Category Archives: Male Reproductive System

State gonorrhea cases up 34 percent

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Gonorrhea bacteria - Photo CDC

Gonorrhea bacteria – Photo CDC

From the Washington State Department of Health

The number of gonorrhea cases in Washington is up substantially this year compared to 2012. There have been 3,137 cases through September 2013 compared to 2,350 during the same time in 2012. That’s a 34 percent increase.

Rates have been going up steadily since 2010. Department of Health experts haven’t been able to attribute a specific cause to the uptick. The jump has occurred among men and women in most age groups, but young adults remain the most affected.

Rural and urban counties across Eastern and Western Washington have reported a climb in cases. However, several counties have seen more dramatic upswings, including Spokane, Yakima, Thurston, Kitsap and Benton counties, which are at outbreak levels.

Gonorrhea is the second most common sexually transmitted disease in Washington after chlamydia. It’s spread through unprotected sex with an infected partner. The infection often has no symptoms, particularly among women. If symptoms are present, they may include discharge or painful urination.

Serious long-term health issues can occur if the disease isn’t treated, including pelvic inflammatory disease, infertility and an increased likelihood of HIV transmission.

The department continues to monitor case reports. Local public health officials are actively working with health care providers to ensure that people with gonorrhea and those exposed get appropriate testing and treatment to stop ongoing spread of the disease.

“We’re working closely with local health agencies to actively monitor the rise in cases. We’re especially concerned because of gonorrhea’s resistance to antibiotics used to treat it,” said Mark Aubin, sexually transmitted disease controller for the Department of Health. “It’s important for us to assure every reported case is interviewed so the partners of infected people are identified and receive treatment.”

Despite the increase over the last couple years, Washington rates are still well below the national average.

Health officials urge anyone who is experiencing symptoms, or has a partner that has been diagnosed, to be tested. Routine screenings are recommended for sexually active people.

Prevention methods include consistent and correct use of condoms, partner treatment, mutual monogamy and abstinence.”

To learn more about gonorrhea and find out where you can get tested go to Public Health – Seattle & King County’s Sexually Transmitted Disease webpage.

 

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Snohomish to offer free HIV tests for eligible gay & bisexual men, Oct. 1

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aids-ribbonIn support of National Gay Men’s HIV Awareness Day, the Snohomish Health District will host a free evening of information and testing from 4-7 p.m., Tuesday, Oct. 1 in Suite 108 at the Rucker Building, 3020 Rucker Ave., Everett, Wash.

The event is directed to gay and bisexual men who are at risk for HIV infection and other sexually transmitted diseases. No appointment needed. The event includes door prizes and light refreshments, and every man screened will receive a financial incentive.

Snohomish County currently ranks third in the state for new HIV cases, following King and Pierce counties. Recent data show that 58 percent of all new HIV cases in Washington State are among men who have sex with other men (MSM). Gay and bisexual men make up less than 10 percent of the population, but account for almost 60 percent of the burden of HIV disease.

The Health District also will offer free testing to qualified men for Hepatitis C and syphilis, and vaccine for Hepatitis A and B. Both the Hepatitis C and HIV tests are “rapid” antibody tests, requiring only a drop of blood pricked from a finger.

Test results will be available within 30 minutes. The tests are anonymous and confidential.

New prevention tool: Pre-exposure prophylaxis –PrEP

Information about a new HIV prevention tool will be shared by Michael Louella, outreach coordinator for the AIDS Clinical Trial Unit in Seattle.

Pre-exposure prophylaxis, or PrEP, is when HIV-negative individuals take a pill to prevent HIV infection.

The medicine currently is used to treat HIV, and has now been approved for this treatment by the Centers for Disease Control and Prevention, and the Food and Drug Administration.

Research studies show that PrEP can lower the risk of HIV transmission when used with other prevention measures, such as condoms.

For more information about HIV testing and risk, please call David Bayless, 425.339.5238.

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Microscopic view of prostate cancer

New PSA screening guidelines urge weighing harms, benefits

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By Rita Rubin

This KHN story was produced in collaboration with 

Microscopic view of prostate cancer

Prostate Cancer

For nearly a quarter century, doctors have ordered annual PSA tests for men of a certain age to screen for prostate cancer, despite a lack of evidence that the benefits outweighed the risks — especially when tiny, slow-growing tumors were detected.

But the landscape appears to be changing. While questions about PSA screening remain, physicians increasingly recognize the need to discuss both the harms and benefits with patients.

The U.S. Preventive Services Task Force shook up the status quo last July when it advised against using the simple blood test, which measures levels of a protein called prostate specific antigen, with average-risk men of any age who had no prostate cancer symptoms.

That recommendation prompted a backlash from urologists, who argued that screening saves lives, but gave pause to primary care doctors.

In recent weeks, though, urology and internal medicine groups have published surprisingly similar directives.

“I would say it’s a shift toward a more targeted screening approach rather than a one-size-fits-all screening approach,” said Dr. H. Ballentine Carter, a Johns Hopkins urologist, of the American Urological Association guidelines released May 3 and developed by a committee he chaired. The international association has more than 19,000 members worldwide.

Carter’s committee noted that the greatest benefit appears to be for those 55 to 69 but urged that men in that age group discuss the pros and cons with their doctor before deciding whether to proceed.

For those who opt for screening, waiting at least two years between tests could minimize potential harms — namely false-positives and the detection of slow-growing tumors that wouldn’t have caused any symptoms — while preserving most benefits.

Similarly, the American College of Physicians, representing internists, released guidelines April 9 advising members to discuss the test’s “limited benefits and substantial harms” with patients 50 to 69 years old and let them decide.

Both groups agreed that doctors should not screen men younger or older than their guidelines’ age ranges or those expected to live less than 10 to 15 years because of other health conditions.

An elevated PSA level doesn’t necessarily signify prostate cancer, but it can trigger a cascade of tests and treatments that could be riskier than the disease itself, potentially causing impotence, incontinence or even death from prostate cancer surgery.

Even before the latest sets of guidelines were released, Dr. Michael Albert, a Hopkins internist, said he began to change his approach, spurred by the Preventive Services Task Force recommendations and a 2009 U.S. study that concluded PSA screening didn’t save lives.

“It used to be much easier for me to click on the PSA button and order it,” said Albert, medical director of the East Baltimore Medical Center, part of Johns Hopkins Community Physicians.

Dr. Gene Green, a board-certified family practice doctor and internist who is president of the Hopkins-affiliated Suburban Hospital in Bethesda, said he’s been screening a smaller percentage of patients and referring fewer of them with a PSA level of 4 — traditionally the point at which prostate cancer concerns are raised in older men — to urologists.

Carter, head of adult urology at Hopkins, said the AUA guidelines “had absolutely nothing to do with the task force,” and though the two groups’ guidelines were based on similar scientific evidence, they viewed the evidence differently.

“We interpreted the evidence from an individual’s perspective vs. a public health perspective,” he said. Prostate cancer might not represent a threat to the public health the way diabetes or heart disease does, but it’s a “major risk to an individual who’s in your office and who may be very concerned about the possibility,” Carter said.

Dr. Kenny Lin, a family physician, called the informed-consent approach a “cop-out.” Simply by raising the subject of screening, doctors push patients toward it, said Lin, who as a medical officer at the Agency for Healthcare Research and Quality wrote the evidence review on which the Preventive Services Task Force based its recommendation. So, said Lin, now on the faculty at the Georgetown University School of Medicine, “I don’t bring it up necessarily.”

Meanwhile, the American Association of Clinical Urologists, whose website said its membership includes 45 percent of U.S. urologists, warns in a statement that these recent sets of guidelines could leave the impression that early detection of prostate cancer is no longer needed.

The Preventive Services Task Force and the AUA committee agree that one life is saved for every 1,000 men screened.

“There’s really no doubt [it] saves lives,” said Dr. William Nelson, a medical oncologist and urologist who directs Hopkins’ Sidney Kimmel Comprehensive Cancer Center.

The death rate from the disease has been declining since it peaked 20 years ago, although it isn’t clear how much is due to PSA screening and how much to improved treatment.

Still, Nelson acknowledged, “a lot more men die with prostate cancer than will ever die of it. The greatest threat to their health and happiness is attempts to treat them.”

ProstateSince the 1990s, screening has led to a diagnosis of early-stage prostate cancer in more than a million U.S. men who probably never would have developed symptoms. More than nine out of 10 of them chose aggressive treatment.

Mark Humphrey, now 71, a retired General Electric executive, lived in western Massachusetts when a 2006 test showed his PSA had nearly doubled to 3.5. Although still in the normal range below 4, the rapid increase spurred his doctor to refer him to a urologist for a biopsy, which revealed abnormal cells.

But his cancer appeared unlikely to be aggressive. That information, coupled with memories of his late brother-in-law’s experience with incontinence and impotence after surgery, led Humphrey to take a pass on the aggressive approach.

So Humphrey, who now lives in Baltimore, enrolled in the world’s first prostate cancer “active surveillance program,” which Carter directs at Hopkins. Instead of treating Humphrey’s disease, Carter is keeping an eye on it, with PSA testing and a rectal exam every six months.

Approximately 1,000 men have opted for active surveillance since the program launched more than 16 years ago. By following the participants, Carter said, he and his colleagues hope to learn more about what distinguishes slow-growing from aggressive cancers. Their goal: to build a better screening test.

“And then we want to learn more about the personal preferences of patients,” Carter said. For example, are they comfortable living with cancer?

Albert remembers seeing one patient, an otherwise healthy man in his early 60s with a PSA-detected tumor. After six months in the program, the man chose surgery. “He couldn’t fathom the idea that you’d sit on a cancer that could metastasize.”

Carter, Nelson and Green are among a group of Hopkins urologists and primary care doctors working on an app to help doctors discuss the risks and benefits of PSA screening with patients.

The app, to be tested later this year, takes into account such factors as life expectancy and prior PSA levels. It will be integrated into patients’ electronic medical records.

Notes Green: “Very few times in our lives can we say ‘always’ or ‘never.’”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Teen Pregnancy, Part 5: Teens Raising Children

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By Jen Brown, RN
From Seattle Children’s Teenology 101 weblog

It’s hard to write a brief post on something as complicated on teens having and raising children! Your story will be different than anyone else’s, and your experience unique. However, I think the following 8 points are good ones to consider when your teen tells you they are thinking about becoming a parent.

1. Your teen needs to make this decision. Let your teen know what you think about them having and raising the child, and why. Make a pro-con list. Discuss your experience in parenting and give them a realistic view of what to expect. But even if you disagree with their decision, it’s important to respect it. This isn’t a decision you can make for them without the possibility of major repercussions down the road.

2. This is going to be a hard adjustment. Many parents of teens are looking forward to a time when the house will be theirs again, when they can retire and take trips and generally relax. Now there is the prospect of a new infant in the home. It’s completely normal to feel disappointed or angry, even while you know you’ll love your grandchild. If the feelings persist or are interfering with your ability to cope, seek help from a counselor. Likewise, if you feel like your teen is having trouble adjusting, have them see a counselor as well.

3. Your teen needs your help. Remember how lost you felt, the first time you were caring for a newborn? Hopefully, you had wise friends and family to help you with taking on the role of a new parent. Your teen needs that wise advice, and your experience is invaluable. Any teen can learn to feed, change, and clothe a baby. But they will need your ongoing support to interact with their baby, learn to play with them, differentiate normal behavior from worrisome signs, and adjust to their rhythms.

4. Make a plan. Any teen will appreciate help with babysitting, diaper changes, and driving to the doctor’s appointments, but some teens simply expect their parents to raise the baby. Even young teenagers can and should take on parenting responsibilities. Sit down with your teen before the baby is born and work through what your expectations are, including their responsibilities in getting prenatal care now and planning for the birth. Make sure they know that as they get older, more parental responsibility will shift to them. Conversely, some teens may expect to be able to take on all care immediately, with little to no parental help. Let them know that you are happy to assist, and they will usually take you up on it once the baby is born.

5. Don’t abandon educational and career goals. Your teen needs to attend school full-time after their time off to have the baby, making use of day care as needed. If your teen gets any pushback at school, this may be illegal; the ACLU has information about ways to respond effectively. If your teen was planning on college, having a child shouldn’t change that. Many campuses have family housing, day care facilities, and support for student parents. Further education or career training leads to better financial stability in the future, which will help both your teen and their child.

6. Let your teen have a life. Part of teen development is spending time with peers, and your teen is no different. They need to be able to go out with their friends, date, and have an active social life. While they should expect some nights in, it’s important that they spend time having fun outside the house. By offering to babysit and let your teen go be a typical teen for a while, you’re helping them mature into a socially healthy adult. In addition, find community programs (this one is a good example) where your teen can meet other teen parents.

7. Expect rough patches. Babies are adorable. Toddlers are adorable, too, but at around age 2 they become much less pliable. Your teen may have a lot of trouble with the “terrible twos”, when their baby is discovering its identity, being contradictory, and fighting parental authority. For a teen whose developmental tasks are discovering their identity, being contradictary, and fighting parental authority, this can be a lot to take. Know that there are times in the development of both your teen and your grandchild when a cooler head and more experienced hands may be called for.

8. You’re going to love your grandchild. Even if this wasn’t exactly when you planned on having a grandchild, you’ll still love this baby like crazy. Your family is growing, perhaps unexpectedly, but you will have a new love in your life along with all the chaos this situation brings!

What advice would you give to parents whose teens are planning to have and raise a child? What advice would you give to teens?

 

About Jen Brown, RN, BSN

Jen-Brown-RN-BSN_avatar-100x100Teens never cease to amaze me with their strength, creativity, and new perspectives! Throughout my career, I’ve enjoyed helping teens and their parents tackle health concerns and navigate social issues. Nursing is my second career; my first degree was in biology from Carleton College, and a few years later I went to the University of Virginia for their Second Degree Nursing Program. Recently I began a graduate program at the University of Washington

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Teen Pregnancy, Part 4: Adoption

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By Jen Brown, RN
From Seattle Children’s Teenology 101 weblog

One option for pregnant teens is to bear the pregnancy to term, have the baby, and put it up for adoption. 2-3% of teens who are pregnant choose this route. However, the term “adoption” is not as simple as it used to be; there are different types of adoptions available. In this post, we’ll explore resources, basic information, and options for you and your teen to consider.

Many adoptions in the popular media are portrayed as unsatisfactory in some way, sometimes to the point of being ridiculous. The truth is that the majority of adoptions work out very well, enriching the life of the child being adopted as well as that of the adoptive family. They also allow the birth mother to continue her life without the unplanned impact of raising a child.

If your teen is considering continuing the pregnancy, and having the child adopted,  it may be hard for her to decide how she will feel after the adoption is through. Ask her to picture what it might be like. She might be able to see herself feeling relieved, deprived, proud, anxious, responsible, or miserable. It’s normal to be uncertain which emotion would predominate (especially as she will likely experience many.) Work through these emotions with her. What difference would it make in her life if she felt proud and responsible? What might she feel anxious about? What if she felt like she had made the wrong decision? What will it be like to get prenatal care and deliver the baby? How will this decision affect her life goals?

If your teen decides she wants to carry the pregnancy and adopt out the baby, the next decision is what kind of adoption she wants to have. The two broadest categories are “open” or “closed” adoptions. An “open” adoption means that she (and the baby’s father, if he wishes) will communicate with the adoptive family. This can range to everything from meeting them once during the pregnancy to regular, in-person visits with her child as he or she grows up.  Most people who choose open adoption end up somewhere in between those two ends of the spectrum. If your teen wants, she can select which family adopts the baby.

“Closed” adoptions mean that your teen will not meet the adoptive parents, and will be uninformed and uninvolved regarding the child’s placement, although she can make requests to a third party. Most closed adoptions do involve her releasing a medical history, since it is vital for someone to know what disease risks run in their biological family.

Research has shown that open adoption is, in general, better for the mother’s mental health than closed adoption. But your teen is a person, not a statistic. If she desires a closed adoption, that’s her choice. It’s best to allow some room for leeway, in case she decides she wants some basic information on the child down the road. It’s much easier to ask for less information and contact in an open adoption, than to try and get more in a closed one.

Adoptions can be performed through an adoption agency, through independent legal counsel, or by the your family independently. I would highly recommend at least having contact with a specialist, even if that person or agency does not end up handling the adoption.  This document has information about some local agencies and lawyers who are informed on the various issues around adoption, and can guide the process. Make sure your teen gets to research different choices and decide what works best for her. If the whole process is intimidating, partner with her to look at options.

These are the Washington state laws pertaining to adoption. It’s a dry read, and can be hard to understand, but I’d encourage you to go through them with your teen. If she asks, “What does that mean?” and you don’t know, contact a specialist and find out. (This is a short cheat sheet, if you’d rather start with something less technical before moving on to the laws themselves.) Your teen is about to make a big decision, and it’s important that she understand the adoption process thoroughly.

Many people have had their lives touched in some way by adoption. I’d love to hear your stories!

 

About Jen Brown, RN, BSN

Jen-Brown-RN-BSN_avatar-100x100Teens never cease to amaze me with their strength, creativity, and new perspectives! Throughout my career, I’ve enjoyed helping teens and their parents tackle health concerns and navigate social issues. Nursing is my second career; my first degree was in biology from Carleton College, and a few years later I went to the University of Virginia for their Second Degree Nursing Program. Recently I began a graduate program at the University of Washington

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National Black HIV/AIDS Awareness Day – Feb. 7

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HIV take charge logoFrom the CDC

African Americans are disproportionately affected by HIV. The Centers for Disease Control and Prevention (CDC) estimates that they accounted for nearly half (44%) of all new infections in 2010, despite making up only 14% of the population. This represents a rate that is eight times as high as that of whites.

Most of these infections are in African American men, most of whom are men who have sex with men (MSM). Young black MSM, in fact, account for more new infections than any other subgroup by race/ethnicity, age, and sex.

While African American women also continue to be far more affected by HIV than women of other races/ethnicities, recent data show early signs of an encouraging decrease in new HIV infections. CDC is cautiously optimistic that this is the beginning of a longer-term trend.

Today, we have many more opportunities than ever before to reduce the burden of HIV that African American men, women, and young adults bear. Working together with state and local public health agencies, African American communities, and other partners in the public and private sectors, CDC continues to address the HIV epidemic in African American communities.

One of these efforts is National Black HIV/AIDS Awareness Day, directed, planned, and organized by a group of organizations that partner with CDC to mobilize communities across the country to fight HIV and lessen its impact on African American communities.

National Black HIV/AIDS Awareness Day was started 13 years ago to mobilize people in African American communities to

  • Get educated about the basic facts on HIV and AIDS.
  • Get tested for HIV. Knowing your status saves lives!
  • Get involved to raise HIV awareness and fight stigma about HIV.
  • Get treated if living with HIV or newly diagnosed.

The theme for 2013, I Am My Brother’s/Sister’s Keeper: Fight HIV/AIDS, emphasizes that all African Americans, regardless of sexual orientation, economic class, or educational level, can be an important part of the solution to the HIV epidemic in African American communities.

Why Do African Americans Face a Higher Risk of HIV Infection?

Research shows that African Americans do not engage in riskier behavior than members of other racial/ethnic groups. However, there are many social and economic barriers that can increase the risk of HIV.

  • The higher the proportion of people living with HIV in a community, the greater the risk with each new sexual encounter of having a sexual partner who has HIV.
  • Higher rates of other sexually transmitted infections can increase the chance of getting and spreading HIV.
  • Social and economic realities—such as poverty, racial discrimination, limited access to health care and housing, and incarceration—are associated with increased risk of HIV.
  • Stigma, fear, and silence can increase the risk of HIV while decreasing the willingness to get support, get tested, and get treatment, if needed.

What Can You Do?

  • Learn about HIV and AIDS. Educate yourself, friends, and family about HIV and AIDS and what you can do to protect yourself.
  • Get tested for HIV. To find a testing site near you, call 1-800-CDC-INFO (232-4636), visit theNational HIV and STD Testing Resources website, or, on your cell phone, text your ZIP code to KNOW IT (566948).
  • Speak out against stigma, homophobia, racism, and other forms of discrimination associated with HIV and AIDS.
  • Donate time to HIV and AIDS organizations that work in African American communities.

What Can Community Organizations Do?

  • Promote National Black HIV/AIDS Awareness Day (NBHAAD) within your business, church, or other organization, by downloading the NBHAAD toolkit. HIV awareness and testing events can provide important information that people can use to protect their health and the health of their loved ones, and to get involved.
  • Educate your organization about HIV and AIDS and encourage staff and members to get involved in NBHAAD activities.

More Information

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Teen Pregnancy, Part 3: Making the Decision

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By Jen Brown, RN
From Seattle Children’s Teenology 101 weblog

Pregnant teens have three options when they are pregnant: They can terminate the pregnancy, or they can carry the pregnancy to term and either raise the child or arrange for an adoption. No matter what happens, this is a decision and a time your teen will always remember. You’ll remember it, too.

It’s vital that you never coerce or force your teen into a choice about her pregnancy. Not only will she be left feeling powerless, but she may feel betrayed by you; that’s not something either of you should have to live with. However, your input and guidance may help her through a difficult time. If there is a choice you are hoping she will make, or one that falls in line with the values of your family, tell her, while making it clear that it’s her decision and you will respect the one she makes.

Adoption:

Your teen may want to bear the child, and have a family adopt the baby and raise it. There are many different types of adoption, and your teen will have a chance to choose what is right for her. It’s very common for a teen thinking about having her baby adopted to fear that she will change her mind. Make sure your teen knows that she can arrange for an adoption and have the child, and then decide to keep it at that point if she really cannot see things going any other way. This certainly isn’t the best or easiest way to go about it, and can be a hardship to a waiting adoptive family. But until she “signs the baby over” to that family, she has the chance to change her mind. This can be comforting for pregnant teens to know. We’ll talk more in upcoming posts about different methods and types of adoption.

Termination: 

A termination, or abortion, means that your teen will seek medical services in order to stop the pregnancy. This is a very emotional topic, and I am not going to address the morality of pregnancy termination. I would encourage you to discuss it with your teen, however, giving your opinion and seeking hers.

One important thing to consider about termination is that the decision to terminate a pregnancy should be made as quickly as possible. This is never a decision you want your teen to rush, but the earlier the termination, the easier it will be to find a provider and have the simplest procedure possible. If your teen cannot decide whether or not to terminate for months and months, she is in essence choosing to bear the child. There’s nothing necessarily wrong with this; this may be the way she ends up making the choice that’s right for her. But make sure she knows that if she is certain this is what she wants, it’s best to start seeking out a healthcare provider.

Raising the Child:

Your teen may decide that she wants to bear and raise the child. Depending on her age, this may involve a lot of you raising the child as well. She will most likely need financial support, not to mention help in learning to parent, fitting a child into her future plans, and dealing with negative reactions from those around her.

Most parents do not plan to raise another baby when they have teenagers. It’s important that your teen be involved in the work as well as the joy of raising a child, and it’s just as important that you’re there to help her. Once you have wrapped your mind around the fact that your kid is having a kid, offer as much support as you can while encouraging her to take responsibility for things like scheduling prenatal care appointments, seeking out a place to give birth, and deciding on how childcare will proceed after the baby is born. Teenage young woman who have children can and do finish  high school, go to college, and complete graduate and professional programs. Having a child might make her educational goals more difficult, but by no means impossible- especially if you commit to helping her reach them.

We will be talking about these three options in more detail over the weeks to come. Please feel free to chime in with any thoughts or questions!

 

About Jen Brown, RN, BSN

Jen-Brown-RN-BSN_avatar-100x100Teens never cease to amaze me with their strength, creativity, and new perspectives! Throughout my career, I’ve enjoyed helping teens and their parents tackle health concerns and navigate social issues. Nursing is my second career; my first degree was in biology from Carleton College, and a few years later I went to the University of Virginia for their Second Degree Nursing Program. Recently I began a graduate program at the University of Washington

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Teen Pregnancy, Part 2: Young Men and Teen Pregnancy

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By Jen Brown, RN
From Seattle Children’s Teenology 101 weblog

Male teenagers who are involved in a teen pregnancy often don’t get much attention. And yet while the young woman bears the physical effects, a pregnancy takes two people. If your teen son is involved in a pregnancy, his reaction may surprise you. He may be expecting to do absolutely nothing regarding this pregnancy and “let her take care of it”, or he may be planning to get married and help raise the child. He may have no idea what he wants. He may feel angry, excited, miserable, joyful, apathetic, guilty, or a confusing combination of emotions. If this pregnancy is unwanted, as many teen pregnancies are, he may be having visions of a “worst case scenario”- whatever that means to him.

Barring a medical problem, there are basically three courses for a pregnancy to take, all of which we will discuss in further detail.

Adoption: If the young woman desires to continue the pregnancy and offer the baby for adoption, your son has a say in this. If he is strongly against it, seek legal help; it’s a complicated situation. Your son may be fine with the adoption, but want an active role in deciding on its aspects. He should communicate respectfully to the young woman and her family, expressing his desire to be involved. Encourage your son to become part of the adoption process if he wants to, and maybe even in the pregnancy itself.

Abortion: It is up to the young woman to decide if she wants to terminate the pregnancy. If this is her plan- or it has happened already- explore his reaction with him. He may be pleased at the decision and feel relief, or he may experience feelings of sadness, betrayal, or anger. Sometimes teens feel guilty for feeling relieved, or impatient if they cannot “get over it” as quickly as they feel they ought to. Oftentimes  feelings will be mixed, especially as the situation is unfolding. Some young men frustrate their parents by acting like it’s no big deal; in his mind, that may be true. Remember that even though your teen is faced with an adult situation, he’s not an adult. Help him learn how to prevent the situation from occurring again. Make sure he knows he can come to you for advice, support, or a sounding board whenever he wants.

Keeping the child: If the young woman is planning on having and raising the child, this is going to be life-changing for your teen. Here are several important issues you and your teen need to start thinking about immediately:

  • Is there any doubt about the paternity of the child? You do have the right to request a paternity test before your teen is named the child’s father. Teen fathers, like adult ones, take on a lot of responsibilities, and your teen may want to ensure that he is in fact the baby’s father. This document has some quick facts on paternity and child support. If you and your teen decide to request proof of paternity, make every effort to do so delicately and respectfully.
  • How involved does your teen want to be with the raising of his child? If your teen wants to be a father, he has every right to be. Since the young woman and your teen don’t live together, arranging this can be complicated. In a best case scenario, both families will come together and agree on a plan that works for everyone. If there are disagreements, seek legal advice before making any major decisions.
  • How closely can you work with the young woman’s family? Most families will be open to talking to you and your teen about what happens next. While both sets of parents may be surprised at being grandparents, remember that you have much-needed skills and wisdom. If you can all work cooperatively to ensure the well-being of both your teens and their baby, things will go much more smoothly.

No matter what happens, your teen may experience very strong feelings, and you need to encourage him to express them and offer emotional support. You need to do this even if you don’t think his feelings are wise or even valid. If your teen is having trouble coping with the situation, help him seek out a counselor to talk to. Remind him that you love him and are there for him no matter what happens, and mean it.

 

About Jen Brown, RN, BSN

Jen-Brown-RN-BSN_avatar-100x100Teens never cease to amaze me with their strength, creativity, and new perspectives! Throughout my career, I’ve enjoyed helping teens and their parents tackle health concerns and navigate social issues. Nursing is my second career; my first degree was in biology from Carleton College, and a few years later I went to the University of Virginia for their Second Degree Nursing Program. Recently I began a graduate program at the University of Washington

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Teen Pregnancy, Part 1: Getting the News

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Seattle Children's LogoBy Jen Brown, RN
From Seattle Children’s Teenology 101 weblog

Finding out that your teen is pregnant, or has gotten somebody pregnant, is usually quite a shock. There are some situations and cultures in which you’re not shocked, and may be okay with the news, in which case your path will be easier. But many parents find themselves reeling at the news. You may feel angry, sad, hurt, astonished, betrayed, scared, confused, disappointed- or a mix of any of these emotions and more. Your kid pregnant- or fathering a child- and yet they are still a kid. You still pay their bills, and weather their bad moods, and sometimes are still driving them around. How did this happen?

If your teen is sexually active and you didn’t know about it, you are certainly not alone. It doesn’t mean you’re a bad parent, or you didn’t encourage them to communicate with you, or you didn’t discuss sex with them. It doesn’t mean they don’t love you and value your viewpoint. It means that they’re a teenager, and many teenagers like to keep secrets. When I was a teen I would hide from my parents that I was dating this or that person, not because they would have minded, but because I liked the kick of having to keep the secret and operate everything under the radar. Or perhaps they feared your reaction, or perhaps they themselves weren’t particularly proud of what they were doing. Perhaps they were coerced or even forced into sex (if not, I’d say that’s something to be thankful for.)

There are lots of possible reasons. But your kid getting pregnant, or getting someone pregnant, does not equal bad parenting. Teens with great parents can still be sexually active, can still take risks, can try to do everything right and end up with outcomes they didn’t expect. So if you’re feeling guilt, you can let go of it and focus on what’s going on.

It’s hard not to get emotional at the news. And it’s okay to get emotional at the news. But now that you know, you need to offer your teen support- even if you’re still really mad at them or are more scared than you’ve ever been in your life. I can guarantee you that your teen is mad and scared too. It’s okay to tell them you’re still mad, and it’s okay to still cry when you talk about it. But if you can’t talk without yelling, or sobbing, or biting your nails, you need to figure out how to get to a different emotional place. The emotions are certainly warranted, but your teen needs this issue approached with a cool head, and it’s unlikely to be theirs.

Now is a time when your teen has options to consider, and they’ll need your help considering them. I’m not saying they need you to make the decision for them; this is a really personal decision and in the end, they should have the final say. This may be the first adult decision they need to make. They can’t put it off. They can’t avoid it. They have to face up to the situation, and a parent who is there to support, guide, and love them throughout is invaluable.

Over the next few posts, we’re going to look at the issue more closely, and options available to pregnant teens. Keep in mind that if your teen fathered a child, their decision-making power in this situation may be limited. Nevertheless, they should be there for, or at least available to, whomever is pregnant. It’s common for teen boys who have fathered a baby to want to run away and hide, but they played a role in causing this situation and they need to deal with it. With you behind them, they can figure out the best way to do that.

Make sure you’ve got support too. Friends, family, or partners can help you. Your teen may beg you not to tell anyone, and with the possible exception of a co-parent, it’s best to respect their wishes. In that case, talk to a counselor, a pediatrician, or someone who doesn’t know your kid at all and you trust to keep things confidential. You need to be able to organize your thoughts and stay strong for whatever comes ahead.

 

About Jen Brown, RN, BSN

Jen-Brown-RN-BSN_avatar-100x100Teens never cease to amaze me with their strength, creativity, and new perspectives! Throughout my career, I’ve enjoyed helping teens and their parents tackle health concerns and navigate social issues. Nursing is my second career; my first degree was in biology from Carleton College, and a few years later I went to the University of Virginia for their Second Degree Nursing Program. Recently I began a graduate program at the University of Washington

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Gonorrhea (Photo: Bill Schwarts/CDC)

Sexually Transmitted Infections: Part 1 Gonorrhea

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By Yolanda Evans, MD, MPH
From Seattle Children’s Teenology 101 weblog

Part of normal adolescence is the development of new relationships. Teens have strong ties with peers and also began to have romantic relationships.

Many teens also choose to start having sex. In fact nearly half (47%) of all high school students have had sex before. With sex comes consequences: intense feelings, possible heart break, as well as the risk of pregnancy and sexually transmitted infections.

Unfortunately, 15-24 year old’s account for almost half of the 19 million new sexually transmitted infections (STI) that occur each year (even though this age group is only a quarter of the US population), but I want to be clear that any person who has sex is at risk for an STI. In this post, I’ll focus on gonorrhea.

Gonorrhea

Gonorrhea CDC-Bill Schwarts

Gonorrhea bacteria amongst white cells. Photo by Bill Schwartz/CDC

Gonorrhea is an STI caused by a bacterium. The CDC estimates that about 700,000 people are infected each year. It’s spread by having sex; that means oral, anal, and/or vaginal sex and can also be spread from an infected mother to an infant (leading to serious illness in the baby).

The symptoms can vary. Most women have no symptoms at all or they may have pain or burning with urination, vaginal discharge or bleeding. It might be mistaken for a urinary tract infection.

Men are more likely to have pain or burning with urination and white/yellow/green discharge from the penis.  People with an infection of the throat may have sore throat or no symptoms at all and rectal gonorrhea infection could cause painful bowel movements or itching, burning, and discharge.

Untreated gonorrhea can cause a painful infection called epididymitis in males and can lead to an infection of the fallopian tubes called pelvic inflammatory disease (PID) in females.

PID can cause scarring of the fallopian tubes that leads to infertility or a life threatening pregnancy outside of the uterus called an ectopic pregnancy.

In both males and females untreated gonorrhea can also lead to a life threatening infection that affects the joints.

Screening for gonorrhea is relatively easy. Anyone with symptoms, a partner who has been diagnosed with gonorrhea, or anyone diagnosed with another STI should be screened. There is now a test that looks for the bacterial DNA in urine, so a person only needs to provide the urine.

Depending on the situation, a medical provider may still obtain a swab from a woman’s cervix (the entrance to the uterus or womb) or a man’s penis but the ability to detect the bacteria in the urine has made screening something that is not painful or uncomfortable. To look for infection in the rectum or throat, a medical provider will need to obtain swabs of these areas.

Fortunately, gonorrhea can be cured if treated appropriately, but antibiotic resistance is increasing. If your teen is diagnosed with gonorrhea or any treatable STI, they should take all the medication provided and should not share medication or take another person’s dose.

The good news is that gonorrhea can be prevented!  Not having sex is the only way to prevent any STI 100% of the time, but knowing the status of your sexual partner and using latex condoms with every sexual act (including oral and anal sex) also reduce the risk of getting gonorrhea.

About Yolanda Evans, MD, MPH

Yolanda-Evans-MD-MPH_avatar-100x100My work is a ‘dream come true’ and it’s what I’ve wanted to do for as long as I can remember. I have the privilege of getting to know some amazing teens and hearing things about them that they may not have told anyone before. When I’m not working, I like trying new foods, traveling around the world, spending time with family and friends, and enjoying the fresh Washington air (though not quite as fresh as Alaska where I grew up, but very close!) – Yolanda Evans, M.D., Adolescent Medicine at Seattle Children’s

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Sexually Transmitted Infections in Teens: An overview of an uncomfortable topic

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Photo by Brunopp

Photo by Brunopp

By Yolanda Evans, MD, MPH
From Seattle Children’s Teenology 101 weblog

This is the start of an entire series on sexually transmitted infections (STI’s) in teens. Rather than starting the series with gruesome pictures or detailed descriptions of specific infections, let’s talk a bit about teens and sexuality.

A normal part of adolescence is developing physically and emotionally. As teens, we start to discover who we are attracted to and what we are looking for in a partner. We also start to experiment with relationships. Friendships may become more intense and we rely more on approval from peers than from family.

At the same time, we start to have crushes and relationships with potential romantic partners. Sometimes these relationships lead to sex, and sex has consequences.

A consequence could be more intense feelings for a partner or realizing you are not ready to be in a committed relationship; it could be pregnancy, or it could be an infection.

Sexually transmitted infections are nothing new, they’ve plagued famous authors, musicians, husbands, and wives for centuries. In this day and age, we can treat and cure many STI’s with antibiotics, yet some are still incurable (though we may be able to treat symptoms) and antibiotic resistance is a growing concern.

STI’s can lead to feeling anger and shame, but can also cause serious infection and even infertility if not treated. In the US, teens and young adults ages 15-24 account 25% of the populations but contribute to most of the STI’s diagnosed each year (>50%). The good news is that STI’s, with all the consequences, are preventable.

Abstinence (not having sex at all) is the only way to prevent STI’s 100% of the time, but condoms and routine screening are the next best way to stay safe if a teen decides to start having sex.

Over the course of this series, I’ll go into details about specific infections that anyone (not just teens) can get from having sex. This is by no means an exhaustive list, but I’ll talk about the infections that are common.

Even though I’ll discuss specific infections, I want to remind parents that they can help keep their teens safe and healthy by communicating.

Keep an open dialogue going about your ideas of a healthy romantic relationship.What are your opinions about sex? What are your expectations for your teen about dating and intimacy? Are your teen’s friends dating? Do you know if their friends are having sex? Have you communicated with your teen in a way that would make them feel comfortable asking you questions about their body’s development and/or sexual activity? Have they asked about condoms and birth control? Have you brought up the topics of sexuality, birth control, and safe sex practices?

A lot of these questions can be uncomfortable to discuss with our own adult friends, let alone our children. If you aren’t comfortable bringing up the topic, schedule a visit with your teen’s health care provider and ask them for tips on how to start the conversation.

Photo courtesy of Brunopp

About Yolanda Evans, MD, MPH

Yolanda-Evans-MD-MPH_avatar-100x100My work is a ‘dream come true’ and it’s what I’ve wanted to do for as long as I can remember. I have the privilege of getting to know some amazing teens and hearing things about them that they may not have told anyone before. When I’m not working, I like trying new foods, traveling around the world, spending time with family and friends, and enjoying the fresh Washington air (though not quite as fresh as Alaska where I grew up, but very close!) – Yolanda Evans, M.D., Adolescent Medicine at Seattle Children’s

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Health reform’s ‘contraceptive mandate’ vs. religious freedom

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Birth control patch - Photo by John Heilman, MD under creative commons licesnse

Birth control patch – Photo by John Heilman, MD (CC)

Analysis by Stuart Taylor Jr.

The Supreme Court famously upheld most of the Affordable Care Act in June. But in a year or two we may see another riveting Supreme Court drama growing out of the health law, this one driven by the passionate objections of many religious employers to the so-called contraceptive mandate.

An Obama Administration regulation requiring that many employers — including religious employers — provide insurance without copays or deductibles that covers a wide range of contraceptives, including sterilization, as part of women’s preventive health care.

Religious groups decry it as an extreme attack on their freedom. Already, more than 40 lawsuits have been filed by Catholic and evangelical plaintiffs including hospitals, universities and private businesses.

The Catholic plaintiffs object to all contraceptives, the evangelicals to methods that induce what they call abortion.

While the legal challenges pose no threat to the law as a whole, they have all the ingredients of a legal donnybrook that might well end up before the high court.

Among the thousands of employers with religious objections are many Catholic hospitals, universities, charities, other religious institutions, and private companies owned by devout Catholics and evangelicals. Collectively, they have millions of employees.

Although the regulation allows for a narrow category of religious employers – mostly churches and other houses of worship — to be exempt from the requirement, the administration has so far refused to grant exemptions to institutions such as Catholic hospitals, because they employ and serve mainly members of the general public and their mission is not primarily religious.

The Legal Issues In Play

The plaintiffs’ claims rest mainly on the Religious Freedom Restoration Act. Congress passed this measure in 1993 to provide broader legal protections than the First Amendment guarantee of “free exercise of religion,” which the Supreme Court had interpreted narrowly in a 1990 decision.

It prohibits the federal government from imposing a “substantial burden” on a person’s “exercise of religion” unless it can prove that doing so is “the least restrictive means of furthering [a] compelling governmental interest.”

The administration and its allies argue that the mandate imposes a slight, indirect burden on religious employers, who would be required only to facilitate contraception decisions made independently by their employees, and furthers a compelling need to avert unwanted pregnancies, improve maternal and child health, reduce health care costs and reduce poverty.

They also stress that 20 states have laws similar to the contraceptive mandate; that many Catholic hospitals and universities already provide birth control coverage for their employees; and that polls show the vast majority of Catholic women use birth control methods banned by the church.

In February, in what the administration called a compromise, it said that the cost of the coverage would be borne not by employers with religious objections but by their insurance companies, which in turn would likely save more than the cost of the contraceptives by averting unwanted pregnancies. The compromise, though, would not apply to companies that self-insure.

The plaintiffs claim the mandate forces many religious employers to violate their religion or be subjected to crippling fines of $100 per employee per day, according to press reports and court documents.

They add that government’s “compelling interest” argument rings hollow because the health law exempts many non-religious employers, with more than 190 million employees, from its coverage requirements, such as businesses with fewer than 50 workers and those with established health plans that were given “grandfathered” status.

The plaintiffs also stress that free or inexpensive contraceptives are available at community health centers and other public clinics.

Action In The Courts

So far the scorecard on this issue in the federal district courts is three preliminary injunctions against the contraceptive mandate and two decisions upholding it, one of which was later stayed without comment on appeal, at least for now.

That decision came on Sept. 28 when Judge Carol Jackson of St. Louis rejected a lawsuit brought by Frank O’Brien and his private, for-profit company, O’Brien Industrial Holdings, LLC.

O’Brien and his company claim that they cannot comply with the contraception mandate without violating his Catholic beliefs and that noncompliance would subject the company to “ruinous fines” that would drive it out of business.

But Jackson said the mandate imposed only a “slight,” indirect burden because the decision to use contraceptives was ultimately in the hands of third parties — individual employees — and O’Brien’s company would pay only indirectly, through its insurance company.

O’Brien won the stay from an appeals court on November 28. By then, Judge Reggie Walton, of Washington, D.C., had rejected Jackson’s reasoning in a Nov. 16 decision related to a separate case, holding that “it is the coverage, not just the use, of the contraceptives at issue to which the plaintiffs object,” so “it is irrelevant that the use of the contraceptives depends on the independent decisions of third parties.”

Walton granted a preliminary injunction to Tyndale House Publishers, Inc., an Illinois publisher of Christian books. The company and its founder and CEO object to any contraceptive that “can cause the demise of an already conceived/fertilized human embryo.”

Walton ruled that the contraceptive mandate imposed a “substantial burden” because it “places the plaintiffs in the untenable position of choosing either to violate their religious beliefs” or to risk financial penalties.

He added that the government had not shown a compelling need for forcing Tyndale to provide coverage for the “very specific subset of contraceptive drugs and devices” to which it objected — especially since “the government itself has voluntarily omitted” millions of people from coverage through the health law’s other exemptions.

Judges in Colorado and Michigan have also issued preliminary injunctions in similar cases.

These early decisions lead some legal experts to suggest that the contraceptive mandate challenges have more chance of ultimate success than other, broader pending lawsuits against health law provisions.

Stuart Taylor Jr. is an author, journalist and nonresident fellow at the Brookings Institution.

Photo courtesy of Dr. John Heilman, M.D. under Creative Commons License

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Today’s health headlines – August 27th

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By Stephanie Stapleton

Today’s early morning highlights from the major news organizations, including reports about this week’s GOP convention, the politics of Medicare and abortion, and the latest health policy news from the states.

Politico: Romney Touts His Health Care Plan

On the eve of the Republican convention in Tampa, Fla., Mitt Romney abruptly embraced his Massachusetts health care law in response to President Barack Obama’s attacks that Republicans have declared a “war on women” (Gibson and Samuelsohn, 8/26).

Politico: GOP Platform: Cut Health Costs, Lose Weight

The draft Republican platform that was accidentally posted on the Republican National Committee website Friday – before POLITICO discovered it and the RNC took it down – suggests that people should do their part to hold down health care costs by avoiding unhealthy habits and lifestyles, which lead to expensive health care needs (Nather, 8/24).

The New York Times: Despite Democrats’ Warnings, Private Medicare Plans Find Success

Even as President Obama accuses Mitt Romney and Representative Paul D. Ryan of trying to privatize and “voucherize” Medicare, his administration crows about the success of private health plans in delivering prescription drug benefits and other services to Medicare beneficiaries. More than a quarter of the 50 million beneficiaries receive coverage through private Medicare Advantage plans, mostly health maintenance organizations, and Medicare’s drug benefits are delivered exclusively by private insurers, subsidized by the government. Obama administration officials, lawmakers from both parties and beneficiaries have generally been satisfied with the private plans (Pear, 8/25).

The Washington Post: Affordable Care Act Driving Health Care Mergers

Two of the region’s corporate giants — one focused on government health insurance, the other specializing in communities for seniors — were acquired by larger industry players last week, as consolidation heats up in health-related sectors (Ho, 8/26).

The Associated Press/Washington Post: Romney Accuses Obama Of Exploiting Abortion Issue

His Republican National Convention curtailed by a threatened hurricane, Mitt Romney conceded Sunday that fresh controversy over rape and abortion is harming his party and he accused Democrats of trying to exploit it for political gain (8/26).

Politico: GOP Sidetracked By Abortion Details

Republicans have been taking ground in the war on abortion for years, putting Democrats on the defensive on specifics like “partial-birth” abortion and parental rights. But suddenly the GOP has fallen into a similar trap, bedeviled by details: rape, invasive ultrasounds and the merits of contraception. Todd Akin’s “legitimate rape” remark forced fellow Republicans to publicly explore the details of how they think about abortion — details that don’t serve their broader argument and that give Democrats a chance to reframe the debate, conservatives say (Allen, 8/24).

Los Angeles Times: Pediatricians’ Group Shifts In Favor Of Circumcision

The American Academy of Pediatrics has shifted its official position on the contentious issue of infant circumcision, stating Monday that the medical benefits of the procedure for baby boys outweigh the small risks (Brown, 8/26).

Politico: Mitt Romney’s Law Has An ‘Unelected Board’ Too

Mitt Romney is on the warpath against President Barack Obama’s “unelected board” of health care bureaucrats — but his own Massachusetts health care law has been blasted more than a few times for the same reason. It’s another reminder that, as much as Romney is trying to campaign against “Obamacare,” there’s almost always some similarity in “Romneycare” that can come back to bite him (Cheney, 8/24).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

 

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Prostate Cancer: Facts and fiction

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Six Myths about prostate cancer

When it comes to prostate cancer, there’s a lot of confusion about how to prevent it, find it early and the best way – or even whether – to treat it. Below are six common prostate cancer myths along with research-based information from scientists at Fred Hutchinson Cancer Research Center to help men separate fact from fiction.

Myth 1 – Eating tomato-based products such as ketchup and red pasta sauce prevents prostate cancer. 

“The vastmajority of studies show no association,” said Alan Kristal, Dr.P.H., associate director of the Hutchinson Center’s Cancer Prevention Program and a national expert in prostate cancer prevention.

Kristal and colleagues last year published results of the largest study to date that aimed to determine whether foods that contain lycopene – the nutrient that puts the red in tomatoes – actually protect against prostate cancer.

After examining blood levels of lycopene in nearly 3,500 men nationwide they found no association. “Scientists and the public should understand that early studies supporting an association of dietary lycopene with reduced prostate cancer risk have not been replicated in studies using serum biomarkers of lycopene intake,” the authors reported in Cancer Epidemiology, Biomarkers & Prevention.  “Recommendations of professional societies to the public should be modified to reflect the likelihood that increasing lycopene intake will not affect prostate cancer risk.”

Myth 2 – High testosterone levels increase the risk of prostate cancer.

“This is a hypothesis based on a very simplistic understanding of testosterone metabolism and its effect on prostate cancer. It is simply wrong,” Kristal said.

Unlike estrogen and breast cancer, where there is a very strong relationship, testosterone levels have no association with prostate cancer risk, he said.

A study published in 2008 in the Journal of the National Cancer Institute, which combined data from 18 large studies, found no association between blood testosterone concentration and prostate cancer risk, and more recent studies have confirmed this conclusion.

Myth 3 – Fish oil (omega-3 fatty acids) decreases prostate cancer risk. 

“This sounds reasonable, based on an association of inflammation with prostate cancer and the anti-inflammatory effects of omega-3 fatty acids,” Kristal said.

However, two large, well-designed studies – including one led by Kristal that was published last year in the American Journal of Epidemiology – have shown that high blood levels of omega-3 fatty acids increase the odds of developing high-risk prostate cancer.

Analyzing data from a nationwide study of nearly 3,500 men, they found that those with the highest blood percentages of docosahexaenoic acid, or DHA, an inflammation-lowering omega-3 fatty acid commonly found in fatty fish, have two-and-a-half times the risk of developing aggressive, high-grade prostate cancer compared to men with the lowest DHA levels.

“This very sobering finding suggests that our understanding of the effects of omega-3 fatty acids is incomplete,” Kristal said.

Myth 4 – Vitamins and dietary supplements can prevent prostate cancer. 

Several large, randomized trials that have looked at the impact of dietary supplements on the risk of various cancers, including prostate, have shown either no effect or, much more troubling, they have shown significantly increased risk.

“The more we look at the effects of taking supplements, the more hazardous they appear when it comes to cancer risk,” Kristal said. For example, the Selenium and Vitamin E Cancer Prevention Trial (SELECT), the largest prostate cancer prevention study to date, was stopped early because it found neither selenium nor vitamin E supplements alone or combined reduced the risk of prostate cancer.

A SELECT follow-up study published last year in JAMA found that vitamin E actually increased the risk of prostate cancer among healthy men.

The Hutchinson Center oversaw statistical analysis for the study, which involved nearly 35,000 men in the U.S., Canada and Puerto Rico.

Myth 5 – We don’t know which prostate cancers detected by PSA (prostate-specific antigen) screening need to be treated and which ones can be left alone.

 “Actually, we have a very good sense of which cancers have a very low risk of progression and which ones are highly likely to spread if left untreated,” said biostatistician Ruth Etzioni, Ph.D., a member of the Hutchinson Center’s Public Health Sciences Division.

“For the majority of newly diagnosed cases of prostate cancer, by taking into account initial clinical and biopsy information we can get a very good idea of who should be treated and who is likely to benefit from deferring treatment.”

In addition to blood levels of PSA, indicators of aggressive disease include tumor volume (the number of biopsy samples that contain cancer) and Gleason score (predicting the aggressiveness of cancer by how the biopsy samples look under a microscope). Gleason scores range from 2-5 (low risk) and 6-7 (medium risk) to 8-10 (high risk).

“Men with a low PSA level, a biopsy Gleason score of 6 or lower and very few biopsy samples with cancer are generally considered to be very low risk,” Etzioni said.

Such newly diagnosed men increasingly are being offered active surveillance – a watchful waiting approach – rather than therapy for their disease, particularly if they are older or have a short life expectancy.

“The chance that these men will die of their disease if they are not treated is very low, around 3 percent,” she said. Similarly, such men who opt for treatment have a mortality rate of about 2 percent. “For the majority of newly diagnosed cases of prostate cancer, by taking into account initial clinical and biopsy information we can get a very good idea of who should be treated and who is likely to benefit from deferring treatment.”

Myth 6 – Only one in 50 men diagnosed with PSA screening benefits from treatment.

“This number, which was released as a preliminary result from the European Randomized Study of Prostate Cancer Screening, is simply incorrect,” Etzioni said. “It suggests a very unfavorable harm-benefit ratio for PSA screening. It implies that for every man whose life is saved by PSA screening, almost 50 are overdiagnosed and overtreated.”

“The correct ratio of men diagnosed with PSA testing who are overdiagnosed and overtreated versus men whose lives are saved by treatment long term is more likely to be 10 to one.”

“Overdiagnosis” is diagnosing a disease that will never cause symptoms or death in the patient’s lifetime. “Overtreatment” is treating a disease that will never progress to become symptomatic or life-threatening.

The 50-to-one ratio, which is based on short-term follow-up data, “grossly underestimates” the lives likely to be saved by screening over the long term and overestimates the number of men who are overdiagnosed, Etzioni said.  “The correct ratio of men diagnosed with PSA testing who are overdiagnosed and overtreated versus men whose lives are saved by treatment long term is more likely to be 10 to one.”

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HPV

What you need to know about HPV

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By Monica Richter, MD, PhD

One of the most important recent advances in women’s health is a vaccine against human papillomavirus (HPV). The HPV vaccine protects against serious health problems such as cervical cancer and other less common cancers.

The first HPV vaccine was approved in June of 2006 after testing in thousands of people around the world.

Two HPV vaccines are currently licensed by the FDA and recommended by the Centers for Disease Control and Prevention (CDC): Gardacil is approved for girls or boys ages 9 to 26, and Cervarix is approved for girls 10 through 25 years of age.

HPV is the most common sexually transmitted virus in the United States. More than half of sexually active men and women are infected with the virus at some time in their lives.

In addition to causing cervical cancer, HPV can cause vaginal and vulvar cancer in women, and other types of cancers in both men and women. It can also cause genital warts and warts in the throat.

But good news! The HPV vaccine can prevent most cases of cervical cancer in women. It can also prevent vaginal and vulvar cancer in women and genital warts and anal cancer in both men and women. Protection from the vaccine is long-lasting.

While we all hope that young teens are abstaining from sexual activity, it is important to vaccinate girls long before their first sexual contact.

In addition, the response to the vaccine is stronger in younger girls and for this reason, we recommend vaccinating girls at age 11 or 12 years. The vaccine is given as a 3-dose series over 6 months.

Both vaccines are available for women, but only one of them can be given to men also.

Vaccines have undergone a lot of scrutiny in recent years, but all of the available scientific evidence confirms their safety and efficacy.

In spite of this, many false rumors are circulating and I continue to be confused by the number of parents who decline the vaccine for their daughters. As a mother and a pediatrician,

I gave my daughter the HPV vaccine as soon as it became available and I urge all parents to do the same.

For more information on the HPV vaccine, visit www.cdc.gov/vaccines.

About Monica Richter, MD, PhD

Dr. Monica Richter is a board certified pediatrician with Valley Children’s Clinic. Over the past 18+ years Dr. Richter has helped hundreds of pubescent girls navigate the physical and emotional aspects of their changing bodies and psyches, including menstruation, body changes, sexuality and how babies are conceived, through her free seminar, As Girls Grow Up. She also teaches BodyWorks, an eight-week health education program developed by the Dept. of Health & Human Services. Bodyworks is designed to provide parents and caregivers of teenage girls and boys ages 9 to 16 with tools to improve family eating and activity habits. Originally from Manhattan, Dr. Richter is married with two grown children. In her spare time she enjoys reading and knitting.

Valley Children’s Clinic is located at 4011 Talbot Road S., Suite 220, in Renton. Phone: 425.656.5300; www.valleychildrensclinic.org

 

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