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By G. Falk. Shimer College.

Primary amenorrhea is Vulval carcinoma the failure to have menstruated by the age when menstruation normally begins discount 20 mg cialis soft mastercard erectile dysfunction pump nhs. Primary amenorrhea is generally accompanied by lack of development of the secondary sex characteristics. En- docrine disorders may cause primary amenorrhea and abnormal development of the ovaries or uterus. Various endocrine disturbances and psychological factors may cause secondary amenorrhea. It is not uncommon, for example, for young women who are in the process of mak- Uterine neoplasms are an extremely common problem of ing major changes or adjustments in their lives to miss men- the female reproductive tract. Secondary amenorrhea is also frequent in smooth muscle tumors (leiomyomas), and most of them are be- women athletes during periods of intense training. Any of these conditions may provoke irregular menstrua- centage of body fat may be a contributing factor. Sickness, fa- tions and may cause infertility if the neoplasms are massive. The most common site of uterine Dysmenorrhea is painful or difficult menstruation accom- cancer is the cervix (fig. The causes of dysmenorrhea ond only to cancer of the breast in frequency of occurrence,is a are not totally understood but may include endocrine distur- disease of relatively young women (ages 30 through 50),espe- bances (inadequate progesterone levels), a faulty position of the cially those who have had frequent sexual intercourse with mul- uterus, emotional stress, or some type of obstruction that pro- tiple partners during their teens and onward. These abnormalities may be caused by hormonal irregulari- ties,emotional factors,or various diseases and physical conditions. Frequent sites of ectopic endome- and Mammary Glands trial cells are on the ovaries, on the outer layer of the uterus, on The breasts and mammary glands of females are highly suscepti- the abdominal wall, and on the urinary bladder. Infections involving the not certain how endometrial cells become established outside the mammary glands usually follow the development of a dry and uterus, it is speculated that some discharged endometrial tissue cracked nipple during lactation. Bacteria enter the wound and might be flushed backward from the uterus and through the uter- establish an infection within the lobules of the gland. Women with endometriosis will infection of the mammary gland, a blocked duct frequently bleed internally with each menstrual period because the ectopic causes a lobe to become engorged with milk. This localized endometrial cells are stimulated along with the normal en- swelling is usually accompanied by redness, pain, and an eleva- dometrium by ovarian hormones. Administering specific antibiotics and ap- of endometriosis are extreme dysmenorrhea and a feeling of full- plying heat are the usual treatments. Endometriosis can cause in- Nonmalignant cysts are the most frequent diseases of fertility. These masses are generally of two types, neither of oral contraceptive pills or by surgery. Dysplasia (fibrocystic disease) is a moval of the ovaries, may be necessary in extreme cases. When uterine displacements occur in younger women, that may become painful during or prior to menstruation. Retroversion, or retroflexion, sia affects nearly 50% of women over the age of 30 prior to is a displacement backward; anteversion, or anteflexion, is dis- menopause. An abortion is defined as the termination of a pregnancy Fibroadenomas are nontender rubbery masses that are easily before the twenty-eighth week of gestation. A fibroadenoma can be ex- abortion, or miscarriage, occurs without mechanical aid or medi- cised in a physician’s office under local anesthetic. One in nine women will develop breast can- abnormal development of the fetus or disease of the maternal re- cer and one-third of these will die from the disease. An induced abortion is removal of the fetus cancer is the leading cause of death in women between 40 and from the uterus by mechanical means or drugs. Men are also susceptible to breast cancer, but are a major issue of controversy because of questions regarding it is 100 times more frequent in women. Breast cancer in men individual rights (those of the mother and those of the fetus), the is usually fatal. The causes of breast cancer are not known,but women who are most susceptible are those who are over age 35,who have a family history of breast cancer,and who are nulliparous Diseases of the Vagina and Vulva (never having given birth). The early detection of breast can- Pelvic inflammatory disease (PID) is a general term for inflamma- cer is important because the prognosis worsens as the disease tion of the female reproductive organs within the pelvis.

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Do not worry if the attorney tells you he or she is busy; however order 20 mg cialis soft with amex erectile dysfunction doctors in fresno ca, be certain that you feel he or she can focus on your case and provide you with the attention you will need. You will need to educate your attorney about the case and to be honest with yourself about the quality of the care you have provided. Review a textbook and the recent literature on the subject matter; then give it to your attorney to review. You must understand that your efforts in educating your attorney about the medical aspects of the case will be worthwhile. You can be certain that the plaintiff attorney is doing the same research. Chapter 3 / Risk Reduction 39 However, no one knows your case like you do. Make certain that the basic medical information that the plain- tiff attorney certainly will have has been provided to your attorney. From the plaintiff attorney’s perspective, when doctors work closely with their attorneys, are not in denial about a lawsuit, and discharge their responsibilities to their patients, the chances of winning are diminished. ONCE YOUR DEPOSITION IS SCHEDULED, THE PLAINTIFF ATTORNEY IS LOOKING FOR SPECIFIC THINGS The order of the information the plaintiff attorney seeks is as impor- tant as their content. Thus, it is important for you to react to people in an accommodating manner. The effort you make in relating to those around you during the deposition and during the trial will be key to whether you are successful in the litigation. If you do not respect your attorney, ask your insurance carrier for another one. Do not show your contempt or lack of respect for the justice system through your lack of respect for your attorney. Plaintiff attorneys are allowed to ask you questions during a deposi- tion. If you are courteous and respectful when asked questions, the plaintiff attorney will conclude that you will behave that way in trial as well. To show respect and be the kind of caring doctor that jurors will love is not how a plaintiff attorney wants you to behave. Study the medical aspects of the case and then teach them to your attorney. You may think you will remember the facts of the case simply by having experienced them, but you will be surprised at the details you have forgotten. However, you still must understand that this is the least important thing the plaintiff attorney is looking for when he or she assesses your ability to fight a potential suit. The most important thing is you and the impression you will makeon a jury. If you are honest and straightforward with your patients when there is a complication and you are honest and straightforward to a jury, you have maximized your risk reduction. The attorney for the injured person must assess his or her ability to win in trial. That attorney is risking his or her time and money to pursue a case for which a fee will only be recovered if he or she wins. The assessment takes place before the attorney ever meets you and is based on what you have written in your medical records. The attorney looks to see if you are honest and forthcoming, which is not something he or she wants to see in a potential defendant. If you share your concerns with the patient when there is a complication, that openness will be a very effec- tive deterrent to a plaintiff lawyer. You may feel you are raising a red flag by documenting that something is wrong. However, you may be keeping your patient from going to an attorney for answers, and you will be showing what a wonderful doctor (and witness) you will be if there is a lawsuit. Your goal is to minimize the chances of your patient seeking legal aid to get answers. Your goal is also to be successful if all that occurred was a complication rather than a deviation from the standard of medi- cal care. Hopefully, this chapter helps you understand some simple ways of accomplishing these goals.

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The degree of visu- using the appropriate technique for clean- al loss that results from an eye injury is a ing and applying contact lenses discount cialis soft 20mg free shipping can erectile dysfunction cause low sperm count. Using Glaucoma is a condition involving in- appropriate eye protection for work, creased intraocular pressure. If left untreat- home, and sports activities that carry a risk ed, permanent damage to the optic nerve of eye injury is one of the major forms of can result, causing blindness. Glaucoma The most common eye disease is con- occurs when the amount of aqueous junctivitis (inflammation of the mem- humor produced exceeds the amount brane that lines the eye, the conjunctiva. In most instances, even though the drainage pipe is blocked, conjunctivitis is easily treated, is self-lim- resulting in overaccumulation of water in iting, and has no permanent effects. Some types of infectious conjunctivitis, such as gonococcal conjunctivitis, or tra- Types of Glaucoma choma, however, can cause ulceration of the cornea and subsequent blindness. Uveitis is an inflammation of the uveal Broad categories are based on the reason tract (iris, ciliary body, choroid). Because the outflow no longer equals the inflow, the amount of Treatment of glaucoma is directed to- aqueous humor builds and pressure in the ward reducing the intraocular pressure by eye increases. Open-angle glaucoma gen- decreasing the amount of aqueous humor erally progresses slowly over many years, produced or by increasing its outflow. This producing no symptoms until the optic can be accomplished with medication or nerve is sufficiently damaged to reduce through surgically creating a new pathway visual acuity and visual field. Vision loss gen- Medication for the treatment of glauco- erally begins with the loss of peripheral ma, whether eye drops or oral medication, (side) vision so that individuals can see must be used daily throughout life to con- only straight ahead, as if looking through trol eye pressure and prevent further dam- a tunnel (tunnel vision). In either type of glaucoma, peripheral vision is often gradual, individ- early detection and treatment are critical uals may be unaware of the problem until to prevent irreversible damage to the optic advanced stages of the condition. Regard- treated, the field of vision continues to less of the type of glaucoma, lifetime med- narrow until all vision is lost. Treatment of Chronic Acute Closed-Angle Glaucoma Open-Angle Glaucoma Acute closed-angle glaucoma develops Chronic open-angle glaucoma may be much more rapidly than chronic open- controlled with medication in the form of angle glaucoma and is a medical emer- eye drops alone to decrease production of gency. Symptoms include sudden severe aqueous humor or in combination with pain, sharply decreased vision, nausea and oral medication that reduces pressure in vomiting, and rapid damage to the optic the eye, thus halting progression of the nerve with associated vision loss. Because eye drops are absorbed closed-angle glaucoma results from an into the bloodstream, they may affect oth- abrupt blockage and obstruction of the er body functions and cause systemic side canal of Schlemm so that aqueous humor effects ranging from generalized weakness rapidly accumulates in the anterior to central nervous system, cardiovascular, chamber of the eye. Oral med- angle glaucoma is much less common ications for the treatment of glaucoma than chronic open-angle glaucoma, it is work by decreasing the production of a medical emergency and must be treat- aqueous humor. For example, arteriosclerot- medical supervision, not only to monitor ic retinopathy is due to changes that occur the condition itself but also to identify any in blood vessels in the retina because of side effects of the medication. Hypertensive retinopathy is When intraocular pressure cannot be due to changes that occur in blood vessels successfully controlled with medication, in the retina because of high blood pres- individuals with chronic open-angle glau- sure. In both instances, treatment of the coma may have a surgical procedure primary underlying condition can control called trabeculectomy that relieves pressure the progress of retinopathy. Individuals may also need and the most common cause of blindness, to continue using eye drops or oral med- is diabetic retinopathy. Diabetic retinopathy ication after surgery to control pressure; is the result of damage to the retina and is however, in some instances surgery may a complication of diabetes mellitus (see eliminate the need for medication. Treatment of Acute Closed-Angle Glaucoma Consequently, regular comprehensive eye examinations by a physician are impor- Acute closed-angle glaucoma results tant in helping to prevent visual loss. Nonproliferative diabetic retinopathy miotics constrict the pupil, thus enlarging 2. Proliferative diabetic retinopathy the drainage passageway and facilitating the outflow of aqueous humor. Because of Nonproliferative diabetic retinopathy is the emergency nature of acute closed- caused by changes in blood vessel walls angle glaucoma, oral or intravenous med- that allow fluids to leak into retinal tissue. As a rior chamber of the eye, thus preventing result, retinal tissues receive too little oxy- further eye damage by relieving built-up gen (ischemia) and growth of new vessels pressure. At times iridotomy abnormally fragile and prone to bleed, may also be performed prophylactically in causing hemorrhage into the vitreous the unaffected eye after an acute attack. Vessels Retinopathy may burst, filling the back of the eye with blood and resulting in significant visual Any disease or disorder of the retina is loss. Retinopathies are often named ated with new vessels can pull on the reti- 132 CHAPTER 4 CONDITIONS OF THE EYE AND BLINDNESS na so that it detaches from underlying tis- scleral buckling is sometimes used to treat sue. Scleral buckling Surgery may be performed to remove mechanically restores contact of the reti- vitreous gel and hemorrhage (vitrectomy), na with the choroid. The area of the scle- or laser treatment may be performed to ra that lies over the retinal defect is stop the bleeding.

As with all coping strategies generic cialis soft 20mg without prescription erectile dysfunction doctor in patna, diver- logical grief reaction, which may become sion of feelings can have negative effects more disabling than the chronic illness or if feelings of anger or hostility are chan- disability itself. Emotional Reactions to Chronic Illness or Disability 7 Fear and Anxiety who have no relationship to the develop- ment of the chronic illness or disability Individuals normally become anxious and no influence over its outcome. A chronic may also be an expression of the realiza- illness or disability can pose a threat be- tion of the seriousness of the situation and cause of the potential loss of function, its associated feelings of helplessness. Some individuals but rather expressed through quarreling, fear the unknown or unpredictability of a arguing, complaining, or being excessive- condition, which provokes anxiety. For ly demanding in an attempt to gain some others, hospitalizations that immerse control. Helping individuals express anger them in a strange and unfamiliar environ- in appropriate ways and enabling them to ment away from home, family, and the experience a sense of control over their sit- security of routine produce anxiety. When uation can help to resolve anger, which conditions are life-threatening, fear and could otherwise be detrimental to success- anxiety may be associated not only with ful rehabilitation. Fear and anxiety associated with chronic Depression illness or disability can place individuals in a state of panic, rendering them psy- With the realization of the reality, chologically immobile and unable to act. Signs of depression include sleep distur- bances, changes in appetite, difficulty con- Anger centrating, and withdrawal from activity. Not all individuals with chronic illness or Individuals with chronic illness or dis- disability experience significant depres- ability may experience anger at them- sion, and, in those who do, depression selves or others for perceived injustices or may not be prolonged. Prolonged or or disability was caused by negligence or unresolved depression can result in self- that their condition was avoidable. If they destructive behaviors, such as substance perceive themselves as victims, anger abuse or attempted suicide. Individuals may be directed toward the persons or cir- with prolonged depression should be cumstances they blame for the condition referred for mental health evaluation and or situation. Anger can also be the result of frustra- Guilt can be described as self-criticism tion. Individuals or family members anger by showing hostility toward those may feel guilt if they believe they con- 8 CHAPTER 1 PSYCHOSOCIAL AND FUNCTIONAL ASPECTS OF CHRONIC ILLNESS AND DISABILITY tributed to, or in some way caused, the or disability and the problems and conse- chronic illness or disability. Chronic illness and dis- intoxicated, may experience guilt because ability at various stages of development of the role they played. In other instances, can affect the independence, self-control, they may experience guilt because they and life skills associated with these differ- feel their chronic illness or disability ent developmental stages. Since the needs, places a burden on their family or because responsibilities, and resources of adults they are unable to fulfill former roles. Family members and others generally Guilt may also be associated with blame. It appropriate behavior, and these modified can be an obstacle to the successful ad- expectations may interfere with the indi- justment to the condition and its limita- vidual’s mastery of the normal skills tions. Self-blame or blame ascribed by required to meet the challenges of future others is detrimental not only to the indi- developmental stages. Guilt that affects Each developmental stage must be under- rehabilitation potential or well-being is an stood within the context of the individ- indication that referral to appropriate pro- ual’s past and current experience. Those fessionals for evaluation and treatment with chronic illness or disability must be may be appropriate. It is ment serve as a guideline not only in a continual process from infancy to old assessing individuals’ functional capacity, age and death. Each developmental stage but also in determining potential stressors is associated with certain age-appropriate and reactions. Although there are no clear lines influence their reactions to chronic illness of demarcation between life stages and all Chronic Illness and Disability Through the Life Cycle 9 individuals develop at different rates, sympathetic parents may condone inappro- there are some commonalities associated priate behaviors rather than correct them. Conditions affecting the development Ideally, those with chronic illness or dis- of communication skills may also affect ability should be encouraged to progress children’s interaction with the environ- through each stage of development as nor- ment, as well as their future development. Congenital conditions (conditions present at Those whose emotional, social, education- birth) or conditions that occur in early al, or occupational development has been childhood require adjustments through- thwarted may be more handicapped by out the life cycle. These limitations must their inability to cope with the subsequent be confronted and compensated for with challenges of life than by any limitations every new aspect of normal development. Before children attend school, ioral disorders (Gledhill, Rangel, & the values, rules, and expectations they Garralda, 2000). In early life, children experience are, for the most part, largely develop a sense of trust in others, a sense those expressed within the family.

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