Cancer caused due to asbestos
My uncle was working for a cement industry from many years as he was paid with good salary, through he got other jobs options he never moved from it. Everything was going fine till last year; he was sudden falling ill too often. He was often complaining about high fever, cough, difficulty in swallowing the food, weakness etc. When we took him to the doctor, he suspected them to be the Symptoms Mesothelioma and immediately asked by uncle to go for CT scan and Chest x ray. After the reports it was confirmed that he was suffering from Mesothelioma; one of the rare types of cancer. We were all very shocked as we never heard about the disease. So I started searched on net for more information about the disease and its treatment options. We took him to the specialist where he suggested for radiation therapy, where high intensity rays are sent into the body to kill the cancer
New Prostate Cancer Test Could Save Thousands of Life
“Hundreds of lives could be saved by a new most cancers check,” the Daily Express noted right now. It explained that the new verify for prostate most cancers “detects two times as numerous situation as the most recent strategy”.
This story is based primarily on a examine in 288 guys with and with no prostate most cancers, which assessed regardless of whether or not a urine check that measures amounts of a protein recognized as EN2 could detect the illness. Situations of prostate most cancers had been confirmed by way of biopsy. The analysis learned that testing for the protein could precisely acknowledge 66% of men with prostate most cancers, and correctly rule out the sickness in virtually 90% of guys without getting the illness.
This research has acknowledged a feasible new marker for prostate most cancers. The closing final results are promising, but the analysis is at an early stage, and a lot furthermore assessment is wanted. The effectiveness of the examination will will need to be confirmed in higher samples of men from the typical population. Correct right after this, scientific studies would need to have to evaluate how the exam has an outcome on outcomes this type of as the figures of males dying from prostate most cancers, and these obtaining pointless biopsies. Newspaper estimates that the test will be all set within just months are most probably overly optimistic.
In which did the tale arrive from?
The analyze was carried out by scientists from the College of Surrey and other investigation centres in the United kingdom. It was funded by Most cancers Examination United kingdom and the Prostate Activity Basis. The authors have been also supported by The University of Cambridge, Hutchison Whampoa Minimal, the NIHR Cambridge Biomedical Investigation Center, the Division of Health, and the Wellbeing Examine Council.
What is Cancer And What Are Its Causes?
Cancer is an illness that consists of anarchical cellular proliferation. When an individual suffers from cancer, a aspect of his or her cells multiply uncontrollably and uninterrupted. In Europe and North The united states, the most typical varieties of cancer are lung cancer, tightly related to cigarette smoking, and breast most cancers, for which causes have not been totally investigated yet. In Africa, the most common sort of cancer is liver and cervical cancer.
What types of most cancers do we know of?
Here are the sorts of most cancers learned all through background (enumerated beneath). I will treat them in depth in personal articles. In purchase to find out about a sort of most cancers from under, you only need to have to click on on its identify. If the name does not nevertheless link to one more page, that implies I am presently operating on the respective article:
Cervical Cancer: What It Does And How It Is Treated
Cervical cancer develops progressively. Before the actual cancer appears, the cervical cells mutate (a process called dysplasia) and turn into abnormal cells belonging to the cervical tissue. Later on, neoplastic cells multiply and spread throughout the cervical colon until they reach neighbouring organs.
Infection with the HPV virus is the most frequent cause of cervical cancer.
There are no symptoms for this type of cancer, but it can be diagnosed by means of annual testing. Early cancer may not present any symptoms or visible signs. Women should check in with their doctor annually, and have the Papanicolaou test (Pap test) carried out, in order to check if there are any modified cells within the cervix.
Risk factors for cervical cancer
The most important risk factor for cervical cancer is HPV-virus infection. HPV stands for “Human Papiloma Virus). However, not all women with HPV virus develop cervical cancer.
Other possible risk factors:
An increased number of pregnancies;
Multiple sexual partners;
First sexual contact at a very young age;
Smoking;
Oral contraceptives;
Weak natural immunity.
Symptoms for cervical cancer
There are no symptoms that announce cervical cancer. Nonetheless, cancer may be diagnosed by means of annual testing. Cancer, in its earliest development, may not present any relevant signs of its presence at all.
Women should take the Pap test early in order to see if there are any modified cells within their cervix. The chances of recovery are better when the cancer is diagnosed at an early stage.
Possible cancer clues include vaginal bleeding and pain. It is recommended you see the doctor if the following symptoms are present:
Vaginal bleeding;
Unusual vaginal discharges;
Pelvic pain;
Pain during sex (also referred to as dyspareunia).
Investigations in cervical cancer
Tests for cervix examination are used to detect and diagnose cervical cancer. The following investigations are usual and recommended:
The Papanicolau test (or “Pap test”)
This test consists of harvesting cell samples from the cervical colon and from the vagina. A small piece of cotton, wood of brush is used when gently harvesting the cells (this does not hurt at all). The cells are, afterwards, studied at a microscope to see if they are modified.
Colposcopy
This is the method through which the doctor may take a look inside the vagina and the cervix in order to spot modified areas. The colposcope (a thin tube with a light-bulb at its tip) is introduced into the cervix through the vagina. This method is also used in order to harvest some tissue samples for biopsy.
Biopsy
If, during the Pap test, modified cells are fond, the doctor will also conduct a biopsy. A small tissue sample is harvested from the cervix and studied at the microscope for signs of cancer.
Pelvic objective examination
This consists of an examination of the vagina, the cervix, the uterus, the Fallopian tubes and the rectum. Two lubricated fingers inside a medical glove are introduced into the vagina and the other hand is placed on the patient’s lower abdominal area in order to feel the size, shape and position of the uterus and the ovaries. A speculum is used to analyse the aspect of the vagina and the cervix.
Endocervical curettage
This is a method used for harvesting tissue or cell samples from the cervical area with the help of a scoop (a medical instrument shaped like a spoon).
Chances of recovery from cervical cancer
There is a number of factors that affect the chances of recovery and the treatment option.
The chances of recovery depend on:
The stage in which the cancer is. Specifically, if it only affects a part of the cervical colon or has already invaded the whole cervix and spread to the lymph nodes or other parts of the body;
The type of cervical cancer (see below);
The size of the tumor.
The treatment opted for depends on:
The stage in which the cancer is;
The size of the tumor;
Whether the patient wants to have children or not;
Patient’s age.
Stages of cervical cancer
After the cancer is diagnosed, research is carried out in order to find out if cancer cells have spread throughout the cervix or other parts of the body. The method by means of which cell invasion is studied is called cancer staging. Information retrieved through the process of staging determines the stage of the cancer. Stage is, in its turn, essential for opting for the best type of treatment. The following investigations may be used during the process of staging:
Chest radiography. This X-Rays the organs and bones of the chest. A radiography is obtained by exposing the chest to X-rays that pass through the body and project themselves on a film, resulting in a “photo” of the anatomical regions of interest;
Computer tomography. This is an investigation by means of which detailed photos of the anatomical regions of interest are taken, from different angles. The photographs are taken by a computer connected to the X-Ray machine. Contrast substance may be used, in which case it is injected in veins or swallowed, so that it may afterwards stress out the image;
Lymphangiography is an investigation method for the lymphatic system. A contrast substance is injected into the lymphatic vessels in your legs. The contrast substance moves upwards through the lymph nodes and radiographies are taken to spot any obstructions. This investigation helps detect tumor invasions within the lymphatic area;Surgical pre-therapeutic staging consists of an investigation of the area to see if tumor cells have extended within the cervix or other parts of the body. In some cases, cervical cancer may be excised in the same time;
Echography is the ultra-sonic examination through which ultra-sounds reflect or change their direction when they meet tissues or organs, producing echoes. Echoes afterwards produce an image of the tissues, called sonogram;
NMR (Magnetic Nuclear Resonance) is a method in which a magnet, some magnetic waves and a computer are used in order to take a series of detailed photos of the body.
These results are analysed and concurred with those from the biopsy in order to determine one of the following stages of cervical cancer.
Stages of cervical cancer
Cervical cancer has the following stages of development:
Stage 0 (zero). The tumor cells are located only in the first layer of the cervix cells and has not, thus, invaded profound layers.
Stage I. The cancer is limited to the cervix. Based on the quantity of the tumor tissue, this stage is divided into stage IA and stage IB:
Stage IA: the tumor tissue found in the cervix may only be observable through the microscope. The cancer does not go below 5mm in tissue depth and does not spread more than 7mm in width;
Stage IB: cancer is observable only through the microscope and goes deeper into the tissue than 5mm and wider than 7mm. Also, there are cases where cancer may be observed without the microscoper and may be spread over 4 cm, but still within the limits of the cervix.
Stage II. The cancer has spread beyond the cervix, but still not beyond the pelvic wall. Stage II is also divided into A and B, based upon the incisiveness of the cancer:
Stage IIA: the cancer spreads beyond the cervix up until the superior 2/3 area of the vagina, but still it is not present within the tissues around the uterus;Stage IIB: the cancer spreads beyond the cervix up until the superior 2/3 area of the vagina and within the tissues around the uterus.
Stage III. The cancer invades the inferior part of the vagina and may also invade the pelvic wall, alongside its neighbouring lymph nodes. This stage is also divided into A and B, according to how much tumor cells have spread:
Stage IIIA: the cancer invades the lower part of the vagina, but not the pelvic wall;Stage IIIB: cancer cells have spread within the pelvic wall and / or they have spread so much that the ureters (the channels that connect the kidneys and the bladder) are blocked. These “jams” lead to swells in kidneys and, eventually, to their failure. Cancer cells may also invade the lymph nodes from the pelvis.
Stage IV. In this stage, the cancer affects the bladder, the rectum or any other separate organ from the body. Stage IV is divided into stages IVA and IVB, according to the localisation of the tumor cells:
Stage IVA: the cancer has spread to the bladder or to the rectal wall, or to the lymph nodes from the pelvis;
Stage IVB: the cancer has spread beyond the pelvis and the pelvic lymph nodes, to other parts of the body, e.g. the abdomen, liver, intestines or lungs.
Recurrent cervical cancer. This nomenclature is used for cervical cancer which appears once more after it has been treated. Cervical cancer may once again appear within the cervix, or other areas of the body.
Treatment of cervical cancer
There are multiple treatment options for women with cervical cancer. Some of these are standard (used frequently), and others are tested in clinical studies. Before beginning a treatment, women may consider the possibility of participating within a clinical trial. A treatment that is included in a clinical trial is a research study that strives to better standard treatments or to obtain new information on new treatments that concern cancer therapy. When a clinical trial proves that a new treatment is better than a standard one, that new treatment may, in its turn, become standard.
Choosing the most adequate treatment for cancer is a decision that usually implies patients, family and doctors. There are three standard treatments:
Surgery in cervical cancer
Surgery is sometimes curative. The following surgical procedures are practiced:
Conization is a method by means of which a conical part of the tissue is removed from the cervix and the cervical colon. Doctors analyse the tissue with the help of a microscope and afterwards choose the best type of treatment, or the best diagnosis. This method is also called conical biopsy;
Total hysterectomy is a method by means of which the uterus and the cervix are removed surgically. If the uterus and the cervix are removed through the vagina, the method is called vaginal hysterectomy. Other types of hysterectomies are: abdominal hysterectomy and Laparoscopic hysterectomy;Bilateral salpingo-oophorectomy is a surgical method used for the ablation of both ovaries, as well as of the Fallopian tubes;
Radical hysterectomy does the same thing as the total hysterectomy, but also additionally removes part of the vagina. The ovaries and the Fallopian tromps, as well as the neighbouring lymph nodes, may also be removed during this procedure;
Pelvic exenteration is a method through which the lower colon, the rectum and the bladder are removed. At women, the cervix, vagina, ovaries and lymph nodes are also removed. Artificial openings are created in order to eliminate urine and fecal matter. Plastic surgery is necessary in order to rebuild a new vagina after the operation;
Cryosurgery is a treatment that uses a special machine for cryogenics and destruction of abnormal tissue. This is also called cryotherapy;
Laser vaporizationis a method in which laser beams are used similar to a knife in order to cut out cancer tissue. Laser is better than a knife because it cuts without provoking bleedings.
Radiotherapy in cervical cancer
Radiotherapy is a cancer treatment that uses X-rays of very high energy, or other types of rays, in order to destroy cancer tumors. There are two types of radiotherapy. External radiotherapy uses a machine that sends radiation towards the cancer, while internal radiotherapy uses a radioactive substance contained in needles, seds and wires that are placed directly into or near the cancer. The irradiation method depends on the type and the stage of the cancer to be treated.
Chemotherapy in cervical cancer
Chemotherapy is a treatment of cancer that uses pharmaceutic substances in order to stop the growth or division of cancer cells. When chemotherapy is conducted orally or through injection in veins/muscles, the substances enter the bloodstream and reach malignant cells from the organism. This is called systematic chemotherapy. Another way to conduct chemotherapy is straight into the spinal cord, into an organ or a cavity (such as the abdomen). This is called regional chemotherapy.
Treatment options according to cancer stage
Stage 0 (zero). Treatment includes:
Laser surgery;
Conization;
Cryosurgery;
Total hysterectomy for women that cannot have children or do not wish to have future children;
Internal radiotherapy for women that cannot be submitted to surgery.
Stage IA. Treatment includes:
Total hysterectomy with or without bilateral salpingo-oophorectomy;
Conization;
Radical hysterectomy and the removal of lymph nodes;
Internal radiotherapy.
Stage IB. Treatment includes:
A combination between internal and external radiotherapy;
Radical hysterectomy and the removal of lymph nodes, followed by radiotherapy and chemotherapy;
Stage IIA. Treatment includes:
A combination between internal and external radiotherapy;
Radical hysterectomy and resection of lymph nodes;
Radiotherapy and chemotherapy
Stage IIB, III and IVA. Treatment may include internal and external radiotherapy, combined with chemotherapy.
Stage IVB. Treatment includes:
Palliative radiotherapy;
Chemotherapy.
Treatment for recurrent cancer includes the following:
Pelvic exenteration;
Radiotherapy, combined with chemotherapy, as a palliative treatment.
During pregnancy, treatment of cervical cancer depends on the stage of the cancer and the age of the fetus. In late pregnancies, treatment may be delayed until after the birth of the baby.
Breast Cancer – Things You Should Know
The Basics
First of all, let’s try to understand what cancer is. Our body’s cells have genes which regulate the growth of said cells. A normal, healthy cell grows at a reasonable rate and eventually it dies out and is replaced by a new one. A cancer cell has the ability to divide at a rapid pace and produces many cells which form a tumor. A benign tumor is simply one that is made up of cells that are virtually normal and is considered harmless for the most part. The ones that concern doctors are malignant tumors which are cancerous and can continue to multiply spreading throughout the body.
Breast cancer is a malignant tumor that develops in the breast, usually in the lobules (milk producing glands) or ducts(tubes that carry milk to the nipple). I say usually because it can also develop in the connective tissues of the breast; which is the fatty part that surrounds the ducts and lobules.
Understanding the Lymphatic System is an important part to understanding how breast cancer can spread. Lymph nodes are an assembly of immune system cells which are connected by lymphatic vessels (small veins carrying lymph away from the breast. Lymph is a clear fluid that contains tissue fluid, waste products and immune system cells. If cancer cells enter the lymphatic vessels they can begin to grow in the lymph nodes. If this happens there is a good chance that they have also gotten into the bloodstream therefore spreading to other parts of the body. However, just because it has reached the lymph nodes, does not mean that you will develop metastases (spread of cancer from one part of the body to another).
Stats
- Breast cancer is the second most common cancer among women in North America, behind skin cancers
- Approximately 1 in 8 women will develop invasive breast cancer at some time in their life
- Caucasian women are more likely to develop breast cancer than women of African descent, but are less likely to die from it. Asian, Hispanic and Native women have the lowest risk for developing and dying from breast cancer.
- A women’s risk doubles if a sister, mother or daughter has had breast cancer
- Approximately 5-10% of breast cancers are hereditary
- Breast cancer death rates have declined in every age group since the mid1990′s
- 1.3 Million people will be diagnosed with Breast Cancer worldwide this year, 465,000 of them will die from it
- 1% of breast cancers diagnosed are in Men
Why?
Only 5 – 10% of cancers are hereditary (passed down from mother or father). The cancer itself is not inherited, but the gene that increases the risk factor for developing the cancer is inherited. The other 90 – 95% of cancers are sporadic.
So what does that mean? Well, our genes have many jobs and are in charge of telling our cells what to do and when to do it. If there is a mutation in those genes it causes the cells to do strange things. In the case of cancer, a mutated gene is telling cells to divide when they shouldn’t be which causes tumors (as discussed in The Basics). For the most part, gene mutations usual happen later in life and are a result of natural aging or exposure to things like smoke, hormones, certain viruses or chemicals and dietary influences. The damage to our cells doesn’t always lead to cancer because our cells are also equipped to repair damage and, as you may remember from grade 9 Science, we have 2 copies of each damage repairing gene (one from each parent). But if a mutation occurs in both copies of the gene, it can mean uncontrolled growth and can lead to cancer.
If a person is born with a mutation in one of the copies of a damage repairing gene pair, this means their risk for developing cancer is higher, known in the medical community as “genetic susceptibility”. That is because they only have one good protective gene remaining and if it is damaged in the aging process or because of other environmental exposures, it can lead to the gene communicating to its cells to divide and multiply at a rapid rate. Hereditary cancer, therefore, usually develops earlier in life.
When a cancer develops in someone who has no family history or “genetic susceptibility” it is called “sporadic cancer”. Since both copies of the protective gene which eventual mutate, start out in good condition, sporadic cancer usually develops later in life as it takes longer for both copies to become damaged.
The genes that are linked to breast cancer are called the BRCA1 and BRCA2 genes. Genetic risk assessment and genetic counselling are available to help you discover your risk for breast and other forma of cancer. Genetic Risk assessment will tell you if you carry the BRCA1 or 2 gene mutation, but it won’t tell you what your risk of developing breast cancer is. Find out more about BRCAPro. Genetic Counselling can help you to understand your risk for hereditary cancer by reviewing family history, discussing genetic testing and providing information and referrals to experts.
Symptoms & Detection
Symptoms or signs of breast cancer can range from lumps and swelling to changes in the skin. Non-cancerous cysts and infections often have the same symptoms. So how can you be sure?
Watch for the following symptoms:
*swelling of all or part of the breast
*skin irritation or dimpling
*breast pain
*nipple pain or the nipple turning inward
*redness, scaliness, or thickening of the nipple of breast skin
*nipple discharge other than breast milk
*a lump in the underarm area
Detection
Breast Self-Exam (BSE)
It is, in my humble opinion, the most important way to stay on top of your breast health – because it is something you can do on your own, and will get you familiar with your body. It is becoming quite a controversial subject. There was a study performed in Russia and China in 2008 of 400,000 women, which reported that BSE does not reduce the mortality rate and may cause more harm due to prompting unnecessary biopsies. It is my opinion that it’s better to be safe than sorry. According to Breastcancer.org about 20% of breast cancers are found by physical exams rather than mammography.
Breast self-examination can be frustrating at first, because you don’t know what to look for, and if you are like most women, there are many bumps and lumps in your breasts that are harmless. That is exactly why you should do this on a regular basis – every month. The best time to perform a BSE is a few days after your period when swelling has gone down. If you feel a lump don’t panic, it is most likely not cancerous. But have it checked out by your doctor and then keep an eye on it to see if anything changes. You may want to keep a journal with notes on where and when you found something suspicious. If a change lasts longer than one cycle see your doctor to have it checked. Learn more about how to perform your BSE
Mammogram
It is one of the most hated words in the English language for women! But I’m here to tell you that they’ve been given a bad rap and they aren’t as horrible as they have been made out to be. They save lives after all! Doctors have been using mammography for the past 40 years to find and diagnose breast cancer. Mammograms have been shown to lower the risk of dying from breast cancer by 35% in women over 50 years old. Cancer Foundations world wide are now recommending that women over 40 be screened annually in order to find tumours before they are able to develop into invasive breast cancers. Early detection often means that the cancer can be removed without having to resort to a mastectomy (breast removal).
Of course, nothing is guaranteed and mammography alone can miss up to 20% of breast cancers because they simply aren’t visible. Breast Self-Examination and other techniques such as ultrasounds or MRI’s can also help detect problems. Read more about Mammography.
Treatment
There are several types of breast cancer and your treatment can differ based on what your diagnoses is. Some of the most common types of breast cancer are explained below:
DCIS – Ductal Carcinoma In Situ
This form of cancer is considered non-invasive because it stays inside the milk duct. It can grow within the duct, but will not spread into the rest of the breast tissue or to the lymph nodes. If caught early enough, DCIS can be removed with a lumpectomy, which is the removal of just the area of the breast containing the cancer. However if the cancer is large, or appears in more places throughout the breast, a mastectomy may be necessary. In most cases a lumpectomy is followed by radiation, but a mastectomy is only followed by radiation if lab tests show cancer near the edge of the removed tissue.
IDC – Invasive Ductal Carcinoma
This is the most common type of breast cancer, making up about 80% of all cases. It begins in the milk ducts and spreads to surrounding breast tissue. If left untreated it can spread to the lymph nodes and other areas of the body. Invasive cancers are given a stage to describe how far it has spread from its original location. It is based on the size of the tumor, whether or not it spread to the lymph nodes and other parts of the body. It can range from stages 1 to 4, where 1 is the earliest stage and 4 is the most advanced stage.
Your doctor will order a variety of tests to help determine which stage the cancer is at and to help determine the best treatment regime. Typically the patient would undergo surgery to remove the tumor and determine whether the cancer has spread to the lymph nodes. This surgery can range from a lumpectomy (removal of only the lump or tumor) to a radical mastectomy (removal of the breast[s] and all the muscle under the breast[s]) or somewhere in between. Radiation may be recommended after the surgery to destroy and remaining invasive IDC cells. This has also been shown to reduce the risk of recurrence.
Chemotherapy is used to treat many higher stage cancers where the cancer has spread to the lymph nodes or other parts of the body. Chemo (for short) is a medication (or combination of medicines) which enter the bloodstream to travel throughout the body interfering with rapidly dividing cells. For the most part they are the cancer cells, however there are also many healthy cells in your body which divide rapidly, such as those in your blood, mouth, intestinal tract, nose, nails, vagina and hair. Therefore the chemotherapy will also affect them causing symptoms ranging from hair loss to osteoporosis.
Your doctor may also recommend hormonal or other targeted therapies. As with any major medical diagnoses, there is follow up care that will be important to your continued health. Regular exams and tests will be required by your doctor.
LCIS – Lobular Carcinoma In Situ
Like DCIS, LCIS is not considered an invasive cancer as it does not spread into other areas within, or outside the breast. It is considered a marker for breast cancer, meaning that the person is at a higher risk for developing an invasive breast cancer in the future and should be monitored with regular mammography and ultra sounds. It is usually found in pre-menopausal women aged 40-50. It is difficult to estimate the risk of a patient with LCIS developing an invasive cancer because LCIS can go undetected, however it has been estimated that your risk increases from 12.5% for the average women, to 30-40% if diagnosed with LCIS.
LCIS is usually diagnosed when a biopsy is performed because of an abnormality in a mammogram. It does not require typical cancer treatment but should be carefully monitored to watch for early signs of invasive cancer. Talk to your doctor about medications and treatments which may help to reduce your breast cancer risk.
ILC – Invasive Lobular Carcinoma
This is the second most common type of breast cancer, making up about 10% of all cases. It begins in the lobules and spreads to surrounding breast tissue. . If left untreated it can spread to the lymph nodes and other areas of the body. ILC tends to be found in more than one area within the breast and is likely to affect both breasts. It is slow to spread outside the breast and tends to show up in the stomach, intestines and ovaries and has been known to eventually spread to the brain spinal cord tissues.
Treatments and care for ILC are similar to that of IDC and will vary depending on the stage of the cancer cells.
Some other, less common forms of breast cancer are Inflammatory Breast Cancer, Male Breast Cancer and Recurrent and Metastatic Breast Cancer.
Coping
Once you have been diagnosed with a form of breast cancer, you have so many questions that you don’t even know where to start. Most of them are likely about your health and what your options are. But there are many other factors in your life that are affected by breast cancer besides your health. Such as how will I pay for my care? What if I can’t work? How will my family cope? How will my life change?
You will need more than just medical support, you need mental and spiritual support. Who do you talk to about your cancer concerns? The same people you talk to about your everyday concerns. You should have a support group that can help you through the difficult times. If you don’t feel that you have anyone close to you that you can talk to, there are still options. Talk to a social worker or psychologist. It is important to get your thoughts and fears out in the open, and as long as you have a sympathetic ear, it will help you let go of some of those fears.
There are many support groups of other people with breast cancer and cancer survivors who can lend an ear, and can also benefit from talking with you. Ask you doctor about support groups in your area, or go the discussion boards on Breastcancer.org.
Written by LeluluStudio
Cardiovascular disease impacts the actual bladder in a number of methods, based on Dianna Malkowski, doctor helper, nutritionist as well as expert agent for that CareGiver Relationship.