WRIST PAIN

Symptoms, Causes, Risk Factors, Tests and diagnosis , Complications, Treatments and drugs AND Prevention

Definition

Chopping vegetables, angling for trout, falling during an athletic activity — there's practically no end to the ways you can hurt your wrists. In fact, hand pain and wrist pain are among the most common musculoskeletal complaints that doctors see.

The causes of wrist pain can range from repetitive stress injuries to sprains, fractures and diseases such as arthritis. Because so many factors can lead to wrist pain, and because the wrist is a complex structure, diagnosing the exact cause of long-standing wrist pain can be difficult.

For most people, wrist pain can be diagnosed and treated. The type of care depends on the cause and severity of the wrist pain.

Symptoms

The signs and symptoms of wrist pain vary by the type of wrist pain you have.

Ligament sprains and tears

A sprain is an injury to a ligament — the fibrous tissue that connects bones. Ligaments are composed of a number of individual fibers, and the degree of injury depends on how many of the fibers are damaged and whether they're completely torn or just pulled apart. A mild sprain will generally cause minor discomfort and swelling, whereas a severe injury or complete tear can lead to:

• Significant pain and swelling that becomes worse with use
  
• Bruising
  
• Inability to use your wrist normally
  
• A painful popping or clicking

Tendinitis

Tendons are thick, fibrous cords that attach muscles to bone. Tendinitis, which occurs when tendons become inflamed or irritated, can cause the following symptoms just outside the affected joint:

• Pain
  
• Mild swelling

Though tendinitis is most common in your shoulders, elbows and knees, it can also affect your hips and wrists.

Fractures

Because the bones in the wrist are small and intricately arranged, they're prone to fractures. Though a broken wrist bone is usually quite painful, it's possible to have a fracture and not realize it. In addition to pain, symptoms may include:

• Swelling
  
• Discolored skin
  
• Limited ability to move your wrist
  
• A deformed or crooked wrist, sometimes with the bone protruding through the skin

Repetitive strain injuries

Any repetitive motion can stress and inflame your joints or worsen an existing injury, especially when done forcefully and for long periods of time without rest. Such motions can range from assembly line work to hitting a golf or tennis ball or typing on a computer. Repetitive strain injuries cause the following symptoms in muscles, joints, tendons and nerves:

• Pain
  
• Inflammation
  
• Dysfunction (sometimes)

Carpal tunnel syndrome

One of the most highly publicized wrist injuries, carpal tunnel syndrome occurs when the median nerve is compressed as it passes through a narrow passageway (carpal tunnel) in your wrist. Symptoms may include:

• Tingling or numbness in your hand or fingers, especially when you're holding a cup, driving a car or reading a newspaper
  
• Pain radiating or extending from your wrist up your arm to your shoulder or down into your palm or fingers, particularly after forceful or repetitive use
  
• A sense of weakness in your hands and a tendency to drop objects
  
• Chronic loss of feeling in some fingers in advanced cases

Osteoarthritis

Osteoarthritis is the breakdown of cartilage that cushions the bones in your joints. Over time, the loss of cartilage can cause:

• Joint pain, swelling and stiffness
  
• Limited motion and weakness in your wrist joint

Rheumatoid arthritis

Unlike osteoarthritis, rheumatoid arthritis is a systemic disease that can cause problems throughout your body. It usually starts in small joints in your hand and wrist, leading to:

• Joint pain and swelling
  
• Loss of motion and strength in the affected joint
  
• Joint deformity
  
• Fatigue and a general feeling of being unwell

Causes

Your wrist is a complex joint made up of eight small bones (carpal bones) arranged in two rows between the bones in your forearm (radius and ulna) and the metacarpal bones in your hand. Tough bands of ligament connect the carpal bones to each other and to the forearm bones and metacarpals. Damage to your ligaments, bones or the cartilage that cushions your joints can cause pain and affect your ability to use your wrist and hand.

Common causes of wrist injury and pain include:

• Ligament sprains and tears. Most ligament sprains or tears result from the kind of high-impact injuries that happen when you fall forward onto your outstretched hand. They can also occur when you push a heavy object or brace yourself against the car dashboard during a sudden stop or collision. The ligament that's most often torn is the scapholunate ligament, which connects the scaphoid bone, on the thumb side of your wrist, to the neighboring lunate bone.

• Cartilage tears. The triangular fibrocartilage complex (TFCC) is a small piece of cartilage and ligaments on the small-finger side of your wrist, just below the ulna. The TFCC can tear when you fall on your outstretched hand, swing a bat or racket, or twist your wrist sharply.

• Fractures. The bones in your wrist can break for many reasons, but they're most likely to fracture when you land on your outstretched hand in an accident; fall from a roof or ladder; are in a car collision; or receive a direct blow to your wrist. But the same injury may not break the same bone in every person. For instance, teens tend to have growth plate fractures — a break in a part of the bone that's still growing — whereas adults who fall the same way might break the scaphoid bone on the thumb side of the wrist.

• Repetitive strain injuries. Any activity that involves a repetitive motion — from hitting a tennis ball or bowing a cello to driving cross-country — can inflame the joints in your wrist, especially when you perform the movement for hours on end without a break.

• Carpal tunnel syndrome. Carpal tunnel syndrome develops when there's increased pressure on the median nerve, which passes through the carpal tunnel, a passageway in your wrist. Studies have failed to pinpoint the exact cause of carpal tunnel syndrome, though they have ruled out the commonly held notion that typing on a computer is to blame. Several studies have found no relationship between using a computer up to seven hours a day and a risk of carpal tunnel.

• Osteoarthritis. In osteoarthritis, the problem lies in the cartilage that cushions the ends of bones in your joints. Over time, the cartilage deteriorates and its smooth surface roughens. If the cartilage wears down completely, you may be left with bone rubbing on bone — damaging the ends of the bones and causing pain in the joint. Arthritis that affects the metacarpal-carpal joint in the thumb is particularly common.

• Rheumatoid arthritis. Some researchers suspect that rheumatoid arthritis is triggered by an infection — possibly a virus or bacterium — in people with an inherited susceptibility. Although the disease itself is not inherited, certain genes that create an increased susceptibility are. People who have inherited these genes won't necessarily develop rheumatoid arthritis. But they may have more of a tendency to do so than others. The severity of their disease may also depend on the genes inherited. Some researchers also believe that hormones may be involved in the development of rheumatoid arthritis.

• Kienbock's disease. Like all living tissues, your bones require a constant supply of blood for nourishment. In Kienbock's disease, the blood supply to the lunate bone is cut off, and the bone slowly dies. The exact cause isn't known, though it may begin with a fall or a series of injuries to the hand or wrist. Kienbock's is often overlooked because its initial symptoms resemble those of a ligament strain. Untreated Kienbock's can lead to arthritis and disability.

• Other diseases. Most wrist pain comes from arthritis or an injury to your wrist joint, but certain systemic diseases can also affect the bones and tissues in your wrist. These include diabetes, gout, Paget's disease, leukemia, scleroderma and lupus erythematosus.

Risk factors

You're a candidate for wrist pain whether you're very sedentary, very active or fall somewhere in between. Still, certain factors can make you more prone to wrist problems, including:

• Certain sports. Professional and amateur athletes of all sorts — basketball, football, hockey and tennis players, pitchers, and golfers — are prone to wrist injuries. But wrist problems are also showing up in more children and teens, especially those who snowboard, rollerblade and skateboard. According to some estimates, nearly 80 percent of young gymnasts have chronic wrist pain.

• Age. Older adults are more likely to have osteoporosis, which makes bones brittle and more susceptible to fractures, than younger people are. They're also more likely to fall and to develop arthritis.

• Repetitive work. Almost any activity that involves your hands and wrists — even knitting and cutting hair — if performed forcefully enough and often enough can lead to disabling wrist pain.

• Pregnancy. Some women develop carpal tunnel in the second and third trimesters of pregnancy because of hormonal changes. Shifts in the balance of estrogen and progesterone cause the body to retain more fluid, which increases swelling in the carpal tunnel.

When to seek medical advice

Not all wrist pain requires medical care. Minor strains, for instance, usually respond to ice, rest and over-the-counter anti-inflammatory medications. But if pain and swelling last longer than a few days or become worse, see your doctor. Delays in diagnosis and treatment can lead to poor healing, reduced range of motion and long-term disability.

Get emergency care if your pain is severe, your wrist looks misshapen or bone protrudes through your skin. An exposed bone can lead to a life-threatening infection if not treated promptly.

Tests and diagnosis

Some wrist injuries can be diagnosed with a medical history and careful examination of the painful area. For example, your doctor can often detect an injury to a ligament simply by examining your hand. Ligament injuries don't always show up on imaging tests.

In other cases, though, you may need further tests. These may include X-rays, sometimes using a contrast material (arthrogram) , or more detailed images from a computerized tomography (CT) scan or magnetic resonance imaging (MRI). If the results are still inconclusive, your doctor may perform an arthroscopy, a procedure used both to diagnose and treat joint problems.

Different tests may be needed to evaluate the degree of carpal tunnel syndrome, including:

• Electromyogram. This test measures the tiny electrical discharges produced in your muscles. A needle-thin electrode is inserted into the muscle, and its electrical activity is recorded when you're at rest and when the muscle is contracted.

• Nerve conduction study. In this variation of electromyography, a small shock is passed through the median nerve to see if electrical impulses are slowed in the region of the carpal tunnel.

Complications

Wrist injuries can sometimes lead to long-term problems, including:

• Ongoing stiffness, aching, numbness or disability. You may have ongoing stiffness, pain or aching even after your injury has healed. These problems sometimes go away, but they may be permanent if your injury was severe. You may also have some deformity in your wrist or limited range of motion. Be sure to talk to your doctor about exercises that might help prevent some of these problems.

• Arthritis. Fractures that extend into the joint can cause arthritis years later. If your wrist or hand starts to hurt long after a break, see your doctor for an evaluation.

• Poor healing. Some wrist fractures — such as scaphoid fractures — may take longer to heal because of poor blood supply to this part of your body or because treatment wasn't started quickly enough. Not immobilizing the fracture properly can also delay healing. And fractures are less likely to heal if you smoke.

• Bone death. Because the scaphoid and capitate bones both have poor blood supplies, they're especially prone to avascular necrosis, which occurs when a lack of blood causes the bone to deteriorate and die.

• Nerve or blood vessel damage. Trauma to your wrist can injure adjacent nerves and blood vessels. Seek immediate care if you notice any numbness or circulation problems.

Treatments and drugs

Treatments for wrist problems vary greatly, depending on the type, location and severity of the injury, as well as on your age and overall health.

Ligament sprains and tears

Minor sprains generally heal on their own with ice, rest and anti-inflammatory medications. More severe sprains or ligament tears may need:

• Splinting. Torn ligaments may be splinted for three to six weeks to allow them time to heal.
  
• 
  
  Surgery. When the ligament is torn and the joints no longer line up, your doctor may suggest surgery to either repair the ligament or pin the bones together to improve alignment while the ligament heals.
  
  
  If a great deal of time has passed since the initial injury, the ligament may need to be replaced with a tendon graft that's usually taken from the same wrist. In cases of long-standing instability or arthritis, two or more wrist bones may be fused together to stabilize the motion between the bones and reduce pain.

Cartilage tears

You can treat some cartilage injuries yourself with rest, ice and anti-inflammatory drugs, but complete tears may need to be surgically repaired. This can usually be done using local anesthetics, small incisions and a fiberoptic scope fitted with a tiny camera and surgical instruments.

Fractures

If you have a broken wrist bone that's properly aligned, you may wear a cast for six weeks to three months or more. You'll have regular X-rays to monitor your progress. If the bone doesn't seem to be healing, your doctor may recommend wearing an electrical stimulator, which looks something like a large bracelet, to encourage the bone to heal.

Other options include:

• Screw fixation. In this procedure, a screw is inserted through the broken bone to help hold it in place. Your doctor may suggest screw fixation instead of a cast because it can lead to a faster recovery and less downtime.

• Removal of dead tissue (debridement) . If your bone doesn't heal even after casting and electrical stimulation, your doctor is likely to suggest surgery. One approach is to remove the old scar tissue between the two halves of the broken bone — a procedure called debridement — which allows the fresh surfaces to try healing again.

• Bone graft. A graft involves using bone tissue from another site in your body or a graft substitute and placing it in the fracture to stimulate healing. A metal pin or screw may be inserted to hold the graft in place. Though minimally invasive procedures can hasten healing and minimize scarring, they still pose certain risks, such as damage to nearby blood vessels.

Repetitive strain injuries

For mild to moderate symptoms of carpal tunnel syndrome and other repetitive strain injuries, your doctor may suggest:

• Wrist splinting. A splint that immobilizes your wrist while you sleep may relieve minor numbness and tingling.

• Nonsteroidal anti-inflammatory drugs (NSAIDS). Over-the-counter pain relievers such as ibuprofen (Motrin, Advil, others) and acetaminophen (Tylenol, others) may help reduce pain from repetitive strain injuries caused by inflammation.

• Corticosteroids. Your doctor may inject the carpal tunnel with cortisone to relieve the pressure on the median nerve.

When pain and numbness are more severe and splinting doesn't reduce your symptoms, surgery may be the best option. Several procedures are used, but all involve cutting the transverse carpal ligament (flexor retinaculum) that's compressing the nerve.

Surgery usually causes marked improvement, but it can take several weeks or months until you have full use of your hand and wrist, and you may have residual numbness, pain, stiffness or weakness. Be sure to discuss all possible outcomes with your doctor before your surgery.

Prevention

It's impossible to prevent the unforeseen events that often cause wrist injuries, but these basic tips may offer some protection:

• Build bone strength. Getting adequate amounts of calcium — at least 1,500 milligrams a day for adults — and vitamin D can help prevent fractures.

• Prevent falls. Falling forward onto an outstretched hand is the main cause of most wrist injuries. To help prevent falls, wear sensible shoes. Remove home hazards. Light up your living space. And install grab bars in your bathroom and handrails on your stairways, if necessary.

• Use protective gear for athletic activities. Wear wrist guards for high-risk activities, such as football, snowboarding and rollerblading. If you're new to extreme sports, consider getting professional instruction, and know your limits.

• Pay attention to ergonomics. The market is flooded with devices such as ergonomic chairs, keyboards and mice that claim to take the stress off your wrists when you're at the office. Using some of these devices, taking regular breaks, keeping your wrists in a relaxed, middle position when you type, and improving your posture can make you more comfortable and help protect your wrists.

OSTEOARTHRITIS

Symptoms, Causes, Risk Factors, Diagnosis

Home Remedies & Alternative Medicines

Definition

Osteoarthritis, sometimes called degenerative joint disease or osteoarthrosis, is the most common form of arthritis. Osteoarthritis occurs when cartilage in your joints wears down over time.

Osteoarthritis can affect any joint in your body, though it most commonly affects joints in your hands, hips, knees and spine. Osteoarthritis typically affects just one joint, though in some cases, such as with finger arthritis, several joints can be affected.

Osteoarthritis gradually worsens with time, and no cure exists. But osteoarthritis treatments can relieve pain and help you remain active. Taking steps to actively manage your osteoarthritis may help you gain control over your osteoarthritis pain.

Symptoms

Osteoarthritis symptoms often develop slowly and worsen over time. Signs and symptoms of osteoarthritis include:

• Pain in a joint during or after use, or after a period of inactivity
  
• Tenderness in the joint when you apply light pressure
  
• Stiffness in a joint, that may be most noticeable when you wake up in the morning or after a period of inactivity
  
• Loss of flexibility may make it difficult to use the joint
  
• Grating sensation when you use the joint
  
• Bone spurs, which appear as hard lumps, may form around the affected joint
  
• Swelling in some cases

Osteoarthritis symptoms most commonly affect the hands, hips, knees and spine. Unless you've been injured or placed unusual stress on a joint, it's uncommon for osteoarthritis symptoms to affect your jaw, shoulder, elbows, wrists or ankles.

Causes

Osteoarthritis occurs when the cartilage that cushions the ends of bones in your joints deteriorates over time. The smooth surface of the cartilage becomes rough, causing irritation. Eventually, if the cartilage wears down completely, you may be left with bone rubbing on bone — causing the ends of your bones to become damaged and your joints to become painful.

It isn't clear what causes osteoarthritis in most cases. Researchers suspect that it's a combination of factors, including being overweight, the aging process, joint injury or stress, heredity, and muscle weakness.

Risk factors

Factors that increase your risk of osteoarthritis include:

• Older age. Osteoarthritis typically occurs in older adults. People under 40 rarely experience osteoarthritis.
  
• Sex. Women are more likely to develop osteoarthritis, though it isn't clear why.
  
• Bone deformities. Some people are born with malformed joints or defective cartilage, which can increase the risk of osteoarthritis.
  
• Joint injuries. Injuries, such as those that occur when playing sports or from an accident, may increase the risk of osteoarthritis.
  
• Obesity. Carrying more body weight places more stress on your weight-bearing joints, such as your knees. But obesity has also been linked to an increased risk of osteoarthritis in the hands, as well.
  
• Other diseases that affect the bones and joints. Bone and joint diseases that increase the risk of osteoarthritis include gout, rheumatoid arthritis, Paget's disease of bone and septic arthritis.

When to seek medical advice

If you have swelling or stiffness in your joints that lasts for more than two weeks, make an appointment with your doctor.

If you're already taking medication for osteoarthritis, contact your doctor if you're experiencing side effects from arthritis medications. Tell your doctor if you experience side effects such as nausea, abdominal discomfort, black or tarry stools, constipation, or drowsiness.

Tests and diagnosis

If your doctor suspects you have osteoarthritis, he or she will examine your affected joint and ask you questions about your joint pain. To better understand the cause of your pain, he or she may also recommend:

• X-rays. X-ray images of your affected joint may reveal a narrowing space within a joint, which indicates that the cartilage is breaking down. An X-ray may also show bone spurs around a joint.
  
• Blood tests. Blood tests may help rule out other causes of joint pain, such as rheumatoid arthritis.
  
• Joint fluid analysis. Your doctor may use a long needle to draw fluid out of the affected joint. Examining and testing the fluid around your joint can determine if your pain is caused by gout or an infection.
  
• Examining the joint with a tiny camera (arthroscopy) . In some cases, your doctor may recommend arthroscopy to see inside your joint in order to determine the cause of your pain. During arthroscopy, small incisions are made around your joint and a tiny camera is inserted to see inside your joint. Your doctor watches a video screen to look for abnormalities within your joint.

Complications

Osteoarthritis is a degenerative disease that worsens over time. As many as a third of people with osteoarthritis will eventually experience significant disability. Joint pain and stiffness may become severe enough to make getting through the day difficult, if not impossible. Some people are no longer able to work. When joint pain is this severe, doctors typically suggest joint replacement surgery. For those who aren't able to undergo surgery, pain medications and assistive devices can make daily tasks more manageable.

Treatments and drugs

There's no known cure for osteoarthritis, but treatments can help to reduce pain and maintain joint movement so that you can go about your daily tasks. While medications and joint replacement surgery are key components of treatment for osteoarthritis, your doctor will likely recommend you try all other possible solutions before you consider those options. Eventually the pain may become severe so that medications and surgery may be necessary.

Initial treatment options for mild osteoarthritis

For mild osteoarthritis pain that is bothersome, but not enough to have a great impact on your daily activities, your doctor may recommend that you:

• Rest. If you're experiencing pain or inflammation in your joint, rest it for 12 to 24 hours. Find activities that don't require you to use your joint repetitively. Try taking a 10-minute break every hour.
  
• Exercise. With your doctor's approval, get regular exercise when you feel up to it. Stick to gentle exercises, such as walking, biking or swimming. Exercise can increase your endurance and strengthen the muscles around your joint, making your joint more stable. Avoid exercising tender, injured or swollen joints. If you feel new joint pain, stop. New pain that lasts more than two hours after you exercise probably means you've overdone it.
  
• Lose weight. Being overweight or obese increases the stress on your weight-bearing joints, such as your knees and your hips. Even a small amount of weight loss can relieve some pressure and reduce your pain. Aim to lose 1 or 2 pounds a week, at most. Talk to your doctor about healthy ways to lose weight. Most people combine changes in their diet with increased exercise.




• Use heat and cold to manage pain. Both heat and cold can relieve pain in your joint. Heat also relieves stiffness and cold can relieve muscle spasms. Soothe your painful joint with heat using a heating pad, hot water bottle or warm bath. Heat should be warm, not hot. Apply heat for 20 minutes several times a day. Cool the pain in your joint with cold treatments, such as with ice packs. You can use cold treatments several times a day, but don't use cold treatments if you have poor circulation or numbness.




• Work with a physical therapist. Ask your doctor for a referral to a physical therapist. The physical therapist can work with you to create an individualized exercise plan that will strengthen the muscles around your joint, increase your range of motion in your joint and reduce your pain.




• Find ways to avoid stressing your joints. Find ways to go about your day without stressing your joints. An occupational therapist can help you discover ways to do everyday tasks or do your job without putting extra stress on your already painful joint. For instance, a toothbrush with a large grip could make brushing your teeth easier if you have finger osteoarthritis. A special seat in your shower could help relieve the pain of standing if you have knee osteoarthritis.
  
• Apply over-the-counter pain creams. Creams and gels available at the drugstore may provide temporary relief from osteoarthritis pain. Some creams numb the pain by creating a hot or cool sensation. Other creams contain medications, such as aspirin-like compounds, that are absorbed into your skin. Read the label so you know what you're using. Pain creams work best on joints that are close the surface of your skin, such as your knees and fingers.




• Try braces or shoe inserts. Consider trying special splints, braces, shoe inserts or other medical devices that can help reduce your pain. These devices can immobilize or support your joint to help you keep pressure off it.

• Take a chronic pain class. The Arthritis Foundation and some medical centers have classes for people with osteoarthritis or chronic pain. Ask your doctor about classes in your area or check with the Arthritis Foundation. These classes teach skills that help you manage your osteoarthritis pain. And you'll meet other people with osteoarthritis and learn their tips for reducing joint pain or coping with your pain.

Treatment options for moderate osteoarthritis

Osteoarthritis pain that persists despite initial treatment may require medications in addition to initial treatment options. Don't assume that taking a medication is all you need. In order to get the most from your treatment, continue exercising when possible and resting when you need to. If you're overweight, continue working to lose weight.

Medications that may be useful for moderate arthritis include:

• Acetaminophen. Acetaminophen (Tylenol, others) can relieve pain, but doesn't reduce inflammation. It has been shown to be effective for people with osteoarthritis who have mild to moderate pain. Taking more than the recommended dosage of acetaminophen can cause liver damage, especially if you consume three or more alcoholic drinks a day. Ask your doctor for guidance on limiting or abstaining from alcohol if you take acetaminophen regularly. Acetaminophen can also affect other medications you may be taking, so be sure to inform your doctor if you're taking it.
  
• NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) can relieve pain and reduce inflammation. Over-the-counter NSAIDs include ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve). Stronger versions of these NSAIDs and others are available by prescription. NSAIDs have risks of side effects that increase when used at high dosages for long-term treatment. Side effects may include ringing in your ears, gastric ulcers, cardiovascular problems, gastrointestinal bleeding, and liver and kidney damage. Consuming alcohol or taking corticosteroids while using NSAIDs also increases your risk of gastrointestinal bleeding.




• Tramadol. Tramadol (Ultram) is a centrally acting analgesic that's available by prescription. Tramadol has no anti-inflammatory effect, but can provide effective pain relief with fewer side effects - such as stomach ulcers and bleeding - than those of NSAIDs. However, tramadol may cause nausea and constipation. It's generally used for short-term treatment of acute flare-ups. Your doctor may recommend using tramadol in combination with acetaminophen to increase pain relief.

Treatment options for severe osteoarthritis

If you've tried other treatments but are still experiencing severe pain and disability, you and your doctor can discuss other treatments including:

• Stronger painkillers. Prescription pain pills, such as codeine and propoxyphene (Darvon), may provide relief from more severe osteoarthritis pain. These stronger medications carry a risk of dependence, though that risk is thought to be small in people who have severe pain. Side effects may include nausea, constipation and sleepiness.
  
• Cortisone shots. Injections of corticosteroid medications may relieve pain in your joint. During this procedure your doctor numbs the area around your joint and then inserts a needle into the space within your joint and injects medication. It isn't clear how or why corticosteroid injections work in people with osteoarthritis. Your doctor may limit the number of injections you can have each year, since too many corticosteroid injections may cause joint damage.
  
• Visco-supplementati on. Injections of hyaluronic acid derivatives (Hyalgan, Synvisc) may offer pain relief by providing some cushioning in your knee. These treatments are made of rooster combs and are similar to a component normally found in your joint fluid. Visco-supplementati on is only approved for knee osteoarthritis, though researchers are studying its use in other joints. Injections are typically given weekly over several weeks. Pain relief may last for a few months. Possible risks include infection, swelling and joint pain. People who are sensitive to birds, feathers or eggs shouldn't undergo visco-supplementati on treatments.

Surgery for osteoarthritis

Surgery is generally reserved for severe osteoarthritis that isn't relieved by other treatments. You may consider surgery if your osteoarthritis makes it very difficult to go about your daily tasks. Surgical treatments include:

• Joint replacement. In joint replacement surgery (arthroplasty) , your surgeon removes your damaged joint surfaces and replaces them with plastic and metal devices called prostheses. The hip and knee joints are the most commonly replaced joints. But today implants can replace your shoulder, elbow, finger or ankle joints. How long your new joint will last depends on how you use it. Some knee and hip joints can last 20 years. Joint replacement surgery can help you resume an active, pain-free lifestyle. In smaller hand joints, it can also improve appearance and comfort and may improve your joint's mobility. Joint replacement surgery carries a small risk of infection and bleeding. Artificial joints can wear or come loose, and may need to eventually be replaced.
  
• Cleaning up the area around the joint (debridement) . Your surgeon may recommend removing loose pieces of cartilage and bone from around your joint to relieve your pain. Debridement is most useful if you're experiencing a locking sensation from a torn cartilage or loose debris in your knee joint. Debridement is typically done arthroscopically, meaning only small incisions are made in your body. A tiny video camera is inserted through the incision to allow your surgeon to see inside your joint. The surgeon uses special surgical tools to clean out any debris pieces from your joint.
  
• Realigning bones. Surgery to realign bones may relieve pain. These types of procedures are typically used when joint replacement surgery isn't an option, such as in younger people with osteoarthritis. During a procedure called an osteotomy, the surgeon cuts across the bone either above or below the knee to realign the leg. Osteotomy can reduce knee pain by transferring the force of the joint away from the worn-out part of the knee.
  
• Fusing bones. Surgeons also can permanently fuse bones in a joint (arthrodesis) to increase stability and reduce pain. The fused joint, such as an ankle, can then bear weight without pain, but has no flexibility. Arthrodesis may be an option if you experience severe pain in your joint, but can't undergo joint replacement surgery.
  

Lifestyle and home remedies

Osteoarthritis pain may flare from time to time. In order to prevent and cope with these flares in pain and stiffness, try self-care techniques. Try to:

• Eat a healthy diet. A healthy diet emphasizing fruit, vegetables and whole grains can help you control your weight and maintain your overall health, allowing you to deal better with your arthritis. However, there's no special diet effective for treating arthritis. It hasn't been proved that eating any particular food will make your joint pain or inflammation better or worse.
• Take your medications as recommended. By taking medications regularly instead of waiting for pain to build, you will lessen the overall intensity of your discomfort.
  
• Use assistive devices. Assistive devices can make it easier to go about your day without stressing your painful joint. A cane may take weight off your knee or hip as you walk. Gripping and grabbing tools may make it easier to work in the kitchen if you have osteoarthritis in your fingers. Your doctor or occupational therapist may have ideas about what sorts of assistive devices may be helpful to you. Catalogs and medical supply stores may also be places to look for ideas.
  
• Avoid grasping actions that strain your finger joints. For example, instead of a clutch-style purse, select one with a shoulder strap. Use hot water to loosen a jar lid and pressure from your palm to open it, or use a jar opener. Don't twist or use your joints forcefully.
• Spread the weight of an object over several joints. Use both hands, for example, to lift a heavy pan. Try using a walking stick or cane.

• Maintain good posture. Poor posture causes uneven weight distribution and may strain ligaments and muscles. The easiest way to improve your posture is by walking. The faster you walk, the harder your muscles must work to keep you upright. Some people find that swimming also helps improve their posture.

• Use your strongest muscles and favor large joints. Don't push open a heavy glass door. Lean into it. To pick up an object, bend your knees and squat while keeping your back straight.

• Choose appropriate footwear. Wearing comfortable cushioned shoes that properly support your weight is especially important if you have arthritis in your weight-bearing joints or back.

Coping and support

Medications and other treatments are key to managing pain and disability, but another major component to treatment is your own attitude. Your ability to cope despite pain and disability caused by osteoarthritis often determines how much of an impact osteoarthritis will have on your everyday life. Talk to your doctor if you're feeling frustrated. He or she may have ideas about how to cope or refer you to someone who can help. In the meantime, try to:

• 
  Keep a positive attitude. Make a plan with your doctor for managing your arthritis. This will help you feel that you're in charge of your disease, rather than vice versa. Studies show that people who take control of their treatment and actively manage their arthritis experience less pain and function better.

• Practice relaxation techniques. Hypnosis, guided imagery, deep breathing and muscle relaxation can all be used to control pain.

• Know your limits. Rest when you're tired. Arthritis can make you prone to fatigue and muscle weakness - a deep exhaustion that makes everything you do a great effort. A rest or short nap that doesn't interfere with nighttime sleep may help.
  

Alternative medicine

People who aren't helped by medications for osteoarthritis pain sometimes turn to complementary and alternative medicine practices for relief. Mainstream doctors are becoming more open to discussing these options with their patients. But, since few of these treatments have been extensively studied in clinical trials, it's difficult to assess whether these treatments are helpful for osteoarthritis pain. In some cases, the risks of these treatments aren't known.

If you're interested in trying complementary and alternative medicine therapies for your osteoarthritis pain, discuss these treatments with your doctor first. He or she can help you weigh the benefits and risks and tell you if the treatments will interfere with your current osteoarthritis medications.

Some common complementary and alternative treatments that have shown some promise for osteoarthritis include:

• Acupuncture. During acupuncture, tiny needles are inserted into your skin at precise spots. Practitioners believe the needles free or redirect your body's energy in order to relieve pain. Studies of acupuncture for knee osteoarthritis have been mixed. Most studies haven't found a benefit, though some have found some short-term relief of pain. Acupuncture can be safe if you select a reputable practitioner — ask your doctor to suggest someone. Risks include infection, bruising and some pain where needles are inserted into your skin.
• Ginger. The ginger plant is best known for its use in cooking, but some research has found ginger extract may be helpful in reducing osteoarthritis pain. Limited studies have been conducted with ginger in people with osteoarthritis, and results have been mixed. Side effects of ginger supplements can include heartburn and diarrhea. Talk to your doctor before taking ginger supplements, since they can interfere with prescription medications such as warfarin (Coumadin).

• Glucosamine and chondroitin. Studies have been mixed on these nutritional supplements. Some have found benefits for people with osteoarthritis, while others haven't. Tell your doctor if you're considering taking these supplements. Don't use glucosamine if you're allergic to shellfish. Chondroitin sulfate may affect blood levels of warfarin if you're taking that medication.

• Magnets. Some people believe placing magnets near your affected joint can relieve osteoarthritis pain. Some small studies have found magnets can provide temporary pain relief, though others haven't found any benefit from magnets. It isn't clear how magnet therapy might work. Still, a variety of magnetic products, such as bracelets, are available. Magnets appear to be safe.

• Tai chi and yoga. These movement therapies involve gentle exercises and stretches combined with deep breathing. Many people use these therapies to abate stress in their lives, though small studies have found that tai chi and yoga may reduce osteoarthritis pain. More study is needed to understand whether tai chi and yoga can relieve osteoarthritis pain. Talk to your doctor if you'd like to give tai chi or yoga a try. When led by a knowledgeable instructor, these therapies are safe. But don't do any moves that cause pain in your joints.

Neck Pain

Tips to Get the Kinks Out

Maybe you have a boss, or a brother-in-law, whom you describe as a pain in the neck. But when it comes to neck pain, the blame—as well as the pain—is probably resting on your shoulders.

"It's keeping your head in an awkward position—that is, pushed forward with your ears in front of your shoulders—for a long time that makes your neck hurt. "That's what many people who have neck problems are doing."

Naturally, some people—because of their occupations—are more at risk than others. "Beauticians, for example, work in a bent-over position all day long".

Regardless of your job or lifestyle, you can rid yourself of blame—and more importantly, pain—by applying a few time-tested methods, replacing bad habits with good ones, and giving your neck regular exercise. So keep your head up and your eyes open. Help is on the way.

Ice down. An ice pack or ice wrapped in a towel is a good choice when stiffness is just settling in. If your neck has been slightly injured, ice can help hold down swelling.

Heat up. After ice has reduced any inflammation, heat is a wonderful soother—be it from a heating pad or a hot shower.

Use a heat rub. These over-the-counter ointments are soothing but have no real healing effect because they don't really penetrate the skin's surface. Never use them with heating pads. At best they provide "psychological benefit."

Exercise Away Neck Pain

Yes, even your neck muscles need to be stretched and strengthened. Here are some exercises to combat stiffness and prevent problems in the future. Do each five times twice a day. Do the first three exercises for two weeks before starting the rest.

• Slowly tilt your head forward as far as possible. Then move your head backward as far as possible.
  
• Tilt your head toward your shoulder, while keeping your shoulder stationary. Straighten, then lean toward the other shoulder.
  
• Slowly turn your head from side to side as far as possible.
  
• Place your hand on one side of your head while you push toward it with your head. Hold for 5 seconds, then relax. Repeat three times. Then do the same exercise on the other side.
  
• Do basically the same exercise as above, only provide slight resistance to the front of your head while you push your head forward. Then provide slight resistance to the back of your head while you push your head backward.
  
• Hold light weights—say 3 to 5 pounds—in your hands while shrugging your shoulders. Keep your arms straight.

Take the old standby. Over-the-counter anti-inflammatories such as aspirin or ibuprofen will help reduce pain and inflammation. Take two pills three or four times a day.

Sit in a firm chair. Like the song says, the backbone is connected to the neck bone. And if you sit in a chair that doesn't give you good back support, you increase your chances of worsening existing neck problems and causing new ones.

Throw in the towel. Actually, roll a towel up and place it against the small of your back when sitting—it will better align your spine and give you additional support.

Take a break. Just as the feet need rest from constant standing, the neck needs a rest from constant sitting. Your head weighs approximately 8 pounds, and that's a lot of weight for the neck to support without much help from the rest of your body. So periodically stand up and walk around.

Keep your chin up. Keep your head level but pull your chin in as if you were making a double chin. Also avoid having your head lowered all the time when working at a desk or reading. This will prevent stressing the muscles in the back of the neck.

See eye to screen. If you work with a video display terminal all day, it's important to have it positioned at eye level. If you force yourself to look up or down hour after hour, you may cause your neck to spasm.

Reach out. And consider putting down the telephone. If you talk on the phone a lot, especially while trying to write, you've got your neck in an awkward position—an invitation to stiffness and pain.

Lift carefully. It's all too easy to forget there's a right way and a wrong way to lift heavy objects. The right way is to bend your knees and hold your spine erect while positioning the object between your feet, which should be shoulder-width apart. When you lift the object, keep it as close to your body as possible.

Sleep on a firm mattress. A lot of neck problems begin, and worsen, with poor sleeping habits. Having a firm mattress is important.

Don't fight with your pillow. Just toss it aside. "A lot of people with neck pain feel better sleeping flat—without a pillow".

MEDICAL ALERT

Whiplash needs a Doctor's Care

If you have been in an auto accident and have severe neck pain afterward, you may have whiplash and should see a doctor. In the meantime treating with ice instead of heat because heat could inflame the injured area.

As a general rule, persistent neck pain warrants professional medical evaluation. "It's extremely remote, but it's possible that neck pain could be a signal that there's a tumor on the spine".

Or get a cervical pillow. These pillows, which can be bought for a little amount, give the neck a proper support.

Don't sleep on your stomach. This is not only bad for your back, but your neck, too.

Sleep like a baby. In other words, sleep in the fetal position—on your side with your knees up toward your chest.

Wrap up. When it's cold and damp outside, you probably wear a hat. But you should cover your neck as well. The weather can aggravate neck stiffness and pain.

Relax. Just being tense can tighten the muscles in your neck and put you in pain. If you're under a lot of pressure or feel tense a lot, learning relaxation techniques, such as meditation or progressive relaxation, can help. Also, audiotapes are available to teach you how to relax.

PROSTATE CANCER - Causes & Treatment

Symptoms, Causes, Daignosis,

Treatment and Alternative Medicine

Definition

Prostate cancer is cancer of the small walnut-shaped gland in males that produces seminal fluid, the fluid that nourishes and transports sperm. Prostate cancer is one of the most common types of cancer in men, affecting about one in six men in the United States. A diagnosis of prostate cancer can be scary not only because it can be life-threatening, but also because treatments can cause side effects such as bladder control problems and erectile dysfunction (impotence). But diagnosis and treatment of prostate cancer have gotten much better in recent years.

Prostate cancer usually grows slowly and initially remains confined to the prostate gland, where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly. If prostate cancer is detected early — when it's still confined to the prostate gland — you have a better chance of successful treatment.

Symptoms

Prostate cancer usually doesn't produce any noticeable symptoms in its early stages, so many cases of prostate cancer aren't detected until the cancer has spread beyond the prostate. For most men, prostate cancer is first detected during a routine screening such as a prostate-specific antigen (PSA) test or a digital rectal exam (DRE).

When signs and symptoms do occur, they depend on how advanced the cancer is and how far the cancer has spread.

Early signs and symptoms of prostate cancer can include urinary problems, caused when the prostate tumor presses on the bladder or on the tube that carries urine from the bladder (urethra). However, urinary symptoms are much more commonly caused by benign prostate problems, such as an enlarged prostate (benign prostatic hyperplasia) or prostate infections. Less than 5 percent of cases of prostate cancer have urinary problems as the initial symptom. When urinary signs and symptoms do occur, they can include:

• Trouble urinating
  
• Starting and stopping while urinating
  
• Decreased force in the stream of urine

Cancer in your prostate or the area around the prostate can cause:

• Blood in your urine
  
• Blood in your semen

Prostate cancer that has spread to the lymph nodes in your pelvis may cause:

• Swelling in your legs
  
• Discomfort in the pelvic area

Advanced prostate cancer that has spread to your bones can cause:

• Bone pain that doesn't go away
  
• Bone fractures
  
• Compression of the spine

Causes

Cancer is a group of abnormal cells that grow more rapidly than normal cells and that refuse to die. Cancer cells also have the ability to invade and destroy normal tissues, either by growing directly into surrounding structures or after traveling to another part of your body through your bloodstream or lymph system (metastasize) . Microscopic cancer cells develop into small clusters that continue to grow, becoming more densely packed and hard.

What causes prostate cancer and why some types behave differently are unknown. Research suggests that a combination of factors may play a role, including heredity, ethnicity, hormones, diet and the environment.

Risk factors

Knowing the risk factors for prostate cancer can help you determine if and when you want to begin prostate cancer screening. The main risk factors include:

• Age. After age 50, your chance of having prostate cancer increases.
  
• Race or ethnicity. For reasons that aren't well understood, black men have a higher risk of developing and dying of prostate cancer.
  
• Family history. If your father or brother has prostate cancer, your risk of the disease is greater than that of the average man.
  
• Diet. A high-fat diet and obesity may increase your risk of prostate cancer. One theory is that fat increases production of the hormone testosterone, which may promote the development of prostate cancer cells.
  
• High testosterone levels. Because testosterone naturally stimulates the growth of the prostate gland, men who use testosterone therapy are more likely to develop prostate cancer than are men who have lower levels of testosterone. Also, doctors are concerned that testosterone therapy might fuel the growth of prostate cancer that is already present. Long-term testosterone treatment also may cause prostate gland enlargement (benign prostatic hyperplasia) .

When to seek medical advice

If you have difficulties with urination, see your doctor. This condition doesn't always relate to prostate cancer, but it can be a sign of prostate-related problems.

Beginning at age 50, the American Cancer Society recommends having yearly screening tests for prostate cancer. If you're black or have a family history of the disease, you may want to begin at a younger age. Yearly screenings can help detect prostate cancer early, when it's easier to treat. They include:

• PSA test. This blood test checks levels of prostate-specific antigen (PSA), which can be a sign of prostate cancer. While this test can detect signs of cancer, elevated PSA levels are sometimes caused by conditions other than cancer, such as prostate enlargement, infection or inflammation.
  
• Digital rectal exam (DRE). This test involves insertion of a lubricated finger into the rectum to feel for bumps on the prostate. While it can be slightly uncomfortable, an annual DRE is a quick, simple exam that can be a lifesaver.

Tests and diagnosis

Prostate cancer may not cause any symptoms at first. The first indication of a problem may come during a routine screening test, such as:

• Digital rectal exam (DRE). During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. If your doctor finds any abnormalities in the texture, shape or size of your gland, you may need more tests.
  
• Prostate-specific antigen (PSA) test. A blood sample is drawn from a vein and analyzed for PSA, a substance that's naturally produced by your prostate gland to help liquefy semen. It's normal for a small amount of PSA to enter your bloodstream. However, if a higher than normal level is found, it may be an indication of prostate infection, inflammation, enlargement or cancer. Studies have not been able to show that routine screening decreases the chance that anyone will die of prostate cancer, but screening with PSA and DRE can help identify cancer at an earlier stage.
  
• Transrectal ultrasound. If other tests raise concerns, your doctor may use transrectal ultrasound to further evaluate your prostate. A small probe, about the size and shape of a cigar, is inserted into your rectum. The probe uses sound waves to get a picture of your prostate gland.
  
• Prostate biopsy. If initial test results suggest prostate cancer, your doctor may recommend biopsy. To do a prostate biopsy, your doctor inserts a small ultrasound probe into your rectum. Guided by images from the probe, your doctor uses a fine, spring-propelled needle to retrieve several very thin sections of tissue from your prostate gland. A pathologist who specializes in diagnosing cancer and other tissue abnormalities evaluates the samples. From those, the pathologist can tell if the tissue removed is cancerous and estimate how aggressive your cancer is.

Determining how far the cancer has spread
Once a cancer diagnosis has been made, you may need further tests to help determine if or how far the cancer has spread. Many men don't require additional studies and can directly proceed with treatment based on the characteristics of their tumors and the results of their pre-biopsy PSA tests.

• Bone scan. A bone scan takes a picture of your skeleton in order to determine whether cancer has spread to the bone. Prostate cancer can spread to any bones in your body, not just those closest to your prostate, such as your pelvis or lower spine.
  
• Ultrasound. Ultrasound not only can help indicate if cancer is present, but also may reveal whether the disease has spread to nearby tissues.
  
• Computerized tomography (CT) scan. A CT scan produces cross-sectional images of your body. CT scans can identify enlarged lymph nodes or abnormalities in other organs, but they can't determine whether these problems are due to cancer. Therefore, CT scans are most useful when combined with other tests.
  
• Magnetic resonance imaging (MRI). This type of imaging produces detailed, cross-sectional images of your body using magnets and radio waves. An MRI can help detect evidence of the possible spread of cancer to lymph nodes and bones.
  
• Lymph node biopsy. If enlarged lymph nodes are found by a CT scan or an MRI, a lymph node biopsy can determine whether cancer has spread to nearby lymph nodes. During the procedure, some of the nodes near your prostate are removed and examined under a microscope to determine if cancerous cells are present.

Grading
When a biopsy confirms the presence of cancer, the next step, called grading, is to determine how aggressive the cancer is. The tissue samples are studied, and the cancer cells are compared with healthy prostate cells. The more the cancer cells differ from the healthy cells, the more aggressive the cancer and the more likely it is to spread quickly.

Cancer cells may vary in shape and size. Some cells may be aggressive, while others aren't. The pathologist identifies the two most aggressive types of cancer cells when assigning a grade. The most common scale used to evaluate prostate cancer cells is called a Gleason score. Based on the microscopic appearance of cells, individual ratings from 1 to 5 are assigned to the two most common cancer patterns identified. These two numbers are then added together to determine your overall score. Scoring can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer).

Staging
After the level of aggressiveness of your prostate cancer is known, the next step, called staging, determines if or how far the cancer has spread. Your cancer is assigned one of four stages, based on how far it has spread:

• Stage I. Signifies very early cancer that's confined to a microscopic area that your doctor can't feel.
  
• Stage II. Your cancer can be felt, but it remains confined to your prostate gland.
  
• Stage III. Your cancer has spread beyond the prostate to the seminal vesicles or other nearby tissues.
  
• Stage IV. Your cancer has spread to lymph nodes, bones, lungs or other organs.

Complications

Complications from prostate cancer are related to both the disease and its treatment. One of the biggest fears of many men who have prostate cancer is that treatment may leave them incontinent or unable to maintain an erection firm enough for sex (erectile dysfunction) . Fortunately, therapies exist to help cope with or treat these conditions.

The typical complications of prostate cancer and its treatments include:

• Spread of cancer. Prostate cancer can spread to nearby organs or travel through your bloodstream or lymphatic system, affecting your bones or other organs. Treatments for prostate cancer that has spread can include hormone therapy, radiation therapy and chemotherapy.
  
• Pain. Although early-stage prostate cancer typically isn't painful, once it's spread to bones it can be. Not all people with cancer that has spread to bones have pain, but in some cases, pain is intense and doesn't go away. Treatments directed at shrinking the cancer often can produce significant pain relief. Medications ranging from over-the-counter pain relievers to prescription narcotics can alleviate pain. If your pain is severe, you may need to see a pain specialist. While it's not always possible to make all of your pain go away, your doctor will work with you to try to control pain to a point where you're comfortable. If you're in serious pain, tell your doctor. Pain can be controlled, and there's no reason you have to suffer.
  
• Difficulty urinating (urinary incontinence) . Both prostate cancer and its treatment can cause incontinence. Treatment depends on the type of incontinence you have, how severe it is and the likelihood it will improve over time. Treatments include behavior modifications (such as going to the bathroom at set times rather than just according to urges), exercises to strengthen pelvic muscles (commonly called Kegel exercises), medications and catheters. If incontinence continues for a prolonged period without getting better, your doctor may suggest more aggressive procedures. These may include implanting an artificial urinary sphincter, placement of a sling of synthetic material to compress the urethra, or the injection of bulking agents into the lining of the urethra at the base of the bladder to reduce leakage.
  
• Erectile dysfunction (ED) or impotence. Like incontinence, ED can be a result of prostate cancer or its treatment, including surgery, radiation or hormone treatments. Medications and vacuum devices that assist in achieving erection are available to treat ED. Medications include sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra). If other treatments fail, penile implants can be inserted surgically to help create an erection.
  
• Depression. Many men may feel depressed after a diagnosis of prostate cancer or after trying to cope with the side effects of treatment. These feelings may last for only a short time, they may come and go, or they may linger for weeks or even months. Talk to your doctor if you have depression that interferes with your ability to get things done or enjoy your life. Treatment such as counseling or antidepressant medication can make a big difference.

Treatments and drugs

There's more than one way to treat prostate cancer. For some men a combination of treatments — such as surgery followed by radiation or radiation paired with hormone therapy — works best. The treatment that's best for each man depends on several factors. These include how fast your cancer is growing, how much it has spread, your age and life expectancy, as well as the benefits and the potential side effects of the treatment. The most common treatments for prostate cancer include the following:

External beam radiation therapy (EBRT)

External beam radiation treatment uses high-powered X-rays to kill cancer cells. This type of radiation is effective at destroying cancerous cells, but it can also scar adjacent healthy tissue.

The first step in radiation therapy is to map the precise area of your body that needs to receive radiation. Computer-imaging software helps your doctor find the best angles to aim the beams of radiation. Precisely focused radiation kills cancer in your prostate while minimizing harm to surrounding tissue.

Treatments are generally given five days a week for about eight weeks. Each treatment appointment takes about 10 minutes. However, much of this is preparation time — radiation is received for only about one minute. You don't need anesthesia with external beam radiation, because the treatment isn't painful.

You'll be asked to arrive for therapy with a full bladder. This will push most of your bladder out of the path of the radiation beam. A body supporter holds you in the same position for each treatment. Ink marks on your skin help guide the radiation beam, and small gold markers may be placed in your prostate to ensure the radiation hits the same targets each time. Custom-designed shields help protect nearby normal tissue, such as your bladder, erectile tissues, anus and rectal wall.

EBRT can cause mild side effects, but in most cases they disappear shortly after your course of treatment is finished.

Side effects of EBRT can include:

• Urinary problems. The most common signs and symptoms are urgency to urinate and frequent urination. These problems usually are temporary and gradually diminish in a few weeks after completing treatment. Long-term problems are uncommon.
  
• Loose stools, rectal bleeding, discomfort during bowel movements or a sense of needing to have a bowel movement (rectal urgency). In some cases these problems persist for months after treatment, but they improve on their own in most men. If you do have long-term rectal symptoms, medications can help. Rarely, men develop persistent bleeding or a rectal ulcer after radiation. Surgery may be necessary to alleviate these problems.
  
• Sexual side effects. Radiation therapy doesn't usually cause immediate sexual side effects such as erectile dysfunction, but some men who've had the treatment have sexual problems later in life.

Radioactive seed implants
Radioactive seeds implanted into the prostate have gained popularity in recent years as a treatment for prostate cancer. The implants, also known as brachytherapy, deliver a higher dose of radiation than do external beams, but over a substantially longer period of time. The therapy is generally used in men with smaller or moderate-sized prostates with small and lower grade cancers.

During the procedure, between 40 and 100 rice-sized radioactive seeds are placed in your prostate through ultrasound-guided needles. The implant procedure typically lasts one to two hours and is done under general anesthesia — which means you won't be awake. Most men can go home the day of the procedure. Sometimes, hormone therapy is used for a few months to shrink the size of the prostate before seeds are implanted. The seeds may contain one of several radioactive isotopes — including iodine and palladium. These seeds don't have to be removed after they stop emitting radiation. Iodine and palladium seeds generally emit radiation that extends only a few millimeters beyond their location. This type of radiation isn't likely to escape your body in significant doses. However, doctors recommend that for the first few months you stay at least six feet (1.83 meters) away from children and pregnant women, who are especially sensitive to radiation. All radiation inside the pellets is generally exhausted within a year.

Side effects of radioactive seed implants can include:

• Urinary problems. The procedure causes urinary signs and symptoms such as frequent, slow and painful urination in nearly all men. You may require medication to treat these signs and symptoms. Some men need medications or the use of intermittent self-catheterizatio n to help them urinate. Urinary symptoms tend to be more severe and longer lasting with seed implants than with external beam radiation.
  
• Sexual problems. Some men experience erectile dysfunction due to radioactive seed implants.
  
• Rectal symptoms. Sometimes this treatment causes loose stools, discomfort during bowel movements or other rectal symptoms. However, rectal symptoms from radioactive seed implants are generally less severe than with external beam radiation.
  

Hormone therapy

Hormone therapy involves trying to stop your body from producing the male sex hormones testosterone, which can stimulate the growth of cancer cells. This type of therapy can also block hormones from getting into cancer cells. Sometimes doctors use a combination of drugs to achieve both. In most men with advanced prostate cancer, this form of treatment is effective in helping both shrink the cancer and slow the growth of tumors. Sometimes doctors use hormone therapy in early-stage cancers to shrink large tumors so that surgery or radiation can remove or destroy them more easily. In some cases, hormone therapy is used in combination with radiation therapy or surgery. After these treatments, the drugs can slow the growth of any stray cancer cells left behind.

Some drugs used in hormone therapy decrease your body's production of testosterone. The hormones — known as luteinizing hormone-releasing hormone (LH-RH) agonists — can set up a chemical blockade. This blockade prevents the testicles from receiving messages to make testosterone. Drugs typically used in this type of hormone therapy include leuprolide (Lupron, Viadur) and goserelin (Zoladex). They're injected into a muscle or under your skin once every three or four months. You can receive them for a few months, a few years or the rest of your life, depending on your situation.

Other drugs used in hormone therapy block your body's ability to use testosterone. A small amount of testosterone comes from the adrenal glands and isn't suppressed by LH-RH agonists. Certain medications — known as anti-androgens — can prevent testosterone from reaching your cancer cells. Examples include bicalutamide (Casodex) and nilutamide (Nilandron). They come in tablet form and, depending on the particular brand of drug, are taken orally one to three times a day. These drugs typically are given along with an LH-RH agonist.

Simply depriving prostate cancer of testosterone usually doesn't kill all of the cancer cells. Within a few years, the cancer often learns to thrive without testosterone. Once this happens, hormone therapy is less likely to be effective. However, several treatment options still exist. To avoid such resistance, intermittent hormone therapy programs have been developed. During this type of therapy, the hormonal drugs are stopped after your PSA drops to a low level and remains steady. You will need to resume taking the drugs if your PSA level rises again.

Side effects of hormone therapy can include:

• Breast enlargement (gynecomastia)
  
• Reduced sex drive
  
• Erectile dysfunction
  
• Hot flashes
  
• Weight gain
  
• Reduction in muscle and bone mass

Certain hormone therapy medications can also cause:

• Nausea
  
• Diarrhea
  
• Fatigue
  
• Liver damage

Recent reports have shown that men who undergo hormone therapy for prostate cancer may have a higher risk of having a heart attack in the first year or two after starting hormone therapy. So your doctor should carefully monitor your heart condition and aggressively treat any other conditions that may predispose you to a heart attack, such as high blood pressure, high cholesterol or smoking.

Surgery to remove the testicles, which produce most of your testosterone, is as effective as other forms of hormonal therapy. Many men are not comfortable with the idea of losing their testicles, so they opt for the above-noted methods of lowering testosterone in the body. However, removing the testicles has the advantage of not having to have an injection every three or four months and can be less expensive. The surgery can be done on an outpatient basis using a local anesthetic.

Radical prostatectomy

Surgical removal of your prostate gland, called radical prostatectomy, is used to treat cancer that's confined to the prostate gland. During this procedure, your surgeon uses special techniques to completely remove your prostate and nearby lymph nodes. This surgery can affect muscles and nerves that control urination and sexual function. Two surgical approaches are available for a prostatectomy — retropubic surgery and perineal surgery.

• Retropubic surgery. The gland is taken out through an incision in your lower abdomen that typically runs from just below the navel to an inch (2.54 centimeters) above the base of the penis. It's the most commonly used form of prostate removal for two reasons. First, your surgeon can use the same incision to remove pelvic lymph nodes, which are tested to determine if the cancer has spread. Second, the procedure gives your surgeon good access to your prostate, making it easy to save the nerves that help control bladder function and erections.
  
• Perineal surgery. An incision is made between your anus and scrotum. There's generally less bleeding with perineal surgery, and recovery time may be shorter, especially if you're overweight. With this procedure, your surgeon isn't able to remove nearby lymph nodes.

During either type of operation, a catheter is inserted into your bladder through your penis to drain urine from the bladder during your recovery. The catheter will likely remain in place for one to two weeks after the operation while the urinary tract heals.

Side effects of radical prostatectomy can include:

• Bladder control problems (urinary incontinence) . These symptoms can last for weeks or even months, but most men eventually regain bladder control. Many men experience stress incontinence, meaning they're unable to hold urine flow when their bladders are under increased pressure. This can happen when you sneeze, cough, laugh or lift something heavy. In some men, urinary incontinence doesn't get better and surgery is needed to help correct the problem.
  
• Erectile dysfunction. This is a common side effect of radical prostatectomy, because nerves on both sides of your prostate that control erections may be damaged or removed during surgery. Most men younger than age 50 who have nerve-sparing surgery are able to achieve erections afterward, and even some men in their 70s are able to maintain normal sexual functioning. Men who had trouble achieving or maintaining an erection before surgery have a higher risk of being impotent after the surgery.

Robot-assisted laparoscopic radical prostatectomy (RALRP)
This is a relatively new procedure for removing the prostate. For robot-assisted laparoscopy, five small incisions are made in the abdomen through which the doctor inserts tube-like instruments, including a long, slender tube with a small camera on the end (laparoscope) . This creates a magnified view of the surgical area.

The instruments are attached to a mechanical device, and the surgeon sits at a console and guides the instruments through a viewing device to perform the surgery. So far, studies show that traditional open prostatectomy and robotic prostatectomy have had similar outcomes related to cancer-free survival rates, urinary continence and sexual function one year after surgery. Longer term outcomes are not yet known.

Watchful waiting
The PSA blood test can help detect prostate cancer at a very early stage. This allows many men to choose watchful waiting as a treatment option. In watchful waiting (also known as observation, expectant therapy or deferred therapy), regular follow-up blood tests, rectal exams and possibly biopsies may be performed to monitor progression of your cancer.

During watchful waiting no medical treatment is provided. Medications, radiation and surgery aren't used. Watchful waiting may be an option if your cancer isn't causing symptoms, is expected to grow very slowly, and is small and confined to one area of your prostate.

Watchful waiting may be particularly appropriate if you're elderly, in poor health or both. Many such men will live out their normal life spans without treatment and without the cancer spreading or causing other problems. But watchful waiting can also be a rational option if you're a younger man, as long as you know the facts, are willing to be vigilant, and accept the risk of a tumor spreading during the observation period, rendering your cancer incurable.

Chemotherapy
This type of treatment uses chemicals that destroy rapidly growing cells. Chemotherapy can be quite effective in treating prostate cancer, but it can't cure it. Because it has more side effects than hormone therapy does, chemotherapy is reserved for men who have hormone-resistant prostate cancer that has spread to other parts of the body.

Cryotherapy
This treatment is used to destroy cells by freezing tissue. Original attempts to treat prostate cancer with cryotherapy involved inserting a probe into the prostate through the skin between the rectum and the scrotum (perineum). Using a rectal microwave probe to monitor the procedure, the prostate was frozen in an attempt to destroy cancer cells. This method often resulted in damage to tissue around the bladder and long-term complications such as injury to the rectum or the muscles that control urination.

More recently, smaller probes and more-precise methods of monitoring the temperature in and around the prostate have been developed. These advances may decrease the complications associated with cryotherapy, making it a more effective treatment for prostate cancer. Although progress continues, more time is needed to determine how successful cryotherapy may be as a treatment for prostate cancer.

Gene therapy and immune therapy
In the future, gene therapy or immune therapy may be successful in treating prostate cancer. Current technology limits the use of these experimental treatments to a small number of medical centers.

Prevention

Prostate cancer can't be prevented, but you can take measures to reduce your risk or possibly slow the disease's development.

• Eat well. High-fat diets have been linked to prostate cancer. Therefore, limiting your intake of high-fat foods and emphasizing fruits, vegetables and whole fibers may help you reduce your risk. Foods rich in lycopene, an antioxidant, also may help lower your prostate cancer risk. These foods include raw or cooked tomatoes, tomato products, grapefruit and watermelon. Garlic and some vegetables such as arugula, bok choy, broccoli, Brussels sprouts, cabbage and cauliflower also may help fight cancer. Vitamin E has shown promise in reducing the risk of prostate cancer among smokers. More research is needed, however, to see whether vitamin E might be effective.
  
• Get regular exercise. Regular exercise can help prevent a heart attack and conditions such as high blood pressure and high cholesterol. When it comes to cancer, the data aren't as clear-cut, but studies do indicate that regular exercise may reduce your cancer risk, including your risk of prostate cancer. Exercise has been shown to strengthen your immune system, improve circulation and speed digestion — all of which may play a role in cancer prevention. Exercise also helps to prevent obesity, another potential risk factor for some cancers. Regular exercise may also minimize your symptoms and reduce your risk of prostate gland enlargement, or benign prostatic hyperplasia (BPH). Men who are physically active usually have less-severe symptoms than do men who get little exercise.
  
• Ask your doctor about taking an NSAID. Nonsteroidal anti-inflammatory drugs (NSAIDs) might prevent prostate cancer. These drugs include ibuprofen (Advil, Motrin, others) and naproxen (Aleve). NSAIDs inhibit an enzyme called COX-2, which is found in prostate cancer cells. More studies are needed to confirm whether NSAID use actually results in lower rates of prostate cancer or reduced deaths from the disease.

Research on prostate cancer prevention has shown that the drug finasteride (Proscar, Propecia) may prevent or delay the onset of prostate cancer in men 55 years and older. This drug is currently used to control prostate gland enlargement and hair loss in men. However, finasteride has also been shown to contribute to increasing sexual side effects and to slightly raise the risk of developing higher grade prostate cancer. At this time, this drug isn't routinely recommended to prevent prostate cancer.

Coping and support

Once you receive a diagnosis of prostate cancer or treatment for this disease, you may experience a range of feelings — including disbelief, fear, anger, anxiety, emptiness and depression. You may not be able to get rid of these distressing feelings. But you can find positive ways to deal with them so they don't dominate your life. The following strategies can help you cope with some of the difficulties of prostate cancer:

• Be prepared. Ask your doctor questions and read about prostate cancer and its potential side effects. The fewer the surprises, the more quickly you'll adapt.
  
• Maintain as normal a routine as you can. Don't let the cancer or side effects from treatment dominate your day. Try to follow the routine and lifestyle you had before learning of your cancer. Go back to work, take a trip, join your children or grandchildren on an outing. You need activities that give you a sense of purpose, fulfillment and meaning. But realize that initially you may have some limitations. Start slowly and gradually build your level of endurance.
  
• Get plenty of exercise. Exercise helps fight depression and is a good way to relieve tension and aggression.
  
• Open up to a friend, a family member or a counselor. Cancer is too heavy a load to carry alone. Sometimes it helps to talk with someone about your feelings and fears. The better you feel emotionally, the better you'll be able to physically cope with your illness. You may find joining a support group helpful, because it can provide you with a sense of belonging, give you an opportunity to talk with people who understand your situation and provide you with advice. Your doctor or someone you know who has experienced prostate cancer may be able to help you locate a support group.
  
• Don't avoid sexual contact. Your natural reaction to impotence may be to avoid all sexual contact. Don't fall for this feeling. Touching, holding, hugging and caressing can become far more important to you and your partner. In fact, the closeness you develop in these actions can produce greater sexual intimacy than you've ever had before. There are many ways to express your sexuality.
  
• Look for the positive. Cancer doesn't have to be an all-negative experience for you. Good can come out of it. Confrontation with cancer may lead you to grow emotionally and spiritually, to identify what really matters to you, to settle long-standing disputes and to spend more time with people important to you.

Alternative medicine

A range of dietary supplements and herbal medicines claim to offer new ways to prevent or treat prostate disease, and cancer in general. Some supplements show promise and are slowly gaining acceptance in mainstream medicine. But the benefits and risks of many products and practices remain unproved. Unfortunately, the production of these products isn't well regulated, and the amount of active ingredient may vary from bottle to bottle or even pill to pill.

Herbal products marketed to relieve common prostate problems, such as frequent urination or a weak urine flow, include:

• African plum tree (Prunus africana)
  
• African wild potato (Hypoxis hemerocallidea, Hypoxis rooperi)
  
• Pumpkin (Cucurbita pepo)
  
• Rye grass (Secale cereale)
  
• Stinging nettle (Urtica dioica, Urtica urens)

Taken in small to moderate amounts, these products appear to be safe. But they haven't been studied in large, long-term trials to confirm their safety or to prove they work.

Saw palmetto
Unlike other herbal supplements, saw palmetto has been widely tested, and the results show promise in the treatment of urinary symptoms caused by prostate problems. However, it is important to know that saw palmetto is recommended to treat symptoms associated with benign prostate gland enlargement, not prostate cancer.

Saw palmetto works slowly. Most men begin to see an improvement in their urinary symptoms within one to three months. If after three months you haven't noticed any benefit from the product, it may not work for you. It appears safe to take saw palmetto indefinitely, but possible effects from long-term use are unknown. One drawback of this herb, and many other such herbal products, is that it may suppress PSA levels in your blood. This action can interfere with the effectiveness of the PSA test. That's why if you take saw palmetto or other herbal medicines, it's important to tell your doctor before having a PSA test.

Lacking scientific evidence
A few herbal and dietary products claim to help cure or prevent cancer. There's no scientific evidence that these products work, and some may be dangerous. Three popular "cancer-fighting" supplements include:

• Chaparral. Also known as creosote bush or greasewood, chaparral (Larrea tridentata) comes from a desert shrub found in the southwestern United States and Mexico. Research hasn't shown that the herb effectively treats cancer, and it can lead to irreversible liver failure.
  
• PC-SPES. This mixture contains eight herbs that have been used for hundreds of years in traditional Chinese medicine to treat prostate issues and other health problems. Some studies show it may reduce cancer growth, but it can also cause side effects. It was sold as a dietary supplement, but is no longer being manufactured because some batches were found to contain prescription drug ingredients. While the individual herbs are still available, the PC-SPES mixture has not been reintroduced because further studies are needed to determine whether it's safe.
  
• Shark cartilage. Shark cartilage contains a protein that has some ability to inhibit the formation of new blood vessels within tumors in sharks. Shark cartilage therapy is based on the theory that capsules containing shark cartilage will do the same in humans — stop and shrink cancerous tumors. However, these benefits haven't been shown in humans.

Talk with your doctor first
Because it's not always easy to tell which products may be unsafe, interact negatively with other medications or affect your overall cancer treatment, it's best to talk with your doctor before you take any dietary or herbal product.