Walk Safety:

1. Cross the street at corners, using traffic signals and crosswalks. Look left, right and left again when crossing and keep looking as you cross.
2. Put electronic devices down, keep heads up and walk, don’t run, across the street.
3. Teach children to make eye contact with drivers before crossing in front of them.
4. Always walk on sidewalks or paths. If there are no sidewalks, walk facing traffic as far to
5. the left as possible.  Children should walk on direct routes with the fewest street crossings.
6. Watch for cars that are turning or backing up. Teach children to never dart out into the street or cross between parked cars.
7. Join kids under age 12 for trick-or-treating. If kids are mature enough to be out without supervision, tell them to stick to familiar areas that are well lit and trick-or-treat in groups.

Have a Healthy Halloween

• Monitor costume accessories. Make sure swords, knives and other accessories are short, soft and flexible.
• Avoid trick-or-treating alone. A trusted adult should accompany smaller children, and older children should travel in groups.
• Remain visible. Trick-or-treating is an evening activity, and it can last until after dark. Fasten reflective tape to costumes and bags to increase visibility for drivers, and use flashlights to see and be seen.
• Be cautious with glow sticks. Glow-in-the-dark sticks and accessories should only be used under adult supervision and should never be cut or broken open.
• Examine treats. Parents should inspect all treats for tampering and/or choking hazards before allowing children to enjoy them.
• Limit treats. Limit the amount of candy and treats your children eat. Too much candy at one time can cause an upset stomach.
• Test and remove makeup. If makeup is going to be used as part of a costume, always test the makeup on a small area of skin first to ensure it does not cause irritation. Remove makeup at bedtime to prevent skin or eye irritation.
• Avoid decorative contact lenses. Decorative contact lenses can cause serious eye injuries.
• Obey traffic rules. Look both ways before crossing the street, and use crosswalks when available. Walk on the sidewalks, when possible; if there aren’t any sidewalks, walk along the far edge of the road facing traffic.
• Ensure costumes and accessories fit properly. Masks, costumes and shoes should fit properly to avoid blocked vision, trips and falls.
• Eat only factory-wrapped treats. Avoid homemade treats made by strangers.
• Carefully choose which homes you visit. Only visit well-lit houses, and enter homes only if accompanied by a trusted adult.
• Ensure costumes are flame-resistant. As a precaution, avoid walking near lit candles or luminaries while in costume.
• Carry a cell phone in case of emergency.Following these simple safety tips will help keep your children safe—without any unplanned scares. St. David’s Round Rock Medical Center wishes everyone a fun and safe Halloween.
• Parents should also supervise children while carving pumpkins. Be sure children use pumpkin carving kits—or knives specifically designed for carving—to avoid injury. Younger children can even use paint, markers or other decorations that do not have sharp edges.
• Have a one destination area, a home with all the kids dressed up having a halloween party meet instead of walking around house to house; or what I heard is a group of people all meet in a parking lot with the kids dressed up with their parents having a halloween meet getting there candy for safety.

CDC recommends the following this Halloween:

Moderate Risk Activities:

“Even though it’s not an official holiday, Halloween is much beloved by children and adults alike. What could be more fun than trick-or-treating, apple bobbing, or costume parties?

To make sure treats are safe for children, follow these simple steps:

• Snacking: Children shouldn’t snack on treats from their goody bags while they’re out trick-or-treating. Give them a light meal or snack before they head out – don’t send them out on an empty stomach. Urge them to wait until they get home and let you inspect their loot before they eat any of it.
• Safe treats: Tell children not to accept – and especially not to eat – anything that isn’t commercially wrapped. Inspect commercially wrapped treats for signs of tampering, such as an unusual appearance or discoloration, tiny pinholes, or tears in wrappers. Throw away anything that looks suspicious.
• Food Allergies: If your child has a food allergy, check the label to ensure the allergen isn’t present. Do not allow the child to eat any home-baked goods he or she may have received.”

U.S. Food and Drug Administration (https://www.fda.gov/food/buy-store-serve-safe-food/halloween-food-safety-tips-parents)

Halloween Candy Safety Tips

Parents should take precautions about Halloween candy safety, but its also important to have a realistic sense of harm. Its easy for the media to give us the sense that the world is a more menacing place than it really is. In the 1980s, a myth spread about the serious risk of troubled people using poison and razor blades to tamper with Halloween candy. Almost all reports were discredited.

But no amount of debunking can completely alleviate parent anxiety. After all, however rare, it could happen. Some Halloween candy safety precautions include:

• For young children, remove any choking hazards such as gum, peanuts, hard candies, or small toys.
• Instruct your children to show you all their candy before eating it so that you can carefully inspect it for tampering.
• Tell your children not to accept or eat anything that isnt commercially wrapped.
• Throw out candy or treats that are homemade, unwrapped, or have torn wrapping.

And managing the Halloween candy craze? First, to reduce trick-or-treat munching, give your children a snack or light meal before you leave the house. Decide ahead of time how many pieces of candy they can eat on Halloween night.

Pumpkin Carving Safety Tips

• Carve pumpkins on stable, flat surfaces with good lighting.
• Have children draw a face on the outside of the pumpkin and then do the cutting yourself.
• Place lighted pumpkins away from curtains and other flammable objects, and do not leave lighted pumpkins unattended.
• If you set jack-o-lanterns on your porch with candles in them, make sure that they are far enough out of the way so that childrens costumes wont accidentally set on fire.
• Artificial lights and candles are a safer alternative to real candles.

Halloween Costume Safety Tips

• If possible, have your children wear clothing that is bright, reflective, and flame retardant.
• If your child is carrying a prop, such as sword or pitchfork, make sure that the tips are smooth and flexible enough to not cause injury if your child falls on them.
• Avoid long, baggy, or loose costumes to prevent tripping.
• Insist that your children wear well-fitting, sturdy shoes. Mom’s high heels are better for costume parties, not trick-or-treating.
• Securely fit hats and scarves to prevent them from slipping over your childrens eyes.
• Apply a natural mask of cosmetics rather than have your child wear a mask that might restrict breathing or obscure vision. If you use a mask, make sure it fits securely and has eyeholes large enough to allow full vision.

Have a happy and safe Halloween!

BE SAFE WITH YOUR ANIMALS!

“To help ensure adults and children have a safe holiday, follow these Halloween safety tips:

● Be sure to choose a costume that won’t cause safety hazards; all costumes, wigs and accessories should be fire-resistant
● If children are allowed out after dark, fasten reflective tape to their costumes and bags, or give them glow sticks
● Opt for nontoxic Halloween makeup over masks, which can obscure vision; always test makeup in a small area first to see if any irritation develops
● Remove all makeup before children go to bed to prevent skin and eye irritation”

National Safety Council – NSC (https://www.nsc.org/community-safety/safety-topics/seasonal-safety/autumn-safety/halloween?srsltid=AfmBOoqTlCaJeYjJhU5m32xSXESW8ZnWaGqY1eq8Tee_elCyKDAzgJzR)

“The statistics on Cirrohosis by the CDC:

Number of adults age 18 and older with diagnosed liver disease: 4.5 million

Percent of adults age 18 and older with diagnosed liver disease: 1.8%

Number of deaths: 54,803

Deaths per 100,000 population: 16.4

Cause of death rank: 10”

Centers for Disease Control and Prevention – CDC (https://www.google.com/search?client=firefox-b-1-d&q=statistics+of+cirrhosis)

    HEALTHY LIVER               LIVER DISEASED

The liver is an organ about the size of a football that sits just under your rib cage on the right side of your abdomen. The liver is essential for digesting food and ridding your body of toxic substances.

Liver disease can be inherited (genetic) or caused by a variety of factors that damage the liver, such as viruses and alcohol use. Obesity is also associated with liver damage.

Over time, damage to the liver results in scarring (cirrhosis), which can lead to liver failure, a life-threatening condition.

What is cirrhosis of the liver?

Cirrhosis is a complication of many liver diseases characterized by abnormal structure and function of the liver. The diseases that lead to cirrhosis do so because they injure and kill liver cells, after which the inflammation and repair that is associated with the dying liver cells causes scar tissue to form. The liver cells that do not die multiply in an attempt to replace the cells that have died. This results in clusters of newly-formed liver cells (regenerative nodules) within the scar tissue.

What are the causes of cirrhosis?

There are many causes of cirrhosis including chemicals (such as alcohol, fat, and certain medications), viruses, toxic metals (such as iron and copper that accumulate in the liver as a result of genetic diseases), and autoimmune liver disease in which the body’s immune system attacks the liver.

The liver is an important organ in the body. It performs many critical functions, two of which are producing substances required by the body, for example, clotting proteins that are necessary in order for blood to clot, and removing toxic substances that can be harmful to the body, for example, drugs. The liver also has an important role in regulating the supply of glucose (sugar) and lipids (fat) that the body uses as fuel. In order to perform these critical functions, the liver cells must be working normally, and they must have a close proximity to the blood because the substances that are added or removed by the liver are transported to and from the liver by the blood.

The relationship of the liver to the blood is unique. Unlike most organs in the body, only a small amount of blood is supplied to the liver by arteries. Most of the liver’s supply of blood comes from the intestinal veins as the blood returns to the heart. The main vein that returns blood from the intestines is called the portal vein. As the portal vein passes through the liver, it breaks up into increasingly smaller and smaller veins. The tiniest veins (called sinusoids because of their unique structure) are in close contact with the liver cells. In fact, the liver cells line up along the length of the sinusoids. This close relationship between the liver cells and blood from the portal vein allows the liver cells to remove and add substances to the blood. Once the blood has passed through the sinusoids, it is collected in increasingly larger and larger veins that ultimately form a single vein, the hepatic vein, which returns the blood to the heart.

In cirrhosis, the relationship between blood and liver cells is destroyed. Even though the liver cells that survive or are newly-formed may be able to produce and remove substances from the blood, they do not have the normal, intimate relationship with the blood, and this interferes with the liver cells’ ability to add or remove substances from the blood. In addition, the scarring within the cirrhotic liver obstructs the flow of blood through the liver and to the liver cells. As a result of the obstruction to the flow of blood through the liver, blood “backs-up” in the portal vein, and the pressure in the portal vein increases, a condition called portal hypertension. Because of the obstruction to flow and high pressures in the portal vein, blood in the portal vein seeks other veins in which to return to the heart, veins with lower pressures that bypass the liver. Unfortunately, the liver is unable to add or remove substances from blood that bypasses it. It is a combination of reduced numbers of liver cells, loss of the normal contact between blood passing through the liver and the liver cells, and blood bypassing the liver that leads to many of the manifestations of cirrhosis.

A second reason for the problems caused by cirrhosis is the disturbed relationship between the liver cells and the channels through which bile flows. Bile is a fluid produced by liver cells that has two important functions: to aid in digestion and to remove and eliminate toxic substances from the body. The bile that is produced by liver cells is secreted into very tiny channels that run between the liver cells that line the sinusoids, called canaliculi. The canaliculi empty into small ducts which then join together to form larger and larger ducts. Ultimately, all of the ducts combine into one duct that enters the small intestine. In this way, bile gets to the intestine where it can help with the digestion of food. At the same time, toxic substances contained in the bile enter the intestine and then are eliminated in the stool. In cirrhosis, the canaliculi are abnormal and the relationship between liver cells and canaliculi is destroyed, just like the relationship between the liver cells and blood in the sinusoids. As a result, the liver is not able to eliminate toxic substances normally, and they can accumulate in the body. To a minor extent, digestion in the intestine also is reduced.

“Liver cancer is cancer that begins in the cells of your liver. Your liver is a football-sized organ that sits in the upper right portion of your abdomen, beneath your diaphragm and above your stomach.

Several types of cancer can form in the liver. The most common type of liver cancer is hepato-cellular carcinoma, which begins in the main type of liver cell (hepatocyte).

Cancer that spreads to the liver is more common than cancer that begins in the liver cells. Cancer that begins in another area of the body — such as the colon, lung or breast — and then spreads to the liver is called metastatic cancer rather than liver cancer. This type of cancer is named after the organ in which it began — such as metastatic colon cancer to describe cancer that begins in the colon and spreads to the liver.”

MAYO Clinic (https://www.mayoclinic.org/diseases-conditions/liver-cancer/symptoms-causes/syc-20353659#:~:text=Several%20types%20of%20cancer%20can,hepatoblastoma%2C%20are%20much%20less%20common.)

The liver is a large, meaty organ that sits on the right side of the belly. Weighing about 3 pounds, the liver is reddish-brown in color and feels rubbery to the touch. Normally you can’t feel the liver, because it’s protected by the rib cage.

The liver has two large sections, called the right and the left lobes. The gallbladder sits under the liver, along with parts of the pancreas and intestines. The liver and these organs work together to digest, absorb, and process food.

The liver’s main job is to filter the blood coming from the digestive tract, before passing it to the rest of the body. The liver also detoxifies chemicals and metabolizes drugs. As it does so, the liver secretes bile that ends up back in the intestines. The liver also makes proteins important for blood clotting and other functions.

The liver is a vital organ of vertebrates and some other animals. In the human it is located in the upper right quadrant of the abdomen, below the diaphragm. The liver has a wide range of functions, including detoxification of various metabolites, protein synthesis, and the production of biochemicals necessary for digestion.

The liver is a gland and plays a major role in metabolism with numerous functions in the human body, including regulation of glycogen storage, decomposition of red blood cells, plasma protein synthesis, hormone production, and detoxification.^[3] It is an accessory digestive gland and produces bile, an alkaline compound which aids in digestion via the emulsification of lipids. The gallbladder, a small pouch that sits just under the liver, stores bile produced by the liver^. The liver’s highly specialized tissue consisting of mostly hepatocytes regulates a wide variety of high-volume biochemical reactions, including the synthesis and breakdown of small and complex molecules, many of which are necessary for normal vital functions Estimates regarding the organ’s total number of functions vary, but textbooks generally cite it being around 500.

Several types of cancer can form in the liver. The most common type of liver cancer is hepatocellular carcinoma, which begins in the main type of liver cell (hepatocyte). Other types of liver cancer, such as intrahepatic cholangiocarcinoma and hepatoblastoma, are much less common.

Not all cancers that affect the liver are considered liver cancer. Cancer that begins in another area of the body — such as the colon, lung or breast — and then spreads to the liver is called metastatic cancer rather than liver cancer.

Most people don’t have signs and symptoms in the early stages of primary liver cancer. When signs and symptoms do appear, they may include:

• Losing weight without trying
• Loss of appetite
• Upper abdominal pain
• Nausea and vomiting
• General weakness and fatigue
• Abdominal swelling
• Yellow discoloration of your skin and the whites of your eyes (jaundice)
• White, chalky stools

It’s not clear what causes most cases of liver cancer. But in some cases, the cause is known. For instance, chronic infection with certain hepatitis viruses can cause liver cancer.

Liver cancer occurs when liver cells develop changes (mutations) in their DNA — the material that provides instructions for every chemical process in your body. DNA mutations cause changes in these instructions. One result is that cells may begin to grow out of control and eventually form a tumor — a mass of cancerous cells.

Factors that increase the risk of primary liver cancer include:

• Chronic infection with HBV or HCV. Chronic infection with the hepatitis B virus (HBV) or hepatitis C virus (HCV) increases your risk of liver cancer.
• Cirrhosis. This progressive and irreversible condition causes scar tissue to form in your liver and increases your chances of developing liver cancer.
• Certain inherited liver diseases. Liver diseases that can increase the risk of liver cancer include hemochromatosis and Wilson’s disease.
• Diabetes. People with this blood sugar disorder have a greater risk of liver cancer than those who don’t have diabetes.
• Nonalcoholic fatty liver disease. An accumulation of fat in the liver increases the risk of liver cancer.
• Exposure to aflatoxins. Aflatoxins are poisons produced by molds that grow on crops that are stored poorly. Crops such as corn and peanuts can become contaminated with aflatoxins, which can end up in foods made of these products. In the United States, safety regulations limit aflatoxin contamination. Aflatoxin contamination is more common in certain parts of Africa and Asia.
• Excessive alcohol consumption. Consuming more than a moderate amount of alcohol daily over many years can lead to irreversible liver damage and increase your risk of liver cancer.

MOST IMPORTANT is PREVENTION:

Reduce your risk of cirrhosis

Cirrhosis is scarring of the liver, and it increases the risk of liver cancer. You can reduce your risk of cirrhosis if you:

• Drink alcohol in moderation, if at all. If you choose to drink alcohol, limit the amount you drink. For women, this means no more than one drink a day. For men, this means no more than two drinks a day.
• Maintain a healthy weight. If your current weight is healthy, work to maintain it by choosing a healthy diet and exercising most days of the week. If you need to lose weight, reduce the number of calories you eat each day and increase the amount of exercise you do. Aim to lose weight slowly — 1 or 2 pounds (0.5 to 1 kilograms) each week.
• Use caution with chemicals. Follow instructions on chemicals you use at home or at work.

Get vaccinated against hepatitis B

You can reduce your risk of hepatitis B by receiving the hepatitis B vaccine, which provides more than 90 percent protection for both adults and children. The vaccine can be given to almost anyone, including infants, older adults and those with compromised immune systems.

Take measures to prevent hepatitis C

No vaccine for hepatitis C exists, but you can reduce your risk of infection.

• Know the health status of any sexual partner. Don’t engage in unprotected sex unless you’re certain your partner isn’t infected with HBV, HCV or any other sexually transmitted infection. If you don’t know the health status of your partner, use a condom every time you have sexual intercourse.
• Don’t use intravenous (IV) drugs, but if you do, use a clean needle. Reduce your risk of HCV by not injecting illegal drugs. But if that isn’t an option for you, make sure any needle you use is sterile, and don’t share it. Contaminated drug paraphernalia is a common cause of hepatitis C infection. Take advantage of needle-exchange programs in your community and consider seeking help for your drug use.
• Seek safe, clean shops when getting a piercing or tattoo. Needles that may not be properly sterilized can spread the hepatitis C virus. Before getting a piercing or tattoo, check out the shops in your area and ask staff members about their safety practices. If employees at a shop refuse to answer your questions or don’t take your questions seriously, take that as a sign that the facility isn’t right for you.

Ask your doctor about liver cancer screening

For the general population, screening for liver cancer hasn’t been proved to reduce the risk of dying of liver cancer, so it isn’t generally recommended. The American Association for the Study of Liver Diseases recommends liver cancer screening for those thought to have a high risk, including people who have:

• Hepatitis B and one or more of the following apply: are Asian or African, have liver cirrhosis, or have a family history of liver cancer
• Hepatitis C infection and liver cirrhosis
• Liver cirrhosis from other causes, such as an autoimmune disease, excessive alcohol use, nonalcoholic fatty liver disease and inherited hemochromatosis
• Primary biliary cirrhosis

Discuss the pros and cons of screening with your doctor. Together you can decide whether screening is right for you based on your risk. Screening typically involves an ultrasound exam every six months.

Diagnosing liver cancer

Tests and procedures used to diagnose liver cancer include:

• Blood tests. Blood tests may reveal liver function abnormalities.
• Imaging tests. Your doctor may recommend imaging tests, such as an ultrasound, computerized tomography (CT) scan and magnetic resonance imaging (MRI).
• Removing a sample of liver tissue for testing. Your doctor may recommend removing a piece of liver tissue for laboratory testing in order to make a definitive diagnosis of liver cancer.

  During a liver biopsy, your doctor inserts a thin needle through your skin and into your liver to obtain a tissue sample. In the lab, doctors examine the tissue under a microscope to look for cancer cells. Liver biopsy carries a risk of bleeding, bruising and infection.

Determining the extent of the liver cancer

Once liver cancer is diagnosed, your doctor will work to determine the extent (stage) of the cancer. Staging tests help determine the size and location of cancer and whether it has spread. Imaging tests used to stage liver cancer include CTs, MRIs and bone scans.

There are different methods of staging liver cancer. One method uses Roman numerals I through IV, and another uses letters A through D. Your doctor uses your cancer’s stage to determine your treatment options and your prognosis. Stage IV and stage D indicate the most advanced liver cancer with the worst prognosis.

Treatment

Treatments for primary liver cancer depend on the extent (stage) of the disease as well as your age, overall health and personal preferences.

Surgery

Operations used to treat liver cancer include:

• Surgery to remove the tumor. In certain situations, your doctor may recommend an operation to remove the liver cancer and a small portion of healthy liver tissue that surrounds it if your tumor is small and your liver function is good.Whether this is an option for you also depends on the location of your cancer within the liver, how well your liver functions and your overall health.
• Liver transplant surgery. During liver transplant surgery, your diseased liver is removed and replaced with a healthy liver from a donor. Liver transplant surgery is only an option for a small percentage of people with early-stage liver cancer.

Localized treatments

Localized treatments for liver cancer are those that are administered directly to the cancer cells or the area surrounding the cancer cells. Localized treatment options for liver cancer include:

• Heating cancer cells. In a procedure called radiofrequency ablation, electric current is used to heat and destroy cancer cells. Using an ultrasound or CT scan as a guide, your surgeon inserts one or more thin needles into small incisions in your abdomen. When the needles reach the tumor, they’re heated with an electric current, destroying the cancer cells.
• Freezing cancer cells. Cryoablation uses extreme cold to destroy cancer cells. During the procedure, your doctor places an instrument (cryoprobe) containing liquid nitrogen directly onto liver tumors. Ultrasound images are used to guide the cryoprobe and monitor the freezing of the cells.
• Injecting alcohol into the tumor. During alcohol injection, pure alcohol is injected directly into tumors, either through the skin or during an operation. Alcohol causes the tumor cells to die.
• Injecting chemotherapy drugs into the liver. Chemoembolization is a type of chemotherapy treatment that supplies strong anti-cancer drugs directly to the liver.
• Placing beads filled with radiation in the liver. Tiny spheres that contain radiation may be placed directly in the liver where they can deliver radiation directly to the tumor.

Radiation therapy

This treatment uses high-powered energy from sources such as X-rays and protons to destroy cancer cells and shrink tumors. Doctors carefully direct the energy to the liver, while sparing the surrounding healthy tissue.

During external beam radiation therapy treatment, you lie on a table and a machine directs the energy beams at a precise point on your body.

A specialized type of radiation therapy, called stereotactic radiosurgery, involves focusing many beams of radiation simultaneously at one point in your body.

Targeted drug therapy

Targeted drugs work by interfering with specific abnormalities within a tumor. They have been shown to slow or stop advanced hepatocellular carcinoma from progressing for a few months longer than with no treatment.

More studies are needed to understand how targeted therapies, such as the drug sorafenib (Nexavar), may be used to control advanced liver cancer.

Supportive (palliative) care

Palliative care is specialized medical care that focuses on providing relief from pain and other symptoms of a serious illness. Palliative care specialists work with you, your family and your other doctors to provide an extra layer of support that complements your ongoing care. Palliative care can be used while undergoing other aggressive treatments, such as surgery, chemotherapy or radiation therapy.

When palliative care is used along with all of the other appropriate treatments, people with cancer may feel better and live longer.

Palliative care is provided by a team of doctors, nurses and other specially trained professionals. Palliative care teams aim to improve the quality of life for people with cancer and their families. This form of care is offered alongside curative or other treatments you may be receiving.

What you can do in being preparred to see your doctor:

• Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there’s anything you need to do in advance, such as restrict your diet.
• Write down any symptoms you’re experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you’re taking.
• Consider taking a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
• Write down questions to ask your doctor.