Kristen Mauk

Background

This type of cancer occurs mainly in older adults, with an average age at diagnosis of 73 years, with 9 out of 10 cases of bladder cancer diagnosed in persons over age 55. The American Cancer Society (ACS)(2012) reported that over 73,000 cases were diagnosed in 2012 and that this diagnosis rate has been relatively stable over the last 20 years. Men are three times as likely to get cancer of the bladder as women (American Foundation for Urologic Disease, 2008) and the incidence increases with age.

Risk Factors

Risk factors include chronic bladder irritation and cigarette smoking, the latter contributing to over half of cases. Male gender and age are also risk factors.

Warning signs

The classic symptom of bladder cancer is painless hematuria (blood in the urine). Older adults may attribute the bleeding to hemorrhoids or other causes and feel that because there is no pain, it must not be serious.

Diagnosis

Assessment begins with a thorough history and physical. Diagnosis may involve several tests including an intravenous pyelogram (IVP), urinalysis, and cystoscopy (in which the physician visualizes the bladder structures through a flexible fiber-optic scope). This is a highly treatable type of cancer when caught early. In fact, the ACS (2012a ) estimates that there were more than 500,000 survivors of this cancer in 2012.

Treatment

Once diagnosed, treatment depends on the invasiveness of the cancer. Treatments for bladder cancer include surgery, radiation therapy, immunotherapy, and chemotherapy (ACS, 2012). Specifically, a transurethral resection (TUR) may involve burning superficial lesions through a scope. Bladder cancer may be slow to spread, and less invasive treatments may continue for years before the cancer becomes invasive or metastatic, if ever. Certainly chemotherapy, radiation, and immune (biological) therapy are other treatment options, depending on the extent of the cancer.

Immune/biological therapy includes Bacillus Calmette-Guérin (BCG) wash, an immune stimulant that triggers the body to inhibit tumor growth. BCG treatment can also be done after TUR to inhibit cancer cells from re-growing. Treatments are administered by a physician directly into the bladder through a catheter for 2 hours once per week for 6 or more weeks (Mayo Clinic, 2012a). The patient may be asked to lay on his/her stomach, back, and or sides throughout the procedure. The patient should drink plenty of fluids after the procedure and be sure to empty the bladder frequently. In addition, because the BCG contains live bacteria, the patient should be taught that any urine passed in the first six 6 hours after treatment needs to be treated with bleach: One cup of undiluted bleach should be placed into the toilet with the urine and allowed to sit for 15 minutes before flushing (Mayo Clinic, 2012a).

If the cancer begins to invade the bladder muscle, then removal of the bladder (cystectomy) is indicated to prevent the cancer from spreading. Additional diagnostic tests will be performed if this is suspected, including CT scan or MRI. Chemotherapy and/or radiation may be used in combination with surgery. When the cancerous bladder is removed, the person will have a urostomy, a stoma from which urine drains into a collection bag on the outside of the body, much like a colostomy does. Bleeding and infection are two major complications after surgery, regardless of type, whether a TUR or cystectomy is performed. Significant education of the patient related to intake/output, ostomy care, appliances, and the like is also indicated.

Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L.
Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Sudbury, MA: Jones and Bartlett Publishers. Used with permission.

Save

Save

Save

Consider these facts about stroke from the American Stroke Association (2013): Be informed about stroke.

• Nearly 800,000 Americans annually suffer a new or recurrent stroke.
• A stroke occurs about once every 40 seconds. About every 4 minutes, someone dies of a stroke.
• Stroke is the 4th leading cause of death in the United States, killing more than 137,000 people a year.
• Risk of stroke death is higher for African American males and females than for whites. Females have a higher rate of death from stroke than males.
• In 2010, Americans paid about $73.7 billion for stroke-related medical costs and disability.

Stroke is simply defined as an interruption of the blood supply to the brain. It is most often caused by a clot that either originated in the brain or traveled from another part of the body. Warning signs of stroke include (National Stroke Association, 2013):
• Sudden weakness or paralysis, usually on one side of the body
• Sudden confusion, speaking or understanding
• Sudden changes in vision
• Sudden dizziness, incoordination, or trouble walking
• Sudden severe headache with no known cause

If you or someone you love experiences any of these symptoms, call 911 immediately. Do not delay. New medical treatments may be able to reverse the effects of stroke, but time is critical. Note the time that the symptoms started so that you can inform the medical professionals who are providing treatment.
The effects of stroke depend on the area of the brain that is damaged. Some common results of stroke are weakness or paralysis on one side of the body, difficulty walking or dressing oneself, aphasia, trouble eating or swallowing, bowel and bladder changes, cognitive changes such as memory problems, and emotional issues such as depression and mood swings. Stroke affects the entire family, so be sure to seek out resources and support in your community if a stroke has touched your family.

For stroke survivors, treatment in an acute rehabilitation facility with an interdisciplinary team approach is highly recommended and results in more positive outcomes. The rehabilitation team works together with the survivor and family to accomplish personal goals and achieve the highest level of function possible. Although some of the effects of stroke may be long-lasting or permanent, there is hope of continued progress and good quality of life after stroke.

Most of us have New Year’s resolutions. One of my new goals for 2020 is to age better. Andrew Weil, MD, in his bestseller Healthy Aging: A Lifelong Guide to Your Well-Being (2005) said, “to age gracefully requires that we stop denying the fact of aging and learn and practice what we have to do to keep our bodies and minds in good working order through all the phases of life” (p. 7). You may well ask, “how does one do that”? For me, it means actually practicing what I preach. We are fortunate today to have so much research and information on aging that we can pinpoint some specific areas that are common to successful aging. I have taught these to numerous students and groups of older adults, but it wasn’t until I joined the over 50 age group that this knowledge seemed more personally applicable. So, let me share with you five keys that both scientists and the oldest old persons in our society have found contribute to healthy aging.

Have a positive attitude towards life. This includes having good coping skills and being able to deal with grief and loss appropriately.  Most centenarians will say that you should always having something to look forward to. Make a list of places you want to travel this year, vacations to take, people you need to visit, or things that need to be fixed around the house. Then start to cross them out as you do them, and bask in your accomplishments.

Maintain key relationships. These include having a stable marriage and/or being involved in a religious or social community. In George Vaillant’s book Aging Well (2002), he reported the results of the Harvard Study of Adult Development. Generativity, or selfless investment in others (including the next generation), was found to be the best predictor of a long and happy marriage. Likewise, studies show that older persons who affiliate with a religious organization, such as attending church regularly, report better health and better social support systems, and tend to remain independent longer.

Maintain a healthy weight through proper nutrition. Eat a diet with plenty of fiber, fruits, vegetables and water. Limit saturated fats, salt, processed foods, and less useful calories from alcohol or sugary drinks.

Stay active. Physically, do some moderate exercise on most days of the week. For persons who are older and unable to do strenuous activity, remember that regular daily chores that include continuous motion such as doing laundry, gardening, or cleaning house can count as exercise and can also be spread throughout the day to accumulate the recommended 30 minutes of activity. If able, brisk walking is highly recommended. Keep your mind active as well. Resolve to take up a new hobby such as a craft, learning to play an instrument, or studying a foreign language. Working puzzles, playing cards, and reading are also good ways to stimulate your brain function and keep your memory sharp.

Avoid negative behaviors such as overeating or drinking too much alcohol.  Adopt an attitude of “everything in moderation”. Don’t smoke, and if you do smoke, stop. Sadie Delany (1994) at over 100 years of age wrote in her book Having Our Say, “so you want to live to be 100. Well, start with this: No smoking, no drinking, no chewing” (p. 11).

Resolve with me to age more gracefully during 2020 and let’s see how we do. Do you have any secrets of healthy aging that have worked for you or your parents/grandparents? Please share them with us.

And the Oscar Goes to…
Watching the Oscars can be quite entertaining. Imagine the vision, creativity, and artistry that it takes for scores of people to come together to make a film that captivates the country by bringing a story to life! The coveted gold statue represents the pinnacle of one’s profession, a universally recognizable prize that causes a seasoned actor to forget his acceptance speech or lose her gracefulness while tripping over a ridiculously expensive gown. It made me wonder: What if there were Oscars awarded to the people who influenced healthcare? Here are some suggestions for the most deserving:

Best Picture: an award for radiologists viewing the film of a cancer-free survivor

Actor/Actress in a Leading Role: the oncologists who don’t let their patients see them cry after having to give a terminal diagnosis

Actor/Actress in a Supporting Role: the nurse who provides comfort to the parents of a dying child

Best Adapted Screenplay: the rehabilitation team members who help survivors find new life again after stroke

Cinematography: for persons who capture the inspiring moments of the Special Olympics
Costume design: the prosthetists, orthotists, and biomechanical engineers who create both function and beauty to clothe persons needing artificial limbs

Directing: the heads of national organizations that lead the way in research and education in a specialty area

Best Makeup: the funeral home directors who help make our loved ones look their best for the final goodbye

Best Visual Effects: the burn specialists and plastic surgeons who reconstruct the facial features of a firefighter or war veteran after severe burns

Best Sound Mixing: the audiologists and manufacturers of hearing devices that help us to listen and attend to the sounds around us

Best Film Editing: the skilled surgeons who remove the bad parts and recreate our inward parts so that our life picture is the best it can be
Best Original Song: the one sung by the double lung transplant survivors, like Charity Tillman-Dick, and made possible by the lung transplant team

I wish that we gave such awards to the people who make a real difference in the lives of so many. There are hundreds of unsung heroes of healthcare who influence our world but go unnoticed. When you come across one, won’t you tell them how much they are valued and appreciated? They may never win an Oscar, but without them we couldn’t shine.