Being Your Own Advocate

There is a common saying that “Health is Wealth”. This is very true because while one can attain a lot of wealth if they don’t have health, they won’t be able to enjoy the wealth. While a good number of health conditions such as inherited or genetically based diseases are not under a person’s control, a number of acquired conditions such as hypertension, diabetes, and hypercholesterolemia can be managed or prevented by following a healthy lifestyle which basically includes diet and exercise.  

Even if a person lives a healthy lifestyle, it doesn’t make them immune from developing health problems because healthy living is only part of the equation. Some other factors that are important in determining whether a person develops certain conditions include genetic predisposition and environmental factors. Therefore, it's important to not only be aware of the various acute health conditions that can occur but also very important to be able to recognize the symptoms when they occur and seek prompt medical care.

It's very important to realize the value of early diagnosis to initiate the appropriate treatment/intervention in a timely manner to obtain the best results possible. Some acute life-threatening emergencies include heart attack, stroke, and pulmonary embolism. Heart disease is the leading cause of death in the US. A heart attack occurs when a blood vessel supplying the heart muscle is occluded leading to dysfunction of the heart muscle which pumps blood to the entire body. If the symptoms of a heart attack are not recognized promptly and the patient does not get to the emergency room in time this can lead to irreversible damage to the heart muscle, heart failure, and death. Prompt treatment of a heart attack includes opening up of an occluded vessel by a cardiologist and placing a stent to keep the vessel open. This would restore blood supply to the heart muscle and prevent further damage.  

An ischemic stroke occurs when one of the blood vessels supplying the brain becomes occluded leading to permanent damage of that area of the brain being supplied by that vessel. This can lead to loss of functionality, memory impairment, physical impairment, and even death if the area involved is large and complications such as a bleed or herniation occur. There is a short time window frame from the onset of stroke symptoms to diagnosis and treatment which includes thrombolysis/clot removal and restoring circulation to the brain parenchyma to prevent irreversible permanent damage. 

Both heart attack and stroke often occur as a result of a ruptured atherosclerotic plaque that travels up from one of the vessels and occludes a vessel either supplying the heart muscle or the brain.  Pulmonary embolism is another acute emergency where a clot travels up usually from one of the vessels in the legs and lodges in one of the pulmonary arteries resulting in respiratory problems, compromising oxygenation of the blood, and potentially heart failure if not diagnosed, and treated promptly.  

Some other common emergent, life-threatening conditions include severe allergic/anaphylactic conditions, bowel obstructions, acute appendicitis, and throat infections such as epiglottitis which if treated promptly can lead to complete recovery.  

In the remained of this article, I’d like to discuss cancer. Cancer is the second leading cause of death in adults in the United States after heart disease according to the CDC. Cancer occurs when certain cells mutate and become cancerous cells and keep multiplying. Depending on the grade/aggressiveness of cancer, it can spread to other parts of the body, called metastasis.

As with other acute life-threatening conditions, early diagnosis is the key to achieving the best outcomes. While there are now many new treatments for various types of cancers that are helping people live longer and more productive lives even if diagnosed at a more advanced stage, the best outcomes are often seen if the cancer is diagnosed at an early stage.  

In order to achieve this, it's important to follow the screening guidelines for various cancers for early detection. These screening exams include annual mammograms for early breast cancer detection, screening colonoscopies for early colon cancer detection, and surveillance CT scans of the chest for early lung cancer detection. In higher-risk groups, the screening might start at an earlier age.

While some cancers have screening guidelines, many types of cancer do not have screening guidelines. As a result, it is very important to be knowledgeable about various types of common cancers for early detection. One specific cancer I’d like to discuss is bladder cancer. It's the fourth most common cancer affecting men. While men are four times more likely to develop bladder cancer than women, women tend to be diagnosed at a later stage, due to multiple factors.  

Some of the common symptoms of bladder cancer include visible blood in your urine known as gross hematuria, pain with urination (dysuria), needing to urinate frequently, trouble with urination, or persistent bladder infections. While the exact cause of bladder cancer is not known, some of the risk factors that may increase your chance of developing bladder cancer include cigarette smoke, radiation exposure, chemotherapy, exposure to certain chemicals, frequent bladder infections, and chronic catheter use. Cigarette smoke is known to more than double your risk of developing bladder cancer and exposure to second-hand smoke, smoking pipes, and cigars may also increase risk. Radiation therapy used to treat cancer in the pelvis region may increase your risk of developing bladder cancer. People who work with certain chemicals used in dyes, rubber, leather, paint, some textiles, and hairdressing supplies might also have an increased risk of developing bladder cancer.  

There are different types of bladder cancer, and the most common type is transitional cell carcinoma (about 90% of all bladder cancers). Cancer cells also have a grade, that determines how abnormal they appear, with more abnormal-appearing cells demonstrating more aggressive features. Low grade means they are less likely to spread and are not life-threatening and high grade means they are more likely to spread and are life threatening. With high-grade tumors, abnormal cells can spread from the inner lining of the bladder to the other layers deep in your bladder including the connective tissue layer, muscle layers, and through the bladder wall into the fatty tissues surrounding your bladder and then into the adjacent lymph nodes and then distally to other organs such as bone, liver, and brain. 

Bladder cancer can also be categorized as being noninvasive, non-muscle-invasive, or muscle-invasive and staged appropriately based on the degree of invasion and spread. If diagnosed in the earlier stages, the outcomes are great and poorer with higher stages.  With new immunotherapy and chemotherapy drugs and improved technologies in aiding better detection and surgical treatments, even patients diagnosed at later stages are now seeing better outcomes.  

Urologists are surgeons who diagnose and treat bladder cancer so if a person experiences unusual bladder symptoms it's important to seek their advice. They would determine if they need to look inside their bladder, a test called cystoscopy to see if they see any areas of abnormality that need to be biopsied. As mentioned above, women sometimes tend to be diagnosed at a later stage than men resulting in poorer outcomes due to multiple factors. Some factors include mistaking painless intermittent visible blood in the urine for menstrual or irregular post-menopausal bleeding or mistaking it for infection, which is also a common cause of blood in the urine. In conclusion, in order to achieve the best health outcomes possible, it is important to listen to your body, be your own advocate, and be persistent with your medical care.