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  • Professor, Neurology UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA

A multidisciplinary prostate cancer care doctor about whether tumor sequencing is right for you discount sumycin 500 mg antibiotics for uti cats, team will give you the most comprehensive assessment or visit pcf sumycin 500mg discount treatment for dogs bitten by ticks. As a matter of fact purchase 500 mg sumycin overnight delivery antibiotics for uti without sulfa, your doctor may not recommend Many hospitals and universities have multidisciplinary treatment at all (termed observation or watchful prostate cancer clinics that can provide a consultation waiting) 500 mg sumycin with visa antibiotics for kidney bladder infection, or might recommend putting you under on what team of doctors might be right for you. It’s important to learn as localized prostate cancer, the chance of “cure” is now much as possible about the treatment options available the same whether you have radiation therapy or surgery. However, one treatment may be preferred > Don’t be afraid to shop around and get second or for you based on the associated side effects, and your even third opinions team of doctors will evaluate your type of prostate cancer to develop a treatment plan that may include > Be careful of random advice. Feelings of Decisions about how to treat your prostate cancer can’t powerlessness are a common concern around a cancer be made in a vacuum. A new diagnosis can come with a diagnosis; your loved ones want—or even need—to lot of confusing information and feelings. Normally, of this disease can affect the way you view yourself, this may feel like a fantastic offer. But after a cancer the way you interact with others, and the way others diagnosis, you may feel confused about how much interact with you. Keeping open to make some important decisions, based on your channels of communication is the key. To help you along the way, it’s prudent to work with your network of family, friends, Tips for Spouses, Caregivers and Adult Children and practitioners to align expectations and seek support > Agree on how you will make decisions as appropriate. If you physical ability, and sexual function are newly diagnosed, start by consulting your diagnosing > It is normal to experience loneliness and fear doctor, that is, the one who found your prostate cancer. Don’t hesitate to seek He or she may be an expert in the field, or they may out a support group for spouses and/or caretakers refer you to one or more doctors who are. Tips for Young Children Other factors to consider when selecting a doctor: > Keep children informed, as age appropriate, and > Are they covered by your health insurancefi For younger children, consult Do they seem interested in making you a partner in your therapist for suggestions on how much this processfi Urological Oncologists perform surgeries for treating prostate and other urological cancers. Genitourinary Oncologists perform surgeries for issues of the urinary and genital organs. Medical Oncologists specialize in treating cancer with medical therapies, such as chemotherapy, hormone therapy, and targeted therapies. Radiologists or Nuclear Medicine Physicians specialize “ I needed and expected my spouse to be my in interpreting imaging scans that you may have and may advocate and help me hear the doctors. I needed also perform specialized biopsies or deliver radioactive my friends to listen and laugh, and not give me medical therapies. Your Support Network Outside of your immediate family, there may be many Oncology Nurses administer treatment and monitor close friends and colleagues who care deeply about you, your vitals as you progress through the disease. With friends and family who have volunteered their assistance, don’t be shy Dietitians and Naturopathic Doctors counsel patients about letting them know a few specific things that on nutrition issues related to cancer and treatment. Examples might include rides Physical Therapists create and execute rehabilitation to treatment, meals, caring for young children, or programs to restore function and prevent disability performing difficult chores during recovery. On the other Occupational Therapists work with patients to help hand, don’t be shy about saying no to help you don’t them develop, recover, and improve the skills needed want, however generous. Genetic Counselors specialize in understanding and counseling you about inherited risks of cancer for you and your family. Social Workers, Therapists & Counselors help patients and their families cope with the emotional, social, financial and practical aspects of cancer. Sometimes this decision process can be empowering, and sometimes it can be bewildering. For example, although the first instinct may be to choose a therapy from the first provider you see who promises to eradicate the disease, you should take your time to investigate your options. Depending on the features of your cancer, and your age, overall health, and personal family circumstances, Active Surveillance may be the right choice for you. Side effects of each treatment are also important to consider, and only you can know what potential outcomes are acceptable to you. Regardless of which treatment you choose, it’s important to observe recommended diet and lifestyle modifications from the moment you are diagnosed. Work with your network of family, friends, and practitioners to set expectations and seek In the end, after all of your research into different support where appropriate. However, the Many friends and family choose to become active decision is very unique to you and it may not be in the cancer community in order to diminish the right for your brother, your friend, or any of the common feeling of powerlessness that can comes twenty other people you consulted, but you need with a loved one’s cancer diagnosis. For more info to decide what is the best choice for you to get on getting involved, visit Some people find the decision process liberating; others find it You beyond their individual ability. Use this guide to Sadness, fear, sleeplessness, and anger are all normal begin to understand your options, but don’t be early emotions around a cancer diagnosis. Coping afraid to rely on professionals, friends, and family with these emotions isn’t something you should take to help you navigate your final treatment plan. Seeking professional help, either from an online community, clergy, a church group, a cancer support group, or a private mental health professional isn’t a sign of weakness. Taking care of your mental health is akin to the kind of psychological training that a quarterback goes through to make sure he can keep his head in the game: it’s vital. It’s important to understand the basics of prostate cancer and identify with your medical team what treatment options are right for you. If multiple values over time have been collected, how fast has it risen, and what does this mean for mefi

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Age: the risk of prostate cancer increases with age order 250mg sumycin with visa bacteria that live on the ocean floor are sustained by, and average age at diagnosis of prostate cancer in the United States is 69 years discount sumycin 500mg on-line antibiotics kombucha. Race: African Americans are more likely to order sumycin 250mg fast delivery win32 cryptor virus develop prostate cancer and have more than twice the risk of dying from it discount sumycin 500mg amex infection yellow pus. Conversely, Asian men who live in Asia have the lowest risk; but when they migrate to the west, their risk increases. Family history: A man with a father or brother who developed prostate cancer has a twofold-increased risk for developing it. This risk is further increased if the cancer was diagnosed at a younger age (less than 55 years of age) or affected 3 or more family members. You should discuss with your doctor if you have a family history of not only prostate cancer, but also breast cancer, ovarian cancer, colon cancer, or pancreatic cancer. Where you live: the risk of developing prostate cancer for men who live in rural China is 2%, and is 17% for men in the United States. Similar results were found in Sweden, which is also a high-risk country for prostate cancer: immigrants to Sweden had a lower risk compared with native-born Swedes but, interestingly, the difference diminished the longer they were in Sweden. As mentioned, prostate cancer is over 8 times more common in Western culture than in Asia; moreover, when Asian men migrate to western countries the risk of prostate cancer increases over time. Researchers are now looking at prevention strategies which may shed light on this mystery. Benefits include early 40 If you have a family history> detection, offering a better chance to cure the disease if your cancer warrants treatment. It also 45 If you are African American> may inform you that you don’t need your prostate 50 If you have no history and you> cancer treated at all. Age 40 is a reasonable time to start screening for those at highest risk (genetic predispositions or strong family histories of prostate, breast, or ovarian cancer at a young age). For men they continued to recommend against screening ages 55 to 69 years, guidelines currently recommend for prostate cancer, with the rationale that shared decision making with the physician about potential benefits do not outweigh the harms. In general, all men should consult with their doctor and create a proactive prostate health plan that is right for them based on their lifestyle and family history. Other groups suggest this is an individual decision based on life expectancy and overall current health. There is general agreement that men with a life expectancy less than 10 years have more harm than benefit from prostate cancer screening. Discuss these individual tests with run in families with prostate cancer (hereditary your doctor to make screening decisions that prostate cancer). These Having a sister with breast cancer diagnosed at an early mutations may also increase risk for pancreatic and age (in her 40s or younger) may be valuable information other gastrointestinal cancers. Talk to your doctor about a referral to a genetic counselor if you have any of the Family members who learn that they are following risk factors that may indicate the presence carriers need to discuss their findings with of a hereditary cancer-risk mutation: genetic counselors and their doctors to > Personal history of metastatic prostate cancer determine their risk and recourse for > various cancers. Other gene mutations may have and/or who died from prostate cancer less known about them and/or tests can result in > Three or more family members, on the same side of variants of uncertain significance. These may require the family, with one or more of the following cancers: further discussion with a genetic counselor and breast cancer diagnosed at <50 years old, ovarian patients/families with these may consider participating cancer, pancreatic cancer, colon cancer, other cancers in research registries to help doctors and researchers learn more about those specific variants. While this other genes that increase risk for prostate cancer, this information can have important benefits, it has critical implications for all his family members. Early detection and management of cancer risk is a very specialized field and it is strongly recommended that families consider consulting doctors at a Center of Excellence (a medical center actively engaged in the latest research and treatments) to get the most updated information, recommendations and the best medical plan if they are found to have a cancer risk mutation. It is critical to be aware that the risk for any given cancer that is associated with any given mutation is not always clear. There are several well Fish, berries, cooked tomatoes, broccoli, and studied mutations that researchers believe are more green tea are fve of the top foods for protecting often present in patients with cancer. If you or someone in your family has been treated for prostate cancer, your family’s urologist or oncologist Improvements in diet and exercise are among the most may have a recommendation for a local genetic commonly accepted strategies for prevention. Try to keep the amount of fat you get from red meat and dairy products to a minimum. There is much hope on the horizon for men with Some calcium is okay, but avoid taking more than prostate cancer and their families. Eat more fish—evidence from several studies suggest and diet and exercise changes can help men with that fish can help protect against prostate cancer prostate cancer live longer and better lives. Avoid trans fatty acids (for example, margarine, In closing, although living a healthy lifestyle and eating microwave popcorn, packed baked goods). Try to incorporate cooked tomatoes that are cooked of prostate cancer, nor will they cure you by themselves with olive oil and cruciferous vegetables (like broccoli if you are diagnosed with prostate cancer. Soy age 50 or over, if you are age 40 or over and African and green tea are also potential dietary components American or have a family history of prostate cancer, that may be helpful. Recent studies have shown that drinking unfiltered “Italian Remember: Every patient is unique. Seek medical treatment for stress, high blood options, information, and questions with your physician. Treating these conditions may save your life and will improve your survivorship with prostate cancer. Too many vitamins may “fuel the cancer,” and while a multivitamin is not likely to be harmful, if you follow a healthy diet with lots of fruits, vegetables, whole grains, fish, and healthy oils you likely do not even need a multivitamin. Reducing stress in the workplace and home will improve your survivorship and lead to a longer, happier life. Quality Of Research Level I Evidence obtained from a systematic in about 40% of patients. It results review of all relevant randomised from the systemic effects of controlled trials.

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In tion’s commitment to generic sumycin 250mg with visa antibiotics yellow urine implementing a fully particular buy sumycin 500 mg overnight delivery antibiotic resistance research grants, clinical supervisors in trauma integrated buy sumycin 500 mg fast delivery virus barrier, trauma-informed system of care purchase 250 mg sumycin with amex infection behind ear lobe. Clinical Case Illustration: Arlene Arlene is a 50-year-old licensed substance abuse counselor who has a personal history of trauma, and she is actively engaged in her own recovery from trauma. She is an experienced counselor who has several years of training in trauma-informed and trauma-specific counseling practices. Her clinical supervisor, acting in the role of consultant, begins the supervision session by inviting her to set the agenda. Arlene brings up a clinical situation in which she feels stuck with a client who is acting out in her Seeking Safety group (for more information on Seeking Safety, see Najavits, 2002a). Arlene reports that her client gets up suddenly and storms out of the group room two or three times during the session. The supervisor, acting in the role of the counselor and focusing on personaliza­ tion, asks Arlene to reflect on the client’s behavior and what feelings are activated in her in response to the client’s anger. Arlene is able to identify her own experience of hyperarousal and then paralysis as a stress reaction related to her prior experience of domestic violence in her first marriage. The supervisor, acting in the role of teacher and focusing on conceptualization, reminds Arlene that her client is experiencing a “fight-or-flight” response to some experience in the group that reminds her of her own trauma experience. The supervisor then suggests to Arlene that her own reactions are normal responses to her previous history of trauma, and that when her client is angry, Arlene is not reexperiencing her own trauma but is being activated by the client’s traumatic stress reaction to being in group. In this way, the supervisor highlights the parallel process of the client–counselor’s stress reactions to a perceived threat based on prior trauma experiences. The supervisor, acting again as a consultant and focusing on personalization this time, invites Arlene to reflect on the internal and external resources she might be able to bring to this situation that will help remind her to ground herself so she can lessen the impact of her stress reactions on her coun­ seling strategy with this client. Arlene states that she can create a list of safe people in her life and place this list in her pocket before group. She can use this list as a touchstone to remind her that she is safe and has learned many recovery skills that can help her stay grounded, maintain her bounda­ ries, and deal with her client’s behavior. The clinical supervisor, acting as a consultant and now focus­ ing on intervention, asks Arlene if she has some specific ideas about how she can address the client’s behavior in group. Arlene and the clinical supervisor spend the remainder of the session discussing different options for addressing the client’s behavior and helping her feel safer in group. Clinical unusual cases supervisors need to recognize counselors’ • Opportunities to process clients’ traumatic trauma reactions (whether they are primary or material secondary to the work with survivors of trau­ • Boundaries in the therapeutic and supervi­ ma) and understand that a confrontational or sory relationship punitive approach will be ineffective and likely • Assessment of secondary traumatization retraumatize counselors. The styles and types of client–counselor and counselor–supervisor supervision and consultation may vary accord­ relationships is standard practice. This ing clients in an intensive early recovery respectful, collaborative supervisory relation­ treatment program using a manualized ship is the main source of training and profes­ trauma-specific counseling protocol. Competence-based clinical supervision models identify the knowledge and clinical Secondary Traumatization skills each counselor needs to master, and they the demands of caregiving exact a price from use targeted learning strategies and evaluation behavioral health professionals that cannot be procedures, such as direct observation of coun­ ignored; otherwise, they may become ineffec­ selor sessions with clients, individualized tive in their jobs or, worse, emotionally or coaching, and performance-based feedback. In a study of Mas­ Studies on competence-based supervision ap­ ter’s level licensed social workers, 15. The author 193 Trauma-Informed Care in Behavioral Health Services concluded that be fessional satisfaction. Providing directly to a leave the field counselors with the resources to help them traumatic event. It is impera­ responsibility of making decisions and can tive that clinical supervisors provide a non­ offer input into clinical and program policies judgmental, safe context in which counselors that affect their work lives. Clinical supervisors When organizations support their counselors should work collaboratively with supervisees to in their work with clients who are trauma­ help them understand their behavior and en­ gage in self-care activities that lessen the stress tized, counselors can be more effective, more that may be contributing to these behaviors. The and a lack of tolerance for strong emotions terms “compassion fatigue,” “vicarious trauma­ (Newall & MacNeil, 2010). Other negative tization,” “secondary traumatization,” and coping strategies include substance abuse, oth­ “burnout” are used in the literature, sometimes er addictive behaviors, a lack of recreational interchangeably and sometimes as distinct activities not related to work, and a lack of constructs. Other re­ individual’s traumatic experiences; this term searchers found that clinicians who engaged in will be used throughout this section, although negative coping strategies, such as alcohol and the studies cited may use other terms. These risk factors include organiza­ trauma; high caseloads of clients with trauma tional constraints, such as lack of resources for related disorders; being younger in age and new clients, lack of clinical supervision for counse­ to the field with little clinical experience or lors, lack of support from colleagues, and lack training in treating trauma-related conditions; of acknowledgment by the organizational cul­ unhealthy coping styles, including distancing ture that secondary traumatization exists and and detachment from clients and co-workers; is a normal reaction of counselors to client trauma (Newall & MacNeil, 2010). Counselors may be more at risk for (2006) point out, “a return to drinking or illicit developing secondary traumatization if the drug use as a strategy for dealing with second­ organization does not allow for balancing the ary trauma reactions would have a profoundly distribution of trauma and nontrauma cases detrimental effect on the recovering counse­ lor” (p. Another protec­ place, using positive personal coping styles, tive factor that may lessen the chances of de­ and possessing resilience or the ability to find veloping secondary traumatization is having a meaning in stressful life events and to rebound diverse caseload of clients. Organizations from adversity (Sprang, Clark, & Whitt “must determine ways of distributing work­ Woosley, 2007). Some of these factors, like load in order to limit the traumatic exposure positive personal coping styles and the ability of any one worker. This may not only serve to to find meaning in adversity, can be developed reduce the impact of immediate symptoms but and enhanced through personal growth work, may also address the potential longitudinal psychotherapy, engagement with spiritual effects” (Bober & Regehr, 2006, p. This support was reduced stress, and enhanced self-care of the associated with less emotional fatigue and participants; findings suggested that workers depersonalization, along with a sense of great­ were more likely to practice stress manage­ er personal accomplishment. In a study of do­ ment techniques like mindfulness at their mestic violence advocates, workers who place of work than at home (McGarrigle & received more support from professional peers Walsh, 2011). Organizations can support were less likely to experience secondary trau­ counselors’ individual efforts to enhance posi­ matization (Slattery & Goodman, 2009). Slattery and Goodman (2009) note that “for the trauma worker, good supervision can nor­ One of the organizational protective factors malize the feelings and experiences, provide identified in the literature that may lessen the support and information about the nature and negative impact of secondary traumatization course of the traumatic reaction, help in the on behavioral health professionals is providing identification of transference and counter adequate training in trauma-specific counsel­ transference issues, and reveal feelings or ing strategies, which increases providers’ sense symptoms associated with the trauma” (p.

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In addition discount 250mg sumycin with visa antibiotics for sinus infection how long, having the opportunity to order sumycin 500mg free shipping antibiotics cephalexin establish safe connections—with treatment providers sumycin 500mg amex antibiotics yes or no, families cheap sumycin 500mg mastercard antibiotic prophylaxis for colonoscopy, peers, and the wider community—is reparative for those with early/ongoing experiences of trauma. This experience of choice, collaboration, and connection is often extended to inviting individual involvement in evaluating the treatment services, and forming service user advisory councils that provide advice on service design as well as service users’ rights and grievances. Practitioners emphasize teaching and modeling skills for recognizing triggers, calming, centering, and staying present. Sandra Bloom, in her Sanctuary Model of trauma-informed organizational change [38], described this as having an organizational culture characterized by ‘emotional intelligence’ and ‘social learning’. Again, a parallel attention must be paid to practitioner competencies and learning these skills and values. Trauma-informed services involve service users, practitioners, managers, and all other personnel working in ways that demonstrate an understanding of the needs of people who have experienced trauma. Together with individual interactions, service practices, and policies, they create a non-hierarchical and supportive organizational culture. The principles and practices are underpinned by provision of training and clinical supervision, development of service partnerships, meaningful involvement and inclusion of people accessing services, as well as culturally competent practice. When First Nations, Inuit and Metis children were taken from their families and forced to attend residential schools between the 1860’s and 1990’s, a process of intergenerational trauma was sparked. In residential schools, Aboriginal children were subjected to loss of family, language, and culture as well as extreme forms of degradation and often ritualized abuse [45] including, neglect, physical, and sexual abuse by some residential school staff. Parents and other community members also experienced trauma as they dealt with the incredible loss of their children and their identities as parents, grandparents, siblings, aunts and uncles. Residential schools were supported by aggressive assimilation policies that aimed to destroy the values and cultures of Aboriginal people. The harms that these policies have had on Aboriginal people are devastating and continue to affect the health and well-being of many individuals and communities today. This is consistent with the definition of historical trauma provided by Maria Yellow Horse Brave Heart, who has developed historical trauma and unresolved grief theory and interventions among American Indians. She defines historical trauma as “the cumulative emotional and psychological wounding across generations, including the lifespan, which emanates from massive group trauma” [13]. The Provincial Health Services Authority has developed an on-line Indigenous Cultural Competency Training Program for people working with the health authorities in British Columbia. Participants have an opportunity to strengthen their understanding about aspects of colonial history and contexts for social disparities and inequities. The training promotes a culturally competent view of historical trauma that can assist service providers in building self-awareness and skills in this area. This type of cultural competence is essential to trauma-informed practice with Aboriginal people. At the Centre for Addiction and Mental Health in Ontario, in the Youth Addiction and Concurrent Disorders Service, trauma-informed approaches in the assessment and treatment planning processes have been used to enhance motivation to stay in treatment. This initiative has led to a local and regional community of practice, several shared training opportunities on various aspects of trauma-informed practice, regular cross sectoral dialogue, and a working group that designed a curriculum to be offered on a regular basis. This initiative was later extended to include the acute and tertiary services within the area and a strategic plan for enhancing trauma-informed practice within these areas is now in development. Trauma-informed principles have shaped the development of the program’s holistic approach to offering coordinated substance use, mental health, and primary health services within the context of one program. The principles are considered in all interactions with women who participate in the program. Over time, Atira has continued to deepen their trauma-informed practice by using the Organizational Checklist (see Appendix 2) to support shifts at the organizational level. The practice level approaches are organized as described and illustrated in the diagram below: 1. Preparing for trauma-informed practice— preparing Foundational topics are addressed which will for tip assist in the preparation for implementing trauma-informed care. These topics include, self awareness; vicarious trauma; trauma awareness; and the power of language. Such preparation is a trauma continuous process, foundational to all interactions skill Building informed and engaging and conversations with clients. This section making the links Asking about translates trauma-informed principles into skills with trauma traumafi There are varying perspectives on how to discuss trauma, and how much information should be gathered about trauma histories. Depending on the service and population served, the approach may be more formal or informal. This section provides some guidelines, skills, and strategies to support the conversation as it relates to current functioning. It also offers ideas for responding to disclosure and making referrals in a trauma-informed way. Making the links with trauma—Trauma-informed practice may also involve helping people make the link between their past experiences and present health and to reframe their responses as attempts to cope with what they have been through. This section outlines guidelines for sharing information, key messages related to trauma, and additional skills and strategies for information exchange. Skill building and empowerment—At any point in the conversation, a trauma response may be triggered. In that moment, it is essential to provide safety through grounding and containment skills. This section offers a stepped approach to assist individuals in managing an in-the-moment trauma response through a range of grounding and self-care skills and practices that aim to proactively preserve safety and strengthen resiliency.

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