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Archive for March 2012

How to Advertise Your Business on Facebook for Free

Saturday, March 31, 2012


With more than 64 million active users and around 250,000 new users joining every day, you can tap into the social networking revolution with a free page on Facebook for your blog or business … yes, I said free.
Previously you had to be BIG business with a BIG marketing budget to create a corporate or company Facebook account. Blockbuster Inc., CBS Corp., The Coca-Cola Co., Sony Pictures Entertainment Inc. and Verizon Communications Inc., are examples of well known companies that have a corporate presence on Facebook. Facebook members could then become “fans” by adding your company as a friend.
Now, this option is open to any business. Businesses can add any content they want, including photos, videos and music. Facebook users can share information about a business directly with the company by adding reviews or other information to that business’ page. Small businesses now have the advantage that only Fortune 500 companies could afford previously. It’s simple: here’s how you do it:
Creating A Facebook Business Page
1. Visit this URL
2. Choose the best category for your business.
3. Just enter your business name and then click “Create Page”.
4. Now you can add a description of your business and a website address. You can also add a photo or logo. There are sections to add more photos, video
5. Then click on your hyperlinked business name in the top left corner and click “publish this page.”
6. Finally, from your new profile page, become a fan of your business. This is important as all of your “friends” will now be able to see your page when they visit your profile and it will be shown in the news feed that “Suzanne is a fan of Dot Com Mogul”. With some social networking, some of your Facebook friends will also add your business as a friend and then their friends will see a message… and on and on.
To the left is a screenshot of your admin panel. You can send updates to fans of the business and there’s a link to Promote Page with an Ad. You can also use the pages’ discussion board to start topics, list events, or write on “the wall”. I’ve just added a page for my blog, Dot Com Mogul. You can see it here. (While you’re there, add it as a friend :) I plan to add more interesting info and a video to it, but this is the beginning page with minimal information. If you’re wondering why you should do this, just check out the Facebook statistics below, and did I mention …. it’s free.
Facebook Statistics
General Growth
  • More than 64 million active users
  • An average of 250,000 new registrations per day since Jan. 2007
User Demographics
  • Over 55,000 regional, work-related, collegiate, and high school networks
  • More than half of Facebook users are outside of college
  • The fastest growing demographic is those 25 years old and older
  • Maintain 85 percent market share of 4-year U.S. universities
User Engagement
  • Sixth-most trafficked site in the United States (comScore)
  • More than 65 billion page views per month
  • More than half of active users return daily
  • People spend an average of 20 minutes on the site daily (comScore)
Applications
  • No. 1 photo sharing application on the Web (comScore)
  • Photo application draws more than twice as much traffic as the next three sites combined (comScore)
  • More than 14 million photos uploaded daily
  • More than 6 million active user groups on the site
International Growth
  • The U.K. has the most users outside of the United States, with more than 8 million active users
  • Canada is the third largest country with more than 7 million active users
  • Remaining top 10 countries in order of active users (outside of the U.S., Canada and UK): Turkey, Australia, France, Sweden, Norway, Colombia, and South Africa
Platform
  • Over 15,000 applications have been built on Facebook Platform
  • 140 new applications added per day
  • More than 95% of Facebook members have used at least one application built on Facebook Platform

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A Sister’s Journey: The Cancer Diagnosis

Friday, March 30, 2012 · Posted in ,

Cassandra Hogue (left) with her sister, Caroline at LIVESTRONG event.
“This was never supposed to happen to her, I remember thinking, outraged, as if she and I had been given some kind of special exemption from sickness and suffering.”

Joan Didion wrote those words in her recent memoir, Blue Nights, about her 38-year-old daughter who was seriously ill. Those, too, were my thoughts when my 58-year-old healthy sister was diagnosed with an advanced form of cancer that was particularly difficult to treat.  

“How can this be happening to her? How can this be happening to me? I cannot bear to lose my sister.” 

I am certain every family member of a cancer survivor has had similar thoughts. For me, shock and fear predominated my emotions for three months after her diagnosis.

“How could her doctors have missed this? Why didn’t they find this sooner?”

For six months she had not been feeling well and was losing weight. I was outraged, disappointed, frightened. I didn’t voice this to my sister, but she knew how I felt, and I knew how she felt. 

I tried to stay positive and stay focused on the tasks at hand. I began organizing her medical care. I made her appointments at Penn’s Abramson Cancer Center, where doctors thankfully saw her within two weeks. We waited for PET scan results to determine if the cancer had metastasized.

The next month was the seemingly endless round of medical tests, procedures, surgeries to insert a chemotherapy port and feeding tube and radiation therapy appointments. I did inordinate amounts of research to educate myself about the disease, the statistics, treatments, mortality rates, alternative therapies. I went to support groups and read up on caregiver roles, but I was still in shock, still expecting our special exemption from sickness and suffering. 

My sister told me one night when we were having a long honest talk. “Let’s make a pact that we can always cry together,” she said.

I cried a lot in those three months.

But then, I unexpectedly turned a corner. Maybe I just exhausted that leg of the grief cycle. Who knows?  I participated in the Philadelphia LIVESTRONG ™ Challenge Cycling event sponsored by the Lance Armstrong Foundation.  More than 7,000 people participated – many of them cancer survivors, family members of cancer survivors or had lost loved ones too soon.

I talked to so many people that day.  I heard many stories, so much suffering and so much strength. My sister came to every rest stop, with a great sign: “My sister is riding for me.” She had just started chemotherapy and radiation, and was wearing sun protection, but she looked great.  

I had to just get back on the bike and finish the ride….no time for crying now. 

And no special exemptions.

More next month…

Learn more about the LIVESTRONG ™ Cancer Survivorship Center at the Abramson Cancer Center.

Join the 2012 Penn Medicine/ CHOP LIVESTRONG ™ Challenge Team.
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Walkabout Program for People with Cancer and Caregivers

Thursday, March 29, 2012 · Posted in ,

Collage artwork by a Walkabout program participant
Walkabout: Looking In, Looking Out is an innovative survivorship program at the Joan Karnell Cancer Center at Pennsylvania Hospital that addresses the normal psychological and physical changes that come with a cancer diagnosis and treatment. The goal of the program is to support participants with developing a strong view towards living well.

“Walkabout is a program that allows participants to move with the cancer experience towards making sense of what’s current and what’s next in life,“ says Caroline Peterson, ATR-BC, LPC, the art therapist and mindfulness meditation instructor who developed and leads the Walkabout Program. “In the eight-session Walkabout program, participants explore walking away from the medical environment into the world outside, open to discoveries using mindful attention and digital photography. Photographs, taken on the walkabout, are printed and then reconsidered and used for creative expression making collages.”

Collage art is a user-friendly creative form, and the feedback from Walkabout participants has been very positive. Each participant has used the various opportunities in Walkabout to make a deeper connection with themselves.

‘Taking the photographs reminded me of the beauty we’re surrounded by every day. The collage making gave me a surprising sense of accomplishment. It felt unexpectedly good to create something new.’ - Cancer survivor in active treatment, age 29

‘The photography allowed a filter on my perceptions . . .the resulting collages revealed more about me than I thought they would. The meditative component was also very beneficial in my daily life.’ - Caregiver, age 53

The Walkabout program is designed to be enlivening and strengthening.

“Underlying the pleasures of walking and being out in the world, the creative playfulness and relaxation is a focus on mindfulness skills training to be more attentive, aware and relaxed, less reactive to the stress of life and more at ease in daily living that can be very helpful,” says Peterson.

‘The how-to approach, meditation practice and further input with learning skills to continue on my own were very helpful. I no longer have the inner freight train going through my head. It’s okay to feel okay.’ –Cancer survivor, age 37

‘I learned through the Walkabout experience to be free of fear and to let go of anxiety, and then to be me – healthy and happy.’ - Cancer survivor, age 55

The Walkabout program welcomes those individuals with cancer in active treatment or post treatment. Caregivers are also welcome.

The walkabout is mindfully slow and not physically exerting. Participants should be able to walk slowly for up to 45 minutes.

Participants receive a mindfulness meditation practice CD for home practice following in-class instruction and teaching.

To enroll in the Walkabout program at the Joan Karnell Cancer Center, please call 215-829-8700.

Walkabout program details

Spring session dates: Wednesday evenings beginning April 4 through May 23
Summer session dates: Wednesday evenings beginning June 6 through August 1 (no meeting July 4)
Times: 4:30 to 7pm
Location: Joan Karnell Cancer Center at Pennsylvania Hospital; Farm Journal Building, 2nd Floor; 230 West Washington Square; Philadelphia PA 19106
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BED WETTING (NOCTERNAL ENURESIS) | Cause, Diagnosis, Parental guide and HOMEOPATHY

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                Nocturnal enuresis, commonly called bedwetting, is unintentional passing of urine while asleep after the age at which bladder control usually occurs. Bed wetting of children may be simply a delay in the establishment of voluntary control over the act of micturition
It is the most common childhood urologic complaint and one of the most common pediatric-health problems. Most bedwetting, however, is just a developmental delay. It not an emotional problem or physical illness. Only a small percentage (5% to 10%) of bedwetting cases are caused by specific medical situations. Bedwetting is frequently associated with a family history of the condition.

Most girls can stay dry by age six and most boys stay dry by age seven. By ten years old, 95% of children are dry at night. Studies place adult bedwetting rates at between 0.5% to 2.3%.

Why are you not wetting your bed at night?

      There are two physiological functions that prevent bed wetting at night. First one is an antidiuretic  hormone called arginine vasopressin which reduces urine production at night. Second one is the ability to wake up when the bladder is full. The first one will not be there at birth. Many children develop it between the ages of two and six years old, others between six and the end of puberty.
The typical development process begins with one- and two-year-old children developing larger bladders and beginning to sense bladder fullness. Two- and three-year-old children begin to stay dry during the day. Four- and five-year-olds develop an adult pattern of urinary control and begin to stay dry at night.

Types of nocturnal enuresis.

There are two types
1)      Primary NE:-  In this the child never has been dry.
2)      Secondary NE:- Secondary enuresis occurs after a patient goes through an extended period of dryness at night (roughly six months or more) and then reverts to nighttime wetting. Secondary enuresis can be caused by emotional stress or a medical condition, such as a bladder infection
What cause Bed wetting?
There are many reasons for Bed wetting. Some of them are as follows.
·         Neurological-developmental delay: - Most bedwetting children are simply delayed in developing the ability to stay dry and have no other developmental issues.
·         Genetics :- Children whose parents were not enuretic have only a 15% incidence of bedwetting. When one or both parents were bedwetters, the rates jump to 44% and 77% respectively.
·         ADHD(Attention deficit hyperactivity disorder)
·         Caffeine:- it can increase urine production
·         Alcohol conception
·         Physical abnormalities:- Less than 10% of enuretics have urinary tract abnormalities, such as a smaller than normal bladder.
·         Infection/disease:- these are more strongly connected with secondary nocturnal enuresis and with daytime wetting.
·         Stress:- It is not a cause for primary NE. It is mostly associated with Secondary NE
·         Traumatic: -    After circumcision operation or  Catheterization. It comes in Secondary NE
·         Worms can a reason for NE
·         Bad toilet training , some bad home situations and problems at school can cause NE.
·         Its been said that it is a kind of habit. It’s been found a sudden stopping of NE after marriage in girls.

Symptoms and signs associated with NE.

§  Frequency of urination
§  Urgency
§  Burning on urination
§  Discolored urine
§  Unable to control defecation
§  Constipation
The main symptom will be wetting of bed at night even after age of bladder control.
The above symptoms are mostly seen In secondary NE.

How to Diagnose the situation?

  A careful history should be obtained and a thorough physical examination should be performed to look for causes of Nocternal enuresis in children who present with bed-wetting. Causes of complicated enuresis include urinary tract infection, spinal cord abnormalities with associated neurogenic bladder, posterior urethral valves in boys, and ectopic ureter in girls. In addition, a bowel history is needed to rule out chronic constipation.
Parents should be questioned about their family history and the child's medical history . Careful questioning of parents and children can be extremely helpful in determining the type of enuresis and a possible cause or contributing factors.

What should Parents do?

Parents often are not fully aware of their child's daily voiding habits. Thus, a voiding diary may need to be maintained for a week or more. The family should keep track of how many times the child voids during the day and how many nights the child wets the bed.
Follow the things given below and feel happy with your kid.
  • Limit drinks after dinner, and keep caffeinated beverages to a minimum all day (they irritate the bladder and make the kidneys produce more liquid).
  • Start the habit of using the bathroom right before bed.
  • Explain that it's okay to get up during the night to go to the bathroom. (And leave a nightlight on in there.)
  • Consider stationing a portable potty (and a nightlight) in your child's bedroom.
  • Don't wake your child to use the potty before you turn in  -- it won't teach him to get up on his own.
  • Never push him, shame him, or make him sleep in a soggy bed. It could have the opposite effect, causing daytime accidents and lowering self-esteem.
  • Offer simple gift -- a sticker, say, and words of praise -- when there's a dry night.
  • Expect accidents. Retire the diapers once your child's able to stay dry five nights in a row (it's fine to bring them back out if his streak doesn't last), but don't take the plastic cover off the mattress for another year or so.
Homeopathy for Bed wetting

It is a normal thing till the age 2 to 4. As it is hereditary sometimes, a detailed history is needed for a homeopathic prescription. After figuring The mental and physical generals of the child a constitutional remedy is prescribed by a homeopath. In my experience I have found good improvement in my patients.
I am listing out a group of medicines which can be prescribed for NE
Belladonna:Children with blue eyes , light hair , fine complexion ,delicate skin, restless sleep, involuntary urination consequent upon paralysis of sphincter muscles. This patient has fear of Dogs, cats and dark animals.
Rhus tox: Enuresis due to weakness of bladder with constant dribbling of urine. Weak muscular tone.
Causticum:Particularly in children during first sleep worse in winter and ceases or becomes more moderate in summer with great debility . Incontinence of urine. Urinates while coughing.
Gelsemium:Due to paralysis of sphincter muscles , does not like to talk with anybody .
Petroleum:Due to weakness of bladder, urine drops out even after urination, involuntary at night in bed.
Sulphur: wetting bed at night, copious discharge of children who suffer from chronic cutaneous eruption. Irritable hot intelligent children with a untidy skin and red lips.
Kreosotum:Enuresis with dream of urination in a decent manner, wets the bed at night. Very offensive urine with yellowish discoloration.
Borax : Frequent urination at night, children who are frightened when being laid in a cot or carried down stairs. Useful in hot patients.
Argentum nitricum: Great nervousness with restlessness, urine passes unconsciously and interruptedly, pale fetid urine, drinking coffee aggravates. The child has fear of streets and buildings.
Psorinum:Worse during full moon. Intractable cases, when there is an eczematous history. In children when there are Psoric manifestations. Secretions have filthy smell. The child is very sensitive to cold.
Calcarea carb : complaints of children who are fat, fair and flabby too much emission of urination at night. Sour vomiting of children during dentition with a tendency to eat indigestible things such as chalk, pencils etc, Timidity and slowness of all motions will be seen in this.
Medorrhinum : in children where there is a psychotic history nocturnal enuresis weak memory, fear in the dark as if some one is behind her/him.
Sepia : The sepia child is dull, depressed moody indolent with a greasy skin disinterested in work worse from change of weather. A tendency to diarrhea from boiled mil, the child is prone to enuresis during the first sleep.
Cina: the chief remedy for worms. The child is very irritable useful for round and thread worms (not pin worms) urine turns milky on standing. Enuresis during first sleep, great appetite soon after leaving the table.
Silica : useful for children suffering from worms due to weakness of urinary organs . Obstinate children.
Tuberculinum : Enuresis in a child with primary tuberculosis psychotic persons.
Pulsatilla—suited to cases of nocturnal enuresis occurring in children of tearful habit, conscious of its leakage but unable to control it. The urine passed drop by drop. Mild yielding girls who cries very easily. Intolerance to fatty foods.
Equisetum : Enuresis by day and night, it acts well when it remains a mere force of habit, after removal of the primary cause, dreams of seeing crowd of people
Kali phos : Enuresis in longer children due to nervous factors. 
Kali brom : Nocturnal enuresis from profound sleep of children or young persons.
Benzoic acid: when enuresis is accompanied by high colored and strong smelling urine, Benzoic acid will turn the urine normal and prevent its escape.
Nat. mur : Hungry yet looses flesh , craving for salt , aversion to bread and fats , child emaciating from neck urine passing involuntarily when walking and coughing , has to weight a long time for it to pass if others are present . Bed wetting in school going girls. Hot patient with craving to salt.
 Capsicum:has never recovered from a house move or other displacement.
 I have not listed all possible medicines for bed wetting here. A homeopathic medicine shout be figured after the complete canalization of the case. 
  Sources:
www.Aafp.org
www.Parenting.com
www.Wikipedia.org
ww.Madeformums.com
www.parentsask.com

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Do I really need to get a colonoscopy?

Wednesday, March 28, 2012 · Posted in ,

Vinay Chandrasekhara, MD, is a gastroenterologist at Penn Medicine. Here, he discusses the one cancer screening you shouldn’t avoid.

Colorectal cancer (CRC) is one of the few cancers that can be prevented with screening. In the United States, it is recommended that everyone over the age of 50 be screened for CRC. If you have a family history of colon polyps, cancer at an early age or certain chronic medical conditions you may be encouraged to be screened starting at an earlier age. 

Although the incidence of CRC and cancer-related deaths is decreasing, colon cancer screening remains underutilized. Consequently, CRC remains the third most common cancer worldwide and the second leading cause of cancer deaths. 

One of the main barriers to CRC screening is the lack of awareness of the disease. CRC tends to not be discussed as openly as other conditions such as breast or lung cancer. Furthermore, the thought of undergoing a colonoscopy is not appealing to anyone. This is compounded by the fact that there is a general misperception about the study. 

Colonoscopy can detect early tumors, and more importantly pre-cancerous growths of tissue called polyps. Polyps can be removed at the time of the procedure, thereby preventing you from ever developing cancer.

Know what to expect at a colonoscopy

Preparation for a colonoscopy involves using a prescription laxative the day before the procedure to clear the colon. Prior to the study, anesthetic medications providing “twilight” sedation are given through an IV.  You are able to follow commands under twilight sedation, but remain comfortable if not asleep during the entire exam. 

Once sedated, a long thin flexible tube with a light and a high-definition (HD) camera at the tip is inserted through the rectum and advanced to the end of your colon.  The total length of the exam is typically 20 to 30 minutes.

I tell almost all of my patients that the hardest part of the exam is the preparation the day before the procedure. Many patients wake up from the sedation unaware that the test has already been performed.  At Penn the preparation has been improved so the standard laxative solution is no longer a gallon of fluid, but is a more palatable combination of Miralax® dissolved in Gatorade®.

Alternatives to standard colonoscopy

Frequently, I am asked if there are alternatives to colonoscopy for CRC screening.  Several newer promising technologies are currently under development for CRC screening.

CT colonography or “virtual colonoscopy” is a technique whereby a series of X-rays are used to create 2- and 3-dimensional images of the colon and rectum to evaluate for large polyps and tumors.  Virtual colonoscopy has the advantage of being a less invasive test that does not require sedation.  However, this procedure does expose you to ionizing radiation. While one CT is unlikely to be harmful, recurrent exposure to ionizing radiation may pose a health risk to certain individuals. 

Unfortunately, CT colonography can only reliably detect polyps greater than 5mm in size or early cancers.  Colon polyps smaller than 5mm may be missed.  Furthermore, if a polyp or tumor is detected, a colonoscopy is required for removal of the polyp or to biopsy the area of interest for a tissue diagnosis. Finally, in order for this test to be effective, you still have to drink the colon preparation solution before the examination.

Other new technologies under development are fecal immunochemical test (FIT) and colon capsule endoscopy. 

FIT involves submitting a stool sample to analyze for the presence of occult blood. The sample can be collected in the comfort of your own home without the need for a bowel preparation; however, since this test only detects the presence of blood in the stool, it only identifies tumors or advanced polyps that are bleeding. FIT does not accurately identify early precancerous polyps. 

Colon capsule endoscopy is an intriguing new method in which you swallow a capsule containing small cameras that take pictures of your digestive tract.  Since this technology relies on cameras, you still have to do the colon preparation (the hardest part of the colonoscopy exam) and if a polyp or lesion is identified a subsequent colonoscopy is required for biopsy or removal of the polyp.  

The bottom line is that roughly 80 percent of CRCs can be prevented with adequate screening and colonoscopy screening saves lives.  I encourage everyone to begin the dialogue about CRC screening with their physicians. While no screening test is 100 percent perfect, colonoscopy remains the best method of screening for most individuals.

Are you 50 years old or older? Make an appointment at Penn Medicine for your routine colonoscopy by calling 1-800-789-PENN (7366).

March is Colorectal Cancer Awareness month – learn more.
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A Team Approach to Treating Colon and Rectal Cancer

Tuesday, March 27, 2012 · Posted in , ,

Cary B. Aarons, MD, is an assistant professor of surgery in colon and rectal surgery. In this blog, he discusses surgical treatment of colorectal cancer.

Colorectal cancer is the third most common type of cancer diagnosed in the United States. Fortunately, the overall prognosis for treating colorectal cancer is quite favorable if it is discovered early. In fact, up to 90 percent of patients whose colorectal cancer is diagnosed and treated in the early stages can be cured.

The management of colorectal cancer requires a team approach. From the time of diagnosis, comprehensive treatment demands a coordinated effort between the patient, family, gastroenterologist, oncologist, and surgeon. At Penn’s Abramson Cancer Center, every patient receives a multidisciplinary approach to their cancer care, meaning every member of the team involved in their care works together under one roof.

Experienced patient navigators also assist patients throughout the course of their treatment.

The treatment recommended primarily depends on the stage of the cancer, or the extent to which the cancer has spread.

Surgery offers the only potential for curing cancers localized to the colon and rectum. Invasive cancers localized to the colon typically require a partial colectomy, a procedure in which part of the colon is removed. This procedure is often done with laparoscopic surgery. The surgeon makes smaller incisions in the abdomen through, which specialized cameras and instruments can be inserted. This minimally invasive approach is often less painful and results in a quicker recovery. Laparoscopic and robotic-assisted surgery for rectal cancer are still being studied.

A physician may recommend chemotherapy and radiation be used initially to treat invasive cancers localized to the rectum to decrease the possibility of recurrence after surgery.

Advanced cases of colorectal cancer require chemotherapy and in select cases, there may be a role for surgery.

Learn more about treatment options for colorectal cancer at Penn’s Abramson Cancer Center.

Watch Focus On Gastrointestinal Cancers – an educational conference for patients with a gastrointestinal cancer.

March is colorectal cancer awareness month – learn more.
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Program Connects Patients to Colorectal Screenings

Monday, March 26, 2012 · Posted in ,

Carmen E. Guerra MD, MSCE, Michael L. Kochman, MD, FACP, 
Alicia Lamanna, Medical Assistant and patient liaison for the program and Josh Ramos, 
a Penn junior who was awarded a grant to work on the navigation project.
Colorectal cancer is the second most common cause of cancer deaths in the United States. Although studies prove that screening reduces colorectal cancer morbidity and mortality and is recommended for everyone over the age of 50, only 60 percent of Americans have been screened.

Penn Medicine’s West Philadelphia GI Health Outreach and Access Program is working to improve the colorectal cancer screening rates in the West Philadelphia community. 

The program provides education about colorectal cancer screening and physical navigation through the screening process for people who live in the following zip codes:
  • 19104
  • 19131
  • 19139
  • 19143
  • 19151
Patient navigator, Alicia Lamanna, works with patients on a one-on-one basis and addresses barriers that might prevent them from getting a screening test. She also ensures patients understand the information by using language that is easy to comprehend.

Assisting patients every step of the way

The patient navigation program is committed to providing every patient the assistance and encouragement they need throughout the entire screening process.

The program provides the following:
  • Help with scheduling a colonoscopy.
  • Education about the screening including literature, instructions for the screening preparation and motivational information.
  • Encouragement and support.
  • Reminder phone calls about the screening appointment.
  • Instructions for the day of screening.
  • Transportation assistance.
  • Accompaniment to and from the screening exam. 
With financial support from the American Cancer Society and the Walmart Foundation, the program provides Miralax-Crystal Light bowel prep at no cost for patients who are unable to afford the cost of the prep, along with round-trip Septa tokens for the patient and companion to help them get to and from the procedure. 

Finally, one week after the procedure, Alicia, communicates the physician's findings and recommendations both verbally and in writing to everyone who participates in the screening.

To qualify for the program patients must:
  • Be between the ages of 50 and 75
  • Live in one of the five participating West Philadelphia zip codes
  • Have an order or prescription for a colonoscopy from your Penn primary care physician

Whether the reasons are financial, insurance or personal  — such as being embarrassed or nervous — that keep someone from getting a colorectal screening, the outreach program provides the assistance needed to obtain this life-saving screening. 

To learn more about the program, please call the patient navigation office at 215-439-8281 or email Alicia Lamanna at Alicia.lamanna@upenn.uphs.edu.
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How to Get 1000 Visitors a Day | Website Traffic Tips

Saturday, March 24, 2012


How To Get Traffic To Your Site Fast!


Getting traffic to your website can be exhausting and a hard battle. Some online marketers tend to give up rather quickly because of not getting enough traffic to their website. While it is not an impossible task, you will need determination and the right resources to starting getting at least 1000 visitors a day to your website. Here is how to do it really fast:

1.       Article Sites- Articles sites are a popular way to gain some readership, but they can also get you fast traffic from the search engines. Let me be clear; article sites are not article directories. With most article sites, your content can be publishes in less than a day (in most cases, instantly), which will gain you backlinks more quickly. Some examples of article sites include; Associated Content, Helium and Ehow. Most of these article sites also give you a cash reward for page views, but expect pennies. But, to use them for traffic, simply write an article with a link to your website. It is as simple as that. You can also ping the article’s url using Pingomatic or Pingler.com.

2.       Deep-Link Directories- This is a technique that was just introduced to me like 3 days ago. Google values a website with deep-linking more than just a high page rank index/main page. Deep-linking is when you have a high page rank for all pages of your site. This would include blog post. I also like deep-link directories better because you can constantly add new pages for higher page rank.

3.       Hubsites- Hubsites are a favorite of mine because they work like article directories, only you can get faster results in shorter amount of time. Article directories take up to a week for your article to be published, while with hubsites, it takes less than a day to get your articles indexed in the search engines. Some popular hubsites are; Hubpages, Xomba and Squidoo. Hubpages is the best in my opinion because your link will be dofollow, which will get more attention from the search engines. The other 2 hubsites mentioned have a ‘nofollow’ tag, but they can still boost your page rank to your website.

4.       Forum posting- This is probably the easiest method link building ever. Here is the thing about link-building though; you have to do it in volume in order for it to work. So, just think of it this way; in order to make one sale, you will need to post 50-100 post per day. While this does seem like a tedious project, you can surf and answer other people’s questions. Just make sure to edit your signature using a low competition filled word for your anchor text. That’s it! Every time you post a comment, your signature will instantly be added. Only use forums that have a page rank of 6 or higher.

5.       Multiple blog posting- Writing more than 5 post a day can be quite exhausting, but it is good for your traffic. I would suggest writing at least 10-20 blog post per day. Sometimes, most webmasters don’t have the time to do this themselves. I would suggest buying a PLR article pack. Most of them are affordable and can be found in popular webmaster forums.

6.       Facebook- Facebook has become one of the easiest and free marketing tools to use. Since Facebook is ‘dofollow’, marketers can use the ‘status update’ feature to tell about a new product or a website and add a link as well for Facebook members to use. I would suggest using a pre-existing Facebook page to market instead of creating a new one. It can become obvious that you are only using Facebook as a marketing tool and your account will instantly be banned.
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Positive Margins After Prostatectomy: They Are Not All The Same

Friday, March 23, 2012

One element of a pathology report that every urologist looks for after performing a prostatectomy is the status of the surgical margins.  The term “margins” refers to the cut surfaces of the prostate and, specifically, whether prostate cancer can be found at these cut surfaces.  When pathologists receive a prostate specimen after a prostatectomy they usually cover the surfaces of the prostate with ink.  They then look to see if prostate cancer cells can be found within these inked margins.  The presence of prostate cancer at one of these inked surfaces is termed a “positive margin”.  Found in approximately 30% of prostatectomy specimens, positive margins can impact the prognosis of men with prostate cancer as well as result in the need for adjuvant therapy after surgery.  However, as I will explain, not all positive margins are the same. In this post, I will describe the different types of positive margins as well as the significance of these findings.

Types of Positive Margins

You would imagine that a positive margin is a pretty straightforward thing.  After all, cancer cells are either present at the margins or not, right?  While this is true, prostate margins are, in reality, a little more complicated.  Different types of positive margins occur for different reasons and, in turn, have different consequences.

1)      Positive Margin in Organ Confined Disease (T2):   The prostate is covered by  a lining called the capsule.  Prostate cancer that is organ confined is located entirely within the limits of the prostate and, in turn, within the capsule.  During prostatectomy, the surgeon may accidentally cut into the prostate, stripping some of the prostate capsule away and possible exposing an area of prostate that contains prostate cancer.  In this situation, prostate cancer can be  seen extending to the margin while no capsule is seen in the area.  In this situation, the pathology report may state that the capsule in the area of the positive margin is “stripped” or “not seen.”  This type of positive margin is usually due to technical error during surgery rather than to aggressive disease.  Positive margins have been reported in 5-27% of men undergoing prostatectomy for organ confined disease.


2)      Positive Margin in Non Organ Confined Disease (T3-T4): Occasionally aggressive prostate cancer can extend through the capsule and out of the prostate.  This is called extracapsular extension (ECE) or extraprostatic extension(EPE).  Either way, it means that the cancer went outside of the prostate before the prostatectomy was performed.  Occasionally, the surgeon can cut around the prostate widely enough to still remove the cancer completely despite the ECE.  Sometimes, however, the cancer extends beyond where the surgeon can safely cut and, so, some cancer is left behind, creating a positive margin.  The pathology report in this situation usually reports that cancer cells are seen “extending through the capsule and are noted at the margin.”  This positive margin is caused by the aggressiveness of the cancer rather than by surgical technique. Positive margins have been reported in 17-65% of men undergoing prostatectomy for non organ confined disease.

3)      Artifactual Positive Margin: Sometimes what appears to be a positive margin is not one at all.  Occasionally, the way a prostate specimen is manipulated during surgery or during pathology processing creates an appearance of a positive margin.  This is, of course, often difficult to distinguish from the real thing.  Given the anatomy of the apex of the prostate (the tip of the prostate that connects to the urethra) what appears to be a positive margin at that location is often thought to be an artifact.


Risk Factors for Positive Margins

Many studies have determined specific preoperative factors that make positive margins more likely.  As you might imagine, the different types of positive margins have different risk factors.  Positive margins in non organ confined disease are usually more likely to be found in men with high risk prostate cancer at biopsy.  These men usually have higher PSA, higher Gleason score, and/or prostate nodules that can be felt on rectal exam.  In contrast, risk factors for positive margins in organ confined disease are more technical in nature.  A prostatectomy performed on an obese man or someone with a narrow pelvis is usually more challenging to perform, making an inadvertent cut into the prostate and subsequent positive margin more likely. Obese men, for example, have twice the likelihood of having a positive margin as compared to men of normal weight. Similarly, surgeons with less experience are less likely to be able to identify and preserve the important surgical landmarks of the prostate, also making positive margins more likely.

Impact of Positive Margins

So why do we care about positive margins? Aside from serving as a surgical benchmark for urologists, positive margins also have a significant impact on cancer outcomes after prostatectomy.  For example, studies have shown that men with a positive surgical margin have double the risk of a PSA recurrence (cancer recurrence) as compared to men with negative margins, even after taking into account other risk factors.  Of course, positive margins in men with non organ confined disease (positive ECE) have a worse prognosis than those with positive margins and organ confined disease.  For example, in one study, while 18% of men with positive margins and ECE developed metastases, no men with a positive margin and organ confined disease developed metastatic spread after 7 years of follow up.  Nonetheless, positive margins in organ confined disease also often yield a worse prognosis.  One study, for example, demonstrated that men with organ confined disease and a positive margin have as high a likelihood of having progression of their prostate cancer as men with ECE but negative margins (25%).  Hence, positive margins in organ confined disease have the effect of   “up staging” the prostate cancer from T2 to T3 when seen from the standpoint of prognosis.  While demonstrating such a significant impact on prostate cancer outcomes, however, positive margins do not always result in a prostate cancer recurrence.  In fact, studies have demonstrated that 40-50% of men with a positive margin never demonstrate a PSA recurrence.  This statistic is often attributed to the existence of the artifactual positive margins described above as well as to small positive margins in cases of non-aggressive prostate cancer.

Dissecting Positive Margins Further

As if positive margins and their consequences were not confusing enough, pathologists are now looking at margins in even more detail to create further risk categories.  Some elements of positive margins that have been studied include the length of the positive margin, its location within the prostate, and whether there is a single versus multiple positive margins.  Studies have demonstrated significant impacts of the margin sub-characteristics on the chance of PSA recurrence (and, in turn, prostate cancer recurrence) after surgery.  Multiple positive margins, for example, have been demonstrated to yield a 40% higher chance of PSA recurrence as compared to a single positive margin.  Also, an extensive or long positive margin (the critical length has ranged from less than 1 to over 3 millimeters) has been shown to result in a PSA recurrence 30% more often than small or “focal” positive margins.  The location of positive margins has, also, been demonstrated to predict the potential for recurrent prostate cancer.  Historically, for example, a positive margin at the apex (or tip) of the prostate has been considered to be much less worrisome than positive margins at other areas of the prostate, particularly those at the back of the prostate near its lateral edge.  Unfortunately, there is a great deal of contradictory data emerging about these sub-characteristics of positive margins.  In addition, a recent large study of over 5000 patients demonstrated that while these sub-characteristics do help to predict the risk of cancer recurrence, they do not appear to add any further predictive power above and beyond that derived from the simple presence or absence of positive margins.  As a result, while these sub-characteristics of positive margins are somewhat useful in helping to sort out the significance of a positive margin, they are not powerful enough to substantially change the approach to dealing with a given positive margin.

Managing Positive Margins

While understanding positive margins can be helpful in predicting the risk of cancer recurrence after prostatectomy, this knowledge also creates a dilemma of how to proceed.  As mentioned previously, while positive margins can double the risk of prostate cancer recurrence, nearly half of men with positive margins never have a recurrence of their prostate cancer.  As a result, immediately treating ALL men with positive margins to prevent a recurrence would mean that 50% of these men would be undergoing treatment unnecessarily.  Given the fact that the treatment of choice in this situation would be radiation the added, unnecessary, risks of this radiation to 50% of the men in question would be unacceptable.  As a result, a great deal of controversy exists as to who should get radiation treatment for a positive margin right away (adjuvant radiation) and who should wait for a PSA recurrence first (salvage radiation).  I have discussed this controversy in my previous post entitled, “High Risk Prostate Cancer After Prostatectomy: Radiate or Wait?”  : 

http://prostatecancersymptomstips.blogspot.com/2011/04/high-risk-prostate-cancer-after.html



 

   

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From A Sister's Point of View - Meet Cassandra

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Cassandra Hogue (left) with her sister Caroline at a LIVESTRONG event
Cassandra Hogue is a new contributor to the Focus On Cancer blog.

Cassandra’s sister is a cancer survivor who was treated at Penn’s Abramson Cancer Center. Through her sister’s surgery, several rounds of chemotherapy, radiation therapy and most recently, proton therapy, Cassandra has been a solid source of support and comfort for her sister.

Cassandra recalls Caroline’s observation about their roles as patient and family member:

“Being a family member is equally as hard as being a patient, just in a different way.”

Cassandra has a special interest in quality of life issues and emotional/psychological support for both cancer survivors and their families. She knows first hand how a cancer diagnosis affects the entire family and can present difficult challenges for them.

In 2008, Cassandra joined the Penn Medicine LIVESTRONG ™ Challenge team and currently supports the LIVESTRONG ™ partnership as a grassroots leader for the southeastern Pennsylvania/ Delaware region.

As a contributor to the Focus On Cancer blog, Cassandra brings the perspective of a caregiver, cheerleader and (sometimes) travel planner for a family member with cancer.

Learn more about the LIVESTRONG ™ Cancer Survivorship Center at the Abramson Cancer Center.

Join the 2012 Penn Medicine/ CHOP LIVESTRONG ™ Challenge Team.
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Rising PSA After Negative Prostate Biopsy Part II: Can PCA3 Prevent Unnecessary Biopsies?

Thursday, March 22, 2012 · Posted in , ,


In my last post I discussed some PSA based tools that can be used to determine whether a rising PSA is due to prostate cancer or to other causes.  Such tools are very important because repeat biopsies for men with rising PSAs are positive for cancer in only 10-30% of cases, depending on how many biopsies are performed.  The yield (chance of cancer found) is less and less for every subsequent biopsy performed.  As a result, 70-90% of men may be undergoing these biopsies unnecessarily.  The problem with performing all of these repeat biopsies, aside from the pain and discomfort, is that they are not without risk (some more information about what to expect from prostate biopsies can be found in this previous post).  Unfortunately, the PSA tools I described, while helpful, are far from perfect.  The problem with these tests stems back to the basic problem with PSA: it is not only produced by prostate cancer but by normal prostate tissue.  As a result, PSA tests can be falsely elevated by other factors like infections, large prostates, and having sex.  Due to this limitation, PSA and PSA based tools can often overestimate the risk of prostate cancer in men with previously negative biopsies.  This, in turn, can lead to many unnecessary biopsies in men without prostate cancer.  Fortunately, a new test has recently been approved that may help determine which men really need to undergo a repeat biopsy in response to a rising PSA.  This test, called PCA3, may significantly decrease the need for repeat biopsies in select men with rising PSAs.  In this post, I will explain what PCA3 is, why it may be more informative than PSA, and how it may be used to prevent unnecessary biopsies.

What is PCA3?

Lets first discuss what PCA3 actually is.  PCA3 is a gene found within the DNA of human cells.  Like other genes, PCA3 serves as a code to produce a type of protein called mRNA.  It turns out that prostate cancer cells produce over 60 times more of the PCA3 mRNA than normal prostate cells.  In addition, no other tissue type in the human body produces this mRNA either.  Identifying this very prostate cancer specific protein, scientists then developed a test to identify and quantify it in men.  Unlike PSA, the PCA3 test is actually a urine, rather than blood, based test.  The test begins with a “prostate massage” by the physician.  Basically, this is a vigorous prostate exam that lasts for a few more seconds than a routine rectal exam.  After this exam, the patient then urinates and the urine is analyzed to look for and quantify the amount of PCA3.  The idea here is that the prostate exam causes the prostate to secrete the PCA3 protein into the urine, which can then be collected for quantification.

How is PCA3 better than PSA?

As I mentioned earlier, the major flaw of PSA is that it is not specific enough for prostate cancer.  In other words, way too many other things can cause PSA elevation aside from just prostate cancer.  PCA3, in contrast, is very specific for prostate cancer.  Neither infection nor sexual intercourse elevate PCA3.  In addition, unlike PSA, PCA3 is not proportional to the size of the prostate.  In other words, larger prostates do not produce more PCA3.  Finally, even urological procedures like prostate biopsies and cystoscopies, notorious for raising PSA, have no effect on PCA3.  I am sure that you are now starting to see the beauty of this new test.  Because it is so specific for prostate cancer, it may be able to prevent the unnecessary pain and risk of repeat biopsies in men with rising PSAs.  Lets see how this theoretical advantage pans out in practice.

PCA3 and the Prostate Biopsy Decision

Numerous studies have evaluated the utility of PCA3 in predicting prostate cancer.  One study evaluated the accuracy of PCA3 in predicting the extent and significance of prostate cancer.  The study obtained PCA3 tests from men with known prostate cancer about to undergo radical prostatectomy and then correlated the PCA3 level with the pathology findings from the surgery.  The study reported some very encouraging findings.  First, the study found that men with small amounts of cancer demonstrated significantly lower PCA3 values than those with large cancer volumes (PCA3 scores of 17 versus 47, respectively).  The study similarly found that men with insignificant or low risk prostate cancer also demonstrated substantially lower PCA3 scores than their counterparts with more substantial prostate cancer (PCA3 scores of 16 versus 45, respectively).

While PCA3 has, thus, been demonstrated to be a good predictor of significant prostate cancer, can this new test help predict the presence of prostate cancer and the need for prostate biopsy in men with a rising PSA after a previously negative biopsy?  Several studies have done just that.  A small study of 51 men, for example, performed a PCA3 test on men with a negative prostate biopsy who then underwent  a repeat biopsy for a further rising PSA.  The study reported that men with a positive repeat biopsy demonstrated substantially higher PCA3 values (median 50) as compared to those men with negative repeat biopsy (median 28).  A substantially larger study of over 1100 men undergoing repeat biopsies demonstrated a similar discrepancy of PCA3 values of 34 versus 17 for men with positive versus negative repeat biopsies, respectively.  This large study also reported that men with a PCA3 level greater than 35 had twice the risk of a positive biopsy as compared to those men with PCA3 less than 35.  Given this ability of PCA3 to differentiate prostate cancer from other causes of rising PSA, another study of 127 men reported that the PCA3 test can help avoid up to 73% of unnecessary repeat biopsies. 

Is there a downside to PCA3?

The main downside to PCA3 appears to be the lack of an accepted, definitive cutoff point above which the presence of prostate cancer is nearly certain.  While higher values of PCA3 are certainly more indicative of prostate cancer than lower values, there is no single magic number that can serve as a cutoff.  Numerous studies have used 35 as such a cutoff but with mixed results.  For example, one study evaluated using 35 as the PCA3 cutoff.  The study demonstrated that if only men with PCA3 over 35 were biopsied, 85% of previously undiagnosed prostate cancers would be detected while avoiding 50% of unnecessary, repeat negative biopsies in men without cancer present.  The study demonstrated that if a PCA3 cutoff of 44 is used to trigger a repeat biopsy, in contrast, only 75% of previously undiagnosed cancers would be detected while avoiding 73% of unnecessary, repeat negative biopsies. Still other studies have argued for lower cutoffs (such as 15 or 25), which identify larger percentages of previously undiagnosed cancers (95%) for the tradeoff of substantially more unnecessary biopsies.  So what is the magic number?  Is it more important to identify more cancers or prevent more unnecessary biopsies?  That is the million dollar question that is still being debated.  That is also a drawback of the test.

Take Home Message

For many years, urologists have been looking for a noninvasive test that can reliably predict the presence of prostate cancer in men with a rising PSA and a negative previous prostate biopsy. A rising PSA can often be misleading as its rise can be triggered by factors not related to prostate cancer such as an enlarging prostate, urinary tract infection, or even sexual intercourse.  A test was needed that can eliminate such extrinsic factors to determine if a man really does need a repeat biopsy or if he can safely avoid the risks and discomfort of this procedure. 

In many respects, PCA3 seems to be just such a test. It is only produced by prostate cancer and, so, is not affected by extrinsic factors.  It is fairly easy to obtain if you discount the discomfort of a “vigorous” rectal exam.  It appears to differentiate significant from relatively innocuous prostate cancer.  And it has been demonstrated through numerous studies to significantly reduce the number of unnecessary prostate biopsies while not substantially decreasing the ability to identify prostate cancer.  Is PCA3 the holy grail of prostate cancer diagnosis?  Of course not.  Is it without its limitations?  No.  However, it appears to be a valuable tool to be used in conjunction with the PSA tools I previously discussed to reliably determine which men really need a repeat prostate biopsy and which can avoid the risk and discomfort of a repeat procedure.

 

  

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