When should I see a doctor or nurse?

If your wound is large, soiled, needs stiches, or shows signs of infection, see a doctor immediately. A deep, gaping, or jagged cut that goes right through the skin will most likely need stitches. If your cut is not very deep, it will probably not need stitches. If in doubt, check with your doctor or nurse.

How do I take care of a cut or scrape?

1)     Clean the wound

Wash your wound thoroughly with soap and water. If, after washing, there is still dirt, glass, or another substance in your cut, see a doctor or nurse.

2)     Stop the bleeding

If your wound is bleeding, firmly press a clean cloth or bandage on it for 20 minutes. You can also help slow the bleeding by holding the cut above the level of your heart. If the bleeding doesn't stop after 20 minutes, see your doctor or nurse.

3)     Protect the wound

If available, apply a thin layer of antibiotic ointment (e.g. Bactroban) to the wound. Dress your cut with a clean, dry bandage and change the dressing 1- 2 times a day until the wound heals. Most cuts and scrapes heal on their own within a week, forming a scab in the process. Avoid touching or scratching the scab as this will increase the risk of bleeding, infection, and scarring. If your wound has been treated by a doctor, follow their instructions.

4)     Check for signs of infection

Symptoms of infection include: fever, discharge (e.g. pus), a bad odor, increased pain, redness, swelling, warmth, or red streaks around the edge of the cut. 

Do I need a tetanus shot?

It depends on how old you are and when your last tetanus shot was. Tetanus is a serious infection that causes fever, muscle stiffness, and can even lead to death. It is caused by bacteria found in dirt.

Most children are vaccinated as part of a routine checkup. After three initial doses of the tetanus vaccine (TD, TDAP), regular booster shots are needed to maintain an effective level of protection, usually every 10 years. It’s also common for adults to be vaccinated or receive a booster during a routine checkup. Check your vaccination record if you have one, or check with your doctor.

For simple wounds (e.g. closed, shallow, or clean), you will need a tetanus booster if you haven’t received one in the last 10 years.

For serious wounds (e.g. open, deep, punctured, or soiled with dirt), you will need a tetanus booster if you haven't had one in the last 5 years.

If you have a serious wound and you haven't received all of your tetanus vaccines (or you’re not sure if you have), you will need a tetanus booster shot and another shot of immunoglobulins to fight any tetanus bacteria that may have contaminated the wound.

Please be aware that supplies of the tetanus vaccine are not always stable in China and availability cannot be guaranteed. It is recommended that you get regular, preventative booster shots to avoid the need for urgent doses.

What is Gestational Diabetes?

Diabetes is a common condition in which the body’s cells are unable to effectively obtain glucose from the bloodstream. Glucose is required to provide the body with energy for day-to-day activities. The hormone insulin moves glucose from the blood into the body’s cells, where it can be used for energy. When the movement of glucose into the cells is delayed, blood glucose levels rise, causing diabetes to develop.

Gestational diabetes is a form of diabetes that occurs during pregnancy and usually goes away after the baby is born. Over 10% of pregnant women will develop gestational diabetes and this usually occurs around the 24th to 28th week of pregnancy.

In pregnancy, the placenta produces essential hormones that help the baby grow and develop. These hormones also partly stop insulin working which is called insulin resistance. Usually pregnant women naturally increase their insulin levels to overcome this block. If the body is unable to produce the extra insulin or becomes more resistant, gestational diabetes develops.

Diagnosis of GDM is based on a fasting 75-g oral glucose tolerance test (OGTT) at 24–28 weeks of gestation in pregnant women not previously known to have diabetes. This test can be performed earlier if there are significant risk factors present or there is a clinical indication.

Once a diagnosis of GDM is made, careful planning for the ongoing management of your pregnancy is important.

How does GDM affect the baby?

As the mother’s excess glucose crosses the placenta into the baby’s bloodstream, untreated or uncontrolled GDM may result in complications for your baby such as:

•   Being born very large and with extra fat, thus may make delivery difficult and more dangerous for the baby

•   Low blood glucose levels after birth

•   Breathing problems

•   Requiring admission to a special care nursery

•   Problems maintaining body temperature

•   An increased risk of developing diabetes or obesity later in life.

How to Treat Gestational Diabetes?

The management and treatment of GDM is a team effort, involving the woman and her partner, her obstetrician, endocrinologist, diabetes educator, dietitian and midwife.

Special attention is paid to home blood glucose monitoring, diet and physical activity. Sometimes insulin injections may be needed. Your treating doctor will discuss with you which treatment option is more suitable for you.

•   Start treatment quickly because gestational diabetes can hurt you and your baby.

•   Special meal plans and scheduled physical activity

•   Daily blood glucose testing

•   Insulin injections if needed

Home blood glucose monitoring

Self-monitoring blood glucose (SMBG) is a valuable tool in helping manage GDM. These simple finger prick blood tests will give you an indication on what your blood glucose levels are.

Your diabetes nurse will teach you how to perform home blood glucose monitoring. You will require:

•   A blood glucose meter

•   Lancet device – for pricking finger

•   Testing strips

•   Diary to record blood glucose levels.

Blood glucose meters, lancet device and testing strips may be purchased at your local or online pharmacy.

Target of Glucose Control

The blood glucose checks you do at home are a key part of taking good care of yourself and your baby before, during and after pregnancy

Both American Diabetes Association and Chinese Diabetes Society recommend glucose targets for women with GDM are as follows:

Food and Exercise

During pregnancy, you may need to change your meal plan to avoid problems with low and high blood glucose levels. For most women, the focus of a good meal plan during pregnancy is improving the quality of foods you eat rather than merely increasing the amount of food eaten. A good meal plan is designed to help you avoid high and low blood glucose levels while providing the nutrients your baby need to grow.

Exercise is a key part of diabetes treatment. Discuss your exercise plans with your diabetes team and ask for guidance. Just as you need to get your blood glucose under control before getting pregnant, it's best to get fit before you get pregnant.

In general, it's not a good idea to start a new strenuous exercise program during pregnancy. Good exercise choices for pregnant women include walking, low-impact aerobics, swimming, or water aerobics. Regular physical activity is not only safe for pregnant women, it benefits health by offsetting some of the problems of pregnancy, such as varicose veins, leg cramps, fatigue and constipation. Exercise after meals may help the muscles use the glucose in the bloodstream, and help keep your blood glucose levels in your target range.

Medication (if needed)

For women with gestational diabetes, meal planning and exercise often work to keep blood glucose levels in control; however, if blood glucose levels are still high, your doctor will probably start you on insulin.

What is immuno-oncology (IO) treatment?

Under normal circumstances, the human immune system can identify and remove tumor cells in tumor microenvironment, but tumor cells can adopt different strategies to inhibit the immune system, thus survive and even continue to develop at various stages of the anti-tumor immune response.

Immuno-oncology (IO) treatment or immunotherapy is a treatment that controls and clears tumors by restarting and maintaining the tumor-immune cycle and restoring the body's normal anti-tumor immune response.

Because of its excellent efficacy and innovation, immunotherapy was named the most important scientific breakthrough of the year by Science magazine in 2013. In recent years, good news about immunotherapy has been continuously reported, and it has shown strong anti-tumor activity in the treatment of various tumors. Multiple tumor immunotherapy drugs have been approved for clinical application in dozens of countries around the world, which brings new hopes for cancer patients.

What is the principle of I-O?

Cytotoxic T cells in human lymph nodes are the powerful source in immune system to kill tumor cells. However, in order to prevent "injury" of healthy cells, T cells are also subject to the restriction of "immunization checkpoints", which in turn gives the tumor a chance to grow. Some tumor cells begin to induce "checkpoints" to escape the immune response after being attacked by T cells. PD-1 (Programmed Death 1, Programmed Death Receptor 1) / PD-L1 (Programmed Cell Death 1 Ligand 1, programmed death ligand) signaling pathway is one of the mechanisms. By secreting PD-L1, tumor cells bind to PD-1, initiate programmed cell death of T cells, and allow tumor cells to obtain immune evasion.

The working principle of PD-1 inhibitors is to break the binding of PD-1 and PD-L1 and restart the attack and killing function of T cells on tumor cells. 

What disease type could benefit from PD-1? 

Currently, PD-1 inhibitors that have been marketed include Pablolizumab (Keytruda) and Nivolumab (Opdivo). US FDA has approved Opdivo for cancer indications of small cell and non-small cell lung cancer, head and neck squamous cell carcinoma, colorectal cancer (MSI-H/dMMR), melanoma, liver cancer, classic Hodgkin's lymphoma, kidney cancer, bladder cancer, etc. Our domestic CFDA approved Opdivo for second-line treatment of non-small cell lung cancer.

Data from PD-1 manufacturer BMS showed that the five-year survival rate of cancer patients who took PD-1 inhibitors increased several times compared with traditional treatments. For patients with non-small cell lung cancer, the survival rate of lung cancer patients receiving traditional treatment is usually less than one year. The three-year survival rate of immunotherapy in lung cancer has reached 30%, and the five-year survival rate can reach 15.6%.   

What are the side effects of Opdivo?

Opdivo (nivolumab) is different in mechanism from traditional chemotherapeutic drugs. Most of the adverse reactions during the treatment are mild or moderate. Serious adverse reactions are extremely rare, but the consequences may be very serious. Therefore, it is necessary to monitor the side effects of Opdivo medication. Please read the following information carefully with your family:

（1）Adverse reactions may occur at any stage of the treatment, and it is more likely to occur after the treatment has been started for a period of time because your immune system has been activated and is more likely to have an adverse reaction due to immune hyperfunction.

（2） If you feel chest tightness, wheezing, swollen facial lips or even swollen tongue, it means that you may have a severe allergic reaction. If the situation is urgent, please call 120 for help.

（3） If you have the following discomfort, don't panic and please contact your health care team immediately:
• Pulmonary symptoms: cough, chest tightness and pain, shortness of breath, etc.
• Intestinal symptoms: diarrhea, especially bloody, dark or tarry stools
• Severe stomach pain or tenderness
• Liver and kidney function damage: symptoms as nausea and vomiting, pain in the right side of the abdomen, dark urine, decreased urine output, light colored stool, yellowing of the skin or eyes
• Discomfort caused by hormonal changes: rapid heartbeat, significant weight gain or loss, dizziness, chills and even syncope; thirst and polydipsia, increased urine volume
• Other symptoms include: skin and mucous membrane ulcers, fever, fatigue, lethargy, memory disorders

（4）In addition, the following adverse reactions may occur during treatment, which usually does not affect your normal life. Of course, you can also contact us for further help:
• Fatigue
• Loss of appetite sometimes accompanied by nausea
• Mild cough and shortness of breath, sometimes upper respiratory tract infections may occur which can usually disappear spontaneously
• Rash and itching, it is important to note that if you have a large number of rashes, please seek medical advice promptly.
• Constipation or diarrhea
• Muscle and joint pain

（5）Other precautions during treatment
In addition to the above-mentioned adverse reaction, Nivolumab may affect your body's functions by activating your immune system. You need to follow your doctor's regular follow-up. Some related tests are essential for us to assess your physical condition. Blood routine, liver function, and thyroid function are usually checked regularly.

Nivolumab may have little interaction with other drugs, but to ensure medication safety, we will ask you about your medication history in details before each treatment. If you need other medications during the treatment, be sure to let your doctor know that you are using Nivolumab. 

Preparations before medication

Please assist your medical team to know your history of allergies and medication before using the medicine to ensure medication safety;

If you have had an autoimmune disease (such as colitis, Crohn's disease, lupus), organ transplant, lungs or breathing problems, please let us know.

Please relax during the medication, keep normal diet, and have proper rest.

At the end of each treatment, we will remind you of the time of next medication. If you missed the appointment, please contact the medical team timely. 

What services can Jiahui International Cancer Center provide for patients under I-O?

As the first demonstration center for immuno-oncology (IO) treatment in China, the Immune-oncology Center of Excellence at Jiahui International Hospital has received the first patient and completed the first infusion of O-medicine. (PD-1 antibody drug Opdivo) on August 29.

In cooperation with the affiliated hospital of Harvard Medical School, Massachusetts General Hospital as a strategic partner, Jiahui is committed to providing patients with Opdivo medication assessment and monitoring services based on international standards.

Massachusetts General Hospital, as the teaching hospital under the Harvard Medical School, has been using PD-1 immunotherapy for over 8 years, treating more than 20,000 cancer patients, and is the world's most experienced hospital for providing immunotherapy to Asian patients. At the Cancer Center of Jiahui International Hospital, patients may make an appointment to receive a diagnosis from one or several oncologists at the Massachusetts General Hospital through video or face to face. Now experts from Massachusetts General Hospital provides clinical services at Jiahui for one week per month on average. They will work with the doctors of Jiahui International Cancer Center to sort out the patient's condition and explore an overall treatment plan through multi-angle considerations such as pathology, genetics, and etc.

Please dial (021) 53393266 during working hours (Monday-Friday, 9:00-18:00) for more information. Or leave a voice message at other times and we will contact you as soon as possible.  

There is a silent, global crisis going on in men’s mental health. All around the world, men are turning up in droves to their local Accident and Emergency Departments. They are in pain, but unlike patients with cuts or fractures, their wounds are invisible to the naked eye. Oftentimes, they have suffered in silence for months or years until the burden becomes too heavy to bear.

Silencing the Stigma

Evidence suggests that men are significantly less likely to use clinical services in response to a mental health issue in comparison to women. At Jiahui Health, we want to reduce that stigma.

With appropriate assessment, identification, and intervention, mental illnesses can be successfully treated and managed.

Our mental health specialist is qualified in a variety of clinical methods and approaches to best meet the individual needs of patients. If you or someone you know is suffering from a mental health issue, please don't hesitate to contact us. You are not alone, and help is always at hand.

If you are experiencing recurring negative thoughts and emotions that affect your social life, relationships, work, or day-to-day functioning, you should talk to a mental health specialist. Getting help for depression/anxiety as early as possible gives you the best chance of recovery.

Therapy options:

Does radiation therapy hurt?
No, radiation therapy does not hurt while it is being given. However, the side effects that people may get from radiation therapy can cause pain or discomfort. Your doctor, and your nurse can help manage side effects.

Will external beam radiation therapy make me radioactive?
No, external beam radiation therapy does not make people radioactive. You may safely be around other people, even babies and young children.

Can I go to work during radiation therapy?
Some people are able to work full-time during radiation therapy. Others can only work part-time or not at all. How much you are able to work depends on how you feel. Ask your doctor or nurse what you may expect based on the treatment you are getting. You are likely to feel well enough to work when you start radiation therapy. As time goes on, do not be surprised if you are more tired, have less energy, or feel weak. Once you have finished your treatment, it may take a few weeks or many months for you to feel better.

What should I bring while on treatment?
•    Anti-nausea, pain or anxiety medications that you would normally take during your treatment time
•    A sweatshirt to wear over your gown to keep you warm while you are waiting
•    Reading materials and music that can help you to relax while you are waiting

Can I drive while I am on treatment?
Driving to and from your treatments is usually not a problem, unless you are taking any medications that have a side effect of drowsiness or another doctor has told you that you cannot drive.

Can I bring my family to the treatment area?
We encourage you to bring a friend or family member with you to your appointments in Radiation Oncology. When you are going back to the treatment area we ask that your support person stay in the lobby area.

Should I eat before treatment?
Unless you are told to do otherwise, please eat as you normally would, don't skip any meals and take your medications as scheduled.

Where can I get food?
•    Coffee and crackers are available in the front waiting area
•    There is a vending machine available on level 1 of the hospital next to the imaging department
•    Patient kitchen: you can order from the Jiahui Patient Kitchen. Please inform us when you needed
•    There are many restaurants located in the nearby area

Where do I get my blood drawn?
Depends on your treatment, your doctor may order blood test to be drawn before, during or after your treatment. The frequency of blood draws depends on the area of the body being treated. The blood will be drawn in our clinic by one our nurses or you can have it done at your local hospitals if you chose.

Will my health insurance cover treatment costs?
Our department Billing Office will submit claims to insurance companies, government programs indicated by you. The billing office personnel will verify the completeness of necessary billing forms and supply all the necessary information for the payers to process and pay the claim. Please bring with you any referrals or authorizations which your insurance company requires in order to make payment for services.

When should I contact my doctor?
NOTIFY YOUR DOCTOR IMMEDIATELY FOR ANY OF THE FOLLOWING:
•    Shaking or chills or a temperature of 101°F or 38.3° C
•    Unusual cough, sore throat, lung congestion or shortness of breath
•    Burning discomfort when you urinate
•    Redness, pain or sores in your mouth
•    Nausea, vomiting or inability to eat or drink for more than 24 hours
•    Diarrhea (loose, watery stools) for more than 24 hours
•    Constipation (no bowel movement in 2-3 days)
•    Bleeding or unusual bruising
•    Pain not controlled by your current medications
•    Any new or unusual symptom that concerns you

Tell your doctor or nurse if you are having any new problems, even if they do not seem to be related to your radiation treatment. If the issues are in fact not related to your radiation therapy, you will be referred to your primary doctor for discussion.