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NURSING EMAIL OF THE WEEK
Medical Question:
I am currently taking tri-norinyl 28-day birth control pills. I started
my period on monday or tuesday of this week (10-4 or 5)
last night (wednesday 10-6), my husband and I were having sex and noticed
afterwards that the condom was broken. I am
currently taking the last 7 pills of the pack which do not contain
hormones. I am still having my period. I was wondering if I am
still protected by the pill even though I am on the last 7 and on my
period. how possible is it that I would have become
pregnant? I am very good about taking my pill- I have never forgotten
one. please let me know, to the best of your ability, the
answer to this question. if there is anything else you might need to know
to answer this, I am more than willing to answer any
questions. thank you so much, xxxxxx
Medications Name:
tri-norinyl 28 day tablets
The Nurse Replies:
ANSWER: Since you are on birth control pill, and take it regularly without
missing any dose, and the fact that you just started your
menstrual cycle, chances are good that you will not become pregnant. But
as you know any contraceptive method is not 100%
full proof. Not even Tubal ligation is 100% full proof (women has been
known to become pregnant but cases are rare) only
abstainate is 100% full proof.
Tri-norinyl: This medicine usually contains two types of hormones,
estrogens and progestins, and when taken properly, prevents pregnancy.
This medicine works by stopping a woman's egg from fully developing each
month. The egg can no longer accept a sperm and fertilization is
prevented.
Sometimes a woman's egg can still develop even though the medication is
taken once each day, more so when more than 24 hours pass between two
doses. In almost all cases when the medicine was taken properly and an
egg develops, fertilization can still be stopped by oral contraceptives.
Reason: because oral contraceptives also thicken cervical mucus at the
opening of the uterus. Making it hard for the partner's sperm to reach
the egg. Also, oral contraceptives change the uterus lining just enough so
that an egg will not stop in the uterus to develop. Therefore, all of
these effects makes it difficult to become pregnant when properly taking
an oral contraceptive.
Chances are very slim that you can be pregnant. But remember no birth
control contraceptive is 100% effected.
I hope that I have answer your question satisfactory, if not, please feel
free to e-mail me anytime.
May God bless you both,
Nurse3: MED-HELP.COM & MED-HELP.NET
To talk with a Nurse from MED-HELP.COM Please visit:
http://www.med-help.net/Ask-The-Nurses.html
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NURSING EMAIL OF THE WEEK
Enter your Medical Question:
I have seperate pains in the (1)left groin area and (2)left hip
area.Came on suddenly with no apparent reason. The pains come and go.
This is important: the pain is worse after eating (gas makes the pain
greater). The pain lessens with a bowel movement and release of gases.
Getting to and from a sitting position is very painful because of the
hip and groin pain. Once I'm standing it isn't painful and once I'm
lying down it isn't painful. I have some lower back pain which may or
may not be related to this problem. My wife is guessing pinched nerve.
The Nurse Replies:
ANSWER: There could be many possibility for your groin pain such as: Possible-
1: hernia, 2: testicular torsion, 3: enlarge lymph glands 4:
inflammation of the inguinal ligament & this is just to name a few.
Questions: Any swelling around scrotum?
Is there any flank pain and does it radiate any where else
besides your hip?
Any blood in urine? Any pain while urinating and or urinary
frequency?
Any nausea or vomiting?
Are you taking any blood pressure medications?
Are you taking any type of INSEDS such as Narcosis, Motrin
etc?
Any illness lately such as infections?
These are just some of the causes for groin pain. Have you seen a
doctor for this problem?
If you haven't as yet, I suggest that you make an appointment with your
Doctor as soon as possible. This has been going on too long, you should
find out exactly why you are having this type of pain.
It could even be Kidney stones. Question: have you been doing any
heavy lifting and or trauma to that area?
I know you would like an easy answer, but due to the length of time that
this has been going on, you are probably going to need some blood work
and some sort of a person to person physical to be able to get more
information on what is going on. If you do received some type of
diagnosis and require any further information please let us know and we
will do our best to help you. One last question: any bruising and
swelling?
You can get back to me @ this address: *******************
God bless,
Pt, Replies:
> I was happy to hear from you. I am still in a lot of pain. Let me fill you in on what has transpired.
I went to see a doctor. I was checked for hernia and lower back pain was
brought up. I was given a digital rectal exam. I was asked some of the
same questions you asked. Swelling in the scrotum area? No.
No recent infections or illness prior to this problem.
There is no flank pain. Just groin and hip and extends down to my knee
on occasion.
No pain while urinating. No blood in the urine.
No nausea or vomiting.
I am not taking any blood pressure medicine. The doctor gave me a muscle
relaxant called Naproxen, (500 mg).>
The doctor did not take x rays or blood. She asked me if I had noticed
any blood in my stools. Answer was no.
At this point she did not suggest what the problem might be. I don't
think she had any idea of what might be going on. She suggested I have a
colon scan and sent me on my way.
The place I went to is called an Urgent Care Center and is right next to
but separate from a hospital. I explained that I had no insurance. Did
they not give me a complete examination because of this? Why no x rays
or blood work.
I'm not sure what to do. The colon scan seems like a shot in the dark
and costs roughly, as she explained, about $2000.
My wife thinks it must be back related (pinched nerve) and wants me to
see a chiropractor.
I know that your service is not set up for the kind of advice I am
asking but any suggestions you could give would be appreciated.
One more point. If someone sees a doctor for an illness that is not
readily recognized is it customary that they simply be turned away. I
can't afford to be passed from doctor to doctor until one of them
recognizes what is wrong with me. Thank you in advance for your concern
and help.>
Nurses 2nd Reply:
Dear Mr. XXXX,
Thank you for getting back to us and letting us know what is going on. Unfortunately sometimes when doctors don't know
what is going on they seem to pass the buck such as in your case. Lack of insurance could be one of the possibility as to why
they did not do any further lab testing, I am surprised that they have not even took a urine sample just to check if there is an in
infection that could be going on.
Naprosyn is not a muscle relaxant. Naprosyn is part of the NSAID'S family. It is an anti-inflammatory - meaning to reduce
inflammation. My suggestion is to go to your County Hospital where they will be much more likely to run the necessary test,
and County Hospital can not deny you when you do not have the funds. They usually work out payment plan according to
what you can pay and or if you can't pay, they still will take you in, they are funded by the County and State.
Please keep in touch and let us know what is going on. You can reach me @ this e-mail address:
xxxxxxx.com
God bless, and I shall be praying for you. Thank you again for your donation, it has been posted on our donation's page at this
address: http://www.med-help.com/Donations.html. It is people like you who help keep this site going.
To God be the glory.
---------End E-Mail------- Posted: 06/08/2000--------
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NURSING EMAIL OF THE WEEK
Your Medical Question:
I just have a general question regarding my daughter who is 5 years old. Saturday morning (6-17-00) she woke up with a
fever, about 101-102, and complained of a sore throat. She saw the Dr. that morning and they said it could be a virus, but they
also took the strep test, which came out negative by the fast test and culture. On Monday, she complained of very very sore
throat, and the Dr. said that it appeared to look like sores on the back of her palatte. This continued and on Wednesday 6-21
I took her to the Dr. again, and she said it looks like Coxsackievirus. The sores appeared alot smaller and she thought they
were healing. My question, is the rest of the family exposed? And, how long before we may see symptoms, and what type of symptoms will
we see. What is the incubation period. She has a brother who is 7 yrs old. What is the timeframe before he could catch it, and
can adults catch it too? Is there anything to help the pain? Her physician told us, gargling with warm salt water, advil or
tylenol,
but basically no other prescription would help.
The Nurse Replies:
Dear Xxxxxx,
Anyone can catch it. It is more common in young children due to the fact that their hands are everywhere and they tend to not
wash their hands as well. Good hand washing is essentials. The good thing is that most cases are mild and recovery is good.
Apparently (which is a good thing) your doctor does not feel it is very serious and that perhalps she is getting over it. Below is
more information on signs and symptoms of this virus. You can also find it on our Medical Library.
http://www.med-help.net/Medical-Library.htm#C
God bless you and your family.
Jocelyn Nurse3. (you can e-mail me at this address - and please don't forget to add your authorization number
on the subject line)
Coxsackievirus: it is a enteroviruses. A group of vruses which can be found in the
alimentary canal (the intestines) of infected people. Enteroviruses includes:
polioviruses, coxsackievirus and echoviruses.
Coxsackieviruses can be mild to severe and even fatal disease humans.
Reseachers of coxsackievrus B3 (CVB3) have focused primarily on the ability of
CVB# to replicate in heart cells and the complications. They found that the virus
replication by itself causes damage to heart cells, and that they evaluated the ability of
replicating virus to cause white blood cells (cell to fight infections/immune cells) to enter
the heart tissue. therefore causing myocarditis (inflammation of the heart tissue). They
also showed that the enteroviral infections with myocarditis and with heart failure called
idiopathic (unknown cause) dilated (enlarged heart size) cardiomyopathy (a heart with
abnormal heart cell) also called: IDC.
Researchers believes taht the enteroviruses is a major source for causing IDC or heart
failure, and may be a primary caused in the disease processes which result in heart
failure and heart trransplantations.
Hand-foot-and -mouth disease is known to be associated with coxsackieviruses:
mainly affecting young children.
The Centers for Disease Control and Prevention (CDC) in the United States has made
recommendations for hand-foot-and-mouth disease in the child care setting:
Make sure that all children and adults use good handwashing technique. especially
after toileting and diaper changing and before eating.
Do not exclude ill persons, because exclusion may not prevent additional cases
since the virus may continue to be excreted for weeks after the symptoms have
disappeared. Also, some persons excreting the virus may have no symptoms.
However, some benefit may be gained by excluding children who have blisters in their
mouths and drool or
who have weeping lesions on their hands.
The most common sickness caused by coxsackieviruses is a nonspecific febrile illness.
Children have a fever which lasts an average of 3 days. Sometimes the fever leaves for
2 or 3 days and then returns. Sometimes this is the only symptom, but sometimes
children also have a headache or a sore throat. Some children vomit at the beginning of
the illness, or say, complain about having a 'tummy ache'.
Sometimes they have one or two loose stools. The patient may have muscle pains,
especially in the legs. Usually not much is found on physical exam or blood test.
Coxsackieviruses can cause the common cold. They can also cause croup, bronchitis,
pneumonia, hepatitis, pancreatitis, arthritis, diabetes, meningitis, encephalitis, temporary
or permanent paralysis, and viral myocarditis -- to name some of the many possibilities
These infections can be extremely serious. Viral myocarditis, such as what you are
now seeing in Malaysia, is an infection of the heart muscle. When coxsackievirus causes
myocarditis, the fatality rate is high (International Journal of Cardiology, May 1996).
The majority of coxsackieviral infections are mild and complete recovery is the rule.
There are serious cases but are rare.
Treatment: Your doctor may prescribed other than the usuall classical medications
for heart failure, (usually for the child who is seriously ill. ---Acyclovir (Zovirax) is an
antiviral medicine that shound'nt work, but found that it helps with symptoms. ( it is
used for chicken pox and herpes)
Your doctor may start an I.V. immunoglobulin (this contains antibodies to
coxsackieviruses made by people who have effectively fought off the infection)
Researchers also found that an antiviral medicine that is developed to fight the AIDS
virus may help to fight against coxsackievirus.
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NURSING EMAIL OF THE WEEK
Your Medical Question:
My significant other is a 68 year old male who has had a problem with a
weak urine stream all of his life. As he has aged the problem has
worsened. About two years ago his symptoms were so severe that he had
to seek help with a urologist. He has been on medications ever since
with the problem worsening as time went on. He was first given cardura
which helped at first and then stopped working after a few months. He
was then given flomax which he had to stop after 3 days becasue of
severe side effects. Currently he is taking proscar which he has been
on about 5 months. The proscar has never helped and his syptoms are
getting worse daily. He has had 2 cystoscopies, after which the last
time he was told he needed surgery. His bladder is clear and his
prostate is not enlarged beyond what it should be for a man of his age.
He is scheduled for a terp on Friday 7/14. My understanding of a terp
is that it is for an enlarged protate. His urologist has told me that
he doesn't!
know the cause of his symptoms and needs to do the surgery to determine
a diagnosis. xx'x (the patient) symptoms were helped after the last
cystoscopy which would make me think that the problem may be in the
urethra or the bladder muscle. Are there no tests which could show
whether or not that is the case? Our concern is that why do a prostate
resection on the slim chance that it may help when the Dr. has no idea
what is causing the problem. Also, because of the smallness of the
prostate, how many resections can be done on it? What if in ten years
he really needs a terp? His surgeon has not discussed the surgery with
xx at all. The information we have I obtained through phone calls with
the surgeon. He has said that he doesn't know what is causing the
severe symptoms that xx is having. He feels as though he has to urinate
frequently and he is never able to empty his bladder completely. He is
alwasys tired as he is unable to get a good night's sleep. xx is
hesitant t!
o reschedule this surgery so that he can get a second opinion be
Name of Medications being taken:
Proscar 5 mg.,calin 120,comidun 5 mg.,cozaar 50 mg.,digoxin .25 mg.
The Nurse Replies:
Dear Xxxxxx,
Transurethral Resection of the Prostate
Prostate Resection TURP
TURP: transurethral resection of the prostate; a surgical procedure in which tissue is cut from the prostate using a
resectoscope
Dear Mrs Xxxxxx,
Since your husband does not have an unusually enlarge prostate, I believe what the doctors want to find out if there is any other
conditions which may cause the obstruction of the flow of urine. This is to say that there might be a possible growth, or even
possibly a muscle spasm in the center of the prostate, which his urinary tube passes through. Again, even though the prostate
may not be visually or palpably large on the outside, in the center where the tube passes through, there may lie an inconsistency
at that point as shown in figure A at the bottom, which could cause a constriction.
Figure A.
Have they tried a Dye in his Urine to visualize the inside of his Urethra? A Fluoroscope.
Urologist are pretty thorough, I am sure that your husbands doctor has done lab test and urine culture already, but it is always
good to have a second opinion, especially if you are both uncomfortable with the upcoming surgery. Below are some
symptoms and what the surgery is about, I hope this will help you some. I was uncertain as to what surgery your husband is
getting, whether it is TURP or TUIP so I included both of them.
May God bless you both,
Jocelyn Nurse3 (please feel free to e-mail me @ this address) xxxxxx@xxxxx
In regards to prostate enlargement and or blockage:
When symptoms are severe or there is evidence of cancer, surgery is usually recommended. About 85 percent of patients experience marked relief of symptoms. In the most common surgery, the patient is placed under anesthesia, but no incision is needed. A
small cutting instrument called a resectoscope (resect means to remove part of an organ) is passed through the penis and into the prostate by way of the urethra. Using an electrical apparatus at the end of the scope, the surgeon carves away the inner prostate, leaving a
hollow shell through which the urine can flow. This procedure is known as TUR, or transurethral resection.
In about 15 percent of cases, TUR can have complications, including possible impotence and urinary incontinence; some patients experience infection or bleeding, and others require a second operation to reopen the urinary tract. For these reasons, and because of the desire of patients to avoid surgery, there is much enthusiasm for nonsurgical resectioning methods. Several kinds of laser resecters, which can be used for outpatients, have shown good results. The instrument is passed through the urethra, as in TUR; the laser is then fired,
and the heat quickly coagulates and vaporizes excessive prostate tissue.
Microwave devices, similarly inserted, have been widely employed in Europe and Canada for nearly a decade; in the U.S., however, they have not yet been approved by the FDA and are available only at selected centers. Like laser resections, they can be done in an outpatient setting.
If the prostate is too large for TUR or other methods, the surgeon may recommend open prostatectomy, the removal of the prostate gland via surgical incision.
Prostatitis: A prolonged course of antibiotics is usually successful in eliminating the infection. Stool softeners, sitz baths, and nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed for discomfort. If an infection is neglected too long, antibiotics may not be effective -- and it may be difficult to remove the infection even by surgery
without causing further complications.
TURP
Transurethral resection of the prostate (TURP) is the most common surgical
procedure for benign prostatic hyperplasia ( BPH ). TURP is performed using
spinal or general anesthesia. A special kind of cystoscope (resectoscope) is
inserted into the meatus (opening at the tip of the penis ), through the urethra
to reach the prostate gland. A special cutting instrument is inserted through
the resectoscope to remove the prostate gland. Blood vessels are cauterized
(using heat to stop the bleeding ) with electric current during the surgery. A
foley catheter may be placed to help drain the bladder after surgery. The urine
will initially appear very bloody with shreds of tissue. A bladder irrigation
solution may be attached to the catheter to continuously flush the catheter
thus keeping it from becoming clogged with blood or tissue. The bleeding will
gradually decrease, and the catheter will be removed within a few days. You
will remain in the hospital for 3 to 5 days.
TUIP
Transurethral incision of the prostate (TUIP) is similar to TURP, but is usually
performed in people who have a relatively small prostate. This procedure is
performed on an outpatient basis and does not require a hospital stay. A
small incision is made in the prostatic tissue to enlarge the lumen (opening)
of the urethra and bladder outlet, thus improving the urine flow rate and
reducing the symptoms of BPH. A foley catheter may be placed to help drain
the bladder after surgery. The catheter will remain in place for a few days after
surgery. You may be instructed on how to remove the catheter at home.
TUIP has been shown to successfully relieve the symptoms of benign
prostatic hyperplasia ( BPH ) in people with a relatively small prostate gland.
Symptoms of prostate enlargement and blockage (obstruction) include:
1. frequent urination with small amounts of urine
2. recent need to urinate at night ( nocturia )
3. difficulty starting a stream of urine
4. slow stream of urine
5. urine dripping out of urethra after urination (dribbling)
6. feeling that bladder is never empty
Here are some links with pictures you may want to take a look at.
Links:
http://www.med.uni-muenchen.de/urolog/seiten/bilder.html
http://www-medlib.med.utah.edu/WebPath/RENAHTML/RENALIDX.html
http://www.meb.uni-bonn.de/evang_waldkh/urologie/bild01.htm
http://www.mamc.amedd.army.mil/WILLIAMS/GU/GUTOC.htm
http://www.dua.com/videos.shtml
The link below can be translated from German to English using MED-HELP.COM's Translation Page. http://www.med-help.com/Translation.html
After viewing the link below, Copy the URL of the page and paste it in the Translator at the bottom of Our page, And the New translated page will apear in your browser.
This is the link: http://www.meb.uni-bonn.de/evang_waldkh/urologie/bild01.htm
Part of the references and information's has been gathered from other medical sites and medical books
Dear Mrs. Xxxxx,
Please use the Larger picture that I sent you as an illustration NOT the
smaller one!
Ps: Also the amount of tissue removed via the TURP is usually insignificant to what happens with a total removal of the prostrate.
They, in most case's, take just the tissue that appears to be causing the blockage.
PLEASE if you feel that all that should be done as to the care of your Husband is NOT being done, Get a second, or even a third opinion. You
may want to get seen by your closest University Hospital if one is near you, to see if there are some new procedures, and or studies being
conducted in this field of Urology! Also if there is another Urologist in the same building, He may not charge you for a second opinion.
Please let me know if this has helped!
We will be Praying for you & your Husband.
God Bless.
Mark.
Cordially, Mark Norwood. Head Nurse & CEO: MED-HELP.COM & MED-HELP.NET
http://www.med-help.com & http://www.med-help.net
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