Testicular Cancer With Metastasis

Testicular cancer with metastasis

Recently I took care of a patient with testicular cancer and multiple metastasis to bones, lungs and the brain. This was a mid adulthood male who was admitted to the ICU with shortness of breath and pain all over the body related to pathological fractures.

The patient in his history talked about a lump he had on his testicles years ago and he described it as “itchy” lunp under the skin but didn’t hurt enough to seek medical attention. It went on for years and later he forgot about it as he got used to the mild itchy feeling in his scrotum.

On arrival to ER, the patient had been having shortness of breath with blood tinged sputum and sudden weight loss. He also complained on bones pain all over the body and on x-ray, he was found to have pathological fractures of long bones of the upper and lower legs bilaterally. He also got a chest x-ray that showed multiple masses in his lungs consistent with lung cancer.

Further, the patient was sent for CT-Scan of the whole body and was found to have brain masses sitting on the 4^th ventricle and brain stem areas. The outcome is almost certain that it was just a matter of time before bidding goodbye to this world.

Any physician at such a time when a patient has stage 4 cancer would explain things to the family and facilitate end life tough decisions. This was done and with Hispanic community, letting go of a loved one no matter how sick they are is never an option. Hispanics are known to keep their patients even when there is no possibility of survival.

Chaplain was contacted and after the family insisted that everything possible should be done to save the life of their loved one, the doctors in ER sent the patient to ICU and I was the one to take care of this patient.

Immediately on arrival, serial labs were ordered and drawn. The physicians in ICU without wasting time inserted a central line anticipating the need of good intravenous access for fluid resuscitation.

The patient shortness of breath was getting worse by the minute and the doctors decided to draw an arterial blood gas to check oxygenation status of the patient. In 15 minutes the results were called from the lab as panic with CO2 level of 78. The normal CO2 level in arterial blood gas is 35-45. The oxygen level was only 42 (normal is 78-95). This warranted immediate intubation to secure the airway and optimize oxygenation.

Anesthesia team was paged and within a matter of minutes, they arrived in the ICU and intubated the patient. Everything was explained to the family that he might never be able to breathe on his own for the rest of his life. The family insisted that they wanted everything done.

The following day, the oncology experts evaluated the patient and was started with chemotherapy. Radiation therapy was not an immediate option as cancer had spread to many parts of the body.

The first round of chemotherapy was done with every expectation explained clearly to the family. The patient was first given 4 units of blood as he had very low hemoglobin count. He also received several units of platelets that he needed the most.

24 hours after the initial chemotherapy dose, the patient was literally fighting for his life on the ventilator. His heart rate was in 160’s and poor perfusion was evident. Doctors were concerned because of the fact that the bone marrow was destroyed so bad by cancer that the patient was barely making any new blood cells. This meant that the patient had to be transfused many times with multiple blood products.

The struggle fighting for life went on and on and eventually, he coded after being in ICU for about 2 weeks. His bones were so fragile and brittle that CPR the sternum and most ribs, making it a bloody experience.

He died days later after his initial arrest, leaving behind a wife and three beautiful girls. The youngest was 6 years old and the oldest was 10 years old.

Everyone in the unit was feeling the pain just imagining the family and the loss they have incurred. No words could have been good enough for the young girls who came to bedside to view the body of their beloved dad. No tears were painful enough than those shed by the wife, a homemaker who never had a job and could barely speak a word in English. It is a life ahead full of broken dreams for the family. It was an experience painful enough even for doctors and nurses who took care of the patient until their final breath.

Moral of this story

1. Testicular exams are very necessary and every man should do it every month.
2. Never ignore anything that feels or appear abnormal to you. See a doctor immediately for evaluation.
3. Testicular cancer is curable if identified early. Lance Armstrong survived it because it was caught early before metastasis.
4. Testicular cancer can metastasize fast especially to the spine, lungs and the brain. The earlier it is diagnosed, the better the outcome.
5. Multiple organ metastasis called stage 4 cancer and has poor prognosis. Chances of surviving stage 4 cancer are very low, sometimes none.
6. When cancer is a true end stage, hospice care could be a better option that aggressive treatment which the already cancer weakened body cannot tolerate.
7. There is no age too young for cancer. Testicular cancer is commonest between 14 and 40 years. This is such a young age that a lot of people may not think they are in danger.
8. Testicular cancer is one of the most curable cancers known but it has to be identified early enough to increase chances of survival.
9. Any pain, swelling, lump, lack of sexual interest, blood in the semen, lower abdominal dull ache should be reported immediately to your physician.
10. Annual physical exams are vital in detection of testicular cancer.

Understanding Diabetic Ketoacidosis

What is it?

* Diabetic ketoacidosis is also called “DKA.” It is a serious problem in people with diabetes  mellitus. DKA happens when your blood sugar gets very high and is not treated properly.

* Much of what you eat and drink is changed into sugar (glucose). Sugar gives you energy. Insulin makes your body use this sugar and helps keep your blood sugar normal. With diabetes mellitus, your body does not make enough insulin or your body does not respond normally to insulin. Without insulin, sugar builds up in the blood.

* With diabetes, sugar stays in your blood and is not changed into energy. Your body must now use fat for energy. When this happens, chemicals called ketones are left in your blood. Your blood sugar will keep getting higher if you do not get enough insulin. Ketones build up in your blood and cause body cells to be damaged. This makes you very sick and you can even die.

Causes: DKA can come on slowly or happen very quickly. Some of the main causes are:

• * Not getting enough insulin.
• * Missing a dose of insulin.
• * Illness, such as pneumonia.
• * Infection, such as a urinary tract infection.
• * New diagnosis of diabetes.
• * Diabetes that is not being treated.
• * Stress.
• * Injury.

Signs and Symptoms:

* Early signs and symptoms of DKA:

** Fast, deep breathing.

** High blood sugar.

** Vomiting (throwing up).

** Weakness.

* Later signs and symptoms of DKA:

** Abdominal pain.

** Chest pain.

** Confusion.

** Dry mouth.

** Fruity-smelling breath.

** Fullness in abdomen (belly).

** Headache.

** Hungrier than usual.

** Nausea (upset stomach).

** Tiredness or sleepiness.

** Thirstier than usual.

** Urinating (going to the bathroom) more than usual.

** Weight loss.

** Coma (unable to be woke up from sleeping).

Care:

* DKA can be treated and controlled most of the time. But early treatment is very important. Call your caregiver when you see or feel any signs of DKA. Check your blood sugar and urine ketone levels as often as your caregiver tells you to. Check your blood sugar more often when you are sick. Ask your caregiver for the CareNotes(tm) handouts explaining how to do these tests if you don’t know.

* You may need to be put in the hospital for tests and treatment. You may need to have an EKG, blood tests, x-rays, and have an IV. The dose or type of medicine that you take for diabetes may have to be changed. Your diet may have to change, and your urine and blood checked often. Ask your caregiver for information about DKA to help you understand about the different tests and treatments.

Nursing care for Seizures

I was given an opportunity to create a learning presentation for nurses in a place that I work part time about seizures. This topic is exciting to tackle as I have seen seizures and nurses sometimes tend to be overwhelmed.

I home you will enjoy the lesson that I presented.

 

SEUZURES

Objectives:

1.  Define a seizure

2.  Differentiate a seizure from epilepsy

3.  Be able to differentiate types of seizures

4.  Review Causes of Seizures

5.  Review nursing responsibilities and priorities during a seizure

 

 

What is a seizure?

A seizure is an episode of abnormal electrical activity in the brain. A seizure, just like headache, is a symptom rather than a disease.

 

What is epilepsy?

Epilepsy is a diagnosis given when a person has two or more unprovoked seizures.

 

Difference between seizure and epilepsy:

All people with epilepsy have seizures but not all people with seizures have epilepsy. A seizure is a symptom of an underlying condition. Epilepsy is a clinical diagnosis assigned to a patient having more than two unprovoked seizures.

 

Types of Seizures:

There are two main categories of seizures: -

1.      Generalized Seizures

a.       Tonic Clonic Seizures (Grand mal)

b.      Absence Seizures (Petit mal)

2.      Partial Seizures.

a.       Simple partial

b.      Complex partial

Tonic Clonic Seizures (Grand mal)

Signs and symptoms:

1.      Sudden loss of consciousness

2.      Muscle rigidity and stiffening

3.      Jerking movements

4.      Shrill cry

5.      Incontinence

6.      Apnea (pt may turn blue)

7.      Dilated Pupils

 

Absence seizures

Signs and symptoms

1.      Sudden behavioral arrest

2.      Staring

3.      Unresponsiveness

4.      Only last for 1-15 seconds

 

Simple partial seizures:

Signs and symptoms

1.      No alteration or loss of consciousness

2.      There could subjective symptoms reported by the patients in absence of objective signs (smell, sound, taste or visual perception)

3.      Pt remains awake and aware, sometimes unable to communicate until the seizure is over

Complex Partial Seizures:

Signs and symptoms

1.      Alteration of consciousness (Not complete loss of consciousness)

2.      Automatisms: Simple repetitive uncontrollable actions performed during the seizure.

a.       Lip smacking

b.      Chewing

c.       Picking at clothes, etc

3.      Patient has no awareness of what they are doing

4.      Patient cannot remember what happened

5.      This is the most common seizure by those diagnosed with epilepsy.

Causes of seizures:

1.      Trauma

2.      Drug overdose

3.      Alcohol or drug withdrawal

4.      Non-compliance of anti-epileptic medications

5.       Stroke

6.      Febrile

7.      Intracranial processes and increase in intracranial pressure. E.g. tumors. A seizure occurring in an adult without any obvious underlying cause like alcohol, etc should be evaluated for brain cancer.

8.      Infections. E.g. Meningitis

9.      Metabolic and electrolyte imbalance. E.g. Uremia and Hyponatremia

 

Nursing Responsibilities and Priorities During Seizures.

What Do I do?

1.      Remain calm. This is your strength during any medical emergency. Make it an active process and tell your self: “I need to remain calm to help the situation and avoid causing errors, accidents or downright malpractice”.

2.      Mark the seizure start time.

3.      If a patient is standing, lay them to the ground and roll them to the side

4.      If the patient is in bed, roll them to the side;

5.      The patient can never swallow their tongue. Never place anything in patient mouth or try to open their mouth. This can compromise the airway or cause more harm to the patient.

6.      Never hold the patient down or try to stop their movements. This can cause injury to the patient. Instead, protect the patient from hitting hard surfaces with soft puddings like pillows.

 

Priorities

ABC assessments

1.      By rolling the patient to the sides, you may achieve a patent airway.

2.      Administer 100% oxygen

3.      Check oxygen saturation. It may be below 90 due to apnea. The patient may turn blue on the lips and fingers. Do not panic!

4.      Patient will have oral secretions. Suction at bedside to keep the airway patent.

5.      If help is available, establish an IV- line for possible IV medication administration if the seizure continues for a long time (Status epilepticus). You do not have to have a physician order to start an IV line in this case.

 

Safety:

1.      Do not run or panic. You may become a victim of the circumstance.

2.      Put the side rails up to prevent falls

3.      Pad the bed of any patient expected to get seizures. Injuries caused by unpadded bed can count against you.

4.      Your drug of choice during seizure is Ativan IV push.

 

 

Test.

1.      You are taking care of a patient with history of seizures. A nursing assistance calls you to the room and you find the patient having seizures. You should do all of the following except.

a.       Remain calm

b.      Roll the patient to the side

c.       Ask the nursing assistant to hold down the patient while you try to open their mouth

d.      Monitor oxygen saturation

2.      You are passing medication in a psychiatric unit and Mr. Crazy is sited quietly staring at you. You notice Mr. Crazy smacking his lips and making repetitive hands movements as if he is wiping the table. This goes on for a while and then stops. Mr Crazy cannot remember anything about the occurrence. What type of seizures did Mr. Crazy has?

a.       Simple partial seizures

b.      Grand mal Seizures

c.       Complex partial seizures

d.      Alcohol seizures.

3.      The drug of choice during a seizure activity is_____________.

a.       Methadone IV Push

b.      Morphine IV Push

c.       Lorazepam IV Push

d.      Dilantin IV Push

4.      The following are causes of seizures expect?

a.       Alcohol or drug withdrawal

b.      Infections like meningitis

c.       Toothache

d.      Trauma

5.      What is the first thing you should do as soon as notice a patient is having grand mal seizures?

a.       Note the time the seizure started

b.      Run down the hall and get the crash cart

c.       Administer IV Ativan per PRN orders

d.      Call 911

6.      What is the therapeutic level for dilantin that you must monitor on patients taking this medication? (Nurses only)

a.       1-5 ug/ml

b.      5-10 ug/ml

c.       10-20 ug/ml

a.       20-40 ug/ml

All patients with epilepsy have _______________ but not all patients with _________ have epilepsy.

Gastro-Esophageal Reflux Disease

Gastro-Esophageal Reflux Disease  (GERD) Case

 

          I know it has been a while since I last posted an ICU case but today I have an exciting one about GERD. I am sure most of you already know what Gastro Esophageal Reflux Disease is or at least have heard the word FERD. Gastro-Esophageal Reflux Disease is a very common disease that affects people of all ages and commonly known as heart burn. When you talk about heartburn though, you should be aware that it is not all heartburns can be called GERD.

          As usual, I never give any personal identifying information to keep privacy in observance of HIPPA laws. This case about Gastro-Esophageal Reflux Disease is about a young male in 40’s who was admitted in ICU in critical condition.

The patient went to seek medical help after he couldn’t swallow anything including his own saliva due to pain. On arrival to ER, he had very low hematocrit and appeared malnourished.

 

His heart rate was in130’s and 140’s and his blood pressure was very low with systolic blood pressure of 70’s and 80’s. These are critical findings on admission that made the patient to be automatically admitted to ICU. Immediately he arrived in the ICU, the GI-Team came and did an endoscopy on him only to find that his esophagus had eroded so much to a point of having perforations. There was no way to repair such a damaged tissue other than to remove it.

 

In Gastro-Esophageal Reflux Disease, the acid produced in the stomach regurgitates through the esophagus and can be felt as a burning sensation with belching. Sometimes it may be happening when a patient is lying down especially at night sleeping and so may not be noticed immediately until some significant changes have occurred.

 

This patient had to be taken to operating room for a long urgent surgery to repair his torn esophagus. Can you imagine acid so potent that it can erode your esophagus to a point of getting perforations? In surgery, the surgeons took out his esophagus all the way down to the stomach. Then, they cut a part of his small intestine called Jejunum and improvised it to become his new esophagus. This was a long procedure that took hours by a team of 3 surgeons.

 

So I took care of this patient for 2 days and it has been in a while since I saw someone in so much pain that even on dilaudid epidural pump, the guy was still in pain.

 

You will notice that I am changing the style of my nursing stories. I am changing it such that anyone reading this blog post can benefit from it whether you are a nurse like me or you are a consumer, someone who might be a looking for information about the topic am blogging about.

 

So what causes Gastro-Esophageal Reflux Disease?

 

GERD is mostly caused by foods we eat and lifestyle and we have a lot in our hands that we can control to avoid GERD.

Certain foods and lifestyle are considered to promote gastroesophageal reflux:

1.      Coffee alcohol, and excessive amounts of Vitamin C supplements stimulate gastric acid secretion. Be careful the way you take your vitamins. Taking these before bedtime especially can cause evening reflux.

2.      Antacids based on calcium carbonate (but not aluminum hydroxide) were found to actually increase the acidity of the stomach. However, all antacids reduced acidity in the lower esophagus, so the net effect on GERD symptoms may still be positive.

3.      Foods high in fats and smoking reduce lower esophageal sphincter competence, so avoiding these tends to help. Fat also delays stomach emptying.

4.      Eating within 2-3 hours before bedtime.

5.      Large meals. Having more but smaller meals reduces GERD risk, as it means there is less food in the stomach at any one time.

6.      Carbonated soft drinks with or without sugar.

7.      Chocolate and peppermint.

8.      Acidic foods, such as oranges and tomatoes.

9.      Cruciferous vegetables: onions, cabbage, cauliflower, broccoli, spinach, brussels sprouts.

10.  Milk and milk-based products containing calcium and fat, within 2 hours of bedtime. Now this sounds tricky as you may have heard that milk actually help curb GERD. NO, Milk only makes you feel relieved as you swallow it down soothing your esophagus. Milk also causes a lot of thick mucous secretion (take warm glass of milk and try to spit. You will see how much thick mucous you gotJ)

 

Now that you know what may cause GERD, what are you going to do about it? Do you think you might be doing something that might put you at a risk of having GERD? Or do you actually have GERD but not aware of it?

¨       If you sometimes feel like there is something in your throat that you can’t swallow, you may be having Gastro-Esophageal Reflux Disease.

¨       If you sometimes get horse in your voice especially in the mornings, you may have Gastro-Esophageal Reflux Disease

¨       If your baby/children are having tooth decay that is linear or has a pattern, they may be having Gastro-Esophageal Reflux Disease.

¨       If you sometimes feel hot sour tasting regurgitation in your mouth, you may be having Gastro-Esophageal Reflux Disease.

¨       You need to see your doctor.

Genital Herpes Outbreak

There are several ugly things that once you see them, you pray to never see anything like it ever. Some things are so “disturbing” to look at that you might find yourself having nightmares about them. Recently, I happened to take care of a patient who had herpes related to HIV disease. This patient had extensive herpes blisters that were covering all his genitals and perianal area.

 

A lot of people have herpes type one and this does not show up until your body is under enough stress and pressure. Example is when one is exposed to extreme cold for long periods of time and may form herpes blisters on the lips. This is an indication of body stress either physically, or psychologically. It is scientifically known as herpes febrilis.

 

Genital herpes on the other side is a disease caused by herpes simplex virus 2. (HSV2). Presence of herpes blisters indicates that one is contagious and contact with fluid from those herpes blisters would result to a herpes infection.

 

This patient was full blown AIDS with a CD-4 count of <10. That means that his immunity was so compromised that he had almost no immunity to anything. He has herpes blisters that resembled broccolis only that they were pink and not green as broccolis.

 

Now that his body had almost zero defense, he had all sorts of opportunistic infections but herpes was took a toll on him because he could not excrete his bowels or urine without suffering severe pain. From his confession, he stated that he has been a “generous gay person” and admitted prostituting in clubs and truck rest areas on interstates.

 

Herpes does not have a cure but can be prevented by using condoms and avoiding indiscriminate sex. When herpes virus is dormant, it resides inside the mitochondria or nerve ganglia. A person may have herpes and not show any physical signs. Genital herpes is contagious during an outbreak and blisters are present. Sometimes these blisters might be tiny and may not be seen especially if they are inside the vagina or on vaginal labia.

 

Expectant mothers with history of labia should report this to their doctors and should not be let to have a natural delivery as long as they are having active herpes of their genitals have blisters. In this situation a caesarian section must be performed to save the baby from getting infected. Newborns infected with genital herpes usually die within a few weeks to months.

 

Herpes febrilis found on the mouth lips can be transferred to the genitals through oral sex and become genital herpes. Avoid indiscriminate oral sex and it can be equally dangerous as natural intimacy.

 

If you think that you might be having herpes, see your doctor immediately. You should not have any sexual encounter if you suspect that you are having a genital herpes outbreak.

Angioedema & Ace Inhibitors

Today I took care of a patient with angioedema as a result of allergic reaction to possible and ace inhibitor. You have not seen anything like this yet as it is very scary.

 The patient walked to ER with his tongue swollen so much that he could not talk. Everyone was surprised to see how bad it was and immediately, ER nurses attended him. Within no time, the patient started having problems breathing die to blocked airway.

 As you know, if your tongue is so swollen that it is protruding out and bit by the teeth even with mouth open, chance are that the intubation would be very difficult or impossible.

 The ER doctors tried to do nasal intubation but they were unsuccessful. The patient kept on having hard time breathing and this time, they had to do an emergency tracheostomy.

 When an allergic reaction is this severe, swelling it the most predominant sign that you see. The attempt for bedside tracheostomy was unsuccessful due to swollen airway. This meant that the patient had to be rushed to operating room to have an emergency tracheostomy done under anesthesia.

 

In OR, the immediately knocked the patient out with paralytic drugs called vecuronium and succinylcholine, followed by fentanyl for pain and as anesthesia adjunct. The tracheostomy was successfully done and finally, the patient got a patent airway. 

The patient was transferred to ICU where he was stabilized and treated with high doses of steroids and anti-histamine in an attempt to lower his swelling.

 Unfortunately his tongue is still very swollen and having hard time breathing on his own. Chest x-ray showed fluid accumulation in the lungs. Normally, this happen when there is an anaphylactic reaction. The blood vessels become permeable and fluids leaks to open cavities (third space) like lings in this case.

 Angioedema is common in African Americans taking ace-inhibitors for blood pressure issues. Over 94% of all cases of angioedema are caused by drugs such as ace inhibitors (e.g. lisinopril).

 To cut the long story short, I found a picture online that looks exactly how this patient was. Please know your allergies and keep an allergy band on all the time. It might help save your life.

See eMedicine Health overview about Angioedema

How to Calculate Gestational Age

What is gestational age?
Gestational age is the age of an unborn baby, or fetus in the uterus. It is measured in weeks and days and is based on the date of your last menstrual period.

 Your healthcare provider will talk about your pregnancy in terms of weeks, not months. There are 3 stages of each pregnancy, called trimesters. The first trimester is from the 1st week through the 13th week. The second trimester is from the 14th through the 27th week, and the third trimester is from the 28th week to delivery.

 Why is it important to know the gestational age?
At specific stages of the pregnancy, certain things are expected. For example, first hearing the heartbeat, or feeling the baby move, is expected to happen at a certain time during the pregnancy. How the pregnancy is going can be judged as normal or abnormal only when the age of your baby is correctly known. It is very important to know your baby’s age if problems occur and the baby needs to be delivered early. It is also important to know when a baby is overdue so the health of the baby can be more carefully watched.

 How is gestational age calculated?
The age of your baby and your due date may be calculated from the date of your last menstrual period. If your periods were regular before you became pregnant, and you are sure of the first day of your last period, your due date is estimated to be 40 weeks from the day you started your last period. An early exam of the uterus and an early positive pregnancy test also help determine your baby’s age.

 Ultrasound can be used to confirm your baby’s age. The baby can be measured with ultrasound as early as 5 or 6 weeks after your last menstrual period. This method is most accurate in the first half of the pregnancy. The best time to date a pregnancy with ultrasound is between the 8th and 18th weeks of pregnancy.

 If you have had a special procedure to become pregnant, such as artificial insemination or in vitro fertilization, you will know when your baby was conceived. In these cases there is no doubt about a baby’s age.

 It can be hard to determine accurately a baby’s age and your due date if:

 

• Your periods were irregular.
• You cannot remember the date of your last period.
• The baby is unusually large or small.
• The due date based on the last menstrual period does not correspond with the size of the uterus early in pregnancy or with measurements of your uterus later in the pregnancy.

Cocaine Addiction & Treatment

What is Cocaine Addiction & dependence?
Dependence on cocaine means that you have a strong emotional, psychological, and physical need to take the drug. You might take more of the drug over longer periods than you intended. Using cocaine may interfere with the rest of your life.

 Cocaine is a drug made from the leaves of the coca plant, which grows in South America. It is a stimulant, which means it causes talkativeness, increased breathing and heart rate, increased energy, and sleeplessness. In very high doses, it can cause heart attacks and seizures.

 Crack, a less expensive form of cocaine that is smoked rather than snorted, has helped make cocaine abuse a widespread problem.

 Some people are more sensitive than others to cocaine. A small amount of the drug can kill people sensitive to it.

 Pregnant women using cocaine are at high risk of miscarriage. Babies born to cocaine-dependent mothers are addicted at birth. The infants are jittery and don’t respond well to people. Moreover, they have to go through the painful process of withdrawal.

 

Cocaine dependence can be treated, although it is a long-term process. The most important part of treatment is for you to be in a drug-free environment.

 How does Cocaine Addiction occur?
Cocaine powerfully affects some of the chemicals of the brain that change mood and emotions. At first you feel pleasure, increased energy, and enhanced self-esteem. You also experience decreased anxiety and social inhibitions.

 Cocaine also affects sexual behavior. In small doses cocaine increases sexual arousal and makes orgasms and erections easier. In large doses cocaine makes you feel increased sexual desire but you are less able to achieve orgasm. Men may have problems with impotence.

 Over time, cocaine keeps your brain from storing and using chemical messengers that create these good feelings. Because you lack a way to use these natural chemical messengers, you may feel depressed. As a result, you develop a craving for more cocaine and the good feelings it produces.

 As the addiction progresses, you tend to withdraw from friends and spend more time using cocaine. Later, you may lose your job and become isolated from everyone. Family problems and crises occur, such as divorce and financial problems.

 What are the symptoms of Cocaine Addiction?
If you use cocaine over a long period you feel wired, irritable, and depressed. You can’t sleep. You lose your appetite and are not content with life. You may also:

•  lose your sex drive
• develop disturbed thinking, such as paranoid delusions (ideas that others are out to get you when they are not)
• become depressed
• in some circumstances, have hallucinations (for example, seeing things that are not there or feeling things, such as bugs under your skin, that are not there)
• feel disoriented.

Other symptoms of cocaine dependence include:

•  use of the drug throughout the day
• episodes of overdose
• problems in social activities and work, such as missing work, fighting, losing friends
• inability to reduce or stop the use of cocaine.

When you stop taking the drug and the level of it in your blood drops, you are said to “crash.” Possible effects of crashing include:

 

• depression
• fatigue
• suicidal feelings
• sleepiness
• decreased level of activity
• increased craving for cocaine.

How is Cocaine Addiction diagnosed?
To diagnose cocaine dependence, your healthcare provider will review your symptoms, examine you, and take a history of drug use. He or she may order an analysis of your urine. Cocaine can remain in urine for many hours after you have used the drug.

 How is Cocaine Addiction treated?
Usually, the first thing your healthcare provider treats are your physical complications. Complications of cocaine dependence may include:

 

• effects on the heart, including heart attack, disturbances in the rhythm of the heart, and high blood pressure
• effects on the nervous system, including paranoia, hallucinations, lethal high fever, stroke, and seizures.

For any treatment to be successful, you must want to give up cocaine. The most important part of treatment is for you to be in a drug-free environment. Treatment for cocaine dependence is long-term and ongoing. You can join a self-help group (for example, Cocaine Anonymous), a support group, a therapy group, or be part of a supervised treatment program. The healthcare providers and counselors in any treatment program will work with you regularly to help you adapt to a life free from cocaine.

 

While you are withdrawing from cocaine, you may be tempted to use more alcohol and other drugs to reduce your restlessness and anxiety. Seek professional help so that you don’t switch to other harmful drugs. Antidepressants and mood stabilizers prescribed by your healthcare provider can help treat both mania and depression that may occur with cocaine withdrawal.

 You need to regain general physical health by eating nutritious meals, getting enough sleep, and exercising regularly.

 If this therapy does not work, you may need to be hospitalized for treatment.

 How can I take care of myself?
The best way to help yourself is to see your healthcare provider and make plans to stop taking cocaine. If you are already seeing a healthcare provider, it is important to take the full course of treatment he or she prescribes.

 You may want to call the National Clearinghouse for Alcohol and Drug Information (NCADI) at 1-800-729-6686.

 Changing your lifestyle can help you to stop using cocaine. Make the following a regular part of your life:

 

• Exercise 30 minutes three times a week.
• Participate in relaxing recreation activities at least once or twice a week.
• Do progressive relaxation exercises daily.
• Imagine, or call to mind, your positive life experiences often.
• Eat balanced, nutritious meals.
• Get 7 to 9 hours of rest per night.
• Practice deep breathing exercises during times of high stress.
• Talk with friends and develop other support systems.
• Drink little or no alcohol or caffeine.
• Listen to music to help you relax.
• Develop and maintain an attitude that things will work out.
• Ask for assistance at home and work when the load is too great to handle.
• Seek professional help to talk through anxiety-producing life events. Ask for help in developing positive coping methods.

Understanding Sexual Addiction

What is sexual addiction?
Sexual addiction is a pattern of sexual behaviors acted out even though it is harmful to self or others.

 How does sexual addiction occur?
The exact cause of sexual addiction is not known. Experts think it may be caused by physical differences in the brain or nervous system. It might also be related to things such as child abuse or a family history of mental illness.

 What are the symptoms of sexual addiction?
Symptoms of sex addiction include: 

• being unable to stop thinking about sex
• needing to have sex more and more often
• trying and failing to control, cut back, or stop having sex
• feeling restless or in a bad mood when trying to control sexual urges
• having school, job, or relationship problems because of sex.

Some out of control repetitive behaviors, which may reflect sexual addiction include: 

• masturbation
• extramarital affairs
• pornography
• cyber sex or phone sex
• multiple anonymous partners
• unsafe sexual activity
• thinking of sex partners as just objects to be used
• going to strip clubs and adult bookstores
• prostitution.

How is sexual addiction diagnosed?
Your healthcare provider or therapist will ask about your symptoms and will make sure you do not have a medical problem. Your therapist will also check for other problems, such as substance abuse, mood disorders, and personality disorders.

 How is sexual addiction treated?
Treatment for sexual addiction is long-term and ongoing. Good options include self-help groups, support groups, or supervised treatment programs. Cognitive behavior therapy may also help.

 Female hormones or testosterone-lowering medicines may be used to reduce sex drive in men. SSRI antidepressants may reduce sex drive and lessen obsessive thoughts and compulsive behaviors. Mood stabilizers or antipsychotic medicines may also be helpful.

 When should I seek help?
Thinking about sex all the time may cause loss of friendships and family relationships. Fear of being caught may cause stress. Sexual addiction also increases the risks for HIV/AIDS and other sexually transmitted diseases. Sex addiction may cause job loss or high levels of debt from paying for prostitutes, cyber-sex, or phone sex. People who are addicted to sex may have legal problems due to sexual harassment, obscene phone calls, prostitution, rape, or child molesting.

HOW IS ALCOHOLISM DIAGNOSED

Barriers to a Diagnosis: Even when people with alcoholism experience withdrawal symptoms, they nearly always deny the problem, leaving it up to coworkers, friends, or relatives to recognize the symptoms and to take the first steps toward encouraging treatment. Denial, in fact, may be an important warning signal for alcoholism.

 

Family members cannot always rely on a physician to make an initial diagnosis. Although 15% to 30% of people who are hospitalized suffer from alcoholism or alcohol dependence, physicians often fail to screen for the problem. In addition, doctors themselves often cannot recognize the symptoms. In one study, alcohol problems were detected by the physician in less than half of patients who had them. Even when physicians identify an alcohol problem, however, they are frequently reluctant to confront the patient with a diagnosis that might lead to treatment for addiction.

 

Screening Tests for Alcoholism: A physician who suspects alcohol abuse should ask the patient questions about current and past drinking habits to distinguish moderate from heavy, or hazardous, drinking. [See Box Definition of Alcohol Use and Abuse.]

 

A physician who suspects alcohol abuse or dependency have a number of short screening tests available, which a person can even take on his or her own. Because people with alcoholism often deny their problem or otherwise attempt to hide it, the tests are designed to elicit answers related to problems associated with drinking rather than the amount of liquor consumed or other specific drinking habits.

 

CAGE Test. The CAGE test is an acronym for the following questions and is the quickest test:

 

• Attempts to CUT (C) down on drinking.

 

• ANNOYANCE (A) with criticisms about drinking.

 

• GUILT (G) about drinking.

 

• Use of alcohol as an EYE-OPENER (E) in the morning.

 

This test and another called the Self-Administered Alcoholism Screening Test (SAAST), appear to be most useful in detecting possible alcoholism in white middle-aged males. They are not very accurate for identifying alcohol abuse in older people, white women, and African-and Mexican-Americans.

 

T-ACE Test. The T-ACE test is a four-question test that appears to be quite accurate in identifying alcoholism in both men and women. It asks the following questions:

 

• Does it TAKE (T) more than three drinks to make you feel high?

 

• Have you ever been ANNOYED (A) by people’s criticism of your drinking?

 

• Are you trying to CUT DOWN (C) on drinking?

 

• Have you ever used alcohol as an EYE OPENER (E) in the morning?

 

A positive response to two of these four questions is considered to indicate possible alcohol abuse or dependence.

 

AUDIT Test. A more effective and important test for most people may be the Alcohol Use Disorders Identification Test (AUDIT), which is the only test specifically designed to identify hazardous or harmful drinking. It asks three questions about amount and frequency of drinking, three questions about alcohol dependence, and four questions about problems related to alcohol consumption.

 

A Single-Question. One simple question may be as sensitive as the CAGE or Audit test: “When was the last time you had more than five drinks (for men) or four drinks (for women) in one day?” An answer of “within three months” accurately identified about half of people who were problem drinkers. Problem drinking is defined as hazardous drinking within the last month or some alcohol-use disorder during the past year. [See Box Definition of Alcohol Use and Abuse.]

 

Other Screening Tests. Other short screening tests are the Michigan Alcoholism Screening Test (MAST) and The Alcohol Dependence Scale (ADS).

 

Ruling Out Other Problems: Some symptoms of alcoholism may be attributed to other disorders, particularly in the elderly, where symptoms of confusion, memory loss, or falling may be attributed to the aging process alone. Heavy drinkers may be more likely to complain to their doctors about so-called somatization symptoms, which are vague ailments such as joint pain, intestinal problems, or general weakness, that have no identifiable physical cause. Such complaints should signal the physician to follow-up with screening tests for alcoholism.

 

Alcoholism is particularly less likely to be recognized in elderly women. In fact, only 1% of older women who need treatment for alcoholism are diagnosed accurately and treated appropriately. Instead, they are often diagnosed with depression and may even be prescribed anti-anxiety drugs or antidepressants that can have dangerous interactions with alcohol.

 

Tests for Related Medical Problems A physical examination and other tests should be performed to uncover any related medical problems.

 

Tests for alcohol levels in the blood are not useful for diagnosing alcoholism because they reflect consumption at only one point in time and not long-term usage. Certain blood tests, however may provide biologic markers that suggest medical problems associated with alcoholism or indications of alcohol abuse:

 

• A test for a factor known as carbohydrate-deficient transferrin (CDT) has been approved as a marker for heavy drinking. It can be helpful in monitoring patients for progress towards abstinence and may also be an indicator for a higher risk for suicide in people with alcoholism.

 

• Gamma-glutamyltransferase (GGT). This liver enzyme is very sensitive to alcohol and can be elevated after moderate alcohol intake and in chronic alcoholism.

 

• Aspartate and alanine aminotransaminases (AST,ALT) are tests for enzymes and factors that can help identify liver damage.

 

• Tests of testosterone levels in men with alcoholism may be low. (This result sometimes persuades men with alcoholism to seek help.)

 

• A mean corpuscular volume (MCV) blood test is sometimes used to measure the size of red blood cells, which increase with alcohol use over time.

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