patient may be offered the option of undergoing chemotherapy, instead of surgery to remove the testicle. In this case, the patient will receive systemic chemotherapy treatments, along with ongoing blood work and x-rays to evaluate the success of the treatment. However, it the doctor does not see sufficient progress, or the cancer seems to be spreading, surgery will be advised.

Stage III Treatment

In stage III Testicular Cancer, if Seminoma cancer cells are found, then the testicle will be removed, with a high probability that the lymph nodes will be removed as well. The patient will then undergo systemic chemotherapy treatment and will be monitored continuously to gauge progress. In Nonseminoma stage III cases, which means that the cancer has spread to other parts of the body, more aggressive treatment is required. The patient will immediately undergo systemic chemotherapy treatment. The patient’s tumor markers, CAT scans and other indicators will be reviewed regularly for signs of progress or additional cancer proliferation.

After the determined number of chemotherapy treatments, the oncologist may order surgery to remove any remaining tumors that remain in the body. In some cases, additional chemotherapy treatment is ordered after surgery to eradicate any lingering cancer cells.

Chemotherapy

Chemotherapy treatment is administered in cases where the oncologist wants to provide extra assurance against cancer returning, to fight cancer that has spread to other parts of the body or to treat reoccurring cancer that has returned after the initial treatment. There are numerous mixtures of drugs that may be administered which depend on the stage, but the most common by far is a mixture of Cisplatin, Etoposide and Bleomycin, known as BEP chemotherapy.

Chemotherapy drugs are administered via an intravenous drip or injection directly into the veins of the patient. The usual administration points are in the arm (a PICC line), or into the main vein in the chest (a central line). If this chest is chosen, local anesthesia will be given before the infusion line is inserted.

Side Affects of Chemotherapy

• Some chemotherapy patients experience acute anemia, with symptoms such as lethargy, breathlessness, and dizziness. This is due to chemotherapy reducing the red blood cell count. Medication can be given to combat anemia and blood transfusions can be administered in severe cases.
• Low platelet counts may affect the blood’s ability to clot effectively, which may cause excessive bleeding from even small wounds, as well as easy bruising.
• The risk of infection increases, due to the reduction of white blood cells.
• Nausea and vomiting may occur, but can be controlled by medication.
• Hair loss is a common side affect of chemotherapy, with the onset at about two to three weeks after the first round of treatment. The amount of hair lost will vary, but should fully return once treatment is completed.
• Loss of appetite is a common side affect of chemotherapy, as well as dry mouth and mouth soreness.
• Shortness of breath and excessive coughing can be caused by the drugs used for chemotherapy.

Outcomes for Testicular Cancer

Testicular Cancer is highly curable. With early detection and prompt intervention, the success rates are impressive, but do vary by stage.

For Stage I Testicular Cancer the cure rate is 99% for Seminoma tumors and 98% for Nonseminomas.
Stage II Testicular Cancer cure rates are 95% for both Seminoma and Nonseminoma cancers.
Stage III Testicular cure rates are lower, but still impressive at 90% for Seminoma and 76% for Nonseminoma.

To ensure the best outcome, patients should make all of their appointments and treatment sessions and report any adverse reactions to their doctor.

Fertility after Testicular Cancer

Removal of one testicle does not translate into infertility, as semen can be produced by the remaining one. However, if the patient is required to have the lymph nodes in their abdomen removed, this can cause a problem with fertility, called Retrograde Ejaculation.

Retrograde Ejaculation means that instead of semen emitting from the penis during ejaculation, it is instead unable to descend and actually moves backwards into the bladder. In this case, a male will still be able to sustain an erection, but will experience a dry climax and is unable to impregnate his mate. However, if a patient desires children, the semen can be removed and inserted into his mate via in-vitro fertilization.

Chemotherapy can also cause infertility. For most individuals, it will cause temporary infertility while undergoing treatment. Some individuals are able to become fertile again after chemotherapy is discontinued. Overall, 80% of men with Testicular Cancer are able to conceive after treatment and 70% of those that received chemotherapy go on to successfully have children.

Sperm Banking

If you are concerned about the possibility of infertility and would like to have more children, there is the possibility to bank some of your sperm for later use in impregnating your partner. To achieve this, the patient will be tested to ensure that their sperm count is sufficient, however if the sperm count is low, there are techniques to salvage usable sperm if there is sufficient time. Once testing is complete, the sperm are removed and frozen in the hospital. When you desire to have children, the sperm are then thawed and the process will begin to inseminate your partner. Note, however that some sperm do die upon thawing and it may take multiple attempts before your partner becomes pregnant.

Possible Testicular Cancer Complications

With Testicular Cancer, early detection is best. Possible complications differ based on the patient’s overall health, whether both testicles are affected, the stage of the cancer and the overall treatment plan and success thereof. Possible complications include:

• Cancer cells can spread to other areas of the body, including the spine, lungs and abdomen.
• There is the possibility of infertility from chemotherapy.
• Removal of the lymph glands in the abdomen or both testicles can also cause infertility.
• Complications of surgery to remove one or both testicles include excessive bleeding and infection.
• If both testicles are removed, hormone replacement therapy may be required.
• During chemotherapy, patients may experience fatigue, nausea, hair loss and skin issues.

Preventing Testicular Cancer

There is no documented means of preventing Testicular Cancer. Researchers state that the best defense is to do routine self examinations and report any abnormalities to your physician for early intervention.

Testicle Self Examination

A self examination is best performed in the shower, under warm running water. This allows the testicles to be fully relaxed.

Check the entire scrotum to see if it feels of normal weight and size. Then, use your fingers to check each testicle individually for size and shape, taking care to look for any swelling or hard masses. It is normal for one testicle to be lower and larger than the other. If you encounter any abnormalities, report them to your physician, who can perform a thorough examination.

If you are a smoker, eliminating this habit reduces the risk of developing Testicular Cancer by 50%.

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References:
National Cancer Institute. Testicular Cancer: http://www.cancer.gov/cancertopics/types/testicular
US National Library of Medicine.  Klinefelter Syndrome: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001420/
US National Library of Medicine. Testicular Cancer: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002266/
US National Library of Medicine. Undescended Testicle: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001968/
Macmillan Cancer Support. Testicular Cancer
Macmillan Cancer Support. Chemotherapy
Mayo Clinic. Testicular Cancer: http://www.mayoclinic.com/health/testicular-cancer/DS00046
Cancer Research UK. Fertility-Having Children after Testicular Cancer
Testicular Cancer Information and Support. Testicular Cancer Treatment: http://www.tc-cancer.com/treatment.html
Testicular Cancer Research Center. Testicular Cancer Info-Staging: http://tcrc.acor.org/staging.html
Staging of Testicular Cancer:http://www.kantrowitz.com/cancer/staging.html
UK NHS. Testicular Cancer-Prevention: http://www.nhs.uk/Conditions/Cancer-of-the-testicle/Pages/Prevention.aspx
American Cancer Society. What is Testicular Cancer

Photo Credits:
http://www.flickr.com/photos/geekstats/ (Geekstats)
Seminoma Cells: By Mattopaedia (Own work) [CC-BY-SA-3.0 (www.creativecommons.org/licenses/by-sa/3.0) or GFDL (www.gnu.org/copyleft/fdl.html)], via Wikimedia Commons

Although triglycerides are fats (a.k.a. lipids) are present in bloodstreams much like cholesterol, they differ from one another in that triglycerides provide energy while cholesterol is a crucial component in building cells and producing some hormones. Kept at appropriate levels, both, triglycerides and cholesterol are critical for good health. However, their access promotes heart disease and other health challenges.

Triglycerides and Health Issues

When individuals consume more calories than their bodies can use, triglycerides accumulate to unhealthful levels and high levels of triglycerides in the bloodstream has been directly associated with atherosclerosis. Atherosclerosis, which is a medical condition that is characterized by thickening of arterial walls due to the buildup of fatty matter, is then associated with heart disease, heart attack and stroke.

Also attributed to high levels of triglycerides is an inflammation of the pancreas (an organ of the digestive and endocrine systems) that is known as pancreatitis.

Triglycerides are, in a way, important measures of heart health and at high levels they are often manifested as obesity and the metabolic syndrome (a wide-scoping group of conditions such as surplus fat around the waist, high blood pressure (hypertension), high triglycerides, high blood sugar (diabetes) and high cholesterol levels.)

Often, high levels of triglycerides are directly caused by overeating of fatty foods but that is not always the case. In some patients, high triglycerides are caused by poorly controlled type 2 diabetes; an underactive thyroid (hypothyroidism); certain liver and/or kidney diseases; a genetic dysfunction which affects how the body converts fat to energy; or a side effect of some medications which may include beta blockers, birth control pills, diuretics, steroids or tamoxifen (a drug administered to breast cancer patients).

According to the American Heart Association and its guidelines for triglyceride levels; the normal levels of triglycerides are in ranges of less than 150 mg/dL and less than 1.69 mmol/L. Ranges of between 150 – 199 mg/dL and 1.70 – 2.25 mmol/L are borderline high levels of triglycerides. Anything beyond those borderline levels requires urgent attention.

Lowering Triglyceride Levels

The most effective ways for lowering triglyceride levels are:

1. Dieting. Weight loss and reduction of caloric intake by: (a) reducing or eliminating the intake of refined sugars and simple carbohydrates (processed sugars and white flour) which raise the production of insulin which, in turn, increases triglycerides; (b) reducing or eliminating the intake of foods which are high in cholesterol (red meats, saturated fats, egg yolks and dairy products); (c) replacing the consumption of saturated fats with monounsaturated which are found in olive, peanut and canola oils and fish; (d) staying away from trans fats that are found in fried foods and pre-packaged snacks; and (e) avoiding alcoholic beverage whose smallest amounts raise triglyceride levels significantly.

2. Participating in regular and routine daily exercise.

3. Controlling existing medical conditions, particularly diabetes and high blood pressure.

4. If all of the above are insufficient to lower high triglyceride levels, cholesterol lowering drugs such as niacin or fibrates may be prescribed.

Among organs which can be transplanted today are the heart, kidneys, liver, lungs, pancreas, and intestine as well as penis and eyes. But organs are not the only body parts which are transplantable; tissues of various types such as bones, bone marrow tendons, cornea, heart valves, veins, arms, hands and skin are also being transplanted successfully.

Types of Transplants Available Today

The types of transplants which are available in modern day medicine include the following:

Autograft. A patient’s own tissues are transplanted from one area to another and it involves excessive tissues or those tissues which are capable of regenerating. The most common among autografts are skin and vein as well as the patient’s own blood which had been stored prior to surgical procedures and is then used as needed during and/or after the surgery.

Allograft. This encompasses most standard human organ and tissue transplants as it involves transplants of organs and/or between the same species as in human to human.

Isograft. This involves organ and/or tissue transplants between identical twins. This is the safest transplant with the highest success rate as it does not trigger immune responses.

Xenograft. This is the transplant of organs and/or tissues from one species to another.

Split Transplants. This involves the splitting of a single donated organ or tissue (such a liver or skin) and transplanting it into two patients.

Domino Transplant. This involves juggling of organs as one patient received both lungs and heart but since the heart of the patient is healthy, it is then transplanted into another patient.

Numeric Facts about Organ Transplants

Organ transplants in humans became a reality and an enormous medical breakthrough which saves countless lives began with several kidney transplants in the early years of the 1950s. This incredible medical advancement opened up many doors for other organ transplants and the procedures have become more and more fine tuned and progressively gained higher success rates while adding more years to patients’ lives. Today, organ transplants are common routines in just about every hospital around the world and, for the most part, they are very safe.

In the year 2000 and in the United States alone; 5,984 cadavers (deceased donors) were donated, plus 5,700 live donors made their transplantable organs available. Also in the United States during the year 2000, the following transplants of major organs were performed successful but there were many more patients waiting for their turn:

Lungs — transplanted 956, on the waiting list 3,812
Heart — transplanted 2,198, on the waiting list 4,139
Heart and lung — 48 transplanted, on the waiting list 213
Liver — transplanted 4,954, on the waiting list 18,752
Pancreas — 435 transplanted, on the waiting list 1,217
Kidney — 13,327 transplanted, on the waiting list 50,898
Kidney and pancreas — 911 transplanted, on the waiting list 2,451
Intestine — 79 transplanted, on the waiting list 183

As can easily be discerned, we are faced with a huge dilemma nowadays; supply does not meet demand as the need and request has become far greater than the availability of organs. There simply are not enough life-saving organs to go around because the rate of donation is much too low. With an average of 114 patients being added to the waiting list for donor transplants, many patients wait for months and even years for the chance at recovery and a new lease on life and many of them suffer and die (5,794 in the year 2000) before they ever reach the top of the long waiting list.

Transplantation Medicine

Having to deal with a number of sensitive issues, transplantation medicine is probably the most challenging fields of modern medicine as it faces multifaceted issues such as: (a) keeping the donated organ healthy and in a fully functioning state while preparing to transplant it from the donor to the recipient (the patient); (b) ensuring that the patient’s immune system does not reject the transplanted organ; and (c) the complex mechanics of the transplant procedure itself.

Transplantation medicine also faces an entire set of bioethical issues which question the definition of life vs. death; the means by which consent for organ transplants is given or gotten; the systems which determines who benefits from organ transplants, when and how; the fact that payment (large payment) is involved in organ transplants; and so on.

After the Transplant

Other than having to deal with the standard issues of recovery after surgery, transplant patients have to also deal with the fact that their immune systems may reject the newly transplanted organs and/or tissues. To help prevent rejection, donor recipients must take immunosuppressants which make them vulnerable to a wide variety of pathogens (disease causing agents such as germs, virus, etc.).

Trans fats are also found naturally in small amounts (approximately 2% to 5% of total fat contents) in various animal-based products such as meats of ruminating animals which include cattle, sheep and others, as well as in dairy products including butter and cream.

The food industry — restaurants, fast-food establishments, manufacturers of packaged and processed foods as well as bakeries all use trans fats because they are inexpensive, because they add extra flavor and pleasing texture, because they extend shelf-life and thus postpone spoilage of foods, because they can be reused many times over and because they adhere to the food restriction of those who abide by the dietary laws of the Judaism (kosher) and Islam (halal) as well as vegetarianism and veganism as ascribed by secular or religious groups such as belonging to Buddhism, Ahimsa, Jainism and Hinduism.

Today, trans fats are found to a larger or smaller degree in a wide variety of foods but most of all in those which are fried and / or baked. Examples of common foods containing trans fats are: doughnuts; French fried potatoes and onion rings; potato, corn and tortilla chips; pizza dough; pie crusts; biscuits, cookies and crackers; icing and whip cream, microwave popcorn; and, of course, margarines and shortenings.

The Harm Caused by Trans Fats

Whereas many dietary fats are essential and promote good health, trans fats are not. As a matter of fact, trans fats are not only unessential but they have also been proven to be harmful in a number of ways. Thus trans fats, which are either monounsaturated or polyunsaturated but never saturated, are believe to be the worst kind of fats even worse than saturated fats which in reality also raise total cholesterol levels.

The solid aspects of trans fats are responsible for clogging up arteries and significantly increasing the risk of coronary heart disease (CHD) which is characterized by the failure of coronary circulation to sufficiently supply blood to the muscles of the heart and to the surrounding tissues. Trans fats are also associated with higher risks of developing type 2 diabetes and suffering a stroke.

All that is due to the fact that trans fats are known to: (a) increase the levels of the “bad” cholesterol that is often also referred to as the LDL cholesterol; (b) decrease the levels of the “good” cholesterol which is also known as the HDL cholesterol; and (c) contribute to weight gain and obesity more than any other types of dietary fats.

Nutritional Advisory

In their 2002 “Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids,” the NAS (the National Academy of Sciences which is an official advisory board on nutrition, public health policies and labeling of food products) expressed grave concern over trans fats which was based on two main points. The first point being the fact that trans fats provide no known health benefits to humans, whether derived from animals or produced artificially. The second point was focused on the fact that trans fats raise the bad cholesterol while at the same time lowering the good cholesterol and in doing that multiply the risk of coronary heart disease.

Thus, the NAS, which was also backed up by the New England Journal of Medicine, concluded that no level of trans fats is acceptable and should, therefore, be avoided whenever and wherever possible.

There is not much to defining the term “tick bites” because it is quite self explanatory — tick bites are bites sustained by ticks. The term may be simple but there is nothing simple about tick bites or, rather, about the saliva that is delivered with such bites.

With the existence of well over 800 known species of ticks, they are all around us and they are potential carriers of a variety of very serious diseases. It is reported that in the United States, ticks are the leading carriers of disease to humans while second only to mosquitoes throughout the world.

Two Distinct Groups of Ticks

Hard Ticks. These types of ticks carry a hard plate on their backs and their feeding sessions can last from a number of hours to several days. The disease which they may carry does not usually get passed onto to their hosts until the end of their feeding. The most common among hard ticks are: American dog tick, wood ticks, deer ticks, and lone star ticks.

Soft Ticks. Soft ticks are more rounded than the hard ticks and they do not carry the same hard plate on their backs. Their feeding time usually last no more than one hour but they transmit whichever disease they carry within the first minute of the feeding. The most common soft ticks that are found in the United States are the pajaroello ticks and the spinose ear ticks.

Symptoms of Tick Bites

There are usually no symptoms when the ticks latch on and begin their feeding. However, once the ticks have completed their meals they fall off and the attacked site may display redness, itching, burning, swelling and, in rare cases, pain.

When disease is transmitted by the tick the initial warning signs may include: flu-like symptoms; numbness of the limbs; skin rashes through the body; mental confusion; overall weakness and lethargy; painful and swollen joints; intense headaches; heart palpitations; shortness of breath and panting; as well as nausea and vomiting.

The Disease Carried and Transmitted by Tick Bites

Ticks and their saliva are guilty of carrying and transmitting diseases such as Rocky Mountain spotted fever, Lyme disease, Texas fever (a.k.a. babesiosis), ehrlichiosis, tularemia, Colorado tick fever and Powassan (a form of encephalitis).

In addition, the saliva that is delivered at the site of the tick bite may contain neurotoxins which may lead to tick paralysis and/or death due to asphyxiation.

Dealing with Tick Bites

When a tick is discovered, it should be removed as quickly as possible. And such removal process should be approached with much caution or the tick may be provoked to transmit its disease carrying saliva before it originally intended.

The best method to remove a tick is by using tweezers to turn it over on its back and then to pull it straight out. In the likelihood of become ill, it is wise to keep it taped to a piece of paper and, when necessary, to show it to the doctor for a more accurate diagnosis. If the head remains imbedded, it may need to be removed by a medical professional.

The site of the tick bite should be thoroughly cleansed and disinfected and an antibiotic ointment should be applied and, sometimes, a topical antihistamine.

When symptoms are more severe, antibiotics and antihistamines may be administered orally or through IVs and a series of tests may be performed to identify or rule out transmitted tick-borne disease.

Preventing Tick Bites

It is not always possible to prevent tick bites but certain precautions should be taken to reduce their likelihood. It is, therefore, advisable to use a repellent containing DEET; when out of doors, to wear light colored clothing that covers as much of the skin as is possible; and to avoid possible areas where ticks may be present, especially during the months between May and September.

TIA does not always precede a major stroke but statistics show that approximately 35% of those who have suffered a TIA will also have a major stroke at some later date, usually within one year. However, accurate diagnosis, effective treatment of TIA and preventive measures can somewhat reduce the risk of a major stroke.

Symptoms and Warning Signs of Transient Ischemic Attack

Depending on which area or areas of the brain are involved and on the victim’s age, gender, overall health, and a whole lot of other factors; symptoms of TIA can vary tremendously but they are quite similar to those of a major stroke. The most common symptoms which come on suddenly and with no forewarning are: difficulty speaking (aphasia) or putting the right words into sentences that make sense; confusion and disorientation; brief loss of sight in one or both eyes; severe weakness (hemiparesis), tingling and/or numbness (paresthesia) on one side of the body or the other; trouble walking, dizziness, loss of balance and/or coordination; partial loss of consciousness; and severe and agonizing headache; as well as paralysis of the face and tongue.

Causes of Transient ischemic Attack

TIA is most often caused by a blockage (embolus) that shuts off the flow of blood in an artery of the brain. Such a blockage is usually caused by atherosclerotic plaque (fatty deposits) that breaks off and becomes lodged in a major artery in the head or neck. TIA can also be caused by a blood clot (thrombus) in the heart that is caused by atrial fibrillation (abnormal rhythm of the heart).

Other, less frequent, causes of TIA may be a variety of blood diseases that cause the blood to thicken. Also, TIA is somehow linked with hypertension (high blood pressure), a number of heart diseases, migraine headaches, tobacco use (smoking or chewing), high cholesterol and diabetes mellitus.

Treating Transient ischemic Attack

The first line of treatment for TIA is administration of anti-platelet drugs (such as aspirin, clopidogrel or ticlopidine) which prevent blood cells (platelets) from clotting. This treatment is then followed up with anticoagulatns (such as heparin and warfarin) which are also intended to prevent blood from clotting. Often anti-platelet drugs and anticoagulants are combined for quicker and more effective results. However it is essential to determine the cause of the TIA so that more specific treatments can then be prescribed.

In patients with moderate to severe narrowing of the neck arteries, a preventive surgical procedure called carotid endarterectomy is recommended in order to remove the built up plaque deposits.

In some cases carotid angioplasty or stenting is a feasible option and it involves the use of a ballooning device to open a clogged artery and then to insert a stent (a tube) which will keep it open.

The Various Types of Thyroid Nodules

Collid nodules are merely overgrowths of the thyroid tissues and they may become large but never spread beyond the grand itself.

Follicular adenomas are also benign nodules of the thyroid gland.

Inflammatory nodules develop as a result of chronic or acute inflammations of the thyroid gland (thyroiditis, subacute thyroiditis or postpartum thyroiditis).

Thyroid cysts are growths which can either be completely filled with fluids or only partially. Those which are all fluid are usually benign while those masses which are partially or fully solid may sometimes be malignant.

Thyroid cancer are malignant nodules which are rather large and painful and quite rare. However, their propensity increases where there is a family history of thyroid or other endocrine cancers, in men who are under the age of 30 and those who are over the age of 60, as well as in those who have had radiation treatments to the head and/or neck.

Multinodular goiter is often caused by a large number (cluster) of thyroid nodules whose presence appears as a large swelling at the base of the neck and often causes tightness in the throat and difficulties breathing and/or swallowing.

Hyperfunctioning thyroid nodules lead to conditions known as toxic adenoma, toxic multinodular goiter and Plummer’s disease which are all related to hyperthyroidism and the excessive production of the thyroid hormones.

Problem Causing Thyroid Nodules

For the most part, nodules are fairly small but when they become very large, they may press on the windpipe and make swallowing difficult and they may become visibly seen at the base of the neck.

Furthermore, some thyroid nodules imitate their hosting thyroid gland by producing the same hormone, thyroxine, which is naturally produced by the gland itself. This results in excessive disbursement of thyroxine which then causes a thyroid disorder known as hyperthyroidism (overactive thyroid) whose signs and symptoms are the following: (a) unexplained and unexpected weight loss; (b) nervousness, anxiety and agitation; (c) excessive sweating; (d) trouble sleeping, a.k.a. insomnia; (e) weakness of the muscles; as well as (f) irregular and accelerated heartbeat and palpitations.

A rather small percentage of thyroid nodules are cancerous or malignant in which cases they display signs and/or symptoms such as: (a) the nodules become visible suddenly as they grow rapidly; (b) the formed nodules are hard and solid masses; (c) the affected individuals become hoarse; (d) swallowing become difficult and sometimes even the breathing; and (e) the nearby lymph nodes in the jaw and neck areas become inflamed and swollen.

Causes of Thyroid Nodules

No one really knows with any measure of certainty what leads to the formation and/or development of the thyroid nodules but the most suspected factors are: (a) the deficiency of iodine in the diet; (b) an autoimmune disease called Hashimoto’s disease, which results in a chronic inflammation and also leads to the thyroid gland’s under-activity (hypothyroidism) and the formation of nodules; (c) a genetic dysfunction of the receptors which release the hormone that stimulates the thyroid gland known as the thyroid-stimulating hormone (TSH); and (d) repeated radiation treatments to the head and neck area during the developmental stages of childhood.

Treating Thyroid Nodules

Treatment options for thyroid nodules take into consideration the type of nodules which are involved and they may include the “watch and wait” tactic, thyroid hormone suppression therapy for nodules that produce the thyroid hormones, radioactive iodine for hyper-functioning adenomas or multinodular goiters and, finally, surgery for the total removal of the thyroid nodules along with a partial removal of the thyroid gland, in which case levothyroxine must be taken for the duration of the patient’s life.

When cells mutate and grow out of control, a cancer tumor may develop. When such a cancerous tumor develops in the throat it is known as throat cancer. Due to its proximity, however, throat cancer can also affect the voice box (larynx) — a structure made of cartilage that houses the vocal cords which vibrate to generate the sound of talking, singing, laughing, etc. Also because of its anatomical nearness, throat cancer can likewise develop in the cells of the epiglottis — the cartilage covering for the windpipe.

According to the American Cancer Society, about 24,000 people get newly diagnosed with throat cancer every year in the United States. Roughly 50% of these throat cancers affect the pharynx, a very small percentage of them affect the epiglottis and the rest of the throat cancers affect the larynx.

The Different Types of Throat Cancer

Throat cancer is a relatively general term which refers to a cancer that develops in the throat (pharyngeal cancer) as well as that which develops in the voice box (laryngeal cancer). However, based on the location where the throat cancer actually began, more specific classifications have also been assigned such as: nasopharyngeal cancer, oropharyngeal, hypophayngeal cancer (laryngopharyngeal cancer), glottic cancer, supraglottic cancer, and subglottic cancer.

Signs of Throat Cancer

Largely depending on its location, the signs of throat cancer are wide and varied. However, the most common of them are: dry and unproductive cough; the voice becomes hoarse and raspy; swallowing becomes progressively more difficult; pain in one or both ears; a sore throat that would just not go away; a swelling or an open sore that refuses to heal; inexplicable weight loss.

Causes and Risk Factors of Throat Cancer

There is no conclusive evidence that points to any one cause or even a set of causes for throat cancer. However, the factors which have been known to increase the risk for its development are:

Tobacco. Smoking (cigarette, cigar or pipe) and/or chewing tobacco.

Alcohol. Extreme consumption of alcoholic beverages.

Dental Hygiene. Poor or inadequate dental hygiene.

HPV. HPV IS the human papillomavirus which is a sexually transmitted disease.

Dietary Deficiency. Low intake of fruits and vegetables.

Toxins. A variety of toxins but most specifically asbestos which is a fiber that is used in manufacturing and construction.

Treatments for Throat Cancer

The treatments for throat cancer depend on the stage of the disease, on the patient’s general health condition and on the type of cells which have been affected.

Radiation. For the most part, radiation therapy to destroy the cancer cells is prescribed for most throat cancer patients, and it can be administered externally or internally.

Surgery. Surgery is another treatment option for throat cancer patients and it may be a mere endoscopic procedure when only surface cells are involved; laryngectomy (the partial or total removal of the voice box); pharyngectomy (the removal of part of the throat or the entire throat); or neck dissection for the removal of affected lymph nodes;.

Chemotherapy. Chemotherapy is the use of drugs to kill cancerous cells and it is often used along with radiation treatments because combining the two increases each of their effects.

Medications. There are several medications (targeted drugs) which are used to inhibit the growth of cancer cells by either depriving them of blood supply or essential nourishment.

Tendons are very strong and have much elasticity to withstand quite a bit of stress and tension but they are by no means infallible.

What is Tendinitis?

Tendinitis is sometimes referred to as tendonitis and it is the clinical condition which characterizes an inflammation or an irritation in a single tendon or a group of tendons. Although tendinitis most frequently occurs around the body’s major joints such as the shoulders, the hips, the elbows, the wrists or the heels; it can occur anywhere else just as well.

Symptoms of Tendinitis

Symptoms of tendinitis vary from one individual to another and they depend on the severity of the condition and its location. The most commonly reported symptoms are pain and tenderness as well as stiffness and swelling. Such symptoms of tendinitis will be further aggravated by movement.

Tendinitis present in different part of the body produces the following more specific and localized symptoms:

Achilles tendinitis — This is also known as Achilles heel and causes pain which is just above the heel.
Adductor Tendinitis — This is tendinitis of the groin area which is where the pain would also be felt.
Patellar Tendinitis — This type of tendinitis is commonly referred to as jumper’s knee and it exhibits its symptoms of pain just below the kneecap.
Rotator Cuff Tendinitis — Tendinitis in the rotator cuff displays its symptoms of pain in the shoulders. Rotator cuff tendinitis is a common complaint of professional as well as non-professional swimmers and baseball pitchers.
Tennis Elbow — This is a common name for tendinitis near and around the elbow and the pain is felt near the elbow and on the outer side of the forearm.
Golfer’s Elbow — This type of tendinitis is similar to tennis elbow but the pain appears on the inner part of the forearm.

Causes and Risk of Tendinitis

The sheaths which surround tendons have a tendency to wear and tear through the normal aging process but also through injuries such as direct blows; overuse incurred during repetitive motions of sports, play or work which is the most common cause; and a variety of inflammatory diseases such as rheumatoid arthritis and many others.

Treating Tendinitis

Plenty of rest, ice packs and over-the-counter pain relieving medications are usually enough to ease the symptoms of tendinitis and to give it sufficient time to heal on its own. However, when tendinitis becomes chronic it can cause the tendons to rupture and/or it may lead to permanent damage of the tissues. Chronic tendinitis is medically renamed as tendinosis or tendinopathy.

If symptoms of tendinitis fail to subside with home remedies, professional assistance is in order and the following treatments may be prescribed:

Corticosteroid. Corticosteroids may reduce the inflammation while decreasing the pain and they may be administered via injections near and around the affected site. Corticosteroids may also be administered via topical solutions applied directly to the affected area and driven through the skin by a procedure involving electric currents called iontophoresis.

Physical Therapy. Very specific set of exercises and massage are prescribed to strengthen the muscles around the affected tendons and to promote increased blood flow.

Autologous Blood Injection. This is a relatively new procedure which involves injecting the patient’s own blood into the affected area and thus promotes faster healing without drugs. The documented success rate of this procedure is approximately 70-80% of tendinitis cases.

Surgery. In cases where tendinitis is not relieved by any other methods, surgery may be prescribed. However, candidacy for surgery depends of the severity and location of the tendinitis as well as on the age of the patient.

The entire process of teething involves the cutting through of 20 deciduous teeth which are also known as “baby” or “milk” teeth and it may take several years. These primary teeth eventually fall out to make room for thirty two permanent teeth.

The teething age is largely influence by heredity. Thus, whether an infant is an early teether or a later teether tends to follow his or her parents’ teething age. Likewise, the pattern in which teething occurs seems to be passed down genetically. For the most part, teeth break through the gums in pairs or clusters and teething most often begins with the two lower central incisors. They are usually then followed by the two upper central incisors, the two upper lateral incisors, the two lower lateral incisors, the first four molars and then the second four molars.

When teeth appearance and in what sequence is not in the least reflective of the child’s otherwise developmental stages nor on his or her overall health.

Signs and Symptoms of Teething

The signs and symptoms of teething may vary greatly from one child to another but the classical among them are bad moods such as crankiness, ill disposition, restlessness, fussiness and decreased sleeping; digestive problems such as upset stomach, diarrhea and / or loss of appetite; the need to chew on hard objects including fingers, toes and anything else they can get their little hands on; excessive salivation and increased drooling which can cause a rash around the mouth; bruised, swollen, reddened, inflamed, blistery and painful gums; runny nose and low grade fever; incessant rubbing of the cheek and ear area.

Relieving the Symptoms of Teething

Teething is not a pathological or a diseased condition and it should not require emergency care. However, teething does come with a set of unpleasant symptoms and to ease them, doctors may prescribe anti-inflammatory or pain-relieving drugs such as acetaminophen (Tylenol) or ibuprofen. Administration of aspirin is forbidden to anyone under 20 years of age because it has been known to cause Reye’s syndrome, a rare but very grave illness.

Home remedies which have proven to be helpful are:

(a) Gently rubbing the sore gums with a clean finger.
(b) Allowing the baby to chew on a clean washcloth that was chilled, or letting the child use a frozen teething ring.
(c) Having the baby sock on an ice cube for a few minutes at a time.
(d) Applying over-the-counter pain relieving topical jells and ointments.

Newly Emerged Teeth

Dentists and medical professionals recommend that the infant’s teeth are brushed as soon as they erupt but fluoridated toothpaste is not suggested while the child is still going through teething. Furthermore, the American Academy of pediatrics (AAP) advises that by the age of six months, all children should be examined by a pediatrician or another healthcare professional who will assess the risk for future dental health problems.